Attmt 10E - Agriculture Specialist 401_Medical Requirements_102616.pdf

U.S. Customs and Border Protection

Agriculture Specialist, 401 Series Medical Requirements

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Permission to make derivative documents must be obtained from the Chief of the Medical and Fitness Branch

Office of Human Resources Management

1400 L Street NW, Washington, D.C. 20229-1144

U.S. Office of Personnel Management Agriculture Specialist Medical Standards, Approved November 10, 2011

The U.S. Customs and Border Protection, Agriculture Specialist, 401 Medical Requirements, effective March 11, 2013, apply to Agriculture Specialist, 401 positions up to, and including, 2nd level supervisors. The following requirements apply for pre-employment and fitness for duty medical determinations.

The medical qualification standards for the Agriculture Specialist are based on physical and perceptual motor demands required to do the work. The essential duties and functions performed by the position are related to complex issues involving national security and the protection of public health and the American economy.

Performance of the job tasks requires a high degree of reliability and dependability. The physical demands range from sedentary activities to moderately heavy manual work.

Medical Requirement

The U.S. Customs and Border Protection’s (CBP) Agriculture Specialist position was established to support the agency’s priority mission to detect and prevent terrorists and instruments of terror from entering the United States while expediting the orderly and efficient flow of legitimate trade and travel. The essential functions and job duties are performed nationwide at international ports of entry (POE) into United States, at land border, airport and seaport facilities and at pre-clearance stations. Agriculture Specialists use their technical expertise and knowledge in biological science, chemistry, botany or entomology to determine the admissibility of agriculture items and prevent the introduction of harmful pests and insects, disease and potential agro/bio-terrorism agents/substances (e.g. chemical) from entering the U.S. borders.

Agriculture Specialists monitor regulatory compliance of the activities associated with the importation and exportation of commercial commodities and conveyances containing agriculture products (e.g. plant, animal) and other items of interest. Agriculture Specialists conduct risk assessments to identify potential high-risk targets (persons, shipments, conveyances) as well as perform progressive visual and physical inspections and examinations of people, merchandise, cargo, and packaging material. The work may expose the Specialist to agriculture grains, plants (fruits, vegetables, flowers), forest products, animals and animal materials, soil, heavy equipment, conveyor belt type x-ray machines, chemicals and pesticides.

The Agriculture Specialist position requires the cognitive ability to analyze data related to different types of commodities being processed and to integrate that information with past inspections that resulted in detection of pests or other diseases. The Agriculture Specialist must be medically and physically capable of performing the

This document incorporates information copyrighted by Human Performance Systems, Inc. delivered and licensed to the

Permission to make derivative documents must be obtained from the Chief of the Medical and Fitness Branch essential tasks and job functions in an efficient and safe manner without endangering the health and safety of co-workers, the public, or oneself. Any condition or use of medication that may affect efficient and safe job performance or result in endangering the health and safety of the individual or others may be disqualifying.

Specific Requirements

Vision

1. Distant Visual Acuity: Must be at least 20/30 or better in the best eye with or without correction.

a. Individuals who have undergone refractive eye surgeries/procedures (e.g., photorefractive laser surgery, keratoplast, LASIK) may be qualified provided they have no post-operative adverse complications and they meet the vision requirements.

2. Near Vision: Must be 20/30 or better Snellen with or without corrective lenses.

3. Color Vision: Must be able to distinguish colors (i.e., red, green, yellow, blue, orange, purple, pink, brown, black, white, gray). Use of an X-chrome lens is not acceptable.

4. Visual Fields: A minimum of 140 degrees in the horizontal meridian.

Hearing (Audiometric)

With or without the use of hearing aids,

1. Hearing level in each ear must not exceed 40 decibel (dB) for the average of the following frequencies 500, 1000, 2000, and 3000 Hertz (Hz).

2. The difference in hearing level between the better ear thresholds and worse ear thresholds may not exceed

15 dB for the average of 500, 1000, 2000, 3000 Hz.

