Downloaded from https://www.everyspec.com j. Cold injury. (See paragraph 3–46). 3–23. Miscellaneous cardiovascular conditions The causes for referral to an MEB are as follows: a. Hypertensive cardiovascular disease and hypertensive vascular disease. Diastolic pressure consistently more than 110 mmHg following an adequate period of therapy in an ambulatory status. b. Rheumatic fever, active, with heart damage. Recurrent attacks. 3–24. Surgery and other invasive procedures involving the heart, pericardium, or vascular system These procedures include newly developed techniques or prostheses not otherwise covered in this paragraph. The causes for referral to an MEB are as follows: a.
Permanent prosthetic valve implantation. b. Implantation of permanent pacemakers, antitachycardia and defibrillator devices, and similar newly developed devices. c. Reconstructive cardiovascular surgery employing exogenous grafting material. d. Vascular reconstruction, after a period of 90 days trial of duty when medically advisable, 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. e.
Coronary artery revascularization, with the option of a 120-day trial of duty based upon physician recommenda- tion when the individual is asymptomatic, without objective evidence of myocardial ischemia, and when other functional assessment (such as exercise testing and newly developed techniques) indicates that it is medically advisable. Any individual undergoing median sternotomy for surgery will be restricted from lifting 25 pounds or more, perform- ing pullups and pushups, or as otherwise prescribed by a physician for a period of 90 days from the date of surgery on DA Form 3349 (Physical Profile).
The policies for trial of duty, profiling, and referral to an MEB and a PEB (as outlined in para 3–25) apply. f. Heart or heart-lung transplantation. g. Coronary or valvular angioplasty procedures, with the option of a 180-day trial of duty based upon physician recommendation when the individual is asymptomatic, without objective evidence of myocardial ischemia, and when other functional assessment (such as cardiac catheterization, exercise testing, and newly developed techniques) indi- cates that it is medically advisable. The policies for trial of duty, profiling, and referral to an MEB and a PEB (as outlined in para 3–25) apply. h.
Cardiac arrhythmia ablation procedures, with the option of a 180-day trial of duty based upon physician recommendation when asymptomatic, and no evidence of any unfitting arrhythmia as noted in paragraph 3–21. The policies for trial of duty, MEB, and physical profile (as outlined in para 3–25) apply. i. Congenital heart disease with surgical or percutaneous repair procedures, with the option of a 180-day trial of duty based upon physician recommendations when the individual is asymptomatic and when other functional assessment procedures indicate it is advisable. The policies for trial of duty and referral to an MEB are outlined in paragraph 3–25. 3–25.
Trial of duty and profiling for cardiovascular conditions a. Trial of duty will be based upon a cardiologist’s recommendation when the individual is asymptomatic without objective evidence of myocardial ischemia, and when other functional assessments (such as coronary angiography, exercise testing, and newly developed techniques) indicate it is medically advisable. b. Prior to commencing the trial of duty period, an evaluation will be accomplished in all cases and a physical activity prescription on DA Form 3349 will be provided by the cardiologist. The results of the trial of duty will include the individual’s interim history, present condition, prognosis, and the final recommendations.
If the Soldier successfully completes the trial of duty, is considered a New York Heart Association Functional Class I, AND there are no physical or assignment restrictions, the Soldier may be returned to duty without referral to a MEB. If the Soldier has any physical restrictions after the trial of duty; he/she should be referred to an MEB. In addition to the documented results of the trial of duty, a detailed report from the commander or supervisor clearly describing the individual’s ability to accomplish assigned duties and to perform physical activity will be incorporated into the MEB record.
The results of the MEB and an updated DA Form 3349 will then be forwarded to a PEB if the Soldier does not met medical retention standards. For RC Soldiers not on active duty, the trial of duty may consider performance in the Soldier’s civilian position, as well as any military duty that may have been performed in the interim. c. The following profile guidelines supplement chapter 7. Individuals recommended for a trial of duty will be given a temporary P–3 profile with specific written limitations and instructions for physical and cardiovascular rehabilitation on DA Form 3349.
If the Soldier later is referred to a MEB, the completed MEB will include a permanent numerical designator in the “P” factor of the physical profile that is based on functional assessment as follows: (1) Numerical designator “1.” Individuals who are asymptomatic, without objective evidence of myocardial ischemia or other cardiovascular functional abnormality (New York Heart Association Functional Class I). 29 AR 40–501 • 14 December 2007