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AR 40-502 Medical Readiness (27 JUN 2019)

Comments: To view or download the complete regulation, click on the link to it in the box above these comments.

Chapter 1

General Provisions

Section I

Overview

1–1.Purpose

This regulation governs individual medical readiness (IMR) requirements and standards; medical readiness processes and policies supporting commander deployability determinations; physical profiles; and medical examinations, periodic health assessments (PHAs), and the Deployment Health Assessment Program (DHAP). In the event provisions or guidance in this regulation conflict with those in AR 40–501, this regulation takes precedence. These conflicts will be addressed in the next revision of AR 40–501….

1–6. Medical readiness classification

a. Medical readiness classification (MRC) is an administrative determination by healthcare providers using a standardized system across the total force. This system enables the commander to measure, achieve, and sustain their Soldiers’ health and ability to perform their wartime requirement in accordance with their military occupational specialty (MOS)/area of concentration (AOC) from induction to separation. Medical readiness is described in chapter 2.

b. Commanders administratively use the medical readiness information to determine if a Soldier is deployable and able to perform the unit’s core designed mission or assigned mission in accordance with readiness reporting guidance in AR 220–1 and DA Pam 220–1. Soldiers are automatically medically deployable in the Medical Readiness System of Record if they are in MRC 1 or 2. This status is automatically uploaded to the readiness reporting system without additional commander action. Commanders can make deployability determinations for readiness reporting on Soldiers who are in MRC 3, with deployment-limiting (DL) 1 and 2, as well as for Soldiers in MRC 4. DL codes 3 to 7 are constrained by policy from deployment, and cannot be overridden by commanders….

1–7.Command application of medical readiness

Commanders will make deployability determinations for all Soldiers authorized by policy for their MRC/DL. In making deployability determinations for readiness reporting, unit commanders should consider the classification categories in paragraph 2–4 and collaborate with a healthcare provider for any questions. Unit commanders will not override duty limitations or instructions on DA Form 3349 (Physical Profile Record). Healthcare providers do not make or engage directly in deployability determinations for readiness reporting. Profiling officers describe and indicate potentially DL conditions for commander review and consideration in their deployment determination. Readiness is a commanders program. Paragraph 3–4 describes the procedure if there is disagreement between the healthcare provider and commander regarding initiating the CCMD waiver process….

Chapter 2

Individual Medical Readiness Key Elements, Standards, Categories, and Goals

...2–4. Individual medical readiness classification

After evaluating the required IMR elements by viewing e-Profile, the Medical Readiness System of Record and the EHR information, the healthcare team will categorize the Soldier into one of four medical readiness categories listed below and depicted in table 2–1.

a. MRC 1: Soldiers in MRC 1 are fully medically ready and deployable if they fulfill the following categories:

  • (1) Soldier meets all medical readiness requirements.
  • (2) Soldier is in Dental Class 1 or Dental Class 2 in accordance with AR 40–35.
  • (3) Soldier may have a transient illness or minor injury with a profile 7 days or less in duration (for example, upper respiratory infection).
  • (4) Permanent duty limiting condition(s) with a 3 or 4 in the physical, upper, lower, hearing, eyes, psychiatric (PULHES) (PULHES is a United States military acronym used in the Military Physical Profile Serial System) series with a completed board and an assigned physical category code of “S, W, or Y”, if no F, V, or X code (see DA Pam 40–502 for physical category codes). Use of certain medications and medical conditions, as established by DOD or CCMD guidance, will require a CCMD waiver for deployment. Upon receipt of an assigned mission, the servicing healthcare providers will evaluate the Soldier to determine the need for CCMD waivers. Each CCMD establishes the specific deployment status guidance and waiver processes for their area of responsibility. Medical readiness, commander deployability determinations, and CCMD waiver requirements are independent of each other.

b. MRC 2: Soldiers in MRC 2 are partially medically ready and deployable. Soldier has one or more of the following deficiencies:

  • (1) Hearing Readiness Class 4 (considered overdue with The Defense Occupational and Environmental Health Readi-ness System – Hearing Conservation hearing test greater than 365 days and all RC table of distribution and allowances Soldiers without an audiogram on file).
  • (2) Vision Readiness Class 4 (considered overdue at 15 months).