3. The difference in hearing level between the better ear and worse ear may not exceed 30 dB at 4000 or 6000

Hz.1

1CBP Note: The requirement means the difference in hearing level between the better ear and worse ear may not exceed 30 dB at 4000 and 6000 Hz.

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Physical Demands and Environmental Factors

The tasks performed are classified into the following categories: vision, read/comprehend, communicate, write, sit, stand, walk, bend/stoop, push/pull, lift/carry, climb, and drive.

The Agriculture Specialist is responsible for performing compliance inspections and confiscating prohibited items (e.g., produce, animal products) from individuals and international companies. The work requires the specialist to read and interpret regulations (e.g., USDA, FDA) and determine whether agricultural products are admissible, need to be quarantined or need to be treated. The Agriculture Specialist must be able to compare archive data as to the type of commodity, source of shipment, scheduled itinerary or recent seizures to develop a plan and determine actions (e.g., refuse shipment, need for pesticides or fumigation). Agriculture Specialists must be able to communicate orally and in writing and interact effectively with others including individuals from other agencies and the public.

The work requires the Agriculture Specialist to inspect warehouse, ship or cargo containers and search for prohibited items. The work requires the Agriculture Specialist to stand for long periods of time (i.e., 45-60 minutes one to three times per day), walk continuously and lift objects (e.g., bags, boxes) weighing 10 to 50 lb. In addition, the Agriculture Specialist must be able to bend/stoop, climb on equipment and crawl in cramped areas to perform visual and manual searches of shipping containers, cargo freight and other vehicles (under dashboards and vehicle seats). The Agriculture Specialist must possess adequate manual dexterity to use knives, small tweezers (to pick up pests) and manipulate a microscope.

The essential tasks and duties are performed indoors and outdoors, during daylight and night hours and under various environmental conditions. These conditions include: exposure to extreme outdoor temperatures (ranging from above 90 degrees to below 32 degrees), high humidity; subject to exhaust fumes, chemicals, dust, wind, humidity, rain, snow and sleet; working on various surfaces (concrete floors, slippery and uneven ground), at heights of 4-8 feet (e.g., gangways, ship stairs, ladders) around moving vehicles, ships and equipment and under various lighting conditions (e.g., bright sun, low light, glare, fog).

Other environmental factors inherent to the work include: dealing with microscopic living organisms (bacteria, fungi); insects and parasites; exposure to agriculture grains, plants (fruits, vegetables, flowers); forest products;

animal and animal materials; soil and heavy equipment; as well as toxic chemicals, pesticides and fumigants. The Agriculture Specialist will be handling products that could contain exotic plant and animal disease (Monkey Pox Virus, Newcastle Disease, Avian Influenza, Mad Cow Disease) and will need to take precautions and wear personal protective equipment (e.g., hard hat, gloves, goggles, ear plugs or muffs, and N95 respirator).

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Other Conditions of Employment

Applicants/employees are responsible for demonstrating that they are physically and mentally able to efficiently perform the essential functions of the position without hazard to themselves or others. These requirements must be met by individuals subsequent to a tentative offer (letter) of employment, including reinstatement of former employees and transfers from positions not covered by this standard.

All applicants must undergo a medical examination provided by the agency before entering on duty. Individuals with a history of or existing medical condition may be required to provide objective information from their personal physician or practitioner that demonstrates the exact nature and stability of the condition(s) and/or physical abnormality. The decision as to the person’s medical acceptability for the position shall be made on a case-by-case basis depending on the information obtained from the general medical examination, consideration of medical records/documentation supplied by the individual and other employment factors.

The mission needs may require the Agriculture Specialist to work, regular and recurring overtime work; irregular and unscheduled hours; weekends, nights and holidays; as well as rotate shifts, assignments and duty locations.

The Agriculture Specialist must possess a current driver’s license. In addition, a pesticide certification may be needed.

