5-14 Medical fitness standards for deployment and certain geographical areas

a. All soldiers considered medically qualified for continued military status and medically qualified to serve in all or certain areas of the continental United States (CONUS) are medically qualified to serve in similar or corresponding areas outside the continental United States (OCONUS).

b. Some soldiers, because of certain medical conditions, may require administrative consideration when assignment to combat areas or certain geographic areas is contemplated to ensure that they are used within their medical capabilities without undue hazard to their health and well-being.

c. Active duty soldiers who do not meet the medical retention standards in chapter 3 of this regulation must be referred to an MEB/PEB for a fitness-for-duty determination. RC soldiers not on active duty, who do not meet medical retention standards are referred for a fitness determination in accordance with paragraphs 9–10 (USAR) and 10–26 (NGB). Soldiers (RC or Active Army) with a permanent 3 or 4 in the physical profile who meet or might meet medical retention standards must be referred to an MMRB to determine if they are world-wide deployable (or be granted a waiver according to AR 600–60). However, soldiers returned to duty by an MMRB or PEB, retained in the RC under paragraphs 9–10 or 10–26, or soldiers with temporary medical conditions may still have some assignment/deployment limitations that must be considered before a decision is made to deploy.

d. Assignment determinations are under the purview of the Deputy Chief of Staff (DCS), G-1. Specific duties in the assignments are under the purview of the soldier's commander. Medical guidance is critical in advising commanders and assignment officers of potential problems, physical limitations, and potential situations that could be harmful to the soldier and/or those with whom the soldier serves. Medical guidance is provided in the form of physical profiles (permanent and temporary) and occurs during deployment processing or during the medical review prior to overseas assignment. (Family member screening prior to overseas assignment will be completed according to AR 608-75, using DA Form 5888 (Family Member Deployment Screening Sheet).)

e. See the DCS, G-1 Personnel Policy Guidance Message for additional deployment requirements on the DCS, G-1 web site at http://www.armyg1.army.mil/militarypersonnel/mission.asp . Medical standards for deployment are meant as general guides. The final recommendation is based on clinical judgment and commander input, which considers the geographical area in which the soldier will be assigned and the potential environmental/austere conditions to which the soldier may be subject. The following medical conditions must be reviewed carefully by the clinician before making a recommendation as to whether the soldier can deploy to duty in a combat zone (or austere isolated area where medical treatment may not be readily available).

(1) Diabetes requiring insulin. This requires an MEB/PEB (or for the RC, processing under paras 9-10 and 10-26). If found fit for duty, the soldier should not deploy to areas where refrigerated insulin and medical support cannot be guaranteed.

(2) Diabetes requiring oral medication for control. This requires an MEB/PEB (or for the RC processing under paras 9-10 and 10-26). If found fit for duty, the soldier may not be deployable. It is recommended that soldiers with d i a b e t e s n o t b e d e p l o y e d i f i n a d e q u a t e r e s o u r c e s e x i s t f o r n e c e s s a r y m o n i t o r i n g . F o r e x a m p l e , t h e s o l d i e r o n rosiglitazone (avandia) or pioglitazone (actos) should have liver transaminases checked every other month; the soldier on metformin should stop taking it in the event of surgery, exposure to intravenous contrast, or in the event of renal insufficiency (serum creatinine > 1.5 mg/dL for males or > 1.4 mg/dL for females). Table 5–1 provides guidance on deployment.

(3) Cardiovascular conditions. Review paragraphs 3-21 through 3-24 to determine if an MEB/PEB/trial of duty (or processing under paras 9-10 and 10-26) is necessary. If the soldier successfully completes a trial of duty and is found fit for duty (or returned to duty by an MMRB), the soldier should not be deployed with any of the following conditions:

(a) Hypertension not controlled with medication.
Recent episodes necessitating emergency room visits or closely monitored follow-up care.
Conditions requiring anticoagulants.

(4) Seizure disorders. See paragraph 3-30 i for profile guidance and for MEB/PEB processing criteria. If the soldier is controlled with medications and seizure free for one year, the soldier may be assigned overseas but should not be assigned to areas where access to medications (or where the ability to monitor dilantin levels) is not available.

(5) Asthma. See paragraph 3-27a for profile guidance and for MEB/PEB processing criteria. If it is determined that the soldier can be returned to duty, the soldier should not deploy if he/she cannot wear protective gear, has experienced recent emergency room visits, or requires repetitive use of oral corticosteroids.

(6) Sleep apnea. This is cause for an MEB/PEB (or processing under para 9–10 or 10–26). If found fit for duty, the 55AR 40–501 • 1 February 2005 soldier should not be deployed if the absence of continuous positive air pressure would hinder the soldier from performing military duty.

