MEDICAL CONDITIONS FOR WHICH THE MILITARY REJECTS APPLICANTS

Standards of Medical Fitness.

Abdominal Organs and Gastrointestinal System

The causes for rejection for appointment, enlistment, and induction are an authenticated history of:

a. Esophagus. Ulceration, varices, fistula, achalasia, or other dismotility disorders; chronic or recurrent esophagitis if confirmed by appropriate x-ray or endoscopic examination.

b. Stomach and duodenum.

(1) Gastritis. Chronic hypertrophic, or severe.

(2) Active ulcer of the stomach or duodenum confirmed by x-ray or endoscopy.

(3) Congenital abnormalities of the stomach or duodenum causing symptoms or requiring surgical treatment, except a history of surgical correction of hypertrophic pyloric stenosis of infancy.

c. Small and large intestine.

(1) Inflammatory bowel disease. Regional enteritis, ulcerative colitis, ulcerative proctitis.

(2) Duodenal diverticula with symptoms or sequelae (hemorrhage, perforation, etc.).

(3) Intestinal malabsorption syndromes, including postsurgical and idiopathic.

(4) Congenital. Condition, to include Meckel’s diverticulum or functional abnormalities, persisting or symptomatic within the past 2 years.

d. Gastrointestinal bleeding. History of, unless the cause has been corrected, and is not otherwise disqualifying.

e. Hepato-pancreatic-biliary tract.

(1) Viral hepatitis, or unspecified hepatitis, within the preceding 6 months or persistence of symptoms after 6 months, or objective evidence of impairment of liver function, chronic hepatitis, and hepatitis B carriers. (Individuals who are known to have tested positive for hepatitis C virus (HCV) infection require confirmatory testing. If positive, individuals should be clinically evaluated for objective evidence of liver function impairment. If evaluation reveals no signs or symptoms of disease, the applicant meets the standards.)

(2) Cirrhosis, hepatic cysts and abscess, and sequelae of chronic liver disease.

(3) Cholecystitis, acute or chronic, with or without cholelithiasis, and other disorders of the gallbladder including post-cholecystectomy syndrome, and biliary system.

Note. Cholecystectomy is not disqualifying 60 days postsurgery (or 30 days post-laproscopic surgery), providing there are no disqualifying residuals from treatment.

(4) Pancreatitis. Acute and chronic.

f. Anorectal.

(1) Anal fissure if persistent, or anal fistula.

(2) Anal or rectal polyp, prolapse, stricture, or incontinence.

(3) Hemorrhoids, internal or external, when large, symptomatic, or history of bleeding.

g. Spleen.

(1) Splenomegaly, if persistent.

(2) Splenectomy, except when accomplished for trauma, or conditions unrelated to the spleen, or for hereditary spherocytosis.

h. Abdominal wall.

(1) Hernia, including inguinal, and other abdominal, except for small, asymptomatic umbilical or asymptomatic hiatal.

(2) History of abdominal surgery within the preceding 60 days, except that individuals post-laparoscopic cholecystectomy may be qualified after 30 days.

i. Other.

(1) Gastrointestinal bypass or stomach stapling for control of obesity.

(2) Persons with artificial openings.

Blood and blood-forming tissue diseases

The causes for rejection for appointment, enlistment, and induction are an authenticated history of:

a. Anemia. Any hereditary acquired, aplastic, or unspecified anemia that has not permanently corrected with therapy.

b. Hemorrhagic disorders. Any congenital or acquired tendency to bleed due to a platelet or coagulation disorder.

c. Leukopenia. Chronic or recurrent, based upon available norms for ethnic background.

d. Immunodeficiency.

Dental

The causes for rejection are for appointment, enlistment, and induction are:

a. Diseases of the jaw or associated tissues which are not easily remediable, and will incapacitate the individual or otherwise prevent the satisfactory performance of duty. This includes temporomandibular disorders and/or myofascial pain dysfunction that is not easily corrected or has the potential for significant future problems with pain and function.

b. Severe malocclusion that interferes with normal mastication or requires early and protracted treatment; or relationship between mandible and maxilla that prevents satisfactory future prosthodontic replacement.

c. Insufficient natural healthy teeth or lack of a serviceable prosthesis, preventing adequate mastication and incision of a normal diet. This includes complex (multiple fixture) dental implant systems that have associated complications that severely limit assignments and adversely affect performance of world-wide duty. Dental implants systems must be successfully osseointegrated and completed.

d. Orthodontic appliances for continued treatment (attached or removable). Retainer appliances are permissible, provided all active orthodontic treatment has been satisfactorily completed.

Ears

The causes for rejection for appointment, enlistment, and induction are:

a. External ear. Atresia or severe microtia, acquired stenosis, severe chronic or acute otitis externa, or severe traumatic deformity.

b. Mastoids. Mastoiditis, residual of mastoid operation with fistula, or marked external deformity that prevents or interferes with wearing a protective mask or helmet.

c. Meniere’s Syndrome. Or other diseases of the vestibular system.

d. Middle and inner ear. Acute or chronic otitis media, cholesteatoma, or history of any inner or middle ear surgery excluding myringotomy or successful tympanoplasty.

e. Tympanic membrane. Any perforation of the tympanic membrane, or surgery to correct perforation within 120 days of examination.

