Downloaded from https://www.everyspec.com ab. Ulcers of the skin. Not responsive to treatment after an appropriate period of time if interfering with the satisfactory performance of duty. ac. Urticaria/Angioedema. Chronic, severe, and not responsive to treatment. ad. Xanthoma. Regardless of type, but only when interfering with the satisfactory performance of duty. ae. Intractable plantar keratosis, chronic. Requires frequent medical/surgical care or that interferes with the satisfac- tory performance of duty. af. Other skin disorders. If chronic or of a nature that requires frequent medical care, or interferes with the satisfactory performance of military duty. 3–39.
Spine, scapulae, ribs, and sacroiliac joints The causes for referral to an MEB are as follows (see also para 3–14): a. Dislocation. Congenital, of hip. b. Spina bifida. Demonstrable signs and moderate symptoms of root or cord involvement. c. Spondylolysis or spondylolisthesis. More than mild symptoms resulting in repeated outpatient visits, or repeated hospitalization or limitations effecting performance of duty. d. Coxa vara. More than moderate with pain, deformity, and arthritic changes. e. Herniation of nucleus pulposus.
More than mild symptoms following appropriate treatment or remedial measures, with sufficient objective findings to demonstrate interference with the satisfactory performance of duty. f. Kyphosis. More than moderate, interfering with military duties. g. Scoliosis. Severe deformity with over 2 inches deviation of tips of spinous process from the midline, or of lesser degree if recurrently symptomatic and interfering with military duties. h.
Nonradicular pain involving the cervical, thoracic, lumbosacral, or coccygeal spine, whether idiopathic or secondary to degenerative disc or joint disease, that fails to respond to adequate conservative treatment and necessi- tates significant limitation of physical activity. Range of motion (ROM) measurements should be obtained using a goniometer (a bubble goniometer/inclometer is also acceptable). SF Form 527 should be used to document the ROM and the method of measurement. Use the VA’s instructions for completion of spine and joint evaluations. This includes the six measurements shown on VASRD Plate V ROM of cervical and thoracolumbar spine. 3–40.
Systemic diseases The causes for referral to an MEB are as follows: a. Amyloidosis. b. Brucellosis. Chronic with substantiated, recurring febrile episodes, severe fatigue, lassitude, depression, or general malaise. c. Leprosy. Any type that seriously interferes with performance of duty or is not completely responsive to appropri- ate treatment. d. Myasthenia gravis. e. Mycosis, Blastomycosis, Coccidioidomycosis, and Histoplasmosis. Active, not responsive to therapy or requiring prolonged treatment, or when complicated by residuals that themselves are unfitting. f. Porphyria, cutanea tarda. g. Sarcoidosis. Progressive with severe or multiple organ involvement and not responsive to therapy. h.
Tuberculosis. (1) Meningitis, tuberculous. (2) Pulmonary tuberculosis (see para 3–26), tuberculous empyema, and tuberculous pleurisy. (3) Tuberculosis of the male genitalia. Involvement of the prostate or seminal vesicles and other instances not corrected by surgical excision, or when residuals are more than minimal, or are symptomatic. (4) Tuberculosis of the female genitalia. (5) Tuberculosis of the kidney. (6) Tuberculosis of the larynx. (7) Tuberculosis of the lymph nodes, skin, bone, joints, eyes, intestines, and peritoneum or mesentery. These will be evaluated on an individual basis, considering the associated involvement, residuals, and complications. i. Rheumatoid arthritis.
That interferes with successful performance of duty or requires geographic assignment limitations or requires medication for control that requires frequent monitoring by a physician due to debilitating or serious side effects. j. Spondyloarthropathies. Chronic or recurring episodes of arthritis causing functional impairment interfering with successful performance of duty supported by objective, subjective, and radiographic findings, or requires medication for control that requires frequent monitoring by a physician due to debilitating or serious side effects. (1) Ankylosingpondylitis. (2) Reiter’s syndrome. 34 AR 40–501 • 14 December 2007