Attmt 10A Border Patrol Agent - Medical Requirements.pdf.pdf

U.S. Customs and Border Protection Border Patrol Agent, 1896 Job Series Medical Requirements

Implementation Date: September 1, 2024 For Pre-employment and Incumbent Application

Permission to make derivative documents must be obtained from

Office of Human Resources Management Medical and Fitness Branch Chief https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.logolynx.com%2Ftopic%2Fus%2Bborder%2Bpatrol&psig=AOvVaw3cFIbAAzuHP08JlO2Ywi35&ust=1587502987103000&source=images&cd=vfe&ved=0CAIQjRxqFwoTCJjf_9jz9-gCFQAAAAAdAAAAABAD

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Table of Contents

Page

Introductory Overview 3 Cardiovascular 3 Dermatology 6 Diabetes 6 Environmental Conditions 7 Gastrointestinal 8 Genitourinary 8 Hearing 8 Infectious Diseases 9 Medications 9 Musculoskeletal 9 Neurological 12 Nose, Pharynx, Larynx, and Trachea 13 Psychiatric and Substance Use Disorders 13 Renal 14 Respiratory 14 Sleep Apnea 15 Tumors and Malignancies 15 Vision 15 References 17

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INTRODUCTORY OVERVIEW

The Border Patrol Agent, 1896 Job Series is an arduous and hazardous law enforcement position involving a high degree of responsibility for the public and sensitive national security concerns. The job series is an exclusive U.S. Customs and Border Protection (CBP) occupation and the medical and physical requirements apply to the series, inclusive of both front-line and supervisory management personnel.

Title 5, Code of Federal Regulations (C.F.R.) Part 339, Medical Qualification Determinations, authorizes CBP to establish necessary medical standards and physical requirements for this job series and once established, to conduct medical evaluations to determine if the nature of a medical condition affects safe and efficient job performance.

The following standards apply to pre-employment and incumbent medical qualification determinations made pursuant to 5 C.F.R. Part 339. The standards will be interpreted and implemented in accordance with the definitions, processes, and requirements of 5 C.F.R. Part 339 and other guidance or directives from the Office of Personnel Management, the Department of Homeland Security, and/or CBP.

The standards represent non-exhaustive examples of medical conditions that may be disqualifying. Any medical condition affecting the ability to safely and efficiently perform the essential job functions and physical requirements, has the potential for sudden or subtle incapacitation, or could otherwise place at risk the safety of self or others, national security, or the continuity of business operations may be disqualifying. All medical conditions will be reviewed on a case-by-case basis to determine an individual’s ability to safely and efficiently perform the duties and requirements of the position. Individuals with medical conditions described in these standards as “is/are disqualifying” will be presumed to be medically disqualified.

CARDIOVASCULAR

The occupational significance of this body system concerns the ability of the heart and vascular system to provide the functional work capacity to meet the oxygen demands of the physical requirements of the position. Any condition that would interfere with heart function could render an individual unable to meet the functional requirements through sudden or subtle incapacitation.

Angina - Without Any Evidence of Underlying Cardiac Disease

• Stable Angina and Unstable Angina will be reviewed on a case-by-case basis considering the ability to meet the physical requirements of the position and to safely and efficiently perform the essential job functions.

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Arrhythmias

• Arrhythmias necessitating the need for a Pacemaker or Automatic Implantable

Cardioverter Defibrillator (AICD) are disqualifying.

• Arrhythmias requiring the use of cardiac medications may be disqualifying.

Coronary Artery Disease Known Coronary Artery Disease, including Myocardial Infarction is disqualifying, unless all the following conditions are met:

• No Angina.

• Left Ventricle Ejection Fraction of 40% or more within the past 12 months.

• No ischemia on an imaging exercise stress test that reaches a level of at least 12 metabolic equivalents (METs) within the past 12 months.

• If prescribed, a stable and compliant regimen of cardiovascular medications for the past month.

• A recovery period of 1 month after Percutaneous Coronary Intervention; 3 months after a Myocardial Infarction; and 6 months after Coronary Artery Bypass Graft Surgery.

Stage I Hypertension

• Systolic Blood Pressure 140 to 159 or Diastolic Blood Pressure 90 to 99 may be disqualifying.

Stage II Hypertension

• Systolic Blood Pressure 160 to 179 or Diastolic Blood Pressure 100 to 109 may be disqualifying.