Hearing

The cause for rejection for appointment, enlistment, and induction is a hearing threshold level greater than that described in paragraph c below.

a. Audiometers, calibrated to standards of the International Standards Organization (ISO 1964) or the American National Standards Institute (ANSI 1996), will be used to test the hearing of all applicants.

b. All audiometric tracings or audiometric readings recorded on reports of medical examination or other medical records will be clearly identified.

c. Acceptable audiometric hearing levels (both ears) are:

(1) Pure tone at 500, 1000, and 2000 cycles per second of not more than 30 decibels (dB) on the average (each ear), with no individual level greater than 35dB at these frequencies.

(2) Pure tone level not more than 45 dB at 3000 cycles per second each ear, and 55 dB at 4000 cycles per second each ear.

Endocrine and Metabolic Disorders

The causes for rejection for appointment, enlistment, and induction are an authenticated history of:

a. Adrenal dysfunction of any degree.

b. Diabetes mellitus of any type.

c. Glycosuria. Persistent, when associated with impaired glucose tolerance or renal tubular defects.

d. Acromegaly. Gigantism or other disorder of pituitary function.

e. Gout.

f. Hyperinsulinism.

g. Hyperparathyroidism and hypoparathyroidism.

h. Thyroid disorders.

(1) Goiter, persistent or untreated.

(2) Hypothyroidism, uncontrolled by medication.

(3) Cretinism.

(4) Hyperthyroidism.

(5) Thyroiditis.

i. Nutritional deficiency diseases. Such diseases include beriberi, pellagra, and scurvy.

j. Other endocrine or metabolic disorders such as cystic fibrosis, porphyria, and amyloidosis that obviously prevent satisfactory performance of duty or require frequent or prolonged treatment.

Upper extremities

The causes for rejection for appointment, enlistment, and induction are:

a. Limitation of motion. An individual will be considered unacceptable if the joint ranges of motion are less than the measurements listed below.

(1) Shoulder:

(a) Forward elevation to 90 degrees.

(b) Abduction to 90 degrees.

(2) Elbow:

(a) Flexion to 100 degrees.

(b) Extension to 15 degrees.

(3) Wrist: a total range of 60 degrees (extension plus flexion) or radial and ulnar deviation combined arc 30 degrees.

(4) Hand:

(a) Pronation to 45 degrees.

(b) Supination to 45 degrees.

(5) Fingers and thumb: inability to clench fist, pick up a pin, grasp an object, or touch tips of at least three fingers with thumb.

b. Hand and fingers.

(1) Absence of the distal phalanx of either thumb.

(2) Absence of distal and middle phalanx of an index, middle, or ring finger of either hand, irrespective of the absence or loss of little finger.

(3) Absence of more than the distal phalanx of any two of the following fingers: index, middle finger, or ring finger of either hand.

(4) Absence of hand or any portion thereof except for fingers as noted above.

(5) Polydactyly.

(6) Scars and deformities of the fingers or hand that are symptomatic or that impair normal function to such a degree as to interfere with the satisfactory performance of military duty.

(7) Intrinsic paralysis or weakness, including nerve palsy sufficient to produce physical findings in the hand such as muscle atrophy or weakness.

(8) Wrist, forearm, elbow, arm, or shoulder. Recovery from disease or injury with residual weakness or symptoms such as to preclude satisfactory performance of duty, or grip strength of less than 75 percent of predicted normal when injured hand is compared with the normal hand (non-dominant is 80 percent of dominant grip).

Lower extremities

The causes for rejection for appointment, enlistment, and induction are:

a. Limitation of motion. An individual will be considered unacceptable if the joint ranges of motion are less that the measurements listed below.

(1) Hip (due to disease, injury):

(a) Flexion to 90 degrees.

(b) No demonstrable flexion contracture.

(c) Extension to 10 degrees (beyond 0 degrees).

(d) Abduction to 45 degrees.

(e) Rotation of 60 degrees (internal and external combined).

(2) Knee (due to disease, injury):

(a) Full extension compared with contralateral.

(b) Flexion to 90 degrees.

(3) Ankle (due to disease, injury):

(a) Dorsiflexion to 10 degrees.

(b) Planter flexion to 30 degrees.

(4) Subtalar (due to disease or injury): eversion and inversion (total to 5 degrees).

b. Foot and ankle.

(1) Absences of one or more small toes if function of the foot is poor or running or jumping is prevented; absence of a foot or any portion thereof except for toes.

(2) Absence of great toe(s); loss of dorsal/plantar flexion if function of the foot is impaired.

(3) Deformities of the toes, either acquired or congenital, including polydactyly, that prevent wearing military footwear or impair walking, marching, running, or jumping. This includes hallux valgus.

(4) Clubfoot or Pes Cavus, if stiffness or deformity prevents foot function or wearing military footwear.

(5) Symptomatic pes planus, acquired or congenital or pronounced cases, with absence of subtalar motion.

(6) Ingrown toenails, if severe.

(7) Planter fascitis, persistent.

(8) Neuroma, confirmed condition and refractory to medical treatment or will impair function of the foot.

c. Leg, knee, thigh, and hip.

(1) Loose or foreign bodies within the knee joint.

(2) Physical findings of an unstable or internally deranged joint. History of uncorrected anterior or posterior cruciate ligament injury.

(3) Surgical correction of any knee ligaments if symptomatic or unstable.

(4) History of congenital dislocation of the hip, osteochondritis of the hip (Legg-Perthes disease), or slipped femoral epiphysis of the hip.

(5) Hip dislocation within 2 years before examination.

(6) Osteochondritis of the tibial tuberosity (Osgood-Schlatter disease), if symptomatic.

d. General.

