Consolidated CONUS Replacement Center (CCRC)

Fort Benning, Georgia 31905

Medical Requirements

(Updated 10 April 2009)

Civilian Medical Processing

1. We recommend all civilian personnel:

a. Review Chapter 7, Personnel Policy Guidance (PPG) which is located at www.armyg1.army.mil/militarypersonnel/ppg and contains a detail description of the medical requirements for all deployment locations.

b. We strongly recommend all personnel provide this document to their health care providers long before arriving to the CRC in order to accomplish these medical requirements and avoid “delay deploy” status. Later, review periodically to ensure all required items are brought or accomplished.

c. Obtain as many required vaccinations and lab tests as possible, at home station. This will reduce the number of vaccinations given on the same day, during medical processing, and help avoid “delay deploy” status.

d. Bring to Fort Benning and to Medical SRP all items listed below, even if you are “TDY and Return”. This includes your 90 days of supply of medications, glasses, protective mask inserts, etc, as described below. Failure to bring all of these items will result in your being designated “Delay Deploy” until you acquire these required items.

2. Civilians who are employed by companies that do not have a contractual agreement with the US Government to receive routine vaccinations or laboratory tests performed by MEDDAC, will be considered “Delay Deploy,” until documentation of completion is presented. All vaccinations and laboratory tests except Anthrax, smallpox, G6PD, and DNA testing are completed at the civilian deployee or contractor’s expense either at home station or CRC.

3. Below are specific requirements for civilian personnel deploying to CENTCOM. CENTCOM includes the countries of Afghanistan, Bahrain, Djibouti, Eritrea, Ethiopia, Iran, Iraq, Jordan, Kazakhstan, Kenya, Kuwait, Kyrgyzstan, Lebanon, Oman, Pakistan, Qatar, Saudi Arabia, Seychelles, Somalia, Sudan, Syria, Tajikistan, Turkmenistan, United Arab Emirates, Uzbekistan, and Yemen.

Bring to Medical SRP

1. Bring to medical processing the following even if you are TDY and return (Failure to bring these items will result in your being designated “Delay Deploy”):

a. Orders that identify deployment location. Without orders MEDDAC cannot perform medical processing.

b. Documentation of your “Mission Essential” or “Emergency Essential” status. This should be clearly stated on your orders or Letter of Agreement.

c. Identification cards if are also a DoD beneficiary (family member or retiree)

d. DD Form DD Form 2766, “Adult Preventive and Chronic Care” Flowsheet, which serves as your deployment medical record.

e. Completed forms used for Medical SRP (see related links on CRC website)

f. Copy of medical records related to current and past significant medical problems that that may affect deployability.

g. Copy of medical records related to “woman’s health”:

(1) PAP smear unless deployee is 30 years or older with no history of dysplasia in the past and has had three consecutive normal pap smears. If so, last pap smear result is valid for two years. Otherwise, need:

(a) Results not over 6 months old for deployments greater than one year.

(b) Results not over 9 months old for deployments less than one year.

(2) Mammogram results for women over 40 years old (results not over 1 year old).

(3) Do not assume these procedures can be accomplished at the CRC during the 6 days of processing and training.

h. Copy of medical records related to a physical exam less than one year old. Do not assume we can locate it in your electronic military health record.

(1) For contractors, any format is allowable, but must include:

(a) Vital signs, height, weight

(b) Systematic record of results (showing normal and abnormal results of examination) focusing on cardiovascular, pulmonary, orthopedic, neurological, endocrine, dermatological, psychological, visual and auditory conditions that may present hazard to the individual or others and/or preclude performing the related functional requirements in the deployed setting.

(c) The signature of the examining Health Care Provider and date performed.

(d) CBC and UA for contract deployees less than 40 years old (examining Health Care Provider will know the meaning).

(e) CBC, UA, CMP, PSA (males only), lipids, and EKG For contract deployees >40 years old or greater (examining provider will know the meaning).

(2) U.S. Government employees must have SF 78, Certificate of Medical Examination.

(3) Do not bring only a statement of health on a prescription form, FAA certificate, or similar documents unless these documents clearly state that the date the physical was done, contains all elements listed above, and states that the deployee meets all physical and psychological requirements for deployment.

(4) Results of previously completed Periodic Health Assessment (PHA) is not a substitute for a physical examination.

i. Copies of medical records related to further testing and/or follow-up as required by abnormalities found on physical examination.

j. Documentation of current vaccinations

(1) While MEDPROS is the prime source of proof of past vaccinations, do not assume we will have access to it during processing.