• Any end-organ damage caused by Hypertension (e.g., Stroke, Nephropathy, or

Retinopathy) is disqualifying unless a normal exercise stress test is obtained within the past 12 months at a level of at least 12 metabolic equivalents (METs).

Stage III Hypertension

• Systolic Blood Pressure 180 or greater or Diastolic Blood Pressure 110 or greater is disqualifying.

• Reevaluation after 3 months of treatment compliance.

Post-Coronary Artery Bypass Graft (CABG) Surgery Individuals who have undergone bypass graft surgery with or without myocardial damage must be evaluated and meet the following criteria:

• Minimum recovery period of 6 months.

• No Angina.

• Healed surgical sites (sternum and leg).

• No ischemia on an imaging exercise stress test that reaches a level of at least 12 metabolic equivalents (METs), conducted at least 3 months after the event but within the past 12 months.

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• Chest X-ray for evaluation of pleural effusions post procedure.

• Normal left ventricular function.

• If prescribed, a stable and compliant regimen of cardiovascular medications for the past month.

Post-Myocardial Infarction The risk of a major cardiac event is greatest within the first few months after a Myocardial Infarction. Individuals who have experienced a Myocardial Infarction must be evaluated after the cardiac incident and annually, and must meet the following criteria:

• Minimum recovery period of 3 months.

• No Angina.

• Normal Left Ventricular Function.

• Normal imaging exercise stress test that reaches a level of at least 12 metabolic equivalents (METs) after the incident and within the past 12 months.

• If prescribed, a stable and compliant regimen of cardiovascular medications for the past month.

Post-Percutaneous Coronary Intervention (PCI) Coronary Angioplasty Individuals who have undergone PCI/Coronary Angioplasty without myocardial damage must meet the following criteria:

• Be evaluated by a Cardiac Specialist post procedure and within the past 12 months.

• Minimum recovery period of 1 week.

• No Angina.

• No evidence of significant hematoma, pseudoaneurysm, or infection at access site.

• Normal Left Ventricular Function.

• Normal imaging exercise stress test that reaches a level of at least 12 metabolic equivalents (METs) after the procedure and within the past 12 months.

• If prescribed, a stable and compliant regimen of cardiovascular medications for the past month.

Cardiac Conditions and Electrocardiogram (EKG) Abnormalities

• Various cardiac conditions may be further evaluated by a Cardiologist, through the use of an Electrocardiogram (EKG).

• Any EKG abnormalities which demonstrate disease or arrhythmias incompatible with functional work capacity will be disqualifying.

Cardiac Conditions and Stress Tests Various cardiac conditions may be further evaluated by a Cardiologist, through the use of a Stress Test. Any of the following criteria found during the Stress Test may be disqualifying:

• Inability to reach 12 metabolic equivalents (METs).

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• Symptoms of Ischemia.

• Ischemic changes on Electrocardiogram.

• Significant Arrhythmias (e.g., frequent Premature Ventricular Contractions, Couplets, or Ventricular Tachycardia) or conduction abnormalities.

• Hypertensive response to exercise with Systolic Blood Pressure greater than 250 or

Diastolic Blood Pressure greater than 115.

• Exercise-induced Hypotension.

DERMATOLOGY

Dermatology Conditions

• Will be reviewed on a case-by-case basis considering the ability to meet the physical requirements of the position and to safely and efficiently perform the essential job functions.

DIABETES

Hemoglobin A1C Level

• A level greater than 10% with or without medications is disqualifying.

Type 1 Diabetes

• Type 1 Diabetes is disqualifying unless symptoms are controlled on a stable regimen (e.g., basal/bolus regimen or insulin pump usage) for the past 6 months.

Type 2 Diabetes

• With Insulin Treatment is disqualifying unless on a stable insulin regimen for the past 3 months.

• Without Insulin Treatment is disqualifying unless on a stable medication regimen for the past month.

Hypoglycemia, Hyperglycemia, and Ketoacidosis The following are disqualifying:

• An episode of Severe Hypoglycemia requiring the assistance of others or the need for medical attention in the past 12 months.

• More than two episodes of Severe Hypoglycemia in the past 3 years.

• An episode of Hyperosmolar Hyperglycemic state requiring the assistance of others or the need for medical attention in the past 12 months.

