Medical Accession Standards
Common Disqualifying Medical Conditions and Questions
1. All applicants to the Active Duty and Ready Reserve Corps must meet the United States
Public Health Service (USPHS) Commissioned Corps weight standards of a Body Mass Index
(BMI) no greater than 27.5 kg/m
2
.
Click here to calculate your BMI.
2. If you are physically fit and your BMI is between 27.6 kg/m2 and 32.9 kg/m2, you can still apply if
the taping measurements done during your physical examination determine that your estimated
body fat percentage meets the standards.
3. If you are pregnant or were pregnant in the last 6 months, you are not eligible to apply until 6
months after your pregnancy.
4. Applicants with disqualifying medical or dental conditions may not apply for a waiver of
accession standards or request an appeal for a disqualifying medical or dental condition.
5. The Accession Medical Review Officer determines eligibility for a waiver recommendation.
6. PLEASE CAREFULLY REVIEW THE LIST OF DISQUALIFYING MEDICAL AND DENTAL
CONDITIONS.
7. Questions? Email [email protected]
CCI 221.01 Medical Accession Standards
2
Appendix A
Disqualifying Medical and Dental Conditions
Table of Contents
Condition
Page
I. Head and Neck……………………………………………………………………………
3
II. Mouth, Nose, Larynx and Trachea……………………………………………………
4
III. Dental Disorders…………………………………………………………..……………
5
IV. Eyes and Vision………………………………………………………………………...
6
V. Ears and Hearing…………………………………………………………...……………
9
VI. Cardiovascular Disorders………………………………………………….……………
10
VII. Pulmonary Disorders……………………………………………………..……………
13
VIII. Gastrointestinal and Hepatobiliary Disorders…………………………...…………
15
IX. Endocrine and Metabolic Disorders……………………………………………………
18
X. Hematological Disorders…………………………………………………..……………
20
XI. Renal and Urologic Disorders…………………………………………….……………
21
XII. Gynecological Disorders and Breast Disease………………………………………
24
XIII. Musculoskeletal and Rheumatologic Disorders………………………..……………
26
XIV. Skin Disorders………………………………………………………….………………
33
XV. Infectious Diseases……………………………………………………………………
36
XVI. Immunologic Disorders………………………………………………………………
37
XVII. Neoplastic Disorders…………………………………………………...……………
39
XVIII. Neurologic and Muscle Disorders…………………………………….……………
40
XIX. Mental Disorders………………………………………………………..……………
43
XX. Substance Use and Addictive Behaviors……………………………………………
46
XXI. Miscellaneous…………………………………………………………...……………
47
CCI 221.01 Medical Accession Standards
3
Condition
Disqualification for Appointment
I. Head and Neck
A. Deformities of the
skull
1.
Deformity of the skull, face, or mandible which is a
manifestation of an underlying progressive disease,
excessively increases risk for injury, or may be reasonably
expected to prevent the individual from the proper wearing of a
protective mask or headgear.
2.
Loss or absence of the bony substance of the skull not
successfully corrected by reconstructive materials or leaving
residual defect(s) in excess of one square inch (6.45 cm2) or
the size of a 25-cent piece.
B. Tumors, cysts,
fistulas, etc.
1.
Any tumor, cyst, fistula, or enlargement of the salivary glands,
lymph nodes, or other structures of the head and neck, unless
the cause is known, considered benign, and no long-term
medical or surgical treatment is indicated.
2.
Congenital neck mass, including cysts of branchial cleft origin,
or those developing from the remnants of the thyroglossal duct,
with or without fistulous tracts, until surgically corrected without
recurrence for 12 months.
3.
Current goiter at or more than two times normal size, with any
nodularity seen on ultrasound, or with any abnormality of
thyroid function tests.
4.
Thyroid nodule unless a solitary thyroid nodule less than 5 mm
or less than 3 cm with benign histology or cytology, and that
does not require ongoing surveillance.
5.
History of complex thyroid cyst or simple thyroid cyst greater
than 2 cm unless surgically resected with a benign pathology
and no further follow up is indicated.
CCI 221.01 Medical Accession Standards
4
Condition
Disqualification for Appointment
II. Mouth, Nose, Larynx and Trachea
A. Abnormalities of the
nose and nasal
passages
1.
Moderate or severe chronic rhinitis (e.g. allergic, vasomotor,
atrophic, etc.) interfering with breathing and not controlled with
oral medications, desensitization, or topical corticosteroids.
2.
Deviated septum, severe, and associated with nasal
obstruction and/or current symptomatic perforation of septum.
3.
Current nasal polyp, or polypoid mass(es) or history of sinus
surgery within the last 2 years, excluding antralchoanal polyp
or sinus mucosal retention cyst.
4.
Other conditions causing significant nasal obstruction
5.
History of recurrent (more than 1 episode per week occurring
over a 3-month period within the last 2 years) or recent severe
epistaxis not easily controlled by simple direct pressure, or if
requires recurrent cauterization (chemical or electrical),
packing/tamponade, or use of topical hemostatics.
6.
Current anosmia (absent sense of smell) or parosmia (distorted
sense of smell).
B. Paranasal sinusitis
1.
Acute purulent sinusitis until cured.
2.
Chronic symptomatic or recurrent acute sinusitis requiring
frequent medical care.
C. Abnormalities of the
larynx
1. Paralysis of vocal cords or other symptomatic vocal cord
conditions or dysfunction (e.g., paradoxical vocal cord
movement, spasmodic dysphonia).
D. Abnormalities of the
trachea
1.
Current tracheostomy, regardless of cause
2.
Congenital or acquired stenosis or fistula
E. Abnormalities of the
mouth and pharynx
1.
History of deformities, or conditions or anomalies of the upper
alimentary tract, mouth, tongue, palate, throat, pharynx, larynx,
and nose, that interfere with chewing, swallowing, speech, or
breathing.
2.
Salivary gland calculus with recurrent swelling, pain, or infections
of the affect gland within the past 2 years.
3.
Leukoplakia or hairy leukoplakia or recurrent severe stomatitis
4.
Chronic or recurrent severe pharyngitis
5.
History of cancer of the oral cavity
CCI 221.01 Medical Accession Standards
5
Condition
Disqualification for Appointment
III. Dental Disorders
A. Dental Disorders
1.
Complex restoration of maxillary/mandibular edentulism and
dental arch stability, until necessary dental treatment has been
satisfactorily completed. Examples of complex procedures
include: full mouth rehabilitation involving extensive fixed
and/or precision removable prosthetics, complete dentures,
dental implants, endodontic procedures, or prolonged
orthodontic treatment. Six or more teeth requiring restoration.
Individuals undergoing endodontic care are acceptable for
accession only if a civilian or military dentist provides
documentation that active endodontic treatment shall be
completed prior to commissioning.
2.
Malocclusion which interferes with the mastication of normal
diet, the correction of which would involve full-banded
orthodontic appliances and/or orthognathic surgery.
3.
Current orthodontic treatment is acceptable for accession only
if a civilian or military orthodontist provides documentation that
active orthodontic treatment shall be completed prior to
commissioning. Fixed or removable retainers, and removable
active orthodontic appliances (e.g., INVISALIGN) are
permissible when reporting to active duty.
4.
Any periodontal disease for which surgery is indicated and/or
sustained therapy (other than routine periodontal
maintenance). The dental reviewer will need to request and
evaluate the periodontal charting and radiographs prior to
making an assessment.
5.
Craniofacial or developmental growth deformities.
6.
Temporomandibular joint dysfunction or myofascial pain that
has been symptomatic or required treatment within the last 12
months, or that is chronic in nature.
7.
Extensive loss of oral tissues (including teeth and supporting
bone and soft tissues), the replacement of which would involve
complex maxillofacial prosthetic appliances.
Not counting third molars and any teeth extracted for
orthodontic treatment; it is disqualifying to have more than 2
missing teeth (which would need a treatment plan for more than
two dental implants/bridges to treat the edentulous area of the
mouth). A dental appliance needs to be present for any missing
anterior teeth.
8.
A minimum of three months healing time must elapse from the
completion of any surgical treatment. The dental reviewer may
determine and specify healing time for certain dental
extractions to be less than three months.
9.
Any disease or condition of the jaw or associated tissues that is
not easily remedied and may incapacitate the individual or
otherwise prevent the satisfactory performance of duty.
10.
Any dental condition whose treatment would require more than
single day absences from the duty station for each appointment
or significant travel expenses.
11.
Any existing dental condition which could potentially cause a
dental emergency during the first month of reporting to active
duty.
CCI 221.01 Medical Accession Standards
6
Condition
Disqualification for Appointment
IV. Eyes and Vision
A. Visual Function
1.
Distant visual acuity which is not correctable to 20/20 in one
eye and 20/400 in the other, or 20/30 in one eye and 20/100 in
the other, or 20/40 in one eye and 20/70 in the other by use of
spectacles.
2.
Near visual acuity that does not correct to 20/40 in the better
eye
3.
Any condition requiring telescopic lens for adequate correction
4.
Any condition that specifically requires contact lenses for
adequate correction of vision, such as corneal scars and
opacities and irregular astigmatism.
5.
Diplopia
6.
Visual field: less than 30 degrees in either eye; a continuous
field of vision which is less than 140 degrees (testing both eyes
together).
7.
Note: for stereo acuity and color vision there is no standard, but
both should be tested and documented, since these are
prerequisites for function within certain categorical
assignments.
B. Lids and adnexa
1.
Below conditions, or other eyelid conditions, if they impair
protection of eye from exposure, chronically irritate the eye, or
interfere with performance of work or daily activities:
•
Marked ectropion or entropion
•
Trichiasis
•
Ptosis
•
Lagophthalmos
•
Chronic or recurring blepharitis, if
severe
•
Blepharospasm
•
Dacryocystitis
•
Obstruction of the nasolacrimal
duct, currently symptomatic
2.
Growth or tumor of eyelid other than a small, benign, non-
progressive lesion.
C. Conjunctiva
1.
Current acute or chronic conjunctivitis excluding seasonal
allergic conjunctivitis
2.
Pterygium if condition is symptomatic enough to interfere with
performance of work or daily activities.
3.
Any other condition of the conjunctiva which currently affects
visual acuity or has the potential to affect visual acuity in the
future.
D. Cornea
1.
Acute keratitis or corneal ulcer until cured and without
sequelae
2.
History of chronic and/or recurrent keratitis within five years or
recurrent corneal ulcerations
3.
Keratoconus of any degree which has not been stable for at
least 5 years and/or which fails to meet visual function
standards.
4.
Corneal dystrophy or degeneration if it requires regular use of
topical treatments, such as hyperosmotics, to maintain comfort
or clarity of vision
5.
Corneal transplant, if not clear or if not in place at least 5 years
6.
Progressive vascularization or opacification of the cornea
CCI 221.01 Medical Accession Standards
7
Condition
Disqualification for Appointment
IV. Eyes and Vision (Continued)
E. Cornea (Continued.)
7. NOTE: A history of laser or incisional corneal correction/surgery
(e.g., photorefractive keratotomy [PRK] or laser-in-situ
keratomileusus [LASIK] or radial keratotomy [RK]) within
the last 6 months or the corrective surgery has resulted in
ongoing post-surgical complications, or the requirement of daily
medications.