(2) PHS 731, Immunization Record (Yellow Shot Card)

(3) Any civilian record of vaccinations

k. Hearing aid and 6 months supply of batteries, if applicable.

l Copy of HIV results less than 90 days old, if you are “Mission Essential” or “Emergency Essential”, are deploying to CENTCOM AOR, and require smallpox vaccination.

m. Copy of blood type results

n. Allergy warning tags (if applicable).

o. Medications:

(1) Enough for the duration of your deployment or 90 days, which ever is less (including malaria prophylaxis medication).

(2) If you do not have the medication, you will be considered “delay deploy” until you acquire it.

(3) Do not bring only the written prescription as we must see the medications.

(4) Inform your health care provider that you require malaria prophylaxis medication if you are deploying to a malaria endemic area.

(5) Deploying contract civilians are not entitled to receive prescription medications from MEDDAC during the medical SRP.

(6) Be prepared to explain your method of receiving medication refills during the deployment. Do not assume the medication is available at the deployment location.

p. DD Form 2813, “Active Duty/Reserve Forces Dental Examination”, completed by a dentist before arrival to CRC. Should state that dentist has panograph on file in their office,

has performed dental exam in last one year and that you will require no dental work during the deployment.

q. Two pair prescriptive lenses eyewear (glasses).

r. One pair prescriptive protective mask inserts).

s. Prescription for eyewear (glasses) (must be < 2 years old).

t. Letter from eye doctor recommending deployment, if you had eye injury or eye surgery within 90 days of deployment.

2. Do not wear contact lenses to medical processing.

Required Vaccinations

1. We strongly recommend all personnel obtain as many required vaccinations as possible and as soon as possible at home station. This will reduce the number of vaccinations given on the same day, during medical processing, and help avoid “delay deploy” status. Contractors that do not have a contract that obligates the U.S. Government to furnish vaccinations will be in a “delay deploy” status until vaccinations are accomplished at a local clinic at the deployee’s expense.

2. Anthrax:

a. Is required for all civilians who are Mission or Emergency Essential if:

(1) Age 18-65

(2) CENTCOM or Korea deployment for > 15 consecutive days.

(3) Not administratively or medically exempted.

b. Is given as five dose series and annual boosters.

c. Is give during medical processing SRP to all eligible personnel if not previously done

3. Smallpox

a. Is required for all civilians who are “Mission Essential” or “Emergency Essential” if:

(1) Age 18-65

(2) Deploying to CENTCOM or Korea for > 15 consecutive days

(3) Not administratively/medically exempt

(4) Not vaccinated in last 10 years

b. Is given during medical processing SRP to all eligible personnel if not previously done

4. Hepatitis A: Is given as a two dose series at day 0 and 6 months later.

5. Hepatitis B: Is given as a three dose series at day 0, 30, and 5 months after day 30.

6. Influenza: Is given as a single dose during October-June each year

7. Meningococcal:

a. Is required for all civilians who are deploying to Djibouti, Ethiopia, Eritrea, Kenya and Somalia

b. Is given as one dose every 5 years.

8. Measles, Mumps, and Rubella:

a. Is required for all civilians unless one of the following applies:

(1) Have physician documentation of each disease, or:

(2) Are prior US Military, or:

(3) Have positive Titer blood tests, or:

(4) Have documentation of vaccination series complete.

9. Pneumovax: Is required for all civilians who have had their spleen removed.

10. Polio:

a. Is required for all civilians unless one of the following applies:

(1) Has physician Documentation disease, or:

(2) Is prior US Military, or:

(3) Has positive Titer blood tests, or:

(4) Has documentation of vaccination series complete.

11. Tetanus/Diphtheria/Pertussis: Is required as a onetime booster when next Tetanus diphtheria booster is needed.

12. Tuberculin skin test (PPD):

a. Is required within 3 months of deployment and results recorded in millimeter (mm) reading (read within 48-72 hours of administration).

b. If results are reported as > 10 mm, need a negative chest x-ray related to that negative to positive conversion.

13. Twinrix (combination Hepatitis A & B):

a. Is required for all civilian personnel as a substitute for the individual Hepatitis A and B vaccines:

b. Is given as a three dose series at Day 0, Day 30, and 5 months after day 30.

14. Typhoid: Is given as a two dose series then a booster every two years or as a five tablet series given every five years.