(3) Deoxyribonucleic acid (DNA) not on file with the Armed Forces Repository of Specimen Samples for the Identification of Remains.

(4) Human immunodeficiency virus (HIV) not drawn/validated with Armed Forces Repository of Specimen Samples for the Identification of Remains (within 24 months) without a previous diagnosis of HIV.

(5) Routine adult immunization profile immunizations to include hepatitis A; hepatitis B; tetanus-diphtheria or tetanus-diphtheria and acellular pertussis; measles, mumps, and rubella; poliovirus; varicella; influenza (seasonal); and if required, rabies (for personnel as required in accordance with AR 40–562).

(6) A Soldier who requires, but does not possess individual medical equipment (1 mask insert (1MI), 2 pairs of eye-glasses, military combat eye protection inserts (MCEP–I), medical warning tags, and hearing aid with batteries).

(7) A temporary profile 8 to 30 days in duration. Soldiers are deployable with these profiles, however, commanders have the discretion to make a commander’s determination that these Soldiers are non-deployable in the Commander Portal.

c. MRC 3: Soldiers in MRC 3 are not medically ready and will default to non-deployable. Soldiers in MRC 3 will be described by one or more of seven DL codes described below and in table 2–1:

  • (1) DL 1 – Temporary profiles greater than 30 days. Soldier is not medically ready and defaults to non-deployable. The commander can make a commander’s determination that these Soldiers are deployable and change the deployability status for all temporary profile(s) greater than 30 days in duration (total time to include extensions) in the Commander Portal. Soldier deployability remains DL 1 as long as there is an active temporary condition identified. Application of CCMD guidance will determine if a CCMD waiver is required for these conditions upon receipt of the assigned mission.
  • (2) DL 2 – Dental Readiness Class 3 conditions. Soldier is not medically ready and defaults to deployable. The commander has the discretion to make a commander’s determination that these Soldiers are non-deployable in the Commander Portal. The Soldier remains DL 2 as long as they have a Dental Readiness Class (DRC) 3 e-Profile. Dentists will use e-Profile to describe these conditions to the commander and guide the deployability determination. These conditions must be corrected before a Soldier deploys.
  • (3) DL 3 – Soldier is pregnant or post-partum. Soldier is not medically ready and is non-deployable. The commander cannot deem Soldier deployable until authorized by policy.
  • (4) DL 4 – MAR2. Soldier is not medically ready and is non-deployable. Soldier cannot be deemed deployable by the commander. This includes Soldiers with a permanent profile with a 3 or 4 in the PULHES without a completed MAR2 board. Soldiers who meet retention standards are eligible for MAR2 process. Soldier will remain DL 4 from when the condition is identified up to when MAR2 process is complete.
  • (5) DL 5 – Soldier is not medically ready and is non-deployable. Soldier cannot be deemed deployable by the commander. Soldiers with a permanent profile with a 3 or 4 in the PULHES, who do not meet retention standards without a completed medical evaluation board (MEB)/physical evaluation board (PEB). Soldiers who do not meet retention standards must be referred for Disability Evaluation System (DES) processing. MEB/PEB is appropriate for LOD conditions. Soldiers remain DL 5 from when the condition is identified until they are separated or have completed the MEB/PEB process.
  • (6) DL 6 – Soldier is not medically ready and is non-deployable. Permanent profile with a 3 or 4 in the PULHES without a completed non-duty PEB. Soldiers who do not meet retention standards due to a non-duty related condition can request a PEB. The Soldier will be DL 6 from when the condition is identified until they are separated or have completed the non-duty PEB process.
  • (7) DL 7 – Soldier is not medically ready and is non-deployable. Any profile with a physical category code of V, F, X, or Y. Soldiers in this category may be eligible for a CCMD waiver in accordance with the applicable published CCMD policy.d. MRC 4: Soldiers in MRC 4 are not medically ready.
  • (1) Commanders determine deployment status (default is deployable).
  • (2) Status is unknown. Soldier is deficient in one of the following:
  • (a) PHA (current if administered within past 15 months).

(b) Dental Class 4.

...

Chapter 3 Physical Profiling

3–1.General

This chapter prescribes a system, which is further described in DA Pam 40–502, for classifying individuals according to functional abilities; documents key aspects of medical readiness; and outlines the administrative management of Soldiers with duty limiting conditions....