F. Uveal tract (iris,
ciliary body,
choroid)
1. Presence or history of recent or recurrent uveitis or iridocyclitis
or need for suppressive medication within the past 5 years,
regardless of cause.
G. Retina
1.
Evidence or history of retinal disease, which is progressive or
which is known to have potential for progression, regardless of
current visual acuity.
2.
Detached retina or retinal tears, with or without a history of
surgical repair, unless unilateral, adequately treated, and
without problems for a period of 3 years.
3.
Significant retinal degeneration likely to cause detachment or
significant decrease of vision in the future.
4.
Congenital or acquired retinal dystrophy, degeneration, or
other disorder that is likely to cause significant decrease of
vision in the future.
5.
Night blindness due to organic eye disease
6.
Chorioretinitis conditions including histoplasmosis,
toxoplasmosis, or vascular conditions of the eye to include
Coats' Disease, Eales' Disease, and retinitis proliferans, unless
single episode that has healed and does not interfere with
vision.
H. Optic nerve
1.
Optic neuritis, or history of optic neuritis, or documented history
of attacks of retrobulbar neuritis except in cases without
significant optic atrophy if etiology is known and unlikely to recur.
2.
Papilledema or history of papilledema except in cases if
etiology is known and unlikely to recur.
3.
Optic atrophy, primary or secondary, unless cause is known,
not considered progressive, and visual function standards are
met.
4.
Congenital or hereditary conditions of the optic nerve unless
cause is known, not considered progressive, and visual acuity
standards are also met.
I. Lens
There are no specific criteria limiting accession, but if candidate has
history of cataract surgery, they must have recovered fully with stable
vision and exam and no ongoing ophthalmic concerns related to the
surgery.
J. Ocular mobility and
motility
1.
Current or recurrent diplopia
2.
Current nystagmus other than physiologic “end-point
nystagmus”
3.
Ocular deviations if they cause candidate to not meet visual
function criteria
4.
History of restrictive ophthalmopathy if expected that it could
recur
CCI 221.01 Medical Accession Standards
8
Condition
Disqualification for Appointment
IV. Eyes and Vision (Continued)
K. Glaucoma or
increased
intraocular pressure
Glaucoma which is severe enough that candidate does not meet visual
function criteria, or is progressive despite optimal management, such
that it would seem likely they might fail visual function criteria in the
future. For example, uncontrolled glaucoma which results in progressive
thinning of optic nerve by optical coherence tomography
(OCT) or progression of visual field loss despite optimal management.
L. Eye trauma
Recent eye trauma, until maximum recovery has occurred without
significant sequela and with good prognosis.
M. Other
Any current or past abnormality of the eye or adnexa, not specified in
these criteria, which threaten vision or visual function or would be
expected to do so in the future.
CCI 221.01 Medical Accession Standards
9
Condition
Disqualification for Appointment
V. Ears and Hearing
A. Ear: abnormalities
of the auricle and
external canal
1.
Acute or chronic infections or inflammation of external canal, if
more than mild, until cured.
2.
Deformities of the auricle or external canal (i.e., atresia,
microtia, stenosis, or traumatic etiology) which interfere with
hearing or predispose to chronic infection, regardless of cause.
B. Otitis media
1.
Acute otitis media until cured and without significant residual.
2.
Chronic or recurrent otitis media after age 13 years, regardless
of cause.
3.
Chronic Eustachian tube dysfunction within the last 3 years as
evidenced by retracted tympanic membrane, or recurrent otitis
media, or the need for pressure-equalization tube.
4.
Presence or history of cholesteatoma.
5.
History of any inner or middle ear surgery, excluding
myringotomy or successful tympanoplasty
6.
History of any surgically implanted hearing device
C. Perforated tympanic
membrane
Current perforation of the tympanic membrane or history of surgery to
correct perforation during the preceding 180 days.
D. Mastoiditis
1.
Acute or chronic mastoiditis
2.
Surgery for mastoid disease within the past 2 years or if
evidence of activity persists after 2 years; or residual of
mastoid operation with fistula.
E. Otosclerosis
Presence or history of otosclerosis
F. Inner ear disease
1.
Presence or history of Meniere's syndrome or other diseases of
the vestibular system
2.
Recurring attacks of vertigo, tinnitus, or other signs and
symptoms referable to cochlear or vestibular dysfunction.
3.
History of motion sickness resulting in recurrent incapacitating
symptoms
G. Hearing
1.
Unaided pure tone at 500, 1000, and 2000 cycles per second
for each ear of not more than 25 decibels (dB) on the average
with no individual level greater than 30 dB at those
frequencies.
2.
Unaided pure tone level not more than 35dB at 3000 cycles per
second or 45 dB at 4000 cycles per second for each ear.
3.
Asymmetric hearing loss as evidenced by 20dB or greater for
two adjacent frequencies except 6000 cycles per second.
CCI 221.01 Medical Accession Standards
10
Condition
Disqualification for Appointment
VI. Cardiovascular Disorders
A. Coronary Artery
Disease
1.
History or evidence of any acute coronary syndrome (e.g.,
myocardial infarction, unstable angina).
2.
Angiographic or other evidence of significant coronary artery
disease, i.e., abnormal resting and/or stress thallium
scintigraphy, radionuclide ventriculography, echocardiography,
or cardiac magnetic resonance imaging (MRl) consistent with
coronary artery disease.
3.
History of revascularization, i.e., coronary artery bypass
surgery, coronary angioplasty, coronary stent.
B. Cardiomyopathies,
Myocarditis,
endocarditis,
pericarditis.
1.
History of significant left ventricular dysfunction, i.e., abnormal
ejection fraction as assessed by contrast ventriculography,
radionuclide imaging, echocardiography, or cardiac MRI.
2.
History or finding of cardiomyopathy, myocarditis, endocarditis,
or pericarditis, regardless of cause (except in cases of history
of mild myocarditis or pericarditis associated with acute
infections, with no residuals, inactive for 2 or more years).
3.
History of rheumatic fever with carditis unless only one episode
occurring 5 years or more in the past without evidence of sequela.
C. Disturbances of
cardiac rate, rhythm
or conduction
1.
Sinus node dysfunction:
•
Sinus tachycardia: Symptomatic resting pulse
rate consistently over 100
•
Sinus bradycardia: Pulse rate below 50 only if
underlying heart disease is present or
symptomatic requiring a pacemaker.
2.
Premature beats (extra systoles, ectopic beats)
•
Disqualifying only if symptoms interfere with
performance of duties or if accompanied by
disqualifying cardiomyopathy or valvular heart
disease.
3.
Paroxysmal supraventricular tachycardia
•
Disqualifying if frequent attacks occur or if not
well-controlled with either medication therapy or
radiofrequency catheter ablation
4.
Atrial fibrillation
•
Disqualifying except in the uncommon case of
single, self-limited episodes associated with:
▪
no underlying disqualifying
cardiomyopathy or valvular heart
disease or
▪
a medically reversible, treatable
cause, such as treated, resolved
pneumonia
5.
Atrial flutter
•
Disqualifying except when eliminated by
effective radiofrequency catheter ablation,
followed by absence of recurrence for two
years.
CCI 221.01 Medical Accession Standards
11
Condition
Disqualification for Appointment
VI. Cardiovascular Disorders (Continued)
C. Disturbances of
cardiac rate, rhythm
or conduction
(Continued)
6.
Ventricular tachycardia
•
Disqualifying except in the rare case of isolated
ventricular tachycardia without symptoms in the
absence of structural heart disease when ECG
consistently shows a pattern consistent with
benign idiopathic ventricular tachycardia.
7.
Atrioventricular conduction bloc
•
Disqualifying if symptomatic and inadequately
treated
8.
Bundle Branch Block
•
Left bundle branch block
D. Heart Failure
History or findings of congestive heart failure regardless of cause.
E. Valvular Disease
1.
Valvular or septal defects and shunts, congenital or acquired
unless thorough evaluation indicates a condition considered
benign.
2.
Surgical treatment for valvular or septal defects, except for
conditions corrected in childhood known to have a good
prognosis.
3.
Pathologic cardiac murmurs:
•
Diastolic murmurs, regardless of cause; and
•
systolic murmurs associated with other signs of
cardiac disease
4.
Prolapsing mitral valve with disabling arrhythmias, or chest
pain or other symptoms, or with more than mild mitral
regurgitation, or with significant valve redundancy or thickness
on echocardiogram.
F. Hypertension
1.
Defined as a preponderance of sitting blood pressures above
90 diastolic or above 140 systolic. Disqualifying unless well-
controlled, on medication or non-medical therapy, over a
minimum of 3 months with no evidence of secondary end-
organ complications.
2.
Labile hypertension in which sitting blood pressures on 4 or
more days in the last 3 years exceeded 160 systolic or 100
diastolic.
G. Disease of aorta or
arteries
1.
Aneurysm of the thoracic or abdominal aorta, dilatation of the
aorta, or arterio-venous fistula, regardless of cause. Arteries.
2.
Acute or chronic peripheral arterial occlusive disease
3.
Clinical evidence of atherosclerotic occlusive disease of major
vessels
4.
Thromboangiitis obliterans (Buerger's disease)
5.
Secondary Raynaud's phenomenon
6.
Marfan's syndrome
7.
Surgical treatment of any of the above
8.
Major congenital abnormalities of aorta, pulmonary artery, or
other major vessels, unless
satisfactorily corrected in childhood
9.
Other major vascular abnormalities
CCI 221.01 Medical Accession Standards
12
Condition
Disqualification for Appointment
VI. Cardiovascular Disorders (Continued)
H. Peripheral venous
disease (varicose
veins,
thrombophlebitis)
1.
Varicose vein, if severe and symptomatic
2.
History of recurrent superficial thrombophlebitis
3.
Thromboembolic disease – see Pulmonary section
I. Syncope
1.
History of recurrent syncope and/or presyncope of unknown
cause including black out, fainting, loss or alteration of level of
consciousness (excludes single episode of vasovagal reaction
with identified trigger such as venipuncture) in the presence of
a normal structural heart evaluation, unless there has been no
recurrence during the preceding 2 years while off all medication
for treatment of this condition
2.
History of Postural Orthostatic Tachycardia Syndrome
J. Other
1.
Unexplained ongoing or recurring cardiopulmonary symptoms
(to include but not limited to syncope, presyncope, chest pain,
palpitations, and dyspnea on exertion).
2.
History of rheumatic fever if associated with rheumatic heart
disease or indication for ongoing prophylactic medication.
3.
Underlying cardiovascular conditions requiring bacterial
endocarditis prophylaxis
CCI 221.01 Medical Accession Standards
13
Condition
Disqualification for Appointment
VII. Pulmonary Disorders
A. Infectious diseases
of the lungs
1.
Infectious pneumonia within the last 3 months
2.
History of any lower respiratory infectious process with
sequelae that prevents satisfactory performance of duty or
prohibits vigorous physical exertion.
3.
History after the 13th birthday of recurrent (2 or more episodes
within an 18-month period) infectious pneumonia.
4.
Abscess of the lung or mediastinum within the last 3 months
B. Tuberculosis
1.