15. Yellow Fever

a. Is required for all civilians if deploying to Djibouti, Ethiopia, Eritrea, Kenya, Somalia, and Sudan.

b. Is given once every ten years.

16. Varicella:

a. Is required for all civilians who are deploying to a detainee or medical treatment facility location unless personnel have a history of having had chicken pox, documentation of vaccination, or have a positive Varicella titer

b. Is given once.

Required Laboratory Tests

1. We strongly recommend all personnel obtain as many required lab tests as possible at home station. This will reduce the possibility “delay deploy” status.

2. Contractors that do not have a contract that obligates the U.S. Government to furnish lab testing will be in a “delay deploy” status until required tests are performed at a local clinic at the deployee’s expense and results are available.

2. HIV:

a. Must have documented negative HIV within 90 days of deployment.

b. Testing is performed at medical processing, if deployee is eligible for care.

3. Deployment serum specimen:

a. Must be obtained within one year of deployment

b. Is performed at medical processing for all deployees, if needed.

3. G6PD:

a. Is done once in a person’s life.

b. Demonstrates the ability to receive Primaquine anti-malaria medication on redeployment.

b. Testing is performed at medical processing, if deployee is eligible for care.

4. DNA:

a. Is done once in a person’s life.

b. Is performed at medical processing for all deployees, if needed.

5. ABO/Rh Blood Type:

a. Acceptable proof is MEDPROS record, Red Cross donor card, lab results form, physician’s statement.

b. Testing is performed at medical processing, if deployee is eligible for care.

6. Pregnancy test:

a. Required for all female civilians unless providing medical documentation of a bilateral tubal ligation or hysterectomy or being post-menopausal state

b. Is performed at medical processing for all deployees, if needed.

Amplification of the Minimal Standards of Fitness for Deployment to CENTCOM

1. General. This section provides amplification of the minimal standards of fitness for deployment to the CENTCOM AOR, including a list of medical conditions that may be sufficient to deny medical clearance for or to disapprove deployment of a civilian employee contractor. The list of deployment-limiting conditions is not comprehensive; there are many more conditions that could be cause to deny medical clearance for deployment. Possession of one or more of the conditions listed in this chapter does not automatically mean that the individual may not deploy. Rather, it imposes the requirement to obtain a knowledgeable physician’s opinion as to the health status and advisability of the deployment. “Medical conditions” as used here also include those health conditions usually referred to as dental, oral, psychological and/or emotional. In addition to the PPG and Mod 9, the Under Secretary of Defense Memorandum titled, “Policy Guidance for Medical Deferral Pending Deployment to Theaters of Operation” dated 09 FEB 06 and Assistant Secretary of Defense Memorandum titled, “Policy Guidance for Deployment-Limiting Psychiatric Conditions and Medications” dated 07 NOV 06 are also useful references.

2. In addition to the health status of the deploying civilian, the medical authority must take into consideration the following facts:

a. Medical care in theater is not as robust and amply available as that in the continental U.S. If maintaining an individual’s health requires frequent or intense medical management and/or specialist care, laboratory testing, or ancillary services, they should not deploy.

b. The individual must take all required medications and medical supplies with him or her. Replacements may not be available in theater.

c. Medical maintenance support for personal medical devices is not available. Common household electrical current (110V AC) is not universally or consistently available.

d. In addition to the individual’s duties, the environmental conditions include extremes of temperature, physiologic demand (water, mineral, salt, and heat management), and poor air quality (especially particulates), while the operating conditions impose

extremes of diet (to include fat, salt, and caloric levels), discomfort, sleep deprivation, emotional stress, and circadian disruption. If maintaining an individual’s health requires avoidance of these extremes or excursions, she/he should not deploy.

3. The issues listed in para 2 should assist the evaluating medical authority to make qualified judgments as to whether a condition is deployable. Any medical condition that markedly impairs an individual’s daily function is grounds for disapproval. Evaluation of functional capacity to determine fitness in conditions of physiologic demand is encouraged to make a decision, such as graded exercise testing when there is coronary artery disease or significant risk thereof. The evaluating care provider should pay special attention to hematologic, cardiovascular, pulmonary, orthopedic, neurological, endocrine, dermatological, psychological, visual, and auditory conditions which may present a hazard to the individual or others and/or prelude performing functional requirements in the deployed setting. Also, the amount of medications being taken and their suitability and availability in the theater environment must be considered.

