Downloaded from https://www.everyspec.com e. Multiple sclerosis, optic neuritis, transverse myelitis, and similar demyelinating disorders. f. Stroke, including both the effects of ischemia and hemorrhage, when residuals affect performance. g. Migraine, tension, or cluster headaches, when manifested by frequent incapacitating attacks. All such Soldiers will be referred to a neurologist, who will ascertain the cause of the headaches. If the neurologist feels a trial of prophylactic medicine is warranted, a 3-month trial of therapy can be initiated. If the headaches are not adequately controlled at the end of the 3 months, the Soldier will undergo an MEB for referral to a PEB.
If the neurologist feels the Soldier is unlikely to respond to therapy, the Soldier can be referred directly to MEB. h. Narcolepsy, sleepwalking, or similar sleep disorders. (See para 3–41.) The evaluation and treatment of these diagnoses by a neurologist or other sleep specialist should be routinely sufficient. i. Seizure disorders and epilepsy. Seizures by themselves are not disqualifying unless they are manifestations of epilepsy. However, they may be considered along with other disabilities in judging fitness. In general, epilepsy is disqualifying unless the Soldier can be maintained free of clinical seizures of all types by nontoxic doses of medications.
The following guidance applies when determining whether a Soldier will be referred to an MEB. (1) All active duty Soldiers with suspected epilepsy must be evaluated by a neurologist who will determine whether epilepsy exists and whether the Soldier should be given a trial of therapy on active duty or referred directly to an MEB for referral to a PEB.
In making the determination, the neurologist may consider the underlying cause, EEG findings, type of seizure, duration of epilepsy, family history, Soldier’s likelihood of compliance with therapeutic program, absence of substance abuse, or any other clinical factor influencing the probability of control or the Soldier’s ability to perform duty during the trial of treatment. (2) If a trial of duty on treatment is elected by the neurologist, the Soldier will be given a temporary P–3 profile with as few restrictions as possible.
(3) Once the Soldier has been seizure free for 1 year, the profile may be reduced to a P–2 profile with restrictions specifying no assignment to an area where medical treatment is not available. (4) If seizures recur beyond 6 months after the initiation of treatment, the Soldier will be referred to an MEB. (5) Should seizures recur during a later attempt to withdraw medications or during transient illness, referral to a PEB is at the discretion of the physician or MEB. (6) If the Soldier has remained seizure free for 36 months, he or she may be removed from profile restrictions. (7) Recurrent pseudoseizures are most commonly seen in the presence of epilepsy.
As such, they are disqualifying under the same rules as epilepsy. While each case may be individualized, their evaluation by a neurologist should be routinely sufficient. j. Any other neurologic conditions, Traumatic Brain Injury (TBI) or other etiology, when after adequate treatment there remains residual symptoms and impairments such as persistent severe headaches, uncontrolled seizures, weak- ness, paralysis, or atrophy of important muscle groups, deformity, uncoordination, tremor, pain, or sensory disturbance, alteration of consciousness, speech, personality, or mental function of such a degree as to significantly interfere with performance of duty. Note.
Diagnostic concepts and terms used in paragraphs 3–31 through 3–37 are in consonance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV). The minimum psychiatric evaluation will include Axis I, II, and III. 3–31. Disorders with psychotic features The causes for referral to an MEB are mental disorders not secondary to intoxication, infectious, toxic, or other organic causes, with gross impairment in reality testing, resulting in interference with duty or social adjustment. 3–32. Mood disorders The causes for referral to an MEB are as follows: a. Persistence or recurrence of symptoms sufficient to require extended or recurrent hospitalization; or b.
Persistence or recurrence of symptoms necessitating limitations of duty or duty in protected environment; or c. Persistence or recurrence of symptoms resulting in interference with effective military performance. 3–33. Anxiety, somatoform, or dissociative disorders The causes for referral to an MEB are as follows: a. Persistence or recurrence of symptoms sufficient to require extended or recurrent hospitalization; or b. Persistence or recurrence of symptoms necessitating limitations of duty or duty in protected environment; or c. Persistence or recurrence of symptoms resulting in interference with effective military performance. 3–34.
Dementia and other cognitive disorders due to general medical condition The causes for referral to an MEB include persistence of symptoms or associated personality change sufficient to interfere with the performance of duty or social adjustment. 32 AR 40–501 • 14 December 2007