History of active pulmonary or extra pulmonary tuberculosis
unless there is reliable medical documentation showing
completion of adequate treatment and complete cure has been
achieved. There should be no evidence of significant cavitation
or significant decreased in pulmonary function.
2.
Treatment of current latent TB infection based upon CDC
guidelines is encouraged, but not required.
C. Bronchiectasis
History of bronchiectasis with recurrent infections unless the area of
bronchiectasis was documented as being localized and was surgically
resected greater than 3 years prior to application.
D. Atelectasis
Presence of atelectasis, until cause is determined and is successfully
treated, and is not otherwise disqualifying.
E. Pulmonary
Thromboembolism
1.
History of thromboembolic disease (Pulmonary embolism and
Deep Vein Thrombosis), unless the only single prior incident
was over one year ago and was secondary to an acquired risk
factor (e.g. post-surgical, lower extremity trauma) and the
thromboembolic event resulted in no clinical sequela, including
the need for long-term anticoagulant therapy.
2.
Current use of anticoagulant therapy (antiplatelet agents are
acceptable, however the underlying condition requiring their
use, maybe disqualifying).
3.
History of previous use of anticoagulant therapy which
exceeded 6-month duration
F. Pneumothorax
1.
History of single episode of spontaneous pneumothorax
occurring within the past 2 years, or pneumothorax due to
trauma or surgery occurring within the past year.
2.
Recurrent (two or more) spontaneous pneumothoraces unless
surgical pleurodesis done after the last episode and it is at
least 1 year since that surgery.
G. Pleural Conditions
1.
History of empyema unless resolved with no sequelae
2.
Pleurisy or pleural effusion within the previous 3 months
3.
Recurrent (two or more) episodes of pleurisy or pleural effusion
4.
Bronchopleural fistula, unless resolved with no sequelae
H. Chronic Obstructive
Pulmonary Disease
Chronic obstructive pulmonary disease including but not limited to
bullous or generalized pulmonary emphysema or chronic bronchitis
(and excludes asthma and conditions addressed in (I) below).
CCI 221.01 Medical Accession Standards
14
Condition
Disqualification for Appointment
VII. Pulmonary Disorders (Continued)
I. Bronchial Asthma
History of airway hyper responsiveness including asthma, reactive
airway disease, or asthmatic bronchitis, after the 13th birthday with the
following exceptions:
•
Exercise-induced asthma requiring no more than the use of
one metered dose inhaler canister of a short-acting
bronchodilator every six months and no history of requiring
daily asthma controller medications after the 13
th
birthday.
•
A single episode of viral respiratory infection induced bronchial
hyperreactivity requiring treatment for no more than 60 days.
J. Pulmonary Fibrosis
and other restrictive
lung disease
Interstitial lung disease including pulmonary fibrosis
K. Other conditions of
the lungs and
bronchi
1.
Any abnormal findings on imaging or other examination of body
structure, such as lung, diaphragm, or other thoracic or
abdominal organ that prevents satisfactory performance of duty
or interferes with vigorous physical exertion now or likely to in
the future.
2.
Current foreign body in lung, trachea, or bronchus.
3.
History of thoracic surgery including open and endoscopic
procedures with sequalae that prevent performance of duties
or prohibits vigorous physical exertion.
4.
History of chest wall surgery, including breast, during the
preceding 6 months, or with persistent functional limitations.
5.
History of other disorders, including but not limited to cystic
fibrosis or lymphangioleiomyomatosis (LAM) that are currently
asymptomatic, but are likely to progress to clinical significance
in the future.
6.
Nocturnal ventilation support (including effectively treated sleep
apnea), respiratory failure, pulmonary hypertension, or any
requirement for chronic supplemental oxygen use.
7.
Sarcoidosis, unless with a history of stable stage I disease with
adenopathy alone without ventilatory deficit and completely
resolved.
L. Abnormalities of the
chest wall and
diaphragm
Current chest wall malformation, including but not limited to pectus
excavatum or pectus carinatum which has been symptomatic,
interfered with vigorous physical exertion, has been recommended for
surgery, or can reasonably expected to interfere with ability to wear
personal protective equipment.
CCI 221.01 Medical Accession Standards
15
Condition
Disqualification for Appointment
VIII. Gastrointestinal and Hepatobiliary Disorders
A. Esophagus
History of Gastro-Esophageal Reflux Disease (GERD), with
complications, including, but not limited to:
•
Stricture
•
Dysphagia
•
Recurrent symptoms or esophagitis despite maintenance
medication
•
Barrett’s esophagus
•
Extraesophageal complications such as: reactive airway
disease; recurrent sinusitis or dental complications;
unresponsive to acid suppression.
•
History of surgical correction (such as fundoplication) for
GERD within 6 months or with complications.
•
History of dysmotility disorders to include but not limited to
diffuse esophageal spasm, nutcracker esophagus, and
achalasia.
•
History of eosinophilic esophagitis
•
History of other esophageal strictures (e.g., lye or other caustic
ingestion
•
History of esophageal disease not specified above; including
but not limited to neoplasia, ulceration, varices, or fistula.
B. Stomach and
Duodenum
1.
Current dyspepsia, gastritis, or duodenitis despite medication
(over the counter or prescription).
2.
Current gastric or duodenal ulcers, including but not limited to
peptic ulcers and gastrojejunal ulcers:
3.
History of a treated ulcer within the last 3 months
4.
Recurrent or complicated by bleeding, obstruction, or
perforation within preceding 5 years
5.
History of surgery for peptic ulceration or perforated ulcer
6.
History of gastroparesis of greater than 6 week’s duration,
confirmed by scintigraphy or equivalent test.
7.
History of bariatric surgery of any type (e.g., lap-band or gastric
bypass surgery for weight loss)
8.
History of gastric varices
CCI 221.01 Medical Accession Standards
16
Condition
Disqualification for Appointment
VIII. Gastrointestinal and Hepatobiliary Disorders (Continued)
C. Small and Large
Intestine
1.
History of inflammatory bowel disease, including but not limited
to Crohn’s disease, ulcerative colitis, ulcerative proctitis, or
indeterminate colitis.
2.
Current infectious colitis
3.
History of intestinal malabsorption syndromes, including but not
limited to celiac sprue, pancreatic insufficiency, post-surgical
and idiopathic.
4.
Dietary intolerances that may be reasonably expected to
interfere with military duty or consumption of military rations.
Lactase deficiency does not meet the standard only if of
sufficient severity to require frequent intervention, or to
interfere with normal function.
5.
History of gastrointestinal functional or motility disorders
including but not limited to volvulus within the past 24 months,
or any history of pseudo-obstruction or megacolon.
6.
Current chronic constipation, requiring prescription medication
or medical interventions (e.g. pelvic floor physical therapy,
biofeedback therapy) coupled with significant physical
functional impairment.
7.
History of diarrhea of greater than 6 weeks duration, regardless
of cause, persisting or symptomatic in the past 2 years unless a
specific infectious agent was identified and successfully treated.
8.
History of gastrointestinal bleeding, including positive occult
blood, if the cause requires treatment and has not been
corrected.
9.
History of irritable bowel syndrome of sufficient severity to
require frequent intervention or prescription medication or that
may reasonably be expected to interfere with military duty.
10.
History of recurrent symptomatic diverticular disease of the
intestine requiring prescription medications or surgical
interventions.
11.
History of familial adenomatous polyposis syndrome or
hereditary non-polyposis colon cancer (Lynch) syndrome.
D. Anorectal
1.
Current anal fissure or anal fistula
2.
History of rectal prolapse or stricture within the last 2 years
3.
History of fecal incontinence after the 13th birthday
4.
Current hemorrhoid (internal or external), if symptomatic or
requiring medical intervention within the last 60 days.
E. Surgical procedures
resulting in
significant alteration
in GI function
History of bariatric surgery of any type (e.g. lap-band or gastric bypass
surgery for weight loss)
F. Abdominal Wall
1.
Current abdominal wall hernia other than small umbilical
hernias determined to not be clinically significant.
2.
History of open or laparoscopic abdominal surgery during the
preceding 3 months
3.
The presence of any ostomy (gastrointestinal or urinary)
CCI 221.01 Medical Accession Standards
17
Condition
Disqualification for Appointment
VIII. Gastrointestinal and Hepatobiliary Disorders (Continued)
G. Hepatic - Biliary
Tract, Hepatitis
1.
History of chronic Hepatitis B Virus (HBV) infection
characterized by the presence of HBsAg for at least 6 months
(as defined by the Update on Prevention, Diagnosis, and
Treatment of Chronic Hepatitis B: AASLD 2018 Hepatitis B
Guidance) unless:
•
On treatment for at least 12 months prior to application
with:
o
Maintenance of alanine transaminase (ALT) ≤ 2x
ULN (ULN: 35 U/L for men and 25 U/L for
women) for at least 6 months prior to application,
o
Achievement and maintenance of HBV DNA
measurements ≤ 1000 IU/ml or at least one log
decreased from pre-treatment levels for at least
6 months prior to application,
o
No evidence of cirrhosis documented by
noninvasive tests or liver biopsy, and
o
No chronic co-infection with hepatitis D
•
Not on treatment with:
o Maintenance of ALT ≤ ULN for at least 6 months
prior to application,
o Maintenance of HBV DNA measurements
≤ 1000 IU/ml for at least 6 months prior to
application,
o No evidence of cirrhosis documented by
noninvasive tests or liver biopsy, and
o No chronic co-infection with hepatitis D
2.
History of chronic Hepatitis C, unless successfully treated and
with documentation of a sustained virologic response at
least12 weeks after completion of a full course of therapy.
3.
Other acute hepatitis in the preceding 6 months, or persistence
of symptoms or abnormal serum aminotransferases after
6 months, or objective evidence of impairment of liver function.
4.
History of cirrhosis, hepatic abscess, or complications of
chronic liver disease.
5.
History of symptomatic gallstones or gallbladder disease
unless successfully treated.
6.
History of sphincter of Oddi dysfunction.
7.
History of choledochal cyst.
8.
History of primary biliary cirrhosis or primary sclerosing
cholangitis or autoimmune hepatitis.
9.
History of metabolic liver disease, excluding Gilbert’s syndrome.
This includes but is not limited to hemochromatosis, Wilson’s
disease, or alpha-1 anti-trypsin deficiency.
10.
History of alcoholic or non-alcoholic fatty liver disease if there
is evidence of chronic liver disease, manifested as impairment
of liver function or hepatic fibrosis.
11.
History of traumatic injury to the liver within the preceding
6 months.
H. Pancreas
1.
History of pancreatic insufficiency
2.
History of acute pancreatitis, unless due to an identified self-
limiting condition (e.g. cholelithiasis successfully treated by
cholecystectomy)
3.
History of chronic pancreatitis
4.
History of pancreatic cyst or pseudocyst
5.
History of pancreatic surgery
CCI 221.01 Medical Accession Standards
18
Condition
Disqualification for Appointment
IX. Endocrine and Metabolic Disorders
A. Pituitary Disease
1.
History of pituitary tumor unless proven non-functional, less
than 1 cm and stable in size over the past 12 months
2.