(1) Deformities, disease or chronic pain of one or both lower extremities that have interfered with function to such a degree as to prevent the individual from following a physically active vocation in civilian life or that would interfere with walking, running, or weight bearing, or the satisfactory completion of prescribed training or military duty.

(2) Shortening of a lower extremity resulting in a noticeable limp or scoliosis.

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Miscellaneous Conditions of the Extremities

The causes for rejection for appointment, enlistment, and induction are an authenticated history of:

a. Arthritis.

(1) Active, subacute, or chronic arthritis.

(2) Chronic osteoarthritis or traumatic arthritis of isolated joints of more than a minimal degree, which has interfered with the following of a physically active vocation in civilian life or that prevents the satisfactory performance of military duty.

b. Chronic Retro Patellar Knee Pain Syndrome with or without confirmatory arthroscopic evaluation.

c. Dislocation if unreduced, or recurrent dislocations of any major joint such as shoulder, hip, elbow, or knee; or instability of any major joint such as shoulder, elbow, or hip.

d. Fractures.

(1) Malunion or non-union of any fracture, except ulnar styloid process.

(2) Orthopedic hardware, including plates, pins, rods, wires, or screws used for fixation and left in place; except that a pin, wire, or screw not subject to easy trauma is not disqualifying.

e. Injury of a bone or joint of more than a minor nature, with or without fracture or dislocation, that occurred within the preceding 6 weeks: upper extremity, lower extremity, ribs and clavicle.

f. Joint replacement.

g. Muscular paralysis, contracture, or atrophy, if progressive or of sufficient degree to interfere with military service and muscular dystrophies.

h. Osteochondritis dessicans.

i. Osteochondromatosis or Multiple Cartilaginous Exostoses.

j. Osteoporosis.

k. Osteomyelitis, active or recurrent.

l. Scars, extensive, deep, or adherent to the skin and soft tissues that interfere with muscular movements.

m. Implants, silastic or other devices implanted to correct orthopedic abnormalities.

Eyes

The causes for rejection for appointment, enlistment, and induction are:

a. Lids.

(1) Blepharitis, chronic, of more than mild degree.

(2) Blepharospasm.

(3) Dacryocystitis, acute or chronic.

(4) Deformity of the lids, complete or extensive, sufficient to interfere with vision or impair protection of the eye from exposure.

b. Conjunctiva.

(1) Conjunctivitis, chronic, including trachoma and allergic conjunctivitis.

(2) Pterygium, if encroaching on the cornea in excess of 3 millimeters (mm), interfering with vision, progressive, or recurring after two operative procedures.

(3) Xerophthalmia.

c. Cornea.

(1) Dystrophy, corneal, of any type, including keratoconus of any degree.

(2) Keratorefractive surgery, history of lamellar and/or penetrating keratoplasty. Laser surgery or appliance utilized to reconfigure the cornea is also disqualifying.

(3) Keratitis, acute or chronic, which includes recurrent corneal ulcers, erosions (abrasions), or herpetic ulcers.

(4) Vascularization or opacification of the cornea from any cause that is progressive or reduces vision below the standards prescribed below.

d. Uveitis or iridocyclitis.

(2) Chorioretinitis or inflammation of the retina, including histoplasmosis, toxoplasmosis, or vascular conditions of the eye to include Coats’ disease, Eales’ disease, and retinitis proliferans, unless a single episode of nown cause that has healed and does not interfere with vision.

(3) Congenital or degenerative changes of any part of the retina.

(4) Detachment of the retina, history of surgery for same, or peripheral retinal injury or degeneration that may cause retinal detachment.

f. Optic nerve.

(1) Optic neuritis, neuroretinitis, secondary optic atrophy, or documented history of attacks of retrobulbar neuritis.

(2) Optic atrophy, or cortical blindness.

(3) Papilledema.

g. Lens.

(1) Aphakia, lens implant, or dislocation of a lens.

(2) Opacities of the lens that interfere with vision or that are considered to be progressive.

h. Ocular mobility and motility.

(1) Diplopia, documented, constant or intermittent.

(2) Nystagmus.

(3) Strabismus, uncorrectable by lenses to less than 40 diopters or accompanied by diplopia.

(4) Strabismus, surgery for the correction of, within the preceding 6 months.

(5) For entrance into the USMA or ROTC programs, the following conditions are also disqualifying: esotropia of over 15 prism diopters; exotropia of over 10 prism diopters; hypertropia of over 5 prism diopters.

i. Miscellaneous defects and conditions.

(1) Abnormal visual fields due to disease of the eye or central nervous system, or trauma. Meridian-specific visual field minimums are as follows:

(a) Temporal, 85 degrees.

(b) Superior-temporal, 55 degrees.

(c) Superior, 45 degrees.

(d) Superior nasal, 55 degrees.

(e) Nasal, 60 degrees.

(f) Inferior nasal, 50 degrees.

(g) Inferior, 65 degrees.

(h) Inferior-temporal, 85 degrees.

(2) Absence of an eye, congenital or acquired.

(3) Asthenopia, severe.

(4) Exophthalmos, unilateral or bilateral, non-familial.

(5) Glaucoma, primary, or secondary, or pre-glaucoma as evidenced by intraocular pressure above 21 millimeters of mercury (mmHg), or the secondary changes in the optic disc or visual field loss associated with glaucoma.

(6) Loss of normal pupillary reflex reactions to accommodation or light, including Adie’s syndrome.

(7) Night blindness.

(8) Retained intraocular foreign body.

(9) Growth or tumors of the eyelid, other than small basal cell tumors which can be cured by treatment, and small nonprogressive asymptomatic benign lesions.