Suzanne T. Ashford October 26, 2016 Chief, Medical and Fitness Branch Benefits, Medical, and Worklife Division

Essential Job Tasks

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Lift/Carry 1 Lift and carry objects and equipment weighing 10 to 20 lbs. (e.g., cargo, crates, luggage, contents of packages, coolers, garbage bags, garbage cans, mail, tools).

2 Lift and carry objects and equipment weighing 30 to 50 lbs. (e.g., cargo, crates, garbage cans, luggage, plants, contents of packages, coolers, garbage bags, confiscated material, ladders, boxes, freight, tires).

3 Lift baggage onto examination table or onto x-ray belt.

4 Unload commodity out of box (e.g., dump box) on to inspection table and replace commodity into box.

5 Remove items from passenger baggage (e.g., prohibited item), and then repack the bag or box.

6 Remove baggage and other items out of vehicle to inspect vehicle and repack vehicle.

Push/Pull 7 Push/pull wheeled inspection table to inspection area.

8 Open/close drawers and lift up bed to inspect inside a recreational vehicle (RV) or commercial bus.

9 Reach overhead to probe and inspect for prohibited items (e.g., baffles, roof of vehicles, overhead compartments on aircraft, vessels).

10 Remove prohibited items from inside container walls, packing materials, hidden compartments in vehicles, and cargo (reach arm in or use screwdriver to pull items out).

11 Push on soft surfaces (e.g., seats, mattresses, bulk rolls of material, cotton) to determine if properly padded or filled with prohibited items.

12 Push on packages or baggage on conveyor belts of X-ray machine so that packages/baggage can enter machine.

13 Dig through cargo contents with hands (past elbow) to check items.

14 Use hammer and chisel, saws, hatchets, or crowbars to collect sample of wood.

15 Cut/remove metal straps on containers or cargo with wire cutters, bolt cutters, or other hand tool to access cargo contents.

16 Push metal probe (e.g., tryer seed probe) into cargo (e.g., cardboard boxes, Styrofoam, hopper rail cars, vessel bulk shipment) to collect a sample of the product (e.g., grain).

17 Push contraband into garbage disposal.

18 Place contraband into garbage bags.

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19 Dump seized items into incinerator.

20 Remove soil from seized plants and place soil in special container.

21 Clean/scrub shoes using a disinfectant solution to get dirt off of shoes.

22 Place CBP, USDA, or Fish & Wildlife stamp on paper work (e.g., manifest, certificate, container list), delivered items, or packages at land border, seaport, airport, or mail facility.

Climb 23 Climb into cab of tractor, truck, or other type of large vehicle.

24 Climb into tractor-trailer cargo bed or semi-trailer container (3-4 feet).

25 Climb on top of freight, cargo, or equipment to inspect cargo, container, or vessel.

26 Climb moveable stairs to inspect cargo during aircraft and vessel boarding.

27 Climb gang way to enter/exit ship.

28 Climb ladders and stairs on a ship.

Crawl 29 Crawl in cramped areas (e.g., in ship, sleeper in tractor, motor homes, trailers, engine room on ship, cabin on ship, large pieces of equipment, cargo holds, anchor chain compartment, containers) to search for prohibited items.

30 Crawl to search underneath vehicles, aircraft, floor of container, or in vessel provision rooms to look for prohibited items or pests.

31 Crawl over cargo to inspect area (e.g., containers, ship holds).

Bend/Stoop 32 Bend to look for items under seats or dash in vehicle or under aircraft seats.

33 Bend/stoop to inspect tires, wheels, bumpers, and underside of vehicles, trailers, mobile equipment, aircraft, or railcars.

34 Bend/stoop inside a trailer or ship container to inspect products, look for pests on the floor, or access areas of the container.