History of pituitary dysfunction, except for resolved growth
hormone deficiency
3.
History of diabetes insipidus
B. Thyroid Disease
1.
History of hyperthyroidism unless treated successfully with
surgery or radioactive iodine and without either recurrence or
need for anti-thyroid medication for at least 2 years.
2.
Current hypothyroidism unless asymptomatic, demonstrated
euthyroid by normal thyroid stimulating hormone testing within
the preceding 12 months, and on stable thyroid replacement
therapy for at least 12 months.
3.
Thyroid nodule unless a solitary thyroid nodule less than 5 mm
or less than 3 cm with benign histology or cytology, and that
does not require ongoing surveillance.
4.
Thyroid cancer or history thereof, unless complete surgical
resection demonstrated features consistent with ATA low risk
papillary thyroid cancer, with no evidence of metastases and
with resulting hypothyroidism controlled as described above.
C. Adrenal Disease
1.
Adrenal dysfunction, current or a history of, requiring treatment
or hormone replacement.
2.
Adrenal neoplasm unless asymptomatic, non-secreting or
non-functional, < 4cm and stable for a minimum of 2 years.
D. Impaired Glucose
Metabolism
1.
History of Diabetes Mellitus
2.
History of unresolved pre-diabetes (as defined by the American
Diabetic Association) within the last 2 years (HgbA1C ≥ 5.7%)
3.
History of gestational diabetes
4.
Current persistent glycosuria, when associated with impaired
glucose or renal tubular defects
E. Hypoglycemia
1.
Fasting or organic hypoglycemia regardless of cause
2.
Symptomatic or non-symptomatic functional or reactive
hypoglycemia
3.
History of islet-cell tumors
4.
Congenital or acquired hyperinsulinism
F. Disorders of calcium
and phosphate
metabolism
1.
History of primary hyperparathyroidism unless surgically
corrected and with stable calcium and phosphate levels for
greater than 12 months
2.
History or hypoparathyroidism
G. Gout, hyperuricemia
1.
History of Gout
2.
Hyperuricemia > 10 gm% not on medication secondary to
increased risks for kidney stones or development of gout.
H. Other inborn errors
of metabolism
1.
Other metabolic disorders not mentioned elsewhere including
porphyrias
2.
Nutritional deficiencies which require frequent treatment or are
associated with significant long-term complications.
CCI 221.01 Medical Accession Standards
19
Condition
Disqualification for Appointment
IX. Endocrine and Metabolic Disorders (Continued)
J.
Overweigh
t
condition
1.
BMI in excess of 27.5 kg/m
2
2.
If BMI is between 27.6 and 32.9 kg/m
2
, appointment may
be granted if estimated percent body fat (as determined by
“taping”) does not exceed:
Age Male Female
-28 24% 32%
28-39 26% 35%
40+ 28% 38%
K. Dyslipoproteinemia
1.
Low density lipoprotein (LDL) greater than 200 mg/dl off therapy
2.
Fasting Triglycerides greater than 400 mg/dl
3.
Requiring more than one medication
4.
LDL greater than 190 mg/dl on therapy
5.
If taking treatment, must have been on stable medication for
minimum of 6 months and without side effects
L. Metabolic Syndrome
As defined by any three of the following:
1.
Increased waist circumference (≥ 40 in or 102 cm for men,
≥ 35 in or 88 cm in women)
2.
Medically controlled dyslipidemia or triglycerides > 150 mg/dl
3.
Reduced High Density Lipoproteins (HDL) (< 40 mg/dl in men,
<50 mg/dl in women)
4.
Medically controlled or elevated blood pressure (≥ 130/85)
5.
Elevated fasting glucose (≥ 100 mg/dl)
M. Underweight
Condition
1.
Weight below BMI of 17.6 kg/m
2
2.
Weight BMI ≥17.6 and ≤ 19 kg/m
2
as a result of chronic weight
loss accompanied by signs and/or symptoms of nutritional
deficiency, other physiologic abnormalities, or eating disorders.
3.
Acute weight loss with signs and symptoms of mental,
behavioral, emotional, and/or physical distress.
N. Hypogonadism
Congenital, treated with hormonal supplementation, or of unexplained
etiology
O. History of Gender
Dysphoria
A history of medical treatment associated with gender transition is
disqualifying, unless, as certified by a licensed medical provider:
The applicant has completed all elements of a medical treatment plan
associated with the applicant’s gender transition; and
The applicant has been stable in the preferred gender for 18 months If
the applicant is presently receiving cross-sex hormone therapy post
gender transition, the individual has been stable on such hormones for
18 months.
CCI 221.01 Medical Accession Standards
20
Condition
Disqualification for Appointment
X. Hematologic Disorders
A. Anemia
MALE
Hct ≤ 39%
Hgb ≤ 13.6 gms %
RBC ≤ 4.3M
FEMALE
Hct ≤ 33 %
Hgb ≤ 12 gms%
RBC ≤ 3.5M
or meeting standards
of testing laboratory
1.
Anemia, as defined, until permanently corrected, demonstrated
to be correctible with conservative therapy, and underlying
cause is known not to be disqualifying.
2.
History of anemia, regardless of present status, unless cause
has been identified and permanently corrected and a sufficient
period of time has elapsed to assure the improbability of
relapse. Generally, still disqualifying:
•
Pernicious anemia
•
Recurrent iron, folic acid, or other
deficiency anemias unless underlying
cause for deficiency has been corrected
•
Bone marrow failure
•
Hereditary spherocytosis unless controlled
by splenectomy
•
Hemolytic anemia
•
Hemoglobinopathies (e.g. sickle cell
anemia; Hemoglobin C; etc.) associated
with anemia or symptoms except for
asymptomatic thalassemia minor or sickle
cell trait
B. Polycythemia
MALE
Hct ≥ 53%
FEMALE
Hct ≥ 46%
1.
Polycythemia vera, regardless of hematocrit
2.
Erythrocytosis if due to an underlying pathological cause
C. Hemorrhagic
Disorders
1.
Hemophilia, von Willebrand's disease or other coagulation
defects
2.
Acute or Chronic thrombocytopenia, for any reason
3.
Presence or history of other bleeding tendencies until cause is
determined, corrected, and is highly
unlikely to recur
4.
Anticoagulant therapy (except aspirin)
D. Leukocytosis,
granulocytosis, or
lymphocytosis
(total WBC ≥ 10K or
with abnormal
differential)
Disqualifying until cause is determined to be benign and has been
corrected
E. Thrombocytosis
(450,000/µL)
Disqualifying until cause is known to be benign and has been corrected
F. Leukopenia
(WBC ≤ 3.3K
(≤ 2.8K if black),
neutropenia (≤ 2K or
≤ 1.0K, if black), or
lymphopenia ≤ 1K
1. Disqualifying if the leukopenia may cause complications and until
the cause is determined to be benign
2. Diagnosis or presumptive diagnosis of Benign Ethnic
Neutropenia (BEN) with Absolute Neutrophil Count >800 with no
history of severe or recurrent infections is not disqualifying
G. Splenic conditions
1.
History of splenomegaly unless secondary to a known
infectious process which is no longer active (e.g. EBV
infection).
2.
Current splenomegaly
•
History of splenectomy except when done for
trauma or conditions unrelated to the spleen or
for hereditary spherocytosis.
CCI 221.01 Medical Accession Standards
21
Condition
Disqualification for Appointment
XI. Renal and Urologic Disorders
A. Infectious or
inflammatory
disease of the
kidney
1.
Acute glomerulonephritis or history thereof except in childhood
and without sequelae for a period of 5 years
2.
Rapidly progressive ("subacute") or chronic glomerulonephritis
regardless of cause
3.
Nephrotic syndrome or history thereof except in childhood
without sequelae for a period of 5 years.
4.
Acute urinary tract infection or pyelonephritis until cured
without sequelae
5.
Repeated episodes of acute pyelonephritis
6.
Chronic pyelonephritis
B. Congenital and
acquired
abnormalities of the
kidney
1.
Renal cystic disease (except simple cysts and medullary
sponge kidney)
2.
Horseshoe kidney
3.
Other congenital or acquired abnormalities resulting in, or likely
to result in, impaired function or recurrent infection
4.
Absence of one kidney, congenital or acquired
5.
Kidney transplant recipient
C. Renal or ureteral
calculi
Urolithiasis if any of the following apply:
•
Current stone of 3 mm or greater
•
Current multiple stones of any size
•
History of symptomatic urolithiasis within the
preceding 12 months
•
History of nephrocalcinosis, bilateral renal calculi,
or recurrent urolithiasis at any time
•
History of urolithiasis requiring medical
(e.g. extracorporeal shock wave lithotripsy) or
surgical procedures
D. Other kidney
diseases or
abnormalities
1. History of proteinuria (protein-to-creatinine ratio greater than
0.2 and/or albumin-to-creatinine ratio ≥ 30mg/g), except in
cases where a thorough evaluation has been performed and the
condition is apparently benign (e.g., orthostatic proteinuria)
2.
Pyuria in the absence of urinary tract infection (3 or more white
blood cells per high-powered field on properly collected
urinalyses)
3.
Hematuria in the absence of urinary tract infection:
•
Gross hematuria
•
Persistent microscopic hematuria (3 or more red
blood cells per high-powered field on properly
collected urinalyses, unless urology evaluation
determines benign essential hematuria)
4.
Elevated creatinine, decreased creatinine clearance, or
decreased glomerular filtration rate (eGFR)
5.
Acute kidney injury, acute renal failure, or history thereof until
resolved without residuals
6.
Chronic kidney disease, chronic renal failure or chronic
insufficiency
7.
Tubular or interstitial disease unless completely resolved and
unlikely to recur
CCI 221.01 Medical Accession Standards
22
Condition
Disqualification for Appointment
XI. Renal and Urologic Disorders (Continued)
E. Infections of the
lower urinary tract
Cystitis or urethritis, presence or history thereof:
•
For males, any cystitis not related to an
indwelling catheter during a hospitalization
•
For females, current cystitis or recurrent cystitis
of greater than two episodes per year, or
requiring daily suppressive antibiotics, or
non-responsive to antibiotics for 10 days
•
For males and females, current urethritis until
cured and without sequelae
F. Abnormalities of the
urinary tract
including voiding
abnormalities
1.
History of interstitial cystitis or bladder pain syndrome
2.
History or treatment of the following voiding symptoms, if not
associated with an active urinary tract infection, within the
previous 12 months:
•
Urinary frequency or urgency more than every
2 hours on a daily basis
•
Nocturia more than two episodes during sleep
period
•
Enuresis
•
Incontinence of urine, such as urge or stress
•
Urinary retention
•
Dysuria
3.
History of neurogenic bladder or other functional disorder of the
bladder necessitating urinary catheterization with intermittent or
indwelling catheter for any period greater than 2 weeks
4.
Nephrostomy, ureterostomy, or ureteral conduit procedure
5.
Cystoplasty or urethroplasty
6.
Cystectomy
7.
Urinary fistula
G. Obstructive
uropathies
1.
Any urinary tract obstruction (e.g., stenosis, stricture) until
relieved and without significant residuals
2.