(10) Any organic disease of the eye or adnexa not specified above, that threatens vision or visual function.

Vision

The causes for rejection for appointment, enlistment, and induction are:

a. Distant visual acuity of any degree that does not correct with spectacle lenses to at least one of the following:

(1) 20/40 in one eye and 20/70 in the other eye.

(2) 20/30 in one eye and 20/100 in the other eye.

(3) 20/20 in one eye and 20/400 in the other eye. However, for entrance into USMA or ROTC, distant visual acuity that does not correct to 20/20 in one eye and 20/40 in the other eye is disqualifying. For entrance into OCS, distant visual acuity that does not correct to 20/20 in one eye and 20/100 in the other eye is disqualifying.

b. Near visual acuity of any degree that does not correct to 20/40 in the better eye.

c. Refractive error (hyperopia, myopia, astigmatism), in any spherical equivalent of worse than -8.00 or +8.00 diopters; if ordinary spectacles cause discomfort by reason of ghost images or prismatic displacement; or if corrected by orthokeratology or keratorefractive surgery. However, for entrance into USMA or Army ROTC programs, the following conditions are disqualifying:

(1) Astigmatism, all types over 3 diopters.

(2) Hyperopia over 8.00 diopters spherical equivalent.

(3) Myopia over 8 diopters spherical equivalent.

(4) Refractive error corrected by orthokeratology or keratorefractive surgery.

d. Contact lenses. Complicated cases requiring contact lenses for adequate correction of vision, such as corneal scars and irregular astigmatism.

e. Color vision. Although there is no standard, color vision will be tested because adequate color vision is a prerequisite for entry into many military specialties. However, for entrance into the USMA or Army ROTC or OCS programs, the inability to distinguish and identify without confusion the color of an object, substance, material, or light that is uniformly colored a vivid red or vivid green is disqualifying.

Genitalia

The causes for rejection for appointment, enlistment, and induction are:

a. Female genitalia.

(1) Abnormal uterine bleeding, including menorrhagia, metrorrhagia, or polymenorrhea.

(2) Amenorrhea, unexplained.

(3) Dysmenorrhea, incapacitating to a degree recurrently necessitating absences of more than a few hours from routine activities.

(4) Endometriosis.

(5) Hermaphroditism.

(6) Menopausal syndrome, if manifested by more than mild constitutional or mental symptoms, or artificial menopause if less than 1 year’s duration.

(7) Ovarian cysts, persistent, clinically significant.

(8) Pelvic inflammatory disease, acute or chronic.

(9) Pregnancy.

(10) Uterus, congenital absence of, or enlargement due to any cause.

(11) Vulvar or vaginal ulceration, including herpes genitalia and condyloma acuminatum, acute or chronic, not amenable to treatment. Such treatment must be given and demonstrated effective prior to accession.

(12) Abnormal Pap smear graded LGSIL or higher severity, or any smear in which the descriptive terms carcinoma-in-situ, invasive cancer, condyloma acuminatum, human papilloma virus, or dysplasia are used.

(13) Major abnormalities and defects of the genitalia such as a change of sex. A history thereof, or dysfunctional residuals from surgical correction of these conditions.

b. Male genitalia.

(1) Absence of both testicles, either congenital, or acquired, or unexplained absence of a testicle.

(2) Epispadias or Hypospadias, when accompanied by evidence of infection of the urinary tract, or if clothing is soiled when voiding.

(3) Undiagnosed enlargement or mass of testicle or epididymis.

(4) Undescended testicle(s).

(5) Orchitis, acute or chronic epididymitis.

(6) Penis, amputation of, if the resulting stump is insufficient to permit normal micturition.

(7) Penile infectious lesions, including herpes genitalis and condyloma acuminata, acute or chronic, not amenable to treatment. Such treatment must be given and demonstrated effective prior to accession.

(8) Prostatitis, acute or chronic.

(9) Hydrocele. Left varicocele, if painful, or any right varicocele.

c. Major abnormalities and defects of the genitalia, such as a change of sex, a history thereof, or dysfunctional residuals from surgical correction of these conditions.

Urinary System

The causes for rejection for appointment, enlistment, and induction are:

a. Cystitis.

b. Urethritis.

c. Enuresis or incontinence of urine beyond age 12.

d. Hematuria, pyuria, or other findings indicative of renal tract disease.

e. Urethral stricture or fistula.

f. Kidney.

(1) Absence of one kidney, congenital or acquired.

(2) Infections, acute or chronic.

(3) Polycystic kidney, confirmed history of.

(4) Horseshoe kidney.

(5) Hydronephrosis.

(6) Nephritis, acute or chronic.

g. Proteinuria under normal activity (at least 48 hours after strenuous exercise) greater than 200 milligrams (mg)/24 hours, or a protein to creatinine ratio greater than 0.2 in a random urine sample, unless nephrologic consultation determines the condition to be benign orthostatic proteinuria.

h. Renal calculus within the previous 12 months, recurrent calculus, nephrocalcinosis, or bilateral renal calculi at any time.

Head

The causes for rejection for appointment, enlistment, and induction are:

a. Injuries, including severe contusions and other wounds of the scalp and cerebral concussion, until a period of 3 months has elapsed.

b. Deformities of the skull, face, or jaw of a degree that would prevent the individual from wearing a protective mask or military headgear.

c. Defects, loss or congenital absence of the bony substance of the skull not successfully corrected by reconstructive materials, or leaving residual defect in excess of 1 square inch (6.45 centimeter (cm) 2 ) or the size of a 25 cent piece.