3–2.Application

The physical profile system is applicable to members of any component of the Army throughout their military Service, whether or not the Soldier is on active duty.

3–3. Profiling overview

...

c. The DA Form 3349 contains all of a Soldier’s current duty limiting conditions with built-in communication links between the profiling officer and commander.... Profiling officers will evaluate all Soldiers with duty limiting conditions for Section 4: Functional Activities. Any permanent limitation in the functional activities section will either require a disability evaluation referral or initiate the RC medical disqualification process according to their duty status (see AR 635–40)….

d. The unit commander will review all profiles of Soldiers in their command. After reviewing a profile the unit commander—

  • (1) Addresses any questions or concerns, including when their observations of the Soldier’s performance is inconsistent with the profile, with the profiling officer.
  • (2) If necessary, has the authority to request a fitness for duty evaluation to include a profile review and second opinion from another profiling officer. Input from the original profiling officer will ensure a comprehensive review and informed opinion. The applicable profile delegation authority will implement a consistent process to ensure timely completion of all requested command reviews, minimizing the impact on readiness. If the original profile deemed the Soldier nondeployable, then the Soldier will remain nondeployable until the fitness for duty evaluation or profile review is completed.
  • (3) Makes deployability determinations in the Commander Portal for MRC 4, MRC 3, DL 1 and 2, and when not constrained by policy.
  • (4) Should extend reasonable consideration to profile restrictions even after expiration if the environment or mission has prevented prompt follow up.
  • (5) Should exercise due diligence in requiring Soldiers to take and (sic) APFT following any temporary conditions that have affected the Soldier’s ability to maintain optimal physical fitness and formulate their APFT policy according to command and leadership policy.

Comments: APFT stands for Army Physical Fitness Test.

e. A profiling officer writes a temporary profile to describe temporary duty limitations or a medical condition that needs to be communicated to the commander, or is required per AR 40–501. Profiling officers will describe duty limitations, capabilities, and physical readiness training guidance for each reason for profile affecting the Soldier. Each temporary reason for profile must be written for the full duration of the limitations, up to 90 days. Extensions must be linked to the previous profile to maintain an accurate description of the total length of time the Soldier has had a profile for that reason. Temporary profiles impact MRC by duration only, and there is no PULHES determination.

Comments: MRC stands for medical readiness classification. PULHES stands for physical, upper, lower, hearing, eyes, psychiatric.

Soldiers will be issued a temporary profile when receiving medical or surgical care during or while recovering from illness or injury for the same medical condition. The Medical Retention Determination Point (MRDP) is reached if the medical condition has stabilized or cannot be stabilized in a reasonable period of time for up to 12 months and impacts successful performance of duty. Successful performance of duty is defined as the ability to perform basic soldiering skills required by all military personnel (DA Form 3349, section 4 and passing one aerobic APFT event) and the ability to perform MOS specific duties. Medical evaluation of Soldiers with temporary profiles is required at least once every 90 days, to assess progress, response to treatment, and the currency of the duty limitations. Specific conditions in AR 40–501 will require specialty care and evaluation to determine if a Soldier meets retention standards. Specialty evaluations should start by the 6th month of the profiled period. If no specialty care is required by policy, a Soldier will have a physician evaluation after 6 months on profile for the same condition. These re-evaluations and progression of care are to ensure that the Soldiers who reach MRDP have recovered and rehabilitated to the point that they can transition to a permanent profile or initiate the appropriate DES process.

  • (1) A DD Form 689 or short-term temporary profile can describe conditions (less than or equal to 7 days). A temporary profile should convey more information to the commander, use standardized templates and establish the initiating event in e-Profile in accordance with AR 40–501.
  • (2) When the condition is stable, the profiling officer will communicate the permanent duty limiting conditions to the commander on a permanent profile. If the condition does not meet retention standards, the provider will initiate a referral to DES in accordance with the eligibility provisions of AR 635–40.
  • (3) The profiling officer must review previous profiles before making a decision to extend a temporary profile. Any extension of a temporary profile will be linked and described as a continuation of the same condition on DA Form 3349 in the EHR based on clinical judgment and the history of any other inciting injury.
  • (4) Temporary profiles will specify an expiration date. If no expiration date is specified, the profile will automatically expire at the end of 30 days from issuance of the profile.
  • (5) If a profile is required beyond a 12-month period, the condition will be documented in the form of a permanent profile. If the condition does not meet retention standards, the DES/RC–NDR process will commence. Exceptions to the 12-month temporary physical profile restriction must be approved by the first general officer in the Soldier’s chain of command, in consultation with the Secretary of the Army or the appropriate designee, senior approving authority, and/or senior medical officer….

