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					   MANMED, NAVMED P-117

Physical Standards for Enlistment,
Commissioning and Special Duty
            14 January 2009
                       MANMED
•   1. BUMED Organization
•   2. Medical Corps: Composition and Duties
•   6. Dental Corps
•   7. Medical Service Corps
•   8. Nurse Corps
•   9. Hospital Corps
•   10. Civilians
•   12. Medical Education and Training
•   14. Special Activities
    • Blood program, Transplantation support, Aviation physiology
                    MANMED
• 15. Physical Examination & Standards for
    Enlistment, Commissioning and Special Duty
•   16. Medical Records
•   17. Decedent Affairs
•   18. MEB, PEB
•   20. Research and Development
•   21. Pharmacy and Drug Control
•   22. Preventive Medicine and Occupational Health
•   23. Reports, Forms and Records
         MANMED Chapter 15
• Physical Standards for Enlistment, Commissioning and
  Special Duty
• Role: “…to give guidance on screening or qualification
  examinations rather than guidance on population health or
  other clinically indicated evaluations.”
• “…for specific screening criteria to answer specific duty or
  qualification questions.”
          MANMED Chapter 15
• The criteria are used to ensure individuals are:
   • Physically capable to perform required duties without incurring
     unnecessary risk to themselves, other service members, or to the
     mission.
   • Not likely to incur physical disabilities due to service.

• Medical criteria are:
   • Based on the needs of the Navy/DoD
   • Subject to ongoing changes in medical information and are
      therefore subject to review and change.
• Regulatory But NOT all components are Mandatory
• Can NOT direct every situation
• Is NOT merely Advisory
          MANMED Chapter 15
Interpretation of Standards:
• Specific and unambiguous as possible
   • Some disorders are disqualifying per se- SPECIFIC
   • Some disorders are disqualifying based on impact to health and
     function- involves clinical judgment- Not Specific in ALL
     Situations

• Consider clinical judgment paramount
   • Concerning history without adequate supporting documentation

• Defines Authority for waiving physical standards
   • Resides with the LINE Commander- BUPERS, CMC
   • Medical provides recommendation- BUMED
          MANMED Chapter 15
• Five Sections of Chapter 15
• I. Performing and Recording Physical Exams
   • Validity, applying and recording of exams; waiver process
• II. Common Medical Exams
   • Identifies groups requiring special exams
• III. Standards for Enlistment/Commissioning
   • Disqualifying conditions; waiver process
• IV. Special Duty Exams and Standards
   • Aviation, Dive, Sub, Nuclear, Ionizing Radiation
• V. Women’s Health
       MANMED Chapter 15
• A. FITNESS for DUTY (General Duty)
  • FFFD- Fit For Full Duty
  • Consistent with Rate and Rank
  • World-wide deployable

• B. SUITABILITY for SPECIAL DUTY
  • MUST be FIT for DUTY from A.
     • not on LIMDU, MED Board, etc.
  • PQ/AA DIF, DIACA
  • SUITABILITY for Sea Duty
        MANMED Chapter 15
• Section I: Performing and Recording PEs
  • DD 2807-1 and DD 2808 replace SF 88, SF 93
  • 2808 must address all significant findings on 2807
• Abbreviations
  • NCD, CD
  • WNR, WR, WG (date)
• Filing Requirements
  • 2 years at the examining facility
        MANMED Chapter 15
• Section I: Performing and Recording PEs
• Validity of exams:
   • General Duty: 2 years
   • Special Duty: 1 year
   • Updating exams
      • 90 days to 2 years
      • Update 2808, 2807
          – Focused exam
          – Address significant issues
         MANMED Chapter 15
• Section II: Common Medical Exams
• 15-9 Routine periodic exams are NOT required
  • Unless required for special duty or program
  • Replaced by PHA- Periodic Health Assessment

• 15-10 Applicants
  • Within 2 years; 90 days to 2 years: updated 2807/2808

• 15-11 Recruit Screening
  • Inside 14 days of recruit training
          MANMED Chapter 15
• Section II: Common Medical Exams (cont.)
• 15-12 Re-enlistment- to identify:
   •   New medical conditions
   •   Material changes in existing medical condition
   •   Preventing safe & effective performance of duty
   •   NPQ- refer to MEB/PEB
• 15-13 Applicants for commissioning or warrant
   • Exam within 2 years
   • 90 days to 2 years: updated 2807/2808
            Chapter 15, Section II cont.
• 15-20/21 Separation / Retirement Physical
   • 1. >30 days continuous duty; within 180 days
   • 2. Identify unresolved medical issues
        • Sustained while in receipt of active duty pay
        • Disability- resolve or refer to MEB/PEB (MANMED Ch. 18)
   • 3. Medically Qualified for Separation
        •   FIT for duty in reserves for the next 6 months
        •   DoD Rating vs. VA Disability
        •   DoD Rating: FIT or UNFIT (MEB/PEB); for separation; not sig for retirement
        •   VA Disability: certainly with UNFIT, possible with FIT
              – Medical benefits
              – Disability Pay