Neck

The causes for rejection for appointment, enlistment, and induction are:

a. Cervical ribs, if symptomatic or so obvious that they are found on routine physical examination. (Detection based primarily on x-rays is not considered to meet this criterion.)

b. Congenital cysts of branchial cleft origin or those developing from remnants of the thyroglossal duct, with or without fistulous tracts.

c. Contraction of the muscles of the neck, spastic or non-spastic, or cicatricial contracture of the neck to the extent that it interferes with wearing a uniform or military equipment or is so disfiguring as to impair military bearing.

Heart

The causes for rejection for appointment, enlistment, and induction are:

a. All valvular heart diseases, congenital or acquired, including those improved by surgery except mitral valve prolapse and bicuspid aortic valve. These latter two conditions are not reasons for rejection unless there is associated tachyarrhythmia, mitral regurgitation, aortic stenosis, insufficiency, or cardiomegaly.

b. Coronary heart disease.

c. Symptomatic arrhythmia (or electrocardiographic evidence of arrhythmia), history of.

(1) Supraventricular tachycardia, or any dysrhythmia originating from the atrium or sinoatrial node, such as atrial flutter, and atrial fibrillation, unless there has been no recurrence during the preceding 2 years while off all medications. Premature atrial or ventricular contractions are disqualifying when sufficiently symptomatic to require treatment or result in physical or psychological impairment.

(2) Ventricular arrhythmias, including ventricular fibrillation, tachycardia, and multi focal premature ventricular contractions. Occasional asymptomatic premature ventricular contractions are not disqualifying.

(3) Ventricular conduction disorders, left bundle branch block, Mobitz type II second degree atrioventricular (AV) block, and third degree AV block. Wolff-Parkinson-White Syndrome and Lown-Ganong-Levine-Syndrome associated with an arrhythmia are also disqualifying.

(4) Conduction disturbances such as first degree AV block, left anterior hemiblock, right bundle branch block, or Mobitz type I second degree AV block are disqualifying when symptomatic or associated with underlying cardiovascular disease.

d. Hypertrophy or dilatation of the heart.

e. Cardiomyopathy, including myocarditis, or history of congestive heart failure even though currently compensated.

f. Pericarditis.

g. Persistent tachycardia (resting pulse rate of 100 or greater).

h. Congenital anomalies of heart and great vessels, except for corrected patent ductus arteriosus.

Vascular system

The causes for rejection for appointment, enlistment, and induction are:

a. Abnormalities of the arteries and blood vessels, including aneurysms, even if repaired, atherosclerosis, or arteritis.

b. Hypertensive vascular disease, evidenced by the average of three consecutive diastolic blood pressure measurements greater than 90 mmHg or three consecutive systolic pressure measurements greater than 140 mmHg. High blood pressure requiring medication or a history of treatment including dietary restriction.

c. Pulmonary or systemic embolization.

d. Peripheral vascular disease, including Raynaud’s phenomenon.

e. Vein diseases, recurrent thrombophlebitis, thrombophlebitis during the preceding year, or any evidence of venous incompetence, such as large or symptomatic varicose veins, edema, or skin ulceration.

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Height

The causes for rejection for appointment, enlistment, and induction are:

a. Men: Height below 60 inches or over 80 inches.

b. Women: Height below 58 inches or over 80 inches.

Weight

a. Applicants for initial appointment as commissioned officers (to include appointment as commissioned warrant officers) must meet the standards of AR 600-9 . Body fat composition is used as the final determinant in evaluating an applicant’s acceptability when the weight exceeds the weight tables.

b. All other applicants must meet the standards of tables (see “Height and Weight” tables in this section). Body fat composition is used as the final determinant in evaluating an applicant’s acceptability when the weight exceeds the weight tables.

Body build

The cause for rejection for appointment, enlistment, and induction is deficient muscular development that would interfere with the completion of required training.

Lungs, Chest Wall, Pleura, and Mediastinum

The causes for rejection for appointment, enlistment, and induction are:

a. Abnormal elevation of the diaphragm, either side.

b. Abscess of the lung.

c. Acute infectious processes of the lung, until cured.

d. Asthma, including reactive airway disease, exercise induced bronchospasm or asthmatic bronchitis, reliably diagnosed at any age. Reliable diagnostic criteria should consist of any of the following elements:

(1) Substantiated history of cough, wheeze, and/or dyspnea that persists or recurs over a prolonged period of time, generally more than 6 months.

(2) If the diagnosis of asthma is in doubt, a test for reversible airflow obstruction (greater than a 15 percent increase in forced expiratory volume in 1 second (FEVI) following administration of an inhaled bronchodilator) or airway hyperactivity (exaggerated decrease in airflow induced by standard bronchoprovocation challenge such as methacholine inhalation or a demonstration of exercise-induced bronchospasm) must be performed.

e. Bronchitis, chronic, symptoms over 3 months occurring at least twice a year.

f. Bronchiectasis.

g. Bronchopleural fistula.

h. Bullous or generalized pulmonary emphysema.

i. Chronic mycotic diseases of the lung including coccidioidomycosis.

j. Chest wall malformation or fracture that interferes with vigorous physical exertion.

k. Empyema, including residual pleural effusion or unhealed sinuses of chest wall.

l. Extensive pulmonary fibrosis.

m. Foreign body in lung, trachea, or bronchus.

n. Lobectomy, with residual pulmonary disease or removal of more than one lobe.

o. Pleurisy with effusion, within the previous 2 years if known or unknown origin.

p. Pneumothorax during the year preceding examination if due to a simple trauma or surgery; during the 3 years preceding examination from spontaneous origin. Recurrent spontaneous pneumothorax after surgical correction or pleural sclerosis.

q. Sarcoidosis.

r. Silicone breast implants, encapsulated if less than 9 months since surgery or with symptomatic complications.

s. Tuberculous lesions.