35 Bend at the waist to reach into mail bins and cargo (e.g., gins, coiled rope) to remove packages or for inspection.

36 Bend to access/identify boxes at the bottom of a stack.

Walk 37 Walk continuously to search a warehouse, ship, or cargo containers.

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38 Walk continuously in airport terminal and baggage claim area to monitor passengers and airport employees.

39 Walk up and down between stopped vehicles at secondary inspection location to check vehicles and question motorists.

40 Walk in and around moving vehicles during searches.

41 Walk on airport grounds (air side) around aircraft during cargo/aircraft inspection.

42 Walk around obstacles and over uneven ground at inspection scene (e.g., rail yards, marine terminal, cargo bay of aircraft, loading docks, foreign mail unit).

43 Walk up 1 to 2 floors of stairs.

Stand 44 Stand and monitor traffic at land border.

45 Stand for extended periods of time (e.g., agriculture inspection, treatment of cargo, passenger intake at airport, airport exit control, monitor the transfer of product from one container to another, inspection work at foreign mail unit).

Sit 46 Sit for extended periods of time for desk duty, to complete/check paper work, airport exit control, operate computer, or conduct analyses of agricultural products (e.g., review electronic manifests, assess risk of incoming containers).

Drive 47 Drive vehicle at posted speeds on public roads to cargo location (e.g., consignee location, rail yard, marine terminal, alternate exam site) to examine consignee's business location.

48 Drive vehicle on airport grounds (airside), marine areas, or rail container areas.

Operate Equipment and Manual Dexterity 49 Operate portable radio or Nextel during work day (not driving).

50 Operate personal radiation detection (PRD) to identify individuals, vehicles, or cargo containers carrying radioactive items.

51 Operate computer to enter and retrieve data (e.g., ATS, manifests, URD, ACS, MARC, TECS systems).

52 Operate grinder to destroy seized agricultural products.

53 Use stereoscope to analyze agricultural products and agricultural pest, disease, weed, and seed specimens.

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54 Use microscope to analyze agricultural products and agricultural pest, disease, weed, and seed specimens.

55 Use loop to magnify object (10x) for visual inspection of small objects (e.g., pests, disease).

56 Use knife to cut into agricultural products (e.g., fruits, vegetables, flower stems).

57 Use knife to open cardboard boxes.

58 Use tweezers to pick up pest, seeds, or noxious weeds.

59 Use can opener to open and inspect canned agricultural products.

60 Use brush to collect pest, dirt, seeds, or noxious weeds.

61 Seal boxes containing prohibited provision stores (e.g., food) with official Agricultural Quarantine tape.

62 Use hands to pick up small pests or seeds and place into vile and seal the cap.

63 Turn agricultural product (e.g., flowers, fruits, vegetables) upside down, shake and slap with hand to dislodge insects or seeds.

64 Strike produce (e.g., broccoli) against inspection table to dislodge pest from inside the produce.

65 Pour alcohol into vile and prepare pest for transfer to entomologist.

66 Disinfect (e.g., bleach) area by spraying or wiping down.

67 Spray dirty shoes and boots, animal pens, or bird cages with a solution to sanitize them.

68 Mix chemical(s) for application as guided by the appropriate treatment schedule (e.g., mixing disinfectant solution).

Read 69 Read manifests (entry #, tariff code #, product, country of origin, destination) to determine whether a container needs to be held.

70 Review passenger written declaration to target high risk agriculture passengers or cargo.

71 Read airway bills (entry #, tariff code #, product, country of origin, destination) to determine whether a product needs to be held.

72 Read maritime waybills, invoices, bills of lading to determine whether a product needs to be searched or held.

73 Compare cargo markings and condition to the information (e.g., vessel name, control number, piece count) on manifest, consys list, or airway bills to verify information on manifest.

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74 Check credential and documents (e.g., visas, passports) of drivers, passengers, or vessel crew members to verify residency, duration of stay, or to determine agriculture risk of passengers.