   • 4. Extras
        • VA Form DD 2697
        • Age >35 offer Hepatitis C screen
   • 6. Read Text: “You have been evaluated because of your planned separation or
      retirement from active duty service….”
         MANMED Chapter 15
• Section III: Standards for Enlistment/Commission
   • Disqualifying conditions and waiver process
   • 15-31 Waiver of Standards
      • BUPERS, CMC Grant Waivers
      • BUMED Recommends Waivers

   • 15-33 to 15-61: Disqualifying conditions
      • By systems
EISENHOWER STRIKE GROUP
         MANMED Chapter 15
Section IV: Special Duty Exams and Standards

 •   Aviation              •   Special Warfare
 •   Selected Passengers   •   Submarine
 •   Rescue Swimmers       •   Explosives Handler
 •   Diving Duty           •   LCAC
 •   Nuclear Field Duty    •   Fire Fighting
 •   Ionizing Radiation        Instructor
        MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
   • Aviation Personnel Classifications Art. 15-63
      • Class I: Pilots, actual control of aircraft, DIACA
      • Class II: Personnel flying not controlling aircraft
         – SNFO, NFO, NFS, AP, AEP, Av Opt, NAC

      • Class III: Personnel not flying, working in aviation
         – ATC, UAV
         – Flight Deck Personnel (critical and non-critical)
         MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Article 15-63 (cont.)
   • Class I Subclasses : Service Groups (SG)
       • SG 1: Solo, No flying limitations
       • SG 2: Solo, restricted from shipboard flying (except Helo)
       • SG 3: Non-solo, must be accompanied by SG 1 or 2 Pilot
   • SG 3 Subcategory
       • Pilot in Command (OPNAV 3710.7T Paragraph 8.8.6)
           – Requested by CO/Chain of Command
           – Limited to period within that chain of command
           – Expires on change of commission, command or PCS.
       SG III Pilot in Command
               Requests.
• Ref: NATOPS
  OPNAVINST 3710.7T SECTION 8.8.6
• Requests for SG III pilot in command duties
  made to BUPERS or CMC via NAMI Code
  342 with justification.
• Aviation physical examination (2807/2808)
  performed within the previous six months.
SG III Pilot in Command Requests

• Issued on an individual basis and
  automatically expire upon billet reassignment
  or failure to maintain the physical waiver
  provisions
• The request shall contain date of designation
  as a naval aviator and background experience
  pertinent to the type of waiver being
  requested.
        MANMED Chapter 15
• Section IV: Special Duty Exams and
  Standards
• Article 15-63 (cont.)
   • Class III: Flight Deck Subclasses:
      • Critical: directing/controlling Aircraft
      • Non-Critical: other flight-line duties
       MANMED Chapter 15
• Section IV: Special Duty Exams and Standards-
  Article 15-63 (cont.)
  • Other U.S. Branches of Service
     • MOU- Navy accepts physical standards of pilot’s parent
       service; Navy maintains final risk decesion
  • Foreign Nationals: NATO STANAG [responsibilities]
     • Parent nation: 1* standards, perm DQ, grounding >30 days
     • Host nation: periodic exam procedures, grounding <30 days
  • Special Passengers
     • OPNAV 3710.7 (NATOPS)
         MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-64 Authorized Aviation Medical Examiners
        (to perform flight physicals on Naval Aviators)
   • Medical Officer
   • Navy FS: Authorized by Chief, BUMED, with privileges
   • US Army/USAF FS: Authorized by their respective authority, with
     privileges to perform flight physicals
• Art. 15-65 Aviation Applicants
   • SNA more rigid standards than Designated Class I
       • Class I, SG1 plus additional
       • SNA applicants can NOT have aircraft restrictions
           – Exceptions case-by-case
       • SNA already in pipeline- considered Designated (pseudo?)
        MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-66 Qualification
   • PQ: Physically Qualified
   • NPQ: NOT Physically Qualified
   • CD: Considered Disqualifying
   • NCD: NOT Considered Disqualifying
   • WR: Waiver Recommended
   • WG (date): Waiver Granted (BUPERS Date!)
   • FS, NAMI, BUMED Recommend Waivers
   • BUPERS, CMC GRANT Waivers
         MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-67 Aeronautical Adaptability
   • Concerns:
       • Personality Disorders AA: Aeronautically Adaptable
       • Maladaptive Personality Traits
       • USAF- also include Persistent Airsickness- Administrative!
   • NAA: NOT Aeronautically Adaptable
       • FS suggests NAA
       • ONLY NAMI PSY can determine NAA!
        MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-68
   • FNAEB- Fee’ Nab
      • Field Naval Aviator Evaluation Board
      • Safety, Punitive, “Wings at Stake”
      • Aviation Violation, Mishap, Performance issues