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Mouth

The causes for rejection for appointment, enlistment, and induction are:

a. Cleft lip or palate defects, unless satisfactorily repaired by surgery.

b. Leukoplakia.

Nose, Sinuses, and Larynx

The causes for rejection for appointment, enlistment, and induction are:

a. Allergic manifestations.

(1) Allergic or vasomotor rhinitis, if moderate or severe and not controlled by oral medications, desensitization, or topical corticosteroid medication.

(2) Atrophic rhinitis.

(3) Vocal cord paralysis, or symptomatic disease of the larynx.

b. Anosmia or parosmia.

c. Epistaxis, recurrent.

d. Nasal polyps, unless surgery was performed at least 1 year before examination.

e. Perforation of nasal septum, if symptomatic or progressive.

f. Sinusitis, acute.

g. Sinusitis, chronic, when evidenced by chronic purulent nasal discharge, hyperplastic changes of the nasal tissue, symptoms requiring frequent medical attention, or x-ray findings.

h. Larynx ulceration, polyps, granulated tissue, or chronic laryngitis.

i. Tracheostomy or tracheal fistula.

j. Deformities or conditions of the mouth, tongue, palate throat, pharynx, larynx, and nose that interfere with chewing, swallowing, speech, or breathing.

k. Pharyngitis and nasopharyngitis, chronic.

Neurological Disorders

The causes for rejection for appointment, enlistment, and induction are:

a. Cerebrovascular conditions, any history of subarachnoid or intracerebral hemorrhage, vascular insufficiency, aneurysm, or arteriovenous malformation.

b. Congenital malformations, if associated with neurological manifestations or if known to be progressive; meningocele, even if uncomplicated.

c. Degenerative and hereditodegenerative disorders affecting the cerebrum, basal ganglia, cerebellum, spinal cord, and peripheral nerves, or muscles.

d. Recurrent headaches of all types if they are of sufficient severity or frequency to interfere with normal function within 3 years.

e. Head injury.

(1) Applicants with a history of head injury with –

(a) Late post-traumatic epilepsy (occurring more than l week after injury).

(b) Permanent motor or sensory deficits.

(c) Impairment of intellectual function.

(d) Alteration of personality.

(e) Central nervous system shunt.

(2) Applicants with a history of severe head injury are unfit for a period of at least 5 years, after which they may be considered fit if complete neurological and neurophysical evaluation shows no residual dysfunction or complications. Applicants with a history of severe penetrating head injury are unfit for a period of at least 10 years after the injury. After 10 years they may be considered fit if complete neurological and neuropsychological evaluation shows no residuals dysfunction or complications. Severe head injuries are defined by one or more of the following:

(a) Unconsciousness or amnesia, alone or in combination, of 24 hours duration or longer.

(b) Depressed skull fracture.

(c) Laceration or contusion of dura or brain.

(d) Epidural, subdural, subarachnoid, or intracerebral hematoma.

(e) Associated abscess or meningitis.

(f) Cerebrospinal fluid rhinorrhea or otorrhea persisting more than 7 days.

(g) Focal neurologic signs.

(h) Radiographic evidence of retained metallic or bony fragments.

(i) Leptomeningeal cysts or arteriovenous fistula.

(j) Early post-traumatic seizure(s) occurring within 1 week of injury but more than 30 minutes after injury.

(3) Applicants with a history of moderate head injury are unfit for a period of at least 2 years after injury, after which they may be considered fit if complete neurological evaluation shows no residual dysfunction or complications. Moderate head injuries are defined by unconsciousness or amnesia, alone or in combination of 1 to 24 hours duration or linear skull fracture.

(4) Applicants with a history of mild head injury, as defined by a period of unconsciousness or amnesia, alone or in combination, of 1 hour or less, are unfit for at least 1 month after injury; after which they may be acceptable if neurological evaluation shows no residual dysfunction or complications.

(5) Persistent post-traumatic sequelae, as manifested by headache, vomiting, disorientation, spatial disequilibrium, personality changes, impaired memory, poor mental concentration, shortened attention span, dizziness, altered sleep patterns, or any findings consistent with organic brain syndrome are disqualifying until full recovery has been confirmed by complete neurological and neuropsychological evaluation.

f. Infectious diseases.

(1) Meningitis, encephalitis, or poliomyelitis within 1 year before examination, or if there are residual neurological defects.

(2) Neurosyphilis of any form, general paresis, tabes dorsalis meningovascular syphilis.

g. Narcolepsy, sleep apnea syndrome.

h. Paralysis, weakness, lack of coordination, pain, sensory disturbance.

i. Epilepsy, beyond the age of 5 unless the applicant has been free of seizures for a period of 5 years while taking no medication for seizure control, and has a normal electroencephalogram (EEG). All such applicants will have a current neurology consultation with current EEG results. EEG may be requested by the reviewing authority.

j. Chronic disorders such as myasthenia gravis and multiple sclerosis.

k. Central nervous system shunts of all kinds.

Disorders with Psychotic Features

The causes for rejection for appointment, enlistment, and induction are disorders with psychotic features.

