Downloaded from https://www.everyspec.com detectable hepatitis B Deoxyribonucleic acid (DNA) viral load in serum. Chronic hepatitis C as documented by detectable hepatitis C RNA viral load in serum. g. Hernia, including inguinal, and other abdominal, except for small asymptomatic umbilical, with severe symptoms not relieved by dietary or medical therapy, or recurrent bleeding in spite of prescribed treatment or other hernias if symptomatic and if operative repair is contraindicated for medical reasons or when not amenable to surgical repair. h. Crohn’s Disease/Ileitis, regional, except when responding well to treatment. i.
Pancreatitis, chronic, with frequent abdominal pain of a severe nature; steatorrhea or disturbance of glucose metabolism requiring hypoglycemic agents. j. Peritoneal adhesions with recurring episodes of intestinal obstruction characterized by abdominal colicky pain, vomiting, and intractable constipation requiring frequent admissions to the hospital. k. Proctitis, chronic, with moderate to severe symptoms of bleeding, painful defecation, tenesmus, and diarrhea, and repeated admissions to the hospital. l.
Ulcer, duodenal, or gastric with repeated hospitalization, or “sick in quarters” because of frequent recurrence of symptoms (pain, vomiting, or bleeding) in spite of good medical management and supported by endoscopic evidence of activity. m. Ulcerative colitis, except when responding well to treatment. n. Rectum, stricture of with severe symptoms of obstruction characterized by intractable constipation, pain on defecation, or difficult bowel movements, requiring the regular use of laxatives or enemas, or requiring repeated hospitalization. 3–6. Gastrointestinal and abdominal surgery The causes for referral to an MEB are as follows: a.
Colectomy, partial or total, when more than mild symptoms of diarrhea remain or if complicated by colostomy. b. Colostomy, when permanent. c. Enterostomy, when permanent. d. Gastrectomy, total. e. Gastrectomy, subtotal, with or without vagotomy, or gastrojejunostomy, with or without vagotomy, when, in spite of good medical management, the individual develops “dumping syndrome” which persists for 6 months postoperative- ly; or develops frequent episodes of epigastric distress with characteristic circulatory symptoms or diarrhea persisting 6 months postoperatively; or continues to demonstrate appreciable weight loss 6 months postoperatively. f. Gastrostomy, when permanent. g.
Ileostomy, when permanent. h. Pancreatectomy. i. Pancreaticoduodenostomy, pancreaticogastrostomy, or pancreaticojejunostomy, followed by more than mild symp- toms of digestive disturbance, or requiring insulin. j. Proctectomy. k. Proctopexy, proctoplasty, proctorrhaphy, or proctotomy, if fecal incontinence remains after an appropriate treat- ment period. 3–7. Blood and blood-forming tissue diseases The causes for referral to an MEB are as follows: a. Anemia, hereditary, acquired, aplastic, or unspecified, when response to therapy is unsatisfactory, or when therapy is such as to require prolonged, intensive medical supervision. b. Hemolytic crisis, chronic and symptomatic. c.
Leukopenia, chronic, when response to therapy is unsatisfactory, or when therapy is such as to require prolonged, intensive medical supervision. d. Hypogammaglobulinemia with objective evidence of function deficiency and severe symptoms not controlled with treatment. e. Purpura and other bleeding diseases, when response to therapy is unsatisfactory, or when therapy is such as to require prolonged, intensive medical supervision. f. Thromboembolic disease when response to therapy is unsatisfactory, or when therapy is such as to require prolonged, intensive medical supervision. g. Splenomegaly, chronic. h.
HIV confirmed antibody positivity, with the presence of progressive clinical illness or immunological deficiency. For Active Army Soldiers and RC Soldiers on active duty for more than 30 days (except for training under 10 USC 10148), an MEB must be accomplished and, if appropriate, the Soldier must be referred to a PEB under AR 635–40. For RC Soldiers not on active duty for more than 30 days or on ADT under 10 USC 10148, referral to a PEB will be determined under AR 635–40.
Records of official diagnoses provided by private physicians (that is, civilian doctors providing evaluations under contract with Department of the Army (DA) or DOD, or civilian public health officials) 22 AR 40–501 • 14 December 2007