(7) Musculoskeletal. Soldiers with any recent musculoskeletal injury or surgery that prevents necessary mobility or firing a weapon should not deploy. Any chronic condition that restricts performance in the soldier's MOS (for example, low back pain that prevents lifting) should be referred to an MEB/PEB (or processed under paras 9–10 and 10–26). If found fit for duty, the soldier may be deployed unless he/she cannot function in the specific environment in which he/ she is being assigned. Soldiers who meet medical retention standards but have a 3 in the profile cannot be deployed unless cleared by an MMRB.

(8) Psychiatric. Any disorder that has the potential to prevent performance of duty, even if controlled by medication, should not deploy.

(9) History of heat injuries. See paragraph 3–45 for profile guidance and MEB/PEB criteria. If there is any evidence of significant heat intolerance, the soldier should not deploy to warm austere climates.

(10) Pregnancy. Pregnant soldiers will not deploy.

(11) History of cancer. Soldiers with a history of cancer who have been returned to duty but have a requirement for periodic monitoring every 6 months or less should not deploy.

(12) Miscellaneous conditions. Soldiers pending and scheduled for required surgeries or still in rehabilitation post surgery with temporary profiles, pain syndromes requiring the use of medications (beyond simple NSAIDS), or the use of transcutaneous electrical nerve stimulator units, should not deploy.

(13) Medications. Soldiers taking medications should not automatically be disqualified for any duty assignment. Medications used for serious and/or complex medical conditions are not usually suitable for extended deployments. The medications on the list below are most likely to be used for serious and/or complex medical conditions that could likely result in adverse health consequences. This is not an all-inclusive listing of medications that may render an individual non-deployable but is provided as a guideline to be used during pre-deployment medical screening. Because some medications are used for multiple reasons, any medical screening should take into account whether the drug is being used for a serious and/or complex medical condition or another use that might be appropriate for a deploying soldier. A complete medical evaluation should be initiated on those personnel regularly taking the following medications:

• Antiarrhythmics.
• Antiasthmatics (long acting beta-agonists and inhaled corticosteroids only).
• Anti-cancer/chemotherapy agents.
• Anticoagulants (for example, heparin, warfarin).
• Anticonvulsants (for the treatment of seizure disorder).
• Antidepressants (moderate to severe cases, bipolar, or unstable patients).
• Anti-gout medications (for example, allopurinol, colchicines).
• Anti-HIV medications.
• Antimania (lithium).
• Antiparkinsonians.
• Antipsychotics.
• Anti-tumor necrosis factor (for example, enteracept, and so on).
• Any injectable medications.
• Any type of insulin.
• Chronic anxiolytics.
• Chronic immunosuppressants (for example, azathioprine, cyclosporin, and so on).
• Chronic narcotic analgesics.
• Coronary vasodilators (nitrates).
• Heart failure medications.
• Hematologics (for example, EPO, G-CSF, GM–CSF, and so on).
• Immunomodulators (for example, interferons, methotrexate, and so on).
• Inflammatory bowel disease medications (for example, mesalamine, sulfasalazine, and so on).
• Metformin (see para 5–14 e (2)). 56 AR 40–501
• 1 February 2005
Table 5-1 Guidance on deployment of soldiers with diabetes (table omitted from this version but available in pdf version)

f. Medical Standards for Military Assistance Advisory Groups (MAAGs), military attaches, military missions, and duty in isolated areas where adequate medical care may not be available are listed below in paragraphs 5–14 f(1)–(5). (See AR 55–46, AR 614–200, and AR 600–8–101.) These fitness standards also pertain to dependents of personnel being considered. The following medical conditions and defects will preclude assignments or attachment to duty with MAAGs, military attaches, military missions, or any type of duty in OCONUS isolated areas where adequate medical care is not available:

(1) A history of emotional or mental disorders, including character disorders, of such a degree as to have interfered significantly with adjustment or are likely to require treatment during this tour.
(2) Any medical conditions where maintenance medication is of such toxicity as to require frequent clinical and laboratory follow up or where the medical condition requires frequent follow up that cannot be delayed for the extent of the tour.
(3) Inherent, latent, or incipient medical or dental conditions that are likely to be aggravated by the climate or general living environment prevailing in the area where the soldier is expected to reside, to such a degree as to preclude acceptable performance of duty.
(4) Of special consideration are soldiers with a history of chronic cardiovascular, respiratory, or nervous system disorders who are scheduled for assignment and/or residence in an area 6,000 feet or more above sea level. While such individuals may be completely asymptomatic at the time of examination, hypoxia due to residence at high altitude may aggravate the condition and result in further progression of the disease. Examples of areas where altitude is an important consideration are La Paz, Bolivia; Quito, Ecuador; Bogota, Columbia; and Addis Ababa, Ethiopia.
(5) Remediable medical, dental, or physical conditions or defects that might reasonably be expected to require care during a normal tour of duty in the assigned area are to be corrected prior to departure from CONUS.