Neurotic, Anxiety, Mood, Somatoform, Dissociative, or Factitious Disorders

The causes for rejection for appointment, enlistment, and induction are a history of such disorders resulting in any or all of the below:

a. Admission to a hospital or residential facility.

b. Care by a physician or other mental health professional for more than 6 months.

c. Symptoms or behavior of a repeated nature that impaired social, school, or work efficiency.

Personality, Conduct, and Behavior Disorders

The causes for rejection for appointment, enlistment, and induction are:

a. Personality, conduct, or behavior disorders as evidenced by frequent encounters with law enforcement agencies, antisocial attitudes or behavior, which, while not sufficient cause for administrative rejection, are tangible evidence of impaired capacity to adapt to military service.

b. Personality, conduct, or behavior disorders where it is evident by history, interview, or psychological testing that the degree of immaturity, instability, personality inadequacy, impulsiveness, or dependency will seriously interfere with adjustment in the Army as demonstrated by repeated inability to maintain reasonable adjustment in school, with employers and fellow workers, and with other social groups.

c. Other behavior disorders including but not limited to conditions such as authenticated evidence of functional enuresis or encopresis, sleepwalking, or eating disorders that are habitual or persistent occurring beyond age 12, or stammering of such a degree that the individual is normally unable to express himself or herself clearly or to repeat commands.

d. Specific academic skills defects, chronic history of academic skills or perceptual defects, secondary to organic or functional mental disorders that interfere with work or school after age 12. Current use of medication to improve or maintain academic skills.

e. Suicide, history of attempted or suicidal behavior.

Psychosexual Conditions

The causes for rejection for appointment, enlistment, and induction are transsexualism, exhibitionism, transvestitism, voyeurism, and other paraphilias.

Skin and Cellular Tissues

The causes for rejection for appointment, enlistment, and induction are:

a. Acne, severe, or when extensive involvement of the neck, shoulders, chest, or back would be aggravated by or interfere with the wearing of military equipment, and would not be amenable to treatment. Patients under treatment with isotretinoin (Accutane) are medically unacceptable until 8 weeks after completion of course of therapy.

b. Atopic dermatitis or eczema, with active or residual lesions in characteristic areas (face, neck, antecubital, and or/popliteal fossae, occasionally wrists and hands), or documented history thereof after the age of 8.

c. Contact dermatitis, especially involving rubber or other materials used in any type of required protective equipment.

d. Cysts.

(1) Cysts, other than pilonidal, of such a size or location as to interfere with the normal wearing of military equipment.

(2) Pilonidal cysts, if evidenced by the presence of a tumor mass or a discharging sinus. History of pilonidal cystectomy within 6 months before examination is disqualifying.

e. Dermatitis factitia.

f. Bullous dermatoses, such as Dermatitis Herpetiformis, pemphigus, and epidermolysis bullosa.

g. Chronic Lymphedema.

h. Fungus infections, systemic or superficial types, if extensive and not amenable to treatment.

i. Furunculosis, extensive recurrent, or chronic.

j. Hyperhidrosis of hands or feet, chronic or severe.

k. Ichthyosis, or other congenital or acquired anomalies of the skin such as nevi or vascular tumors that interfere with function or are exposed to constant irritation.

l. Keloid formation, if the tendency is marked or interferes with the wearing of military equipment.

m. Leprosy, any type.

n. Lichen planus.

o. Neurofibromatosis (von Recklinghausen’s disease).

p. Photosensitivity, any primary sun-sensitive condition, such as polymorphous light eruption or solar urticaria; any dermatosis aggravated by sunlight such as lupus erythematosus.

q. Psoriasis, unless mild by degree, not involving nail pitting, and not interfering with wearing military equipment or clothing.

r. Radiodermatitis.

s. Scars that are so extensive, deep, or adherent that they may interfere with the wearing of military clothing or equipment, exhibit a tendency to ulcerate, or interfere with function. Includes scars at skin graft donor or recipient sites if the area is susceptible to trauma.

t. Scleroderma.

u. Tattoos that will significantly limit effective performance of military service or that are otherwise prohibited under AR 670-1 .

v. Urticaria, chronic.

w. Warts, plantar, symptomatic.

x. Xanthoma, if disabling or accompanied by hyperlipemia.

y. Any other chronic skin disorder of a degree or nature, such as Dysplastic Nevi Syndrome, which requires frequent outpatient treatment or hospitalization, or interferes with the satisfactory performance of duty.

Spine and Sacroiliac Joints

The causes for rejection for appointment, enlistment, and induction are:

a. Arthritis.

b. Complaint of a disease or injury of the spine or sacroiliac joints with or without objective signs that has prevented the individual from successfully following a physically active vocation in civilian life or that is associated with pain referred to the lower extremities, muscular spasm, postural deformities, or limitation of motion.

c. Deviation or curvature of spine from normal alignment, structure, or function if –

(1) It prevents the individual from following a physically active vocation in civilian life.

(2) It interferes with wearing a uniform or military equipment.

(3) It is symptomatic and associated with positive physical finding(s) and demonstrable by x-ray.