• An episode of Diabetic Ketoacidosis in the past 12 months.

Systemic Conditions The following are disqualifying:

• Peripheral Neuropathy that interferes with the safe and efficient performance of essential job functions and physical requirements.

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• Chronic Kidney Disease with a Glomerular Filtration Rate (GFR) less than 45 ml/min.1

• Retinopathy that impacts the ability to safely perform the essential job tasks or can cause failure to meet the vision standards.

• Symptomatic Orthostatic Hypotension.

1Note: Diabetes with Chronic Kidney Disease with a glomerular filtration rate (GFR) less than 45 ml/min is disqualifying due to the instability of the Diabetes and the systemic impact on other vital organs, and is associated with a greater risk of hypoglycemia and impaired cardiovascular functioning. The Renal Standards documented on page 14 notes the disqualifying glomerular filtration rate (GFR) parameters affiliated with Stage 4 or Stage 5 Chronic Kidney Disease, independent of Diabetes.

ENVIRONMENTAL CONDITIONS

History of Frostbite

• Any episode of frostbite will be reviewed on a case-by-case basis considering the ability to meet the physical requirements of the position and to safely and efficiently perform the essential job functions.

History of Heat Injury physical requirements of the position and to safely and efficiently perform the essential job functions, noting the following may be disqualifying:

o History of Heatstroke.

o History of three or more hospitalizations related to Heat Illness.

o Current or history of a predisposition to heat injuries, including disorders of the sweat mechanism, combined with a previous serious episode.

o Current or history of any unresolved sequelae of heat injury, including, but not limited to Nervous, Cardiac, Hepatic, or Renal Systems.

Rhabdomyolysis A diagnosis of Exertional Rhabdomyolysis2 may be disqualifying if any of the following are met:

• Recurrent episodes of Exertional Rhabdomyolysis.

• A single episode with severe systemic complications, for example, Compartment

Syndrome.

• If any of the following symptoms occur 2 weeks after experiencing an episode of

Exertional Rhabdomyolysis:

o Persistent residual kidney injury.

o Persistent elevation of serum Creatine Kinase (CK) 5 times the upper limit of the normal laboratory range or delayed clinical recovery.

o A history of Sickle Cell trait.

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2Note: A diagnosis of Exertional Rhabdomyolysis is defined as severe exercise-induced muscle pain resulting from repetitive or extreme physical exertion, with an elevation of serum Creatine Kinase (CK) generally at least 5 times the upper limit of the normal laboratory range.

GASTROINTESTINAL

Abdominal Wall Symptomatic Inguinal Hernia or Femoral Hernia is disqualifying unless all the following are met:

• Compliance with treatment.

• Individual is cleared by the surgeon to perform the essential job functions and physical requirements.

Ulcerative Colitis and Crohn's Disease

• Will be reviewed on a case-by-case basis considering an individual’s ability to meet the physical requirements of the position and to safely and efficiently perform the

Other Gastrointestinal Conditions The following conditions may be disqualifying:

• Hepatic-Biliary Conditions o Current Acute or Chronic Hepatitis.

o A Hepatitis Carrier State, with a viral load that has the potential for transmission.

o Hepatitis in the past 6 months or the persistence of symptoms after 6 months.

o Evidence of liver function impairment.

• Cirrhosis, Hepatic Cysts, Abscess, or Abscess or Sequelae of Chronic Liver Disease.

• Pancreatitis, Acute or Chronic.

• Metabolic Liver Disease.

GENITOURINARY

Genitourinary Conditions

HEARING

• The average threshold at 500, 1000, 2000, and 3000 Hertz (Hz) shall not exceed 25 decibels in either ear, with no single frequency greater than 30 decibels.

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• The average threshold at 4000 and 6000 Hz. shall not exceed 45 decibels in either ear, with no single threshold greater than 50 decibels.

• All testing must be performed without the use of hearing aids or other assistive listening devices.

INFECTIOUS DISEASES

• Any blood-borne or communicable disease will be reviewed on a case-by-case basis considering the potential impact to the public and co-workers, an individual’s ability to meet the physical requirements of the position, and to safely and efficiently perform the essential job functions.

• Contagious Tuberculosis or current treatment for Tuberculosis is disqualifying.