4. Nothing in this guidance document should be construed as authorizing use of defense health program or military health system resources for such evaluations. Generally, Defense Health Program or military health systems resources are not authorized for the purpose of pre-deployment or travel medicine evaluations for contractor employees.

5. The general guidance from MOD 9 section 15B applies to:

a. All U.S. Government civilian employees and contractor employees deploying to theater must be medically and psychologically fit for deployment and posses a current physical (not over 12 months old). Fitness specifically includes the ability to accomplish the tasks and duties unique to a particular operation, and ability to tolerate the environment and operational conditions of the deployed location.

b. Personnel who have existing medical conditions may deploy if:

(1) An approved medical waiver, IAW Section 15.B.3. is documented in the medical record.

(2) And all of the following conditions are met:

(a) The conditioning(s) is/are not of such a nature that an unexpected worsening or physical trauma is likely to have a medically grave outcome.

(b) The condition(s) is/are stable; that is, currently under medical care, and reasonably anticipated by the pre-deployment medical evaluator not to worsen during the deployment under available care in theater, in light of physical, physiological, psychological and nutritional impacts and effects of the duties, location, and limited medical capabilities at the location.

(c) Any required ongoing health care or medications must have no special handling, storage, or other requirements (e.g., refrigeration/cold chain, electrical power, etc.).

(d) No need or anticipation of duty limitations that preclude performance of duty or an accommodation imposed by the medical condition.

(e) There is no need for routine evacuation out of theater for continuing diagnostics or other evaluations (all such evaluations must be accomplished prior to deployment)

7. Documented medical conditions precluding medical clearance. The medical evaluator must carefully consider whether the climate, altitude, nature of available food and housing, availability of medical, behavioral health, dental, surgical, and laboratory services, or whether other environmental and operational factors may be hazardous to the deploying person’s health because of a known physical condition. Medical clearance to deploy with any of the following documented medical conditions may be granted IAW MOD 9 Section 15.B. If personnel who are obviously medically unfit for deployment are found deployed, contact the CENTCOM Surgeon with details of the case. A list of all possible diagnoses and their severity that may cause an individual to be non-deployable would be too expansive. In general, individuals with the following conditions, based on an individual assessment as per DoD 6490.03, should not deploy:

a. Conditions which prevent the wear of personal protective equipment, including protective mask, ballistic helmet, body armor, and chemical/biological protective garments, regardless of the nature of the condition that causes the inability.

b. Conditions which prohibit required theater immunizations (other than smallpox & anthrax per current guidance) or medications (such as anti-malarials, chemical and biological antidotes, and other chemoprophylactic antibiotics).

c. Any chronic medical condition that requires frequent clinical visits, that fails to respond to adequate conservative treatment, necessitates significant limitation of physical activity, or constitutes increased risk of illness, injury, or infection.

d. Any unresolved acute illness or injury that would impair one’s duty of performance during the duration of the deployment.

e. Blood-borne diseases that may be transmitted to others in a deployed environment. Confirmed HIV antibody positivity is disqualifying for deployment unless the civilian has obtain written authorization to deploy from the host nation.

f. Any medical condition that could result in sudden incapacitation such as seizure disorders (within the past year or Diabetes Mellitus, Type I) or Diabetes Mellitus Type II on pharmacological therapy with Hg A1C greater than 7.0.

g. Symptomatic coronary artery disease.

h. Myocardial infarction within one year of deployment.

i. Coronary artery bypass graft, coronary artery angioplasty, carotid endarterectomy, other arterial stinting, or aneurysm repair within one year of deployment.

j. Cardiac dyshythmias or arrhythmias, either symptomatic or requiring medication, electro-physiologic control, or automatic implantable cardiac defibrillator.

k. Hypertension not controlled with medication or that requires frequent monitoring; current heart failure.

l. Morbid obesity (BMI≥40) in accordance with National Heart Lung and Blood Institute guidelines.

m. Asthma that has a Forced Expiratory Volume-1≤50% of predicted despite appropriate therapy that has required hospitalization at least 2 times in the past 12 months, or that requires daily systemic (not inhalational) steroids.

n. Hearing loss. The requirement for use of a hearing aid does not necessarily preclude deployment; however, the individual must have sufficient unaided hearing to perform duties safely.

o. Vision loss. Best corrected visual acuity must meet job requirements to safely perform duties.

p. Therapeutic anticoagulation.