(4) There is lumbar scoliosis greater than 20 degrees, thoracic scoliosis greater than 30 degrees, and kyphosis or lordosis greater than 55 degrees when measured by the Cobb method.

d. Fusion, congenital, involving more than two vertebrae. Any surgical fusion is disqualifying.

e. Healed fractures or dislocations of the vertebrae. A compression fracture, involving less than 25 percent of a single vertebra is not disqualifying if the injury occurred more than 1 year before examination and the applicant is asymptomatic. A history of fractures of the transverse or spinous processes is not disqualifying if the applicant is asymptomatic.

f. Juvenile epiphysitis with any degree of residual change indicated by x-ray or kyphosis.

g. Ruptured nucleus pulposus, herniation of intervertebral disk or history of operation for this condition.

h. Spina bifida when symptomatic or if there is more than one vertebra involved, dimpling of the overlying skin, or a history of surgical repair.

i. Spondylolysis and spondylolisthesis.

j. Weak or painful back requiring external support such as a corset or brace; recurrent sprains or strains requiring limitation of physical activity or frequent treatment.

Systemic Diseases

The causes for rejection for appointment, enlistment, and induction are:

a. Amyloidosis.

b. Ankylosing spondylitis.

c. Eosinophilic granuloma when occurring as a single localized bony lesion and not associated with soft tissue or other involvement should not be a cause for rejection once healing has occurred. All other forms of the Histiocytosis X spectrum should be rejected.

d. Lupus erythematosus and mixed connective tissue disease.

e. Polymyositis/dermatomyositis complex.

f. Progressive Systemic Sclerosis, including CRST (calcinosis, Raynaud’s phenomenon, sclerodactyly, and telangiectasis) variant. A single plaque of localized scleroderma (morphea) that has been stable for at least 2 years is not disqualifying.

g. Reiter’s Disease.

h. Rheumatoid arthritis.

i. Rhabdomyolysis.

j. Sarcoidosis, unless there is substantiated evidence of a complete spontaneous remission of at least 2 years duration.

k. Sjogren’s Syndrome.

l. Tuberculosis.

(1) Active tuberculosis in any form or location, or history of active tuberculosis within the previous 2 years.

(2) One or more reactivations.

(3) Residual physical or mental defects from past tuberculosis that would preclude the satisfactory performance of duty.

(4) Individuals with a past history of active tuberculosis MORE than 2 years prior to enlistment, induction and appointment are QUALIFIED IF they have received a complete course of standard chemotherapy for tuberculosis. In addition, individuals with a tuberculin reaction 10 mm or greater and without evidence of residual disease are qualified once they have been treated with chemoprophylaxis.

(5) Vasculitis such as Bechet’s, Wegener’s granulomatosis, polyarteritis nodosa.

General and Miscellaneous Conditions and Defects

The causes for rejection for appointment, enlistment, and induction are:

a. Allergic manifestations. A reliable history of anaphylaxis to stinging insects. Reliable history of a moderate to severe reaction to common foods, spices, or food additives.

b. Any acute pathological condition, including acute communicable diseases, until recovery has occurred without sequelae.

c. Chronic metallic poisoning with lead, arsenic, or silver, or beryllium or manganese.

d. Cold injury, residuals of, such as: frostbite, chilblain, immersion foot, trench foot, deep-seated ache, paresthesia, hyperhidrosis, easily traumatized skin, cyanosis, amputation of any digit, or ankylosis.

e. Cold urticaria and angioedema, hereditary angioedema.

f. Filariasis, trypanosomiasis, schistosomiasis, uncinariasis, or other parasitic conditions, if symptomatic or carrier states.

g. Heat pyrexia, heatstroke, or sunstroke. Documented evidence of a predisposition (including disorders of sweat mechanism and a previous serious episode), recurrent episodes requiring medical attention, or residual injury (especially cardiac, cerebral, hepatic, and renal); malignant hyperthermia.

h. Industrial solvent and other chemical intoxication.

i. Motion sickness. An authenticated history of frequent incapacitating motion sickness after the 12th birthday.

j. Mycotic infection of internal organs.

k. Organ transplant recipient.

l. Presence of human immunodeficiency virus (HIV-I) or antibody. Presence is confirmed by repeatedly reactive enzyme-linked immunoassay serological test and positive immunoelectrophoresis (Western Blot) test, or other DOD-approved confirmatory test.

m. Reactive tests for syphilis such as the rapid plasma reagin (RPR) test or venereal disease research laboratory (VDRL) followed by a reactive, confirmatory Fluorescent Treponemal Antibody Absorption (FTA-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 FTA-ABS test is not disqualifying if a cause for the false positive reaction can be identified and is not otherwise disqualifying.

n. Residual of tropical fevers, such as malaria and various parasitic or protozoal infestations that prevent the satisfactory performance of military duty.

o. Rheumatic fever during the previous 2 years, or any history of recurrent attacks; Sydenham’s chorea at any age.

p. Sleep apnea.

Tumors and Malignant Diseases

The causes for rejection for appointment, enlistment, and induction are:

a. Benign tumors (M8000) that interfere with function, prevent wearing the uniform or protective equipment, would require frequent specialized attention, or have a high malignant potential.

b. Malignant tumors (V10), exception for basal cell carcinoma, removed with no residual. In addition, the following cases should be qualified if on careful review they meet the following criteria: individuals who have a history of childhood cancer who have not received any surgical or medical cancer therapy for 5 years and are free of cancer; individuals with a history of Wilm’s tumor and germ cell tumors of the testis treated surgically and/or with chemotherapy after a 2-year disease-free interval off all treatment; individuals with a history of Hodgkin’s disease treated with radiation therapy and/or chemotherapy and disease free off treatment for 5 years; individuals with a history of large cell lymphoma after a 2-year disease-free interval off all therapy.

Miscellaneous

Any condition that in the opinion of the examining medical officer will significantly interfere with the successful performance of military duty or training may be a cause for rejection for appointment, enlistment, and induction