Hydronephrosis, unless relieved and without significant
residuals for 12 months
CCI 221.01 Medical Accession Standards
23
Condition
Disqualification for Appointment
XI. Renal and Urologic Disorders (Continued)
H. Male genital
abnormalities
1.
Absence of both testicles, current undescended testicle, or
congenital absence of one testicle not verified by surgical
exploration
2.
History of epispadias or hypospadias when accompanied by
history of urinary tract infection, urethral stricture, urinary
incontinence, symptomatic chordee, or voiding dysfunction or
surgical intervention for these issues within the past 24 months
3.
Current varicocele, unless all of the following are met:
•
Left side only
•
Asymptomatic and smaller than the testes
•
Reducible
4.
Current hydrocele, epidydimal cyst or spermatocele associated
with pain or discomfort or precludes a complete exam of scrotal
contents.
5.
Current or history of recurrent orchitis or epididymitis until
cured and without sequelae
6.
History of penis amputation except in association with history
of sex reassignment surgery (see XI.J) or major genital
reconstruction surgery.
7.
Current penile curvature if associated with symptoms to include
but not limited to pain
8.
Major abnormalities or defect of the genitalia or dysfunctional
residuals from surgical procedures for major abnormalities or
defects
I. Male genital
infections,
inflammation or pain
1.
History of genital infection or ulceration, including but not
limited to herpes genitalis or condyloma acuminatum, if any of
the following apply:
•
Current lesions are present
•
Use of chronic suppressive therapy is needed
•
There are three or more outbreaks per year
•
Any outbreak in the past 12 months interfered
with normal activities
•
After the initial outbreak, treatment included
hospitalization or intravenous therapy
2.
History of urethral condyloma acuminatum
3.
History of acute prostatitis within the last 24 months, history of
chronic prostatitis, or history of chronic pelvic pain syndrome.
4.
History of chronic or recurrent scrotal pain or unspecified
symptoms associated with male genital organs.
J. Sex reassignment
surgery
A history of sex reassignment surgery or major genital reconstruction is
disqualifying, unless documentation is provided that demonstrates:
•
A period of 18 months has elapsed since the date of
the most recent of any such surgery; and
•
No functional limitations or complications persist, nor is
any additional surgery required
K. Tumors of the
genitorinary tract
1.
Tumors of the Genitourinary tract unless benign, is not likely to
interfere with performance of duties and wearing
uniforms/equipment
2.
Current enlargement of testicle, epidydimis or spermatic cord in
addition to those described elsewhere in section
CCI 221.01 Medical Accession Standards
24
Condition
Disqualification for Appointment
XII. Gynecological Disorders and Breast Disease
A. Menstrual
disturbances
1.
Dysmenorrhea regularly resulting in absences of >1 week per
month
2.
Abnormal uterine bleeding (AUB) (bleeding that is longer or
heavier than usual or does not occur at the usual time)
regularly resulting in absences of >1 week per month
3.
Abnormal uterine bleeding related to malignancy or hyperplasia
(AUB-M)
4.
Abnormal uterine bleeding not yet classified (AUB-N)
B. Pregnancy
Pregnancy through 6 months after the completion of the pregnancy
C. Infections of the
female genitalia
1.
Cervicitis (exception: the pap smear demonstrates normal
cytology), vulvitis, or severe vaginitis (Ire disqualifications, until
cured or controlled
2.
Infection of Skene's or Bartholin's glands until definitive
treatment has been completed
3.
Acute pelvic inflammatory disease (PID) which has not been
treated
4.
Current findings of the uterine cervix as listed below would
disqualify for appointment:
•
HGSIL (high-grade squamous intraepithelial
lesion) or more advanced cytologically (via
Pap smear)
•
CIN II (cervical intraepithelial neoplasia, grade
II) or more advanced histologically (by
colposcopic biopsy)
•
ASC-H, which is "atypical squamous cells of
undetermined significance (ASCUS) but
cannot rule out high-grade intraepithelial
lesion.”
•
AGUS (atypical glandular cells of
undetermined significance)
5.
An appointment may be granted to persons demonstrating the
Pap smear results bulleted below only after demonstrating
biopsy findings of either CIN I or less-advanced histology via
colposcopy:
•
ASCUS (excluding ASC-H) on follow-up Pap
smear after a previous ASCUS diagnosis
•
LGSIL (low-grade squamous intraepithelial
lesion)
CCI 221.01 Medical Accession Standards
25
Condition
Disqualification for Appointment
XII. Gynecologic Disorders and Breast Disease (Continued)
D. Other gynecologic
disorders
1.
Screening results (from Pap smear and/or HPV testing)
•
Atypical Glandular Cells (AGC)
2.
Biopsy-confirmed results (from colposcopy or excision)
•
Adenocarcinoma in-situ (AIS)
•
Cervical carcinoma
•
Vaginal carcinoma
•
Vulvar carcinoma
3.
Biopsy or pathology confirmed results
•
Endometrial hyperplasia (simple), until
satisfactorily treated
•
Endometrial hyperplasia (atypical or complex)
•
Endometrial carcinoma
•
Fallopian tube carcinoma
•
Ovarian carcinoma
4.
History of symptomatic endometriosis
5.
History of major abnormalities or defects of the genitalia, such
as hermaphroditism
6.
Current ovarian cyst(s) greater than 5 cm.
7.
Polycystic ovarian syndrome unless no evidence of metabolic
complications as specified by the National Heart, Lung, and
Blood Institute and the American Heart Association guidelines.
8.
History of chronic pelvic pain (6 months or longer) within the
preceding 6 months.
E. Menopausal
syndrome
Menopausal symptoms resulting in absences of >1 week per month
F. Diseases of the
Breast;
gynecomastia
Biopsy or pathology confirmed breast cancer
CCI 221.01 Medical Accession Standards
26
Condition
Disqualification for Appointment
XIII. Musculoskeletal and Rheumatologic Disorders
A. Upper Extremity
Conditions
1.
Limitation of Motion. Current active joint ranges of motion less
than:
•
Shoulder
▪
Forward elevation to 90 degrees
▪
130 degrees abduction
▪
60 degrees external and internal rotation
at 90 degrees abduction
▪
Cross body reaching 115 degrees
adduction
•
Elbow
▪
Flexion to 130 degrees
▪
Extension to 30 degrees
•
Wrist. A total range of 60 degrees (extension
plus flexion), or radial and ulnar deviation
combined are 30 degrees
•
Hand
▪
Pronation to 45 degrees
▪
Supination to 45 degrees
•
Fingers and Thumb. Inability to clench fist,
pick up a pin, grasp an object, or touch tips of
at least three fingers with thumb.
2.
Hand and Fingers
•
Disorder or absence of fingers and/or digits
that would reasonably be expected to interfere
with the performance of duty.
•
Symptomatic mononeuropathies (including but
not limited to carpal tunnel syndrome) that
interfere with function.
•
Focal muscle or limb weakness due to
congenital or acquired causes that causes
weakness of the limb, hand or foot that impair
function (isolated injuries to fingers or toes not
included unless affects functionality).
3.
Residual Weakness and Pain. Current disease, injury, or
congenital condition with residual weakness, pain, sensory
disturbance, or other symptoms that may reasonably be
expected to prevent satisfactory performance of duty, including
but not limited to chronic joint pain associated with the shoulder,
the upper arm, the forearm, and the hand; or chronic joint pain
as a late effect of fracture of the upper extremities, as a late
effect of sprains without mention of injury, and as late effects of
tendon injury.
.
CCI 221.01 Medical Accession Standards
27
Condition
Disqualification for Appointment
XIII. Musculoskeletal and Rheumatic Disorders (Continued)
B. Lower Extremity
Conditions
1.
General
•
Current deformities, disease, or chronic joint
pain of pelvic region, thigh, lower leg, knee,
ankle or foot that have interfered with function
to such a degree as to prevent the individual
from following a physically active avocation in
civilian life, or that may reasonably be expected
to interfere with walking, running, weight
bearing, or with the satisfactory completion of
training or military duty.
•
Current leg-length discrepancy resulting in a
limp.
2.
Limitation of Motion - Current active joint ranges of motion less
than:
•
Hip
▪
Flexion to 90 degrees.
▪
No demonstrable flexion contracture.
▪
Extension to 10 degrees (beyond
0 degrees).
▪
Abduction to 45 degrees.
▪
Rotation of 60 degrees (internal and
external combined).
•
Knee
▪
Full extension to 0 degrees.
▪
Flexion to 110 degrees.
•
Ankle
•
Dorsiflexion to 10 degrees.
•
Planter flexion to 30 degrees.
•
Subtalar eversion and inversion totaling
5 degrees.
3.
Foot and Ankle
•
Current absence of a foot or any portion thereof,
other than absence of a single lesser toe that is
asymptomatic and does not impair function.
•
Deformity of the toes that may reasonably be
expected to prevent the proper wearing of
uniform military footwear or impairs walking,
marching, running, maintaining balance, or
jumping.
•
Symptomatic deformity of the toes (acquired or
congenital), including but not limited to conditions
such as hallux valgus, hallux varus, hallux rigidus,
hammer toe(s), claw toe(s), or overriding toe(s).
•
Clubfoot or pes cavus that may reasonably be
expected to prevent the proper wearing of
uniform military footwear or causes symptoms
when walking, marching, running, or jumping.
•
Rigid or symptomatic pes planus (acquired or
congenital)
•
Current ingrown toenails, if infected or
symptomatic
CCI 221.01 Medical Accession Standards
28
Condition
Disqualification for Appointment
XIII. Musculoskeletal and Rheumatic Disorders (Continued)
B. Lower Extremity
Conditions
(Continued)
•
Current or recurrent plantar fasciitis
•
Symptomatic neuroma
4.
Leg, Knee, Thigh, and Hip
•
Current loose or foreign body in the knee joint
•
History of uncorrected anterior or posterior
cruciate ligament injury
•
History of surgical reconstruction of knee
ligaments within the last 12 months, or which is
symptomatic or unstable or shows signs of thigh
or calf atrophy.
•
Recurrent anterior cruciate ligament
reconstruction
•
Current medial or lateral meniscal injury with
symptoms or limitation of activity
•
Surgical meniscal repair, within the last 6 months
or with residual symptoms or limitation of activity
•
Surgical partial meniscectomy within the last
3 months or with residual symptoms or limitation
of activity
•
Meniscal transplant
•
Symptomatic medial and lateral collateral
ligament instability
•
History of developmental dysplasia (congenital
dislocation) of the hip, osteochondritis of the hip
(Legg-Calvé e-Perthes Disease), or slipped
capital femoral epiphysis of the hip.
•
History of hip dislocation
•
Symptomatic osteochondritis of the tibial
tuberosity (Osgood-Schlatter Disease) within the
past 12 months.
•
Stress fractures, either recurrent or a single
episode occurring during the past 12 months.
C. Neck Conditions
1.
Current symptomatic cervical ribs
2.
Current congenital mass, including cyst(s) of branchial cleft
origin or those developing from the remnants of the
thyroglossal duct or history of surgical correction, within
12 months.
3.
Current contraction of the muscles of the neck, spastic or non-
spastic, or cicatricial contracture of the neck to the extent that it
may reasonably be expected to interfere with the proper
wearing of a uniform or equipment, or is so disfiguring as to
reasonably be expected to interfere with or prevent satisfactory
performance of duty.