75 Read labels on products to determine country of origin and ingredients.

76 Read ATS & ACS electronic information.

77 Review itinerary (shipping, truck pediment, rail cars) to determine what vessels, containers, or railcars are coming into the U.S. and when.

78 Read agriculture documents such as permits, certificates (e.g., product origination, meat products), invoices, garbage disposal receipts, ship stores, and harmonized codes in order to determine actions to be taken (e.g., inspect, hold, release).

79 Match the number on a product to the phylosanitary certificate number.

80 Read addresses on mail.

81 Read manuals, correspondence, investigative reports, follow-up reports, lab reports.

82 Read legal documents, county, state, and federal laws and codes.

83 Review corporate records, indexes, text checks, and phone books for information about consignee or broker business and owners.

84 Review documents, permits, manifests, or certificates to determine their validity, accuracy, and authenticity.

Comprehend 85 Compare manifest data to ATS & ACS selectivity for type of commodity, source of shipment, scheduled itinerary, or recent seizures to develop profile on container shipments and determine actions to be taken.

86 Use profiling techniques to identify suspicious individuals or cargo.

87 Work with customs officers to analyze advance information and target high risk cargo for potentially harmful pests, diseases, or noxious weed seeds.

88 Review pest data to determine whether a trend exists and whether to include the commodity on the targeted list.

89 Analyze and compare cases or historical data for similarity of methods or places to smuggle prohibited items.

90 Determine whether cargo requires special handling (e.g., cargo type, hazardous material, been fumigated).

91 Identify cargo abnormalities and excesses of an item that may be contraband.

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92 Inspect ship, aircraft, or recreational vehicle food stores when they arrive in the U.S. to ensure that food is not actionable and is stored properly.

93 Compare information on the sampling breakdown form to the markings on boxes to determine if the product to be inspected is correct (e.g., biometric sampling).

94 Determine whether probable cause exists to search persons, baggage, or cargo based on integrating information from multiple sources.

95 Determine best method to inspect cargo based on knowledge of the product, country of origin, and other factors.

96 Determine whether agricultural products are acceptable or quarantine, need to be treated, or documentation is needed.

97 Confiscate prohibited produce, agricultural products, animals or animal products, or plant materials using appropriate procedures.

98 Determine the best control measures for a pest or disease in order to eliminate pest or disease risk.

99 Determine the correct product and strength of the solution to perform treatments (e.g., disinfection, sterilization, decontamination, PPQ) on plant pests, contaminants, and prohibited agricultural materials.

100 Determine and issue penalties for violation of CBP-agriculture regulations and collect the fine due for the violations (e.g., fruit, vegetables, birds, animal).

101 Conduct laboratory tests and analyses (using microscope) to determine the presence of pests or disease or the threat level of a product.

102 Determine if further inspection is needed and the areas and methods for inspection (e.g., individual does not declare an item and contraband found).

103 Determine whether cargo previously placed on hold can be released.

104 Quarantine prohibited animal products and animal by-products following accepted procedures, contact veterinary services, and dispose of in an acceptable manner.

105 Interpret and enforce CBP regulations.

106 Interpret and enforce USDA, Fish & Wildlife, and FDA regulations.

107 Monitor the transfer of product from one container to another.

108 Monitor cargo shipments bound for destinations out of the U.S. as they travel thru the U.S.

109 Monitor the disposal of foreign garbage to ensure that is stored, handled, contained, and disposed of properly.

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110 Monitor the sterilization, incineration, or disposal of foreign garbage or product with actionable pests or plants to ensure that proper procedures are followed.

111 Monitor compliance agreements with government agencies, industry, carriers, and other organizations (e.g., airplane caters, warehouse inspector, shipping companies, garbage handlers).

112 Determine violations of compliance agreements.

113 Reboard ship, aircraft, or recreational vehicle to inspect food stores before leaving the port or airport to ensure that they are in compliance (e.g., food stores still sealed, garbage storage) with agriculture regulations.