q. Biologic Response Modifiers (immune suppressors) such as Abatacept, Humira, Enbrel, Remicade, chronic steroidals, etc.

r. Cancer for which the individual is receiving continuing treatment or requiring frequent subspecialist examination and/or laboratory testing during the anticipated duration of the deployment.

s. Precancerous lesions that have not been treated and/or evaluated and that require treatment/evaluation during the anticipated duration of the deployment.

t. Dental and oral conditions requiring or likely to require urgent dental care within six months’ time, active orthodontic care, conditions requiring endodontic care, uncontrolled periodontal disease, conditions requiring prosthodontic care, conditions with immediate restorative dentistry needs, conditions with a current requirement for oral-maxillofacial surgery, or individuals without a dental exam within the last 12 months. Individuals being evaluated by a non-DoD civilian dentist should use a DD Form 2813, as proof of dental examination.

u. History of heat stroke.

v. Meniere’s disease or other vertiginous/motions sickness disorder, unless well controlled on medications available in theater.

w. Recurrent syncope for any reason.

x. Any musculoskeletal condition that significantly impairs performance of duties in a deployed environment.

y. Any medical condition that requires surgery (e.g., unrepaired hernia) or for which surgery has been performed and

the patient requires rehabilitation or additional surgery to remove devices (e.g., external fixator placement).

z. Tracheostomy or aphonia.

aa. Renalithiasis, current symptomatic.

bb. Active tuberculosis.

cc. Pregnancy.

dd. Any medical condition that requires durable medical equipment or appliances (e.g., CPAP, TENS, etc) or that requires periodic evaluation/treatment by medical specialists not readily available in theater.

ee. Psychotic and Bipolar Disorders are disqualifying for deployment. For detailed guidance on deployment-limiting psychiatric conditions or psychotropic medications, refer to Health Affairs Policy Memorandum, “Policy Guidance for Deployment-Limiting Psychiatric Conditions and Medications,” November 7, 2006.

ff. Psychiatric disorders under treatment with fewer than three months of demonstrated stability from the last change in treatment regimen.

gg. Clinical psychiatric disorders with residual symptoms that impair duty of performance, recurrence of impairing symptoms in the deployed environment.

hh. Mental health conditions that pose a substantial risk for deterioration and/or recurrence of impairing symptoms in the deployed environment.

ii. Chronic medical conditions that require ongoing treatment with antipsychotics, lithium, or anticonvulsants.

MALARIA PROPHYLAXIS

COUNTRY MEDICATIONAfghanistan (year round) all area except at altitude >6,561 ft

Doxycycline

Bahrain NoneDjibouti MefloquineEgypt NoneEritrea MefloquineEthiopia MefloquineIran (March – November) DoxycyclineIraq NoneJordan NoneKazakhstan ChloroquineKenya-all area’s except Nairobi/altitudes >8K ft

Mefloquine

Kuwait NoneKyrgyzstan (year round) DoxycyclineOman MefloquinePakistan (year round) DoxycyclineQatar NoneSaudi Arabia (year round in western regions only)

Mefloquine

Somalia MefloquineSudan MefloquineTajikistan (May – October) DoxycyclineTurkmenistan (May – October) DoxycyclineUAE MefloquineUzbekistan (year round) DoxycyclineYemen (year round) Mefloquine

Medical Conditions that Prevent Civilians from Deploying

1. Pregnancy

2. Positive HIV (unless travel approved by host country)

3. BMI greater than 40

4. Use of anticoagulants (Coumadin or heparin or plavix and ASA combination)

5. Diabetes Mellitus Type One and use of injectable insulin

6. Diabetes Mellitus Type Two and use of medication and Hemoglobin A1C is greater than 7 (results must not be earlier than 3 months ago)

7. Current treatment for bipolar or psychosis illness

8. Psychiatric disorders under treatment with fewer than three months of demonstrated stability from last change in treatment regimen

Most Common Reasons for Civilians Not Deploying on Time

1. Missing documentation related to:

a. Vaccinations and lab tests already done.

b. Physical examinations, pap smears, and mammograms.

c. Significant medical problems identified on physical examination and not fully evaluated

d. Abnormal laboratory results identified on physical examination and not fully evaluated

2. Failure to bring two pair of glasses and one pair protective mask inserts.

3. Failure to bring prescription medications (including anti-malarials).

4. Assuming medical documentation is available in electronic medical record and that record is not available to on the day of medical processing

POC for specific questions is: mikki.johansen@us.army.mil