CCI 221.01 Medical Accession Standards
29
Condition
Disqualification for Appointment
XIII. Musculoskeletal and Rheumatic Disorders (Continued)
D. Spine and Sacroiliac
Joint Conditions
1.
Ankylosing spondylitis or other inflammatory spondylopathies
2.
Current deviation or curvature of spine from normal alignment,
structure, or function if any of the following apply:
•
It would interfere with the candidate’s fitness
for duty
•
It can reasonably be expected to interfere with
the proper wearing of military uniform or
equipment
•
It is symptomatic
•
There is lumbar or thoracic scoliosis greater
than 30 degrees, or thoracic kyphosis greater
than 50 degrees when measured by the Cobb
Method
3.
History of congenital fusion involving more than two vertebral
bodies or any surgical fusion of spinal vertebrae.
4.
Current dislocation of the vertebra
5.
Vertebral fractures including but not limited to:
•
Any cervical spine fracture.
•
History of fracture of lumbar or thoracic
vertebral body that exceeds 25 percent height
of a single vertebra or that has occurred within
the last 12 months or is symptomatic.
•
A history of fractures of the transverse or
spinous process if currently symptomatic.
6.
History of juvenile epiphysitis with any degree of residual
change indicated by X-ray or Scheuermann’s kyphosis.
7.
History of uncorrected herniated nucleus pulposus associated
with any treatment, symptoms, or activity limitations.
8.
History of surgery to correct herniated nucleus pulposus other
than a single-level lumbar or thoracic diskectomy that is
currently asymptomatic with full resumption of unrestricted
activity for at least 12 months.
9.
Spinal dysraphisms other than spina bifida occulta
10.
History of spondylolysis or spondylolisthesis, congenital or
acquired
E. Acute, chronic or
recurring
musculoskeletal
pain
History of any condition, in the last 2 years, or any recurrence, including
but not limited to the spine or sacroiliac joints, with or without objective
signs, if any of the following apply:
•
It would interfere with the candidate’s fitness
for duty or is associated with local or radicular
pain, muscular spasms, postural deformities,
or limitation in motion.
•
It requires external support.
•
It requires limitation of physical activity or
frequent treatment.
•
Chronic medication use for greater than
12 weeks.
•
One or more episodes of back pain lasting
greater than 12 weeks requiring other than
self-care.
CCI 221.01 Medical Accession Standards
30
Condition
Disqualification for Appointment
XIII. Musculoskeletal and Rheumatic Disorders (Continued)
F. Rheumatic diseases
and associated
systemic disorders
1.
Rheumatoid arthritis
2.
Spondyloarthritis including but not limited to ankylosing
spondylitis, psoriatic arthritis, reactive arthritis (formerly known
as Reiter’s disease), or spondyloarthritis associated with
inflammatory bowel disease.
3.
Systemic lupus erythematosus
4.
Sjögren’s syndrome
5.
Systemic sclerosis (or scleroderma), including but not limited to
calcinosis, Raynaud’s phenomenon, esophageal dysmotility,
scleroderma, or telangiectasia syndrome (CREST).
6.
Mixed connective tissue disease or undifferentiated connective
tissue diseases
7.
Vasculitides including but not limited to polyarteritis nodosa,
arteritis, Behçet’s, Takayasu’s arteritis, and Anti-Neutrophil
Cytoplasmic Antibody-associated vasculitis.
8.
Henoch-Scholenlein Purpura occurring after the 19th birthday
or within the last 2 years
9.
Rheumatic fever if associated with rheumatic heart disease or
indication for ongoing prophylactic medication.
10.
IgG-4 related disease
11.
Dermatomyositis with or without skin involvement
12.
Polymyositis
13.
Non-inflammatory myopathy including but not limited to
metabolic myopathy such as glycogen
storage disease, lipid storage disease, and mitochondrial
myopathy.
14.
Joint hypermobility syndrome (formerly Ehler’s Danlos
syndrome, Type III)
15.
Any history of connective tissue disease including but not
limited to Ehlers-Danlos syndrome,
Marfan’s syndrome, Pseudoxanthoma Elasticum, and
Osteogenesis Imperfecta.
16.
History of Gout and other crystal induced joint disease
17.
Other autoimmune disease which can lead to chronic disability,
such as anticardiolipin syndrome, systemic amyloidosis.
18.
Osteoarthritis degenerative joint disease, other arthritis, or
other rheumatic disorder if
associated with the following:
•
Chronic or recurrent and/or disabling
symptoms
•
Limitation of motion, tenderness, swelling,
effusion, joint instability, or deformity.
•
Persistent neurologic symptoms or signs, or
muscle weakness
•
Requires sustained use of cervical collar,
cane, crutch, corset, traction, other devices,
and/or ongoing physical therapy.
•
Interferes with function, likely to interfere with
performance of duties now or in the course of
a career.
CCI 221.01 Medical Accession Standards
31
Condition
Disqualification for Appointment
XIII. Musculoskeletal and Rheumatic Disorders (Continued)
F. Rheumatic diseases
and associated
systemic disorders
(Continued)
19.
Fibromyalgia or chronic/recurrent myofascial pain syndrome
20.
Chronic fatigue syndrome (or systemic exertion intolerance
disease or myalgic encephalomyelitis) or chronic multisystem
disease.
G. Miscellaneous
Conditions of the
Extremities
1.
History of chondromalacia, including but not limited to chronic
patello-femoral pain syndrome and retro-patellar pain
syndrome, osteoarthritis, or traumatic arthritis if it could
reasonably be expected to interfere with the performance of
duty.
2.
Dislocation of patella if two or more episodes, or any occurring
within the last 12 months
3.
History of any dislocation, subluxation, or instability of the hip,
knee, ankle, subtalar joint, foot, shoulder, wrist, elbow except
for “nursemaid’s elbow” or dislocated finger.
4.
Acromioclavicular separation within the last 12 months or if
symptomatic
5.
History of osteoarthritis or traumatic arthritis of isolated joints
6.
Fractures, if:
•
Current malunion or non-union of any
fracture (except asymptomatic ulnar styloid
process fracture).
•
Current retained hardware (including plates,
pins, rods, wires, or screws) used for fixation
that is symptomatic or may reasonably be
expected to interfere with proper wearing of
equipment or uniform. Retained hardware is
not disqualifying if fractures are healed,
ligaments are stable, and there is no pain.
7.
Current orthopedic implants or devices to correct congenital or
post-traumatic orthopedic abnormalities except for bone anchor
and hardware as allowed in the second bullet of section XIII.G.6
8.
History of contusion of bone or joint if any of the following
apply:
•
An injury of more than a minor nature with or
without fracture, nerve injury, open wound,
crush, or dislocation which occurred within
the last 6 months.
•
Recovery has not been sufficiently
completed
•
May reasonably be expected to interfere
with or prevent performance of duty
•
Requires frequent or prolonged treatment
9.
History of joint replacement or resurfacing of any site
10.
History of hip arthroscopy or femoral acetabular impingement
11.
History of neuromuscular paralysis, weakness, contracture, or
atrophy not completely resolved and of sufficient degree to
reasonably be expected to interfere with or prevent satisfactory
performance of duty.
12.
Current symptomatic osteochondroma or history of two or more
osteocartilaginous exostoses
CCI 221.01 Medical Accession Standards
32
Condition
Disqualification for Appointment
XIII. Musculoskeletal and Rheumatic Disorders (Continued)
G. Miscellaneous
Conditions of the
Extremities
(Continued)
13.
History of atraumatic fractures or bone mineral density below
expected range for age on a dual energy x-ray absorptiometry
scan with risk factors for low bone density.
14.
Current osteopenia until resolved
15.
History of osteomyelitis within the past 12 months, or history of
recurrent osteomyelitis
16.
History of osteochondral defect, formerly known as
osteochondritis dissecans
17.
History of cartilage surgery, including but not limited to cartilage
debridement or chondroplasty for Grade III or greater
chondromalacia, microfracture, or cartilage transplant
procedure.
18.
History of osteonecrosis of any bone.
19.
History of recurrent tendon disorder, including but not limited to
tendonitis, tendionopathy, tenosynovitis if reasonably be
expected to interfere with or prevent satisfactory performance
of duty or to require ongoing episodes of care.
20.
History of developmental dysplasia (congenital dislocation) of
the hip, osteochondritis of the hip (Legg-Calvé-Perthes
Disease), or slipped capital femoral epiphysis of the hip.
21.
History of hip dislocation.
22.
Symptomatic osteochondritis of the tibial tuberosity
(Osgood-Schlatter Disease) within the past 12 months.
23.
Stress fractures, either recurrent or a single episode occurring
during the past 12 months
CCI 221.01 Medical Accession Standards
33
Condition
Disqualification for Appointment
XIV. Skin Disorders
A. Eczema (erythema,
scale and vesicles)
If more than mild (presently requiring intensive topical therapy or involving
10% or more of the body surface,) or with history of recurrent
exacerbations requiring systemic steroid therapy.
B. Adult atopic
dermatitis (pruritus,
dermatitis; allergies
± eczema)
If more than mild (presently requiring intensive topical therapy or
involving 10% or more of the body surface,) or with history of recurrent
exacerbations requiring systemic steroid therapy.
C. Contact dermatitis
History of recurrent or chronic non-specific dermatitis within the past 2
years to include contact (irritant or allergic) or dyshidrotic dermatitis
requiring more than treatment with topical corticosteroid.
D. Dyshidrosis or other
dermatoses of the
hands and feet
History of severe hyperhidrosis of hands or feet unless controlled by
topical medications
E. Psoriasis
If more than mild (presently requiring intensive topical therapy or involving
more than 10% of the body surface), or with history of
frequent exacerbations requiring more than local therapy, or if
associated with therapy.
F. Bullous eruptions
History of bullous dermatoses, including but not limited to dermatitis
herpetiformis, pemphigus, and epidermolysis bullosa.
G. Chronic
lymphedema
Current or chronic lymphedema
H. Neurofibromatosis
History of oculocutaneous albinism, Neurofibromatosis I (Von
Recklinghausen’s Disease), Neurofibromatosis II, and tuberous
sclerosis.
I. Infectious diseases
of the skin
1.
History of dissecting scalp cellulitis,acne inversa, or
hidradenitis suppurativa
2.
Current localized fungus infections, if they can be reasonably
expected to interfere with the proper wearing of military
equipment or the performance of military duties. History of
furunculosis or carbuncle if extensive, recurrent, or chronic.
History of Pseudofolliculitis barbae or keloidalis nuchae,of a
severity that precludes daily shaving or would reasonably be
expected to interfere with the wearing of equipment.
3.
Severe acne (including nodulocytic acne on or off antibiotics),
or when extensive involvement of the neck, shoulders, chest,
or back will be aggravated by or interfere with the wearing of
required clothing and uniforms and not amenable to treatment.
Applicants under treatment with systemic retinoids, including,
but not limited to isotretinoin (Accutane®), do not meet the
standard until 8 weeks after completion of therapy.
Use of isotretinoin requires documentation of completion of
treatment.
J. Skin manifestations
of systemic disease
1.
