Downloaded from https://www.everyspec.com c. Endocarditis with any residual abnormality or if associated with valvular, congenital, or hypertrophic myocardial disease. d. Heart block (second degree or third degree AV block) and symptomatic bradyarrhythmias, even in the absence of organic heart disease or syncope. Wenckebach second degree heart block occurring in healthy asymptomatic individu- als without evidence of organic heart disease is not a cause for referral to a PEB. None of these conditions is cause for MEB/PEB when associated with recognizable temporary precipitating conditions: for example, perioperative period, hypoxia, electrolyte disturbance, drug toxicity, acute illness. e.
Myocardial disease, New York Heart Association or Canadian Cardiovascular Society Functional Class II or worse. (See table 3–1.) f. Ventricular flutter and fibrillation, ventricular tachycardia when potentially life threatening (for example, when associated with forms of heart disease that are recognized to predispose to increased risk of death and when there is no definitive therapy available to reduce this risk) or when symptomatic enough to interfere with the performance of duty. None of these ventricular arrhythmias are a cause for medical board referral to a PEB when associated with recognizable temporary precipitating conditions:
for example, perioperative period, hypoxia, electrolyte disturbance, drug toxicity, or acute illness. g. Sudden cardiac death, when an individual survives sudden cardiac death that is not associated with a temporary or treatable cause, and when there is no definitive therapy available to reduce the risk of recurrent sudden cardiac death. h. Hypertrophic cardiomyopathy when it restricts activity. i. Pericarditis as follows: (1) Chronic constrictive pericarditis unless successful remedial surgery has been performed. (2) Chronic serous pericarditis. j. Valvular heart disease with cardiac insufficiency at functional capacity of Class II or worse as defined by the New York Heart Association.
(See table 3–1.) k. Ventricular premature contractions with frequent or continuous attacks, whether or not associated with organic heart disease, accompanied by discomfort or fear of such a degree as to interfere with the satisfactory performance of duty. l. Recurrent syncope or near syncope of cardiovascular etiology that is not controlled or when it interferes with the performance of duty, even if the etiology is unknown. m. Any cardiovascular disorder requiring chronic drug therapy in order to prevent the occurrence of potentially fatal or severely symptomatic events that would interfere with duty performance. n.
Congenital heart disease that has long term risks, complications, or impact on duty performance. The exception would be those congenital heart disease conditions that can be repaired with resolution of long term risks, complica- tions, and impact on duty performance. 3–22. Vascular system The causes for referral to an MEB are as follows: a. Arteriosclerosis obliterans when any of the following pertain: (1) Intermittent claudication of sufficient severity to produce discomfort and inability to complete a walk of 200 yards or less on level ground at 112 steps per minute without a rest.
(2) Objective evidence of arterial disease with symptoms of claudication, ischemic rest pain, or with gangrenous or ulcerative skin changes of a permanent degree in the distal extremity. (3) Involvement of more than one organ, system, or anatomic region (the lower extremities comprise one region for this purpose) with symptoms of arterial insufficiency. b. Major cardiovascular anomalies including coarctation of the aorta, unless satisfactorily treated by surgical correction or other newly developed techniques, and without any residual abnormalities or complications. c.
Aneurysm of any vessel not correctable by surgery and aneurysm corrected by surgery after a period of up to 90 days trial of duty that results in the individual’s inability to perform satisfactory duty. The policies for trial of duty, profiling, and referral to an MEB and a PEB (as outlined in para 3–25) apply. d. Periarteritis nodosa with definite evidence of functional impairment. e. Chronic venous insufficiency (postphlebitic syndrome) when more than mild and symptomatic despite elastic support. f. Raynaud’s phenomenon manifested by trophic changes of the involved parts characterized by scarring of the skin or ulceration. g.
Thromboangiitis obliterans with intermittent claudication of sufficient severity to produce discomfort and inability to complete a walk of 200 yards or less on level ground at 112 steps per minute without rest, or other complications. h. Thrombophlebitis when repeated attacks requiring treatment are of such frequency as to interfere with the satisfactory performance of duty. i. Varicose veins that are severe and symptomatic despite therapy. 28 AR 40–501 • 14 December 2007