MEDICATIONS

• Any medications causing cognitive impairment, sedation, drowsiness, equilibrium disturbance, orthostatic hypotension, immunosuppression, sudden or subtle incapacitation, visual changes, or behavioral changes affecting the ability to meet the physical requirements of the position and to safely and efficiently perform the essential job functions may be disqualifying.

• All medications including prescription and non-prescription (over-the-counter) medications and supplements will be reviewed on a case-by-case basis and may be disqualifying.

• The use of amphetamines (stimulants), antiarrhythmics, anticoagulants, barbiturates, benzodiazepines, immunosuppressants, narcotics, neuroleptics, and respiratory inhalers may be disqualifying given the potential impact on safe job performance.

• Any prescription medication use must be in compliance with a valid prescription, inclusive of dosage, and issued by a licensed physician or provider with prescribing privileges, in the United States.

• Be in compliance with Federal Law and Agency Policies.

MUSCULOSKELETAL

Any current or recurrent medical condition without an adequate period of stability involving pain, numbness, weakness, joint instability, and/or limitations in range of motion affecting an individual’s ability to meet the physical requirements of the position and to safely and efficiently perform the essential job functions may be disqualifying.

Shoulder

• Rotator Cuff Tears: A full tear unless surgically repaired is disqualifying.

• Dislocations: Recurrent dislocations of the shoulder when not repaired or surgery is indicated and not performed is disqualifying.

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Knee

• Recurrent dislocation of the patella is disqualifying.

• Anterior Cruciate Ligament (ACL) Injuries: After surgery, 6 months of stability is required prior to evaluation.

• Collateral Ligaments and Posterior Cruciate Ligment Injuries: After surgery, 3 months of stability is required prior to evaluation.

Feet

• Plantar Fasciitis or Heel Spur Syndrome: That is refractory to medical or surgical treatment, interferes with the performance of essential job functions, or prevents the wearing of appropriate footwear is disqualifying.

• Hammertoes: That are severe, refractory to surgical intervention, interferes with the performance of essential job functions, or prevents the wearing of appropriate footwear is disqualifying.

• Pes Planus (Flat Feet): When symptomatic with pronation on weight bearing, which interferes with the performance of essential job functions and physical requirements, prevents the wearing of appropriate footwear, or when associated with vascular changes is disqualifying.

Orthopedic Replacements

• Hip Replacements o Bilateral Hip Replacement is disqualifying.

• Knee Replacements o Total Bilateral Knee Replacement is disqualifying.

o For a Total Single Knee Replacement the following applies:

• Normal range of motion without history of dislocation post replacement is required.

• The repetitive and prolonged ability to meet the essential job functions and physical requirements without pain of impairment or limiting pain is required.

• Evaluation by an Orthopedic Specialist to confirm the individual can complete all the essential job functions and physical requirements is required.

Amputations and Prosthetic Devices

• Amputations and use of artificial or mechanical devices such as artificial joints or prosthetic devices (e.g., artificial legs, arms, or hands) or other medical devices will be reviewed on a case-by-case basis, to determine an individual’s ability to meet the physical requirements of the position and if there are limitations to the device(s) that result in loss of function or pain, or prohibit the ability to perform the essential job functions safely and efficiently.

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Arthritis

• Arthritis Due to Infection: Associated with persistent pain and marked loss of function with objective x-ray evidence and documented history of recurrent incapacity for prolonged periods.

• Arthritis Due to Trauma: When surgical treatment fails or is contraindicated and there is functional impairment of the involved joints so as to prevent the ability to perform the essential job functions and physical requirements.

• Osteoarthritis: With severe symptoms associated with impairment of function, supported by x-ray evidence and documented history of recurrent incapacity for prolonged periods.

Other Arthritic Conditions

Fractures

• Malunion Fractures: When, after appropriate treatment, there is more than moderate malunion with marked deformity and more than moderate loss of function.

• Nonunion Fractures: When, after an appropriate healing period, the nonunion precludes the ability to perform the essential job functions and physical requirements.

• Bone Fusion Defect: When manifested by more than moderate pain and loss of function.

• Excessive Callus: When following a fracture, the callus does not respond to adequate treatment and functional impairment precludes the ability to perform the essential job functions and physical requirements.

Other Orthopedic Conditions

• Avascular Necrosis of the Bone: When severe enough to prevent the ability to perform the essential job functions and physical requirements.