Any skin condition which is known to be a manifestation of or is
commonly associated with systemic disease (such as
amyloidosis, erythema multiforme, erythema nodosum,
panniculitis, purpura, petechia, etc.,) unless underlying cause is
known and is not disqualifying.
2.
History of scleroderma, dermatomyositis, lupus erythematosus,
(including CCLE, SCLE, or ACLE).
CCI 221.01 Medical Accession Standards
34
Condition
Disqualification for Appointment
XIV. Skin Disorders (Continued)
K. Pilonidal or
non-pilonidal cyst
1.
The current cyst (other than pilonidal cyst) is of such a size or
location as to reasonably be expected to interfere with the
proper wearing of military equipment.
2.
The current pilonidal cyst is evidenced by the presence of a
tumor mass or a discharging sinus, or is a surgically resected
pilonidal cyst that is symptomatic, unhealed, or less than
6 months post-operative. A pilonidal cyst that has been simply
incised and drained does not meet the standard.
L. Other
1.
Any skin disorder or history thereof which is chronic or recurring
or requires frequent treatment or loss from work or restriction of
duties, or is cosmetically unsightly such as:
•
History of chronic urticaria lasting longer than
6 weeks even if asymptomatic on daily
maintenance therapy.
•
Current lichen planus (either cutaneous or oral)
•
Ichthyosis
•
Photosensitivity
2.
Keloid formation, if the tendency is marked or interferes with
the wearing of required equipment or clothes.
3.
Current scars or grafted skin that can reasonably be expected
to interfere with the proper wearing of military clothing or
equipment, or to interfere with the satisfactory performance of
military duty due to pain or decreased range of motion, strength,
or agility.
4.
History of chronic radiation dermatitis (radiodermatitis)
5.
History of photosensitivity, including but not limited to any
primary sun-sensitive condition, such as polymorphous light
eruption or solar urticaria, or any dermatosis aggravated by
sunlight, such as lupus erythematosus, porphyria, and
xeroderma pigmentosa
6.
Current plantar warts that are symptomatic
7.
Prior burn injury (including graft sites) resulting in functional
impairment to such a degree, due to scarring, as to interfere
with the satisfactory performance of officer duties or proper
wearing and use of uniform wear due to pain or decreased
range of motion, strength, temperature regulation, or agility.
8.
History of congenital disorder of the hair and nails including but
not limited to pachyonychia congenita or ectodermal dysplasia.
M. Congenital giant
pigmented nevus
1.
Lesion greater than 20 cm in any direction
2.
History of congenital disorders of cornification including but not
limited to ichthyosis vulgaris, x-linked ichthyosis, lamellar
ichthyosis, Darier’s Disease, Epidermal Nevus Syndrome, and
any palmo-plantar keratoderma.
10. History of congenital or acquired anomalies of the skin, such as
nevi or vascular tumors, that can reasonably be expected to
interfere with function or are exposed to constant irritation.
CCI 221.01 Medical Accession Standards
35
Condition
Disqualification for Appointment
XIV. Skin Disorders (Continued)
N. Cutaneous
Malignancies
1.
Conditions with malignant potential in the skin including but not
limited to basal cell nevus syndrome, oculocutaneous albinism,
xeroderma pigmentosum, Muir-Torre Syndrome, Dyskeratosis
Congenita, Gardner Syndrome, Peutz-Jeghers Syndrome,
Cowden Syndrome, Multiple Endocrine Neoplasia, Familial
Atypical Multiple Mole Melanoma Syndrome, and Birt-Hogg
Dube Syndrome.
2.
History of cutaneous malignancy before the 25th birthday
including but not limited to basal cell carcinoma and squamous
cell carcinoma. History of the following skin cancers at any age:
malignant melanoma, Merkel cell carcinoma, sebaceous
carcinoma, Paget’s disease, extramammary Paget's disease,
microcystic adnexal carcinoma, other adnexal neoplasms, and
cutaneous lymphoma including mycosis fungoides.
3.
“Malignant Adnexal Neoplasm” as long as not as a
manifestation of genetic dermatoses
CCI 221.01 Medical Accession Standards
36
Condition
Disqualification for Appointment
XV. Infectious Diseases
A. Infectious diseases
1. Any acute infection or infectious disease (other than mild,
self-limited diseases) until cured and without significant
sequelae.
2. Unless specifically referenced in the Medical Accessions
Standards, any chronic infection or infectious disease
(including viral, bacterial, fungal, parasitic, etc. disease,) until
recovered or cured without significant sequelae.
3. Presence of Human Immunodeficiency Virus (HIV) infection
confirmed using the U.S. Centers for Disease Control and
Prevention’s HIV testing algorithm as described in “Laboratory
Testing for the Diagnosis of HIV Infection: Updated
Recommendations” and any technical updates to this
algorithm (all available at
https://www.cdc.gov/hiv/guidelines/testing.html) unless:
•
HIV replication has been durably suppressed
<200 copies/mL for at least the 12 prior months, and
•
CD4 cell count has been maintained at >350 cell/mm3 for
at least the prior 12 months.
4. Reactive Tests for Syphilis, such as the Rapid Plasma Reagin
(RPR) or Venereal Disease Research Laboratory (VDRL),
followed by a reactive confirmatory Fluorescent Treponema
Antibody Absorption (FFA-ABS) test, unless there is a
documented history of adequately treated syphilis. In the
absence of clinical findings, the presence of reactive RPR or
VDRL followed by a negative FFA-ABS test is not disqualifying
if a cause of the false positive reaction can be identified and is
not otherwise disqualifying.
CCI 221.01 Medical Accession Standards
37
Condition
Disqualification for Appointment
XVI. Immunologic Disorders
A. Immunologic
Disorders
1.
Current use of immunosuppressive drugs such as adrenal
suppressive doses of corticosteroids, cyclosporine,
azathioprine, and other agents that carry an unacceptable risk
for increased infection or other significant adverse effects.
2.
History of primary immunodeficiency with symptoms frequent
enough to require continuing diagnostic evaluations, frequent
follow-up or medical care, treatment or therapy which, in the
judgment of the reviewing examiner, may limit geographic area
of assignment or may interfere with performance of duties.
3.
A reliable history of severe allergic reactions or anaphylaxis.
Anaphylaxis is highly likely when any one of the following
3 criteria are fulfilled:
•
Acute onset of an illness (minutes to several
hours) with involvement of the skin, mucosal
tissue, or both (e.g., generalized hives, pruritus or
flushing, swollen lips-tongue-uvula) and at least
one of the following:
▪
Respiratory compromise (e.g., dyspnea,
wheeze-bronchospasm, stridor, reduced
peak expiratory flow, hypoxemia).
▪
Reduced blood pressure (BP) or
associated symptoms of end-organ
dysfunction (e.g., hypotonia [collapse],
syncope, incontinence).
•
Two or more of the following that occur rapidly
after exposure to a likely allergen for the patient
(minutes to several hours):
▪
Involvement of the skin-mucosal tissue
(e.g., generalized hives, itch-flush,
swollen lips-tongue-uvula).
▪
Respiratory compromise (e.g., dyspnea,
wheeze-bronchospasm, stridor, reduced
peak expiratory flow, hypoxemia).
▪
Reduced BP or associated symptoms
(e.g., hypotonia [collapse], syncope,
incontinence).
▪
Persistent gastrointestinal symptoms
(e.g., crampy, abdominal pain,
vomiting).
•
Reduced blood pressure after exposure to known
allergen for that patient (minutes to several
hours):
▪
Infants and children: low systolic
BP (age-specific) or greater than
30 percent decrease in systolic blood
pressure.
▪
Adults: systolic BP of less than
90 mmHg or greater than 30 percent
decrease in from that person’s
baseline.
CCI 221.01 Medical Accession Standards
38
Condition
Disqualification for Appointment
XVI. Immunologic Disorders (Continued)
A. Immunologic
Disorders
(Continued)
4.
History of systemic allergic reaction to biting or stinging insects,
unless it was limited to a large local reaction, a cutaneous only
reaction (including hives) occurring under the age of 16, or
unless there is documentation of 3-5 years of maintenance
venom immunotherapy.
5.
History of severe allergic reaction to fish, shellfish, peanuts, or
tree nuts to include the presence of food-specific
immunoglobulin E antibody if accompanied by a correlating
clinical history.
6.
Allergic reactions to antigens which are severe and such
antigens cannot be easily avoided.
7.
Urticaria or angioedema that requires frequent treatment or
loss from work or restriction from duties or affecting the airway
or occurring with anaphylaxis.
8.
Cold urticarial
9.
Hereditary angioedema
10.
Autoimmune disorders or disorders due to allergy or
hypersensitivity not otherwise covered by the standards and
which require excessive medical supervision and/or treatment.
CCI 221.01 Medical Accession Standards
39
Condition
Disqualification for Appointment
XVII. Neoplastic Disorders
A. Tumors or neoplastic
disorders, including
leukemias and
lymphomas
1.
Any tumor present at time of examination unless it is benign, is
not likely to impair function, and is not associated with systemic
abnormalities. Any benign tumor that interferes with function,
prevents the wearing of uniforms or necessary equipment,
requires frequent specialized attention, or has a high malignant
potential is disqualifying.
2.
Presence or history of malignancy, other than non-melanoma
skin cancer cured by excision (see exceptions below), or
carcinoma in situ of the uterine cervix which had been cured
without sequela.
3.
History of cutaneous malignancy before the 25th birthday
including but not limited to basal cell carcinoma and squamous
cell carcinoma. History of the following skin cancers at any age:
•
Malignant melanoma
•
Merkel cell carcinoma
•
Sebaceous carcinoma
•
Paget’s disease
•
Extramammary Paget’s disease
•
Microcystic adnexal carcinoma
•
Other adnexal neoplasms, and
•
Cutaneous lymphoma including mycosis
fungoides.
4.
Tumors and/or tumor-related problems requiring continuing
diagnostic evaluation, frequent follow-up, medical care,
treatment, or therapy which in the judgment of the reviewing
examiner may limit geographic area of assignment and/or
interfere with performance of duties.
CCI 221.01 Medical Accession Standards
40
Condition
Disqualification for Appointment
XVIII. Neurologic and Muscle Disorders
1. Congenital or
acquired anomalies
of the CNS or
meninges
1.
Hydrocephalus
2.
Spina bifida - exception for asymptomatic spina bifida occulta
3.
Meningocoele
4.
Arachnoid cyst – exception for asymptomatic and stable
arachnoid cysts
5.
Syrinx associated with neurological deficits or symptoms
2. Epilepsy or seizure
disorder
1.
History of epilepsy or seizures regardless of type (except if
associated with toxic agents or other self-limiting etiology) that
require ongoing treatment.
2.
A history of being seizure-free for 5 years without medication
would be deemed acceptable
3. Sleep disorders,
e.g. narcolepsy,
sleep apnea
1.
Chronic insomnia as defined by the Diagnostic and Statistical
Manual of Mental Disorders, Fifth Edition.
2.
Obstructive sleep apnea or any apnea that requires treatment
with CPAP or other positive pressure treatment.
3.
History of narcolepsy, cataplexy, or other hypersomnias
4.