114 Recognize inconsistencies in persons' behavior and verbal statements.

115 Smell inside of vehicle, baggage, or container to determine the presence of agricultural products.

Write 116 Maintain logs (e.g., daily activity [passenger & cargo], vehicle activity log, monetary fine log, target log, port log, cargo hold sheets).

117 Complete reports consisting of short descriptive phrases and/or fill in the blanks (e.g., 523 emergency order, 591 notice of alleged violation, 592 notice of violation, 309 interception record, 280 ship inspection report, declaration for importation

118 Complete narrative reports (e.g., investigative report, incident report, accident report).

119 Correspond with other inspectors through written messages on office computers (e.g., E-mail).

120 Write formal correspondence to supervisors, co-workers, or other agencies.

121 Update computerized databases by entering information into the database.

122 Summarize information from telephone or radio call conversation.

123 Record interview and descriptive information obtained from persons (e.g., name, address, phone, DOB, etc.).

124 Label and safeguard evidence.

125 Obtain signatures from individuals (e.g., CBP, ship master/captain) authorized to approve paperwork

(e.g., emergency action notifications and civil penalties).

Calculate 126 Perform simple arithmetic calculations (add, subtract, multiply, divide, percentages) to determine whether cargo matches bill of lading or invoice.

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127 Calculate conversions to and from English and metric measurements (kgs to lbs, ounces to lbs, inches to km) in order to determine appropriate strength of certain disinfectants, determine the amount of a product, or complete forms.

Communicate 128 Provide accurate and factual information associated with a search, seizure, fine, or actions taken to

CBP and other personnel (e.g., inspectors, canine enforcement officers, INS, USDA, FDA, Fish & Wildlife).

129 Communicate description of individuals or vehicles to inspectors.

130 Communicate with USDA personnel (e.g., entomologist, botanist) to determine whether a pest, plant, or seed is actionable.

131 Use radio/Nextel to report routine or emergency incidents and locations.

132 Use telephone to gather/exchange information (e.g., cargo shipper information).

133 Communicate with managers, officers, and Port Directors to ensure that they are informed of current policies, procedures, and regulations.

134 Interview drivers, vehicle or airline passengers, pedestrians, or vessel captains and crew members to determine their point of origin, contents of vehicle and baggage, reason for entering the United states, and their present citizenship.

135 Talk to drivers, airline employees, ship personnel, or railroad personnel to exchange information.

136 Communicate with carriers, brokers, or importers/exporters about the status of a shipment or to provide information pertaining to the import and export of agricultural cargo and material.

137 Communicate with baggage handlers, warehouse personnel, or stevedores concerning where to locate cargo and what items need to be inspected.

138 Communicate with ship captain, ship steward, or other representative of the vessel to gather information during ship inspection (e.g., where garbage stored, where food in stores originated from).

Hear 139 Listen to radio/Nextel and distinguish appropriate calls.

140 Hear an order or instruction spoken in a normal tone from a distance of 10-25 feet.

141 Hear conversation over the sounds of machinery or traffic, while interviewing individuals or receiving instructions at a land border, seaport, airport, container terminal, or rail yard.

142 Listen for traffic (e.g., fork lift, truck) in immediate area when inspecting cargo at a secondary inspection area, marine terminal, dock, airfield, warehouse, or rail yard location.

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143 Identify speech and voice characteristics over the phone (e.g., sex, age, accent), while recording message accurately.

144 Hear differences in sounds resulting from tapping on product containers, cans, boxes to determine if they contain objects or are full or empty.

145 Hear sounds to determine location of pests or birds.

Vision 146 Locate plants, food items, or seeds in baggage/luggage.

147 Locate plants, food items, or seeds in cargo shipments and mail.

148 Examine food for the presence of pests, diseases, or other quarantine materials.

149 Inspect flowers and plants for the presence of pests, diseases, noxious weeds or seeds or other quarantine materials (e.g., excess soil).