• Chondromalacia or Osteochondritis Dissecans: When severe, manifested by frequent joint effusion, more than moderate interference with function, or with severe residuals from surgery.

• Bony or Fibrous Ankylosis: With severe pain involving major joints or spinal segments in an unfavorable position, and with marked loss of function.

• Contracture of a Joint: With marked loss of function and the condition is not remediable by surgery.

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• Loose bodies within a Joint: With marked functional impairment and complicated by arthritis to such a degree as to preclude favorable treatment results and to be remediable by surgery.

NEUROLOGICAL

Cerebrovascular Accidents Disqualify unless the following are met:

• Transient Ischemic Attack: A recovery period of at least 12 months.

• Ischemic Stroke: A recovery period of at least 12 months. A longer recovery period is required if there is an increased risk of seizure recurrence or if physical or cognitive inability to perform the essential job functions and physical requirements.

• Subarachnoid Hemorrhage: A recovery period of at least 12 months. A longer recovery period is required if there is an increased risk of seizure recurrence or if physical or cognitive inability to perform the essential job functions and physical requirements.

• Hemorrhagic Stroke: A recovery period of at least 12 months. A longer recovery period is required if there is an increased risk of seizure recurrence or if physical or cognitive inability to perform the essential job functions and physical requirements.

• Cerebrovascular Accident: The event did not result in weakness or a decrease in cognition, speech, or sensation, or any other change in baseline neurological status that interferes with the ability to perform the essential job functions and physical requirements.

Migraines

• Migraines will be reviewed on a case-by-case basis considering triggers, frequency, severity, and the ability to meet the physical requirements of the position and to safely and efficiently perform the essential job functions.

Seizure Disorders

• Single Unprovoked Seizure

Disqualify unless all the following conditions are met:

o Evaluation by a Neurologist.

o Normal Brain Magnetic Resonance Imaging (MRI).

o Normal Electroencephalogram (EEG).

o Seizure-free for the past 5 years.

• Provoked Seizure

Disqualify unless all the following conditions are met:

o Evaluation by a Neurologist.

o The cause of the seizure has been successfully treated.

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• Epilepsy or After Provoked Seizure with High Risk of Recurrence Disqualify unless all the following conditions are met:

o Evaluation by a Neurologist with a Brain Magnetic Resonance Imaging (MRI) and an Electroencephalogram (EEG) assessing for the level of risk and a low level of reoccurrence.

o Seizure-free for the past 10 years.

o Currently on anti-seizure medications or not on anti-seizure medications for the past 5 years.

NOSE, PHARYNX, LARYNX, AND TRACHEA

The following is disqualifying:

• Aphonia and conditions that limit the ability to verbally communicate effectively.

PSYCHIATRIC AND SUBSTANCE USE DISORDERS

Any medical condition impairing the ability to perform the essential job functions safely and efficiently, which may affect the safety of self or others, and/or the vulnerability of business operations and information systems to potential threats may be disqualifying.

The following are disqualifying:

• Schizophrenia

• Schizoaffective Disorder

• Delusional Disorder

• Other Psychotic Disorders

• Bipolar Disorders

• Borderline Personality Disorder

• Antisocial Personality Disorder

• Paranoid or Schizoid Personality Disorders

All other psychiatric conditions and any history of seeking psychiatric services or counseling, will be reviewed on a case-by-case basis.

Substance Use Disorders: A diagnosis of a Substance Use Disorder, inclusive of alcohol, may be disqualifying due to the high risk to the individual or others through likely impairment and/or subtle or sudden incapacitation. Substance Use Disorders may be indicated by any number of clinical or behavioral markers, such as:

• One or more substance use related violations such as; driving under the influence, driving while intoxicated, a minor in possession, open container, or public intoxication.

• Continued substance use resulting in a failure to fulfill a major obligation at work, school, or home.

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• Continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance(s).

• Substance use in situations in which it is physically hazardous.

• Continued substance use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance use.

• Noncompliance with treatment recommendations.

For individuals diagnosed with a Substance Use Disorder, sustained remission from the use of the substance(s) is required for at least the past 12 months or longer.

RENAL

• Treatment with Hemodialysis or Peritoneal Dialysis.

• Stage 4 or Stage 5 Chronic Kidney Disease Glomerular Filtration Rate (GFR) less than 30 ml/min.