History of sleep-related movement disorders such as
REM sleep behavior disorder and restless leg syndrome.
5.
History of parasomnia including sleepwalking and night terrors
that persist after the 13th birthday
6.
Circadian rhythm disorders requiring treatment or special
accommodations.
4. Cerbrovascular
disorders
1.
History of stroke (thrombotic, embolic, or hemorrhagic),
transient ischemic attacks, hemorrhage (e.g. subarachnoid or
intracerebral), or other manifestations of vascular disease or
obstruction of blood supply to the brain (e.g. cerebral vein
thrombosis).
2.
History of aneurysm
3.
History of symptomatic or unstable arteriovenous
malformation(s)
5. Disorders of the
CNS (cerebrum,
cerebellum, basal
ganglia and spinal
cord)
1.
Multiple sclerosis and other CNS demyelinating disorders
2.
Parkinson’s disease, multisystem atrophy, and other
degenerative disorders of the basal ganglia
3.
Cerebellar degenerative disorders including spinocerebellar
disorders
4.
Spinal cord disorders including hereditary spastic paraparesis
and other degenerative spinal cord
Disorders.
5.
Motor neuron disorders including Amyotrophic lateral sclerosis
6.
Cognitive disorders including dementias of various types
6. Disorders of the
muscle
1.
Muscular dystrophy or congenital myopathy
2.
Acquired myopathy or myositis that has resulted in continual
weakness or requires ongoing treatment.
3.
Myasthenia gravis or congenital myasthenia
4.
Periodic paralysis or myotonic disorders
5.
Focal muscle or limb weakness due to congenital or acquired
causes that causes weakness of the limb, hand or foot that
impair function (isolated injuries to fingers or toes not included
unless affects functionality).
6.
History of Rhabdomyolysis
CCI 221.01 Medical Accession Standards
41
Condition
Disqualification for Appointment
XVIII. Neurologic and Muscle Disorders (Continued)
7. Disorders of the
Peripheral Nervous
System
1.
Hereditary neuropathies
2.
Acquired neuropathies that are either progressive, interfere
with routine activities, or require medication to control
symptoms.
3.
Brachial plexus or lumbosacral plexus injuries that have not
resolved and have residual weakness that impairs function.
4.
Radiculopathies – cervical or lumbosacral; that have not
resolved with conservative treatment and interfere with
physical activities.
5.
Chronic inflammatory demyelinating neuropathies or acute
inflammatory demyelinating neuropathies (Guillain-Barre
Syndrome) with residual weakness that impairs function and
requires ongoing treatment.
6.
Complex regional pain syndromes
8. Neoplastic disorders
1.
Brain tumors – primary or metastatic
2.
Pituitary tumors – if active or have not been surgically removed
3.
Spinal cord tumors – primary or metastatic
4.
Peripheral nerve tumors – if malignant or associated with
neurological abnormality
5.
Disorders that are prone to neurologically associated tumors
such as neurofibromatosis or von Hippel-Lindau disease.
9. Movement disorders
1.
Facial dystonia – for example, blepharospasm and cervical
dystonia
2.
Limb dystonias-for example, writer’s cramp and leg dystonia
3.
Hereditary dystonias or Tourette’s syndrome
10. Cranial
neuropathies
1.
Optic neuritis
2.
Facial palsy with ongoing inability to close eyes
11. Implanted devices
1.
Ventricular shunts – of any type
2.
Deep brain stimulation
3.
Baclofen or other pumps
4.
Implanted electrical stimulators including vagal nerve
stimulators
12. Traumatic brain
injury
1.
Penetrating head trauma including radiographic evidence of
foreign bodies or bony fragments
2.
Skull fractures, particularly if associated epidural, subdural,
subarachnoid or intracerebral hematomas or associated with
the presence of rhinorrhea or otorrhea for over 7 days.
3.
Moderate or severe head trauma – associated with
post-traumatic seizures after acute injury (30 minutes),
persistent motor, sensory, vestibular, visual or any other focal
neurological deficit, persistent cognitive impairment, or
persistent altered behavior or personality.
4.
Mild head trauma – if associated with persistent neurological or
psychological problems as described for moderate or severe
head trauma.
5.
Post-concussive headaches related to any severity of head
trauma
CCI 221.01 Medical Accession Standards
42
Condition
Disqualification for Appointment
XVIII. Neurologic and Muscle Disorders (Continued)
13. Headache disorders
1.
Migraine headaches – particularly if associated with
neurological deficits other than scotomas or have disrupted
normal activities including work absences, more than twice per
year in the past year.
2.
Cluster headaches
3.
Tension headaches – particularly if they have disrupted normal
activities including work absences more than twice per year in
the past year.
4.
Trigeminal neuralgia
14. Other
1.
Dysautonomias including postural orthostatic tachycardia
2.
Unexplained recurrent episodes of loss of consciousness
3.
Hypoxic-ischemic brain injury with residual neurological deficits
CCI 221.01 Medical Accession Standards
43
Condition
Disqualification for Appointment
XIX. Mental Disorders
A. All Mental Disorders
1.
Attention Deficit Hyperactivity Disorder, if any of the following
apply:
•
With a recommended or prescribed Individualized
Education Program, 504 Plan, or work
accommodations after the 14th birthday.
•
With a history of comorbid mental disorders
•
With prescribed medication in the previous
24 months
•
With documentation of adverse academic,
occupational, or work performance
2.
History of learning disorders after the 14
th
birthday, including
but not limited to dyslexia, if any of the following apply:
•
With a recommended or prescribed Individualized
Education Program, 504 Plan, or work
accommodations after the 14th birthday.
•
With a history of comorbid mental disorders
•
With documentation of adverse academic,
occupational, or work performance
3.
Autism spectrum disorders
4.
History of disorders with psychotic features to include but not
limited to schizophrenic disorders, delusional disorders, or
other unspecified psychoses or mood disorders with psychotic
features.
5.
History of bipolar and related disorders (formerly identified as
mood disorders not otherwise specified) to include but not
limited to cyclothymic disorders and affective psychoses.
6.
Depressive disorder if any of the following apply:
•
Outpatient care including counseling required
for longer than 12 cumulative months for a
single episode of care.
•
Symptoms or treatment within the last
36 months
•
Any intensive outpatient, partial
hospitalization, inpatient treatment in a
hospital or residential facility.
•
Any recurrence.
7.
History of a single adjustment disorder if treated or symptomatic
within the previous 6 months, or any history of chronic (lasting
longer than 6 months), or recurrent episodes of adjustment
disorders.
8.
History of disruptive, impulse control and conduct disorder to
include but not limited to oppositional defiant and other
behavior disorders.
CCI 221.01 Medical Accession Standards
44
Condition
Disqualification for Appointment
XIX. Mental Disorders (Continued)
A. All Mental Disorders
(Continued)
9.
Any personality disorder including unspecified personality
disorder or maladaptive personality traits demonstrated by
either:
•
Repeated inability to maintain reasonable
adjustment in school, with employers or fellow
workers, other social groups, or psychological
testing revealing that the degree of immaturity,
instability, of personality inadequacy,
impulsiveness, or dependency may
reasonably be expected to interfere with
adjustment in the USPHS.
•
Recurrent encounters with law enforcement
agencies (excluding minor traffic violations)
or antisocial behaviors are tangible evidence
of impaired capacity to adapt to service in the
USPHS.
•
Any behavioral health issues that have led to
incarceration for any period
10.
Enuresis or Encopresis after 13
th
birthday
11.
History of any feeding or eating disorder to include but not
limited to Anorexia Nervosa, Bulimia Nervosa, Binge-Eating
Disorder.
12.
Any current communication disorder of such a degree as to
significantly interfere with production of speech or the ability to
repeat commands.
13.
History of suicidality to include suicidal self-directed violence,
suicidal ideation with suicidal intent or preparatory behavior,
or suicide attempt, regardless of whether associated with a
psychiatric disorder or not.
14.
History of non-suicidal self-injury behavior, regardless of
whether associated with a psychiatric disorder or not.
15.
History of obsessive-compulsive disorder, if any of the
following apply:
•
Outpatient care including counseling was
required for longer than 12 cumulative months
for a single episode of care.
•
Symptomatic or treatment within the last
36 months
•
Any intensive outpatient, partial
hospitalization, or inpatient treatment in a
hospital or residential facility.
•
Any recurrence.
16.
History of post-traumatic stress disorder, if any of the following
apply
•
Outpatient care including counseling was
required for longer than 12 cumulative months
for a single episode of care
•
Symptomatic or treatment within the last
36 months
•
Any intensive outpatient, partial
hospitalization, or inpatient treatment in a
hospital or residential facility.
•
Any recurrence
CCI 221.01 Medical Accession Standards
45
Condition
Disqualification for Appointment
XIX. Mental Disorders (Continued)
A. All Mental Disorders
(Continued)
17.
History of anxiety disorders, if any of the following apply:
•
Outpatient care including counseling was
required for longer than 12 cumulative
months for a single episode of care.
•
Symptomatic or treatment within the last
36 months
•
Any intensive outpatient, partial
hospitalization, or inpatient treatment in a
hospital or residential facility.
•
Any recurrence
18.
History of dissociative disorders
19.
History of somatic symptom and related disorders
20.
A history of gender dysphoria is disqualifying, unless, as
certified by a licensed behavioral health provider, the applicant
has been stable without clinically significant distress or
impairment in social, occupational, or other important areas of
functioning for 18 months.
21.
History of paraphilic disorders to include but not limited to
Voyeuristic Disorder, Frotteuristic Disorder, Pedophilic
Disorder.
22.
History of other mental disorders that may reasonably be
expected to interfere with or prevent satisfactory performance
of duty in the USPHS.
23.
Prior psychiatric intensive outpatient, partial hospitalization, or
inpatient hospitalization
CCI 221.01 Medical Accession Standards
46
Condition
Disqualification for Appointment
XX. Substance Use and Addictive Behaviors
Substance use
and Addictive Behaviors
History of any of the following within the past 36 months:
•
Having received clinical treatment for substance-related or
addictive disorders/behaviors in the attempt to reduce
frequency or severity of substance use (including nicotine use)
or addictive behavior.
•
Having adverse medical, legal, social or occupational problems
related to substance use (including nicotine use) or addictive
behaviors.
•
Use of any tobacco or nicotine products (to include, but not
limited to cigarettes, chewing tobacco, e-cigarettes).
CCI 221.01 Medical Accession Standards
47
Condition
Disqualification for Appointment
XXI. Miscellaneous
Other disorders and/or
conditions
1.
Health conditions or problems requiring continuing diagnostic
evaluation, frequent follow-up, medical care, treatment,
therapy, or which in the judgment of the reviewing examiner
may limit geographic area of assignment and/or may interfere
with performance of duties.
2.
Post-surgical cases, regardless of operative procedure, until
such time as post-surgical complications are not likely to occur
and healing has progressed satisfactorily, and the cause for or
result of surgery is not otherwise disqualifying.
3.
Health conditions or problems which place an individual at
unacceptable risk for use of sick leave, or medical, dental,
psychiatric, psychological, or surgical services, or early death
or disability.
4.
Conditions which prevent the performance of full duties at the
time of call to duty