f. A profile is considered permanent when the Soldier has reached MRDP for the condition(s). Because of the signifi-cance of permanent limitations of duty to medical readiness, all permanent profiles will have two profiling officer signa-tures. A physician approving authority will review all permanent “3” and “4” profiles.

  • (1) If the profile is permanent, the profiling officer must assess if the Soldier meets the medical retention standards located in AR 40–501. Soldiers who do not meet the medical retention standards, or cannot complete an aerobic APFT event, or cannot perform any of the functional activities in section 4 in DA Form 3349, must be referred to DES in accordance with AR 635–40. Soldiers in the RCs who are not on active duty and who do not meet medical retention standards for a non-duty related condition will be processed for medical disqualification in accordance with AR 135–175, AR 135–178, and AR 635–40, unless the Soldier requests a non-duty related PEB.
  • (2) Soldiers who meet retention standards but have a 3 or 4 PULHES serial will be referred to MAR2 in accordance with AR 635–40.
  • Comments: MAR2 is Military Occupational Specialty Administrative Retention Review.

3–4. Physical profile serial system

a. The basis for the physical profile serial system is to identify the function of body systems and their relation to military duties. The functions of the various organs, systems, and integral parts of the body are all considered. Since the analysis of the individual's medical, physical, and mental status plays an important role in assignments and welfare of other Soldiers, not only must the functional grading be executed with great care, but clear and accurate descriptions of medical, physical, and mental deviations from normal are essential.

b. In developing the physical profile serial system, body systems or regions were been divided into six factors designated as PULHES: physical/systemic; upper extremity and spine; lower extremity and spine; hearing; eyes; and psycho-logical. For each factor, a numerical designation (serial) of 1, 2, 3, or 4 indicates the overall functional capacity for that system or region. The functional capacity of a particular system or region of the body, rather than the defect per se, will determine the appropriate serial. DA Pam 40–502 describes the use of the physical profile serial system.

c. Soldiers who are medically ready may have health conditions that do not meet the specific CCMD deployment guidance. If the healthcare provider and commander concur that the Soldier is able to deploy, the CCMD policy will describe the initiation of the CCMD waiver process. When medical healthcare providers and unit commanders disagree on the deployment status of a Soldier, the decision to request a CCMD waiver will be raised to the first O–6 in the Soldier’s chain of command (or higher approving authority) and the hospital commander. Both the first O–6 and hospital commander will review both medical and unit commander recommendations to make the final decision whether to seek a CCMD waiver to deploy the Soldier. CCMD deployment guidance is developed to protect both the Soldier’s health and well being and the mission. Guidance is continually updated and is based on consideration of DODIs. The commander will ensure implementation with these individual medical requirements in accordance with all applicable DODIs, to include DODI 6490.07. To the extent that the information within this chapter is inconsistent with later published DOD guidance, DOD guidance will be followed.

3–5. Representative profile serials and codes

To facilitate the assignment of individuals after they have been given a physical permanent profile serial and for statistical purposes, code designations have been adopted to represent certain combinations of physical limitations or assignment guidance as described in DA Pam 40–502. The alphabetical coding system will be utilized and the appropriate code(s) will be recorded on the DA Form 3349. The profile form will be completed as described in DA Pam 40–502. The numerical designations serials for each profile factor and the code system are presented DA Pam 40–502.

3–6. Profiling officer, approving authority, and commander

a. Profiling officers. MTF commanders, ARNG chief and state surgeons, and the USAR command surgeon and RSC surgeons may designate physicians, dentists, physical therapists, optometrists, podiatrists, audiologists, chiropractors, nurse practitioners, nurse midwives, licensed clinical psychologists, licensed clinical social workers, and physician assistants as profiling officers. Under no circumstances will a special forces medic or independent duty corpsman serve as a profiling officer….