RESPIRATORY

Asthma

• Excessive or repetitive hospitalizations, emergency room visits, or loss of duty time is disqualifying.

• Forced Expiratory Volume (FEV1) less than 60% of Predicted Value is disqualifying.

Lung Diseases

• The severity of the disease along with the ability for compliance with the management of the disease will determine the ability to be able to safely and efficiently perform the essential job functions and physical requirements.

History of Anaphylaxis

• History of Anaphylaxis will be reviewed on a case-by-case basis, considering the potential for reoccurrence and sudden incapacitation.

Other Respiratory Conditions The following are disqualifying:

• Current Pneumothorax.

• Active Hemoptysis.

• Pulmonary Hypertension.

• Forced Expiratory Volume (FEV1) less than 60% of Predicted Value is disqualifying.

• Pulse Oximetry Less than 90% On Room Air - With Exertion.

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SLEEP APNEA

Obstructive Sleep Apnea is disqualifying unless the following are met:

• Evaluation by a Pulmonologist, Neurologist, or a provider with expertise in sleep medicine who indicates the individual can safely perform the essential job functions and physical requirements.

• If Continuous Positive Airway Pressure (CPAP) is required, the device is utilized on average of 4 hours per sleep session, for at least 70% of the sleep sessions3 with 1 month of CPAP data.

3Note: Sleep sessions may take place other than during night hours.

TUMORS AND MALIGNANCIES

• Any tumor or malignancy will be reviewed on a case-by-case basis considering an individual’s ability to meet the physical requirements of the position and to safely and efficiently perform the essential job functions.

VISION

Near Vision

• Equal to or better than 20/40, with or without correction with both eyes viewing.

Distance Vision

• Corrected Visual Acuity equal to or better than 20/20 with both eyes viewing.

• Uncorrected Visual Acuity equal to or better than 20/100 in each eye.

• An exemption of the uncorrected distance requirement will be considered for individuals with the successful use of soft contact lenses for at least the past 12 months, as evaluated by an Ophthalmologist or Optometrist.

Color Vision

• Ability to detect fine color differences with no gross color confusions.

• Glasses or contact lenses designed to enhance color discrimination are not permitted during testing.

Peripheral Vision

• Full binocular visual field.

• Minimum of 115 degrees total of temporal plus nasal field in each eye under standardized test conditions.

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Depth Perception

• Normal binocular depth perception.

• Equal to or better “lower” than 70 seconds of arc local stereopsis or 60% or greater on Shepard-Fry Scale.

Refractive Surgical Procedures

• The chart below identifies the minimum recovery periods for various refractive surgical procedures. Individuals may require a longer recovery time based upon their specific post-surgical presentation (e.g., blurred vision, presence of halos, glare, starbursts, or severe dry eye) and the ability to meet the job-related vision requirements.

Procedure Recovery Time

• LASIK

• SMILE

• PRK

• LASEK

• Intraocular Collamer Lens

• Phakic Intraocular Lens

3 Months

• Radial Keratotomy (RK) 1 Year

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REFERENCES

American College of Occupational and Environmental Medicine (ACOEM). Guidance for the Medical Evaluation of Law Enforcement Officers.

American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5).

Cook, L.E. (2019). United States Customs and Border Protection Border Patrol Agent Position, 1896 Job Series, Listening Environment, Hearing Demands, and Recommended Hearing Standards.

Cucina, J.M., Votraw, L.M., Stewart, K.A. & Bordeaux, C.R. (2015). Job Analysis of the Border Patrol Agent Occupation Technical Report. Report No. 15-05. Washington DC:

U.S. Customs and Border Protection, Personnel Research and Assessment Division.

Executive Order 12564, September 15, 1986, Drug-Free Federal Workplace.

U.S. Department of the Army (2017) and (2019). Army Regulation 40-501, Medical Services, Standards of Medical Fitness.

U.S. Department of Homeland Security, Drug-Free Workplace Program Directive 066- 05, August 11, 2014.

U.S. Office of Personnel Management. (2017). Medical Qualification Determinations.

Title 5, Code of Federal Regulations, Part 339.

U.S. Transportation Security Administration (2016). Medical and Psychological Guidelines for Transportation Security Officers, Effective January 22, 2016.

Weaver, J.L. (2019). U.S. Customs and Border Protection, Border Patrol Agent, 1896 Job Series Recommended Vision Standards.