   • Aeromedical Clearance PREREQUISITE
      • Independent FS
      • Second FS on actual Board
      • Waiver for single FS in rare operational circumstances
        MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-70: Exam Frequency
   • Annual for Designated
      • “Vulnerability Window:” Month before to end of birth month
   • SNA- PE within 2 years of starting training
   • Long Form 2807/2808 required after 60 days grounding
   • OPNAVINST 3710.7T (NATOPS)
      • “Flight personnel delinquent in receiving an aviation physical
        examination SHALL not be scheduled to fly unless a waiver
        has been granted by BUPERS/CMC.”
         MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-72: Abbreviated PE: NAVMED 6410/10
   • SHORT FORM- Used for Annual Exam
      • Except age: 25, 30, 35, 40, 45, 50 and annually
        thereafter
• Art. 15-73: Check-in Exam (Special Duty Abstract)
• Art. 15-74: Post-Grounding (>60 days expected)
• Art. 15-75: Post-Hospitalization/Medical Board
         MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-77: Flight Clearance
   • UPCHIT NAVMED 6410/2 (FS Only)
      • Expires in one year at end of birth month
      • Expires based on FS determination
   • Down Chit NAVMED 6410/1 (Any Medical Provider)
      • Expires ONLY with UPCHIT
      • Exception: Dental self-expiring grounding notice
   • Special Duty Abstract NAVMED 6150/2
      • FILL IT OUT!!!
          MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-78: PE Submission to NAMI- REQUIRED
   •   Applicants
   •   Waiver requests and continuation
   •   Grounding Physical (expecting >60 days)
   •   Fitness to Fly- Long Form PE- those down >60 days
   •   Change of Service Group
   •   After MED BOARD
   •   NPQ change to PQ
   •   Post Mishap Exam
   •   Retirement/Separation
          MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-79: Waiver Requests
   • AMS- Aeromedical Summary
      •   Member’s Aviation Status
      •   Previous Waivers
      •   Details of Condition and evaluation
      •   Specific waiver requirements: ARWG
      •   Endorsement by member’s CO
      •   KEEP IT SIMPLE BUT COMPLETE!
   • Physical Exam- long form preferred
   • Supporting Documents
          MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-80: Local Board of FS: LBFS
   • Convened by CO on FS Recommendation
      •   3 medical officers, at least 2 FS
      •   Findings and recommendations in AMS to NAMI
      •   ARWG restricts LBFS in some cases
      •   NOT if BUPERS has denied a waiver
      •   UPCHIT limited to 90 DAYS!
        MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-81: Special Board of FS: SBFS
   • Requested by CO to NAMI OIC as appeal
   • Full exam at NAMI (7 days) Aeromedical
     Advisor/Specialists
   • Review by a Board of FS appointed by NAMI OIC
   • Member’s CO and FS present
   • Private Ballot
         MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-82: Senior Board of FS- Final Appeal
   • Requested by BUMED, CNO, CMC
   • 5 Senior Members
      • 3 BUMED Senior FS
      • 1 Senior Line Officer
      • 1 Presiding Officer
          – Deputy Chief of BUMED OPS
          – Advisor: Director of Aerospace Medicine
        MANMED Chapter 15
• Section IV: Special Duty Exams and Standards
• Art. 15-83: FITNESS for Aviation Duty
   • MUST MEET STANDARDS FOR GENERAL DUTY
   • MUST MEET STANDARDS FOR SPECIAL DUTY
   • Must be FIT for FULL DUTY prior to consideration
   • ARWG is used AFTER applying MANMED Standards
      MANMED Chapter 15
• Section IV cont.
  • Art. 15-84: Disqualifying conditions

• Section V: Women’s Health
               Waiver Rationale
• Purposes:
• A waiver grants a variance from established
  physical standards to permit member to maintain
  flight status.
• Gathers information on the condition and outcomes
• Allows FS and Code 342 to track and scrutinize the
  medical issue
• Continuity of Care despite Changing FS
        Waiver Sanity Check...

Would a reasonable and knowledgeable person
 consider the condition potentially detrimental
 (now or in the future) to mission
 completion, safety of flight or emergency
 egress?
      Consider Type of Duty


• Not all flight personnel equal in
 responsibility
F-18 pilot, single seat, carrier based
AV8 Harrier Pilot on LHA
P-3 Naval Flight Officer
   Sensor Operator




Rescue Swimmer
Crew Chief
Flight attendant
UAV Operators
Air Traffic Controllers
    AEROMEDICAL SUMMARY
           (AMS)

•   Best form of Communication with NAMI
•   Include current FS contact information
•   Keep it Simple, keep it complete
•   Use templates
•   NAMI processes waivers based on
    information provided- No Assumptions.
      For any questions:
          Code 342:
 Comm: 850-452-2257 (ext. 1068)
   DSN: 922-2257 (ext. 1068).

E-mail questions can be addressed to:
  code427-NOMI@med.navy.mil
END

				
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