150 Recognize plant or cut flower type and match to categories of risk (e.g., low, moderate, high).

151 Identify pest's size, shape, and other characteristics and determine whether they are a quarantine specific pest or cosmopolitan (occurring naturally in the US).

152 Identify weeds and seeds and determine if they are noxious or common.

153 Inspect rail cars, cargo containers, or vehicles for the presence of noxious weeds (e.g., in springs, between rail cars).

154 Inspect vehicles and containers for excess dirt or mud.

155 Inspect aircraft (tires, cargo area, galley, passenger area) for prohibited items.

156 Inspect marine vessels (kitchen, stores, decks, garbage) for prohibited items.

157 Visually inspect individuals for bulges and clothing abnormalities (e.g., birds in bra, bird strapped to body).

158 Search vehicles for contraband hidden in trunk, under seat, under hood, etc.

159 Inspect interior and exterior of containers (full and empty) and reefers for cracks or holes.

160 Estimate the number of pests found in an agricultural shipment.

161 Operate X-ray unit (stationary or mobile) and distinguish the shapes and features of prohibited agriculture items (e.g., fruits, vegetables, birds, reptiles, animals) and other contraband (e.g., gun).

162 Distinguish colors of hazardous materials signs.

163 Distinguish colors of pests, weeds, seeds, and disease on agricultural products to identify type of pests or disease.

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164 Distinguish colors (e.g., orange, yellow, blue, green) on x-ray screen to identify prohibited agricultural items.

165 Use flashlight to visually inspect cargo, vehicles, vessel, and containers.

166 Visually check for moving equipment on airport grounds, seaports, rail yards, warehouses, and truck compounds.

167 Observe passenger's, pedestrian's, or crew member's behavior and determine which persons should be monitored, questioned, or searched.

168 Observe occupants of stopped vehicles for any unusual actions (e.g., reaching under seat, discarding material out of window, under the influence of alcohol or drugs, etc.).

169 Recognize a person previously known based on description from a distance of 30 to 100 feet.

HUMAN PERFORMANCE SYSTEMS, INC.

MEDICAL GUIDELINES

FOR

CBP AGRICULTURE SPECIALIST

Physician's Manual

Deborah L. Gebhardt, Ph.D.

Submitted By:

Human Performance Systems, Inc.

5000 Sunnyside Avenue

Suite 203

Beltsville, Maryland 20705

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May 2006

Copyright © Human Performance Systems, Inc. 2006

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Date

List of Addendums

CBP Medical Guidelines for the Agriculture Specialist Physician's Manual

Addendum

03.07.14 • Addendum 1: Hearing - Recommendations for Audiometric Testingthat may be used to Evaluate Individuals who do not Meet the Initial Audiometric Requirements o Provides clarification to the Section on Hearing Loss (with or without hearing aids) found onpage 7.

U.S. Customs and Border Protection

Agriculture Specialist (0401) Addendum 1: Hearing - Recommendations for Audiometric Testing that may be used to

Evaluate Individuals who do not Meet the Initial Audiometric Requirements

Effective Date: March 7, 2014

The clinical recommendations presented below were received from contract audiologist, Lynn E.

Cook, AuD, FAAA, on January 31, 2014. The recommendations replace the information identified in the section titled Hearing Loss (with or without hearing aids) found on page 7 of the CBP Medical Guidelines for the AgricultureSpecialist Physician's Manual (dated, May 2006).

The recommendations update and provideclarification concerning follow-up testing should an individual not meet the initial screening requirements.

Current (Initial) Audiometric (Hearing) Requirement

1. Hearing level- in each ear must not exceed40 decibel (dB) for the average ofthe following frequencies 500, 1000, 2000, and 3000 Hz.

2. The difference in hearing level between the better ear thresholds and worse ear thresholds may notexceed 15 dB for the averageof500,1000, 2000, and 3000 Hz.

3. The difference in hearing level between the betterand worse ear maynot exceed 30 dB at 4000 or 6000 Hz.

If these conditions are not met, refer for functional hearing test recommendations below.

Test Administrators

1. Functional hearing testing must be administered by a licensed and/or certified audiologist who possesses, at a minimum a Master's Degree in Audiology or Hearing Science, or a Doctor of Audiology (AuD) degree or PhD in Audiology or Hearing Science.

2. Ahearing instrument specialist (HIS) is NOT an adequate credential for this level of testing, nor is a Council for Accreditation in Occupational Hearing Conservation (CAOHC) certification as an audiometric technician.

Functional Hearing Testing

Thefunctional hearing testing is to be conducted without the use of hearing aids. All three conditions must being met.

1. Speech reception threshold must not exceed 30 dB in either ear. Recorded list must be used.

2. Speech recognition in quiet at a presentation level of50 dB HL must be > 90% in the better ear, and > 70% in the poorerear. Test must be conducted using recorded NU-6, W-22, or MD CNC lists.

U.S. Customs and Border Protection Office of Human Resources Management

March 7, 2014

Binaural speech recognition in noise in sound field must be > 70%. Listener must be seated 1 meter from speaker, with both signal and noise emanating from the same speaker. Listener may move head as desired, but must maintain 1 meter distance.

Presentation level for speech must be 50 dB HL, with simultaneous presentation of speech noise at 45 dB HL (signal-to-noise ratio of +5 dB). Recorded NU-6, W-22, or MD CNC lists must be used.

Aided Testing

If an individual is unable to pass the functional hearing test withoutthe use of hearing aids, they mayattempt to meet the standard with the use ofone or two hearing aids. Aided testing must be administered by a licensed and/or certified audiologist, who possesses, at a minimum a Master's Degree in Audiology or Hearing Science or a Doctor ofAudiology (AuD) degree or PhD in Audiology or Hearing Science. A hearing instrument specialist (HIS) is not adequate credential for this level of testing, nor is CAOHC certification as an audiometric technician.

It is customary to test aided listeners in a sound field in the binaural mode (both ears tested together). However, because auditory localization has been identified as an essential job function for this position, it is critical to ascertain the aided hearing sensitivity levels ofeach ear for this position.

While it may bedifficult, and sometimes even impossible to completely separate right and left earperformance, the examining audiologist must be informed of the need to plug and/or mask the non-test ear forsome of these tests. Hearing aids must be set at a level and program that is appropriate for the listener, and should not be adjusted once testing has begun.

In sound field, with non-test ear plugged and/or masked as appropriate (for all but #6 below), aided thresholds must be assessed using a 5% FM warble tones or narrow bands of noise.

With the use of hearing aids the following applies:

1. Hearing level in each ear must not exceed 40dB for the average ofthe following frequencies, 500, 1000, 2000, and 3000 Hz.

2. The difference in hearing level betweenthe betterear thresholds and worse ear thresholds, may not exceed 15dB for theaverage of500,1000, 2000, and 3000 Hz.

3. Thedifference in hearing level between the better and worseear may not exceed 30 dB at 4000 or 6000 Hz.

4. Speech reception threshold may not exceed 30dB in either ear, using recorded lists.

5. Speech recognition in quiet must be >90% in the better ear, and > 70% in the poorer ear, at a presentation level of50 dB HL and using recorded NU-6, W-22, or MD CNC lists.

6. Binaural speech recognition in noise field must be >70%. Listener must be seated 1 meter from speaker, with both signal and noise emanating from the same speaker.

U.S. Customs and Border Protection Office of Human Resources Management

Listener may move head as desired, but must maintain 1 meter distance. Presentation level for speech must be 50 dB HL, with simultaneous presentation of speech noise at 45 dB HL (signal-to-noise ratio of +5 dB). Recorded NU-6, W-22, or MD CNC lists must be utilized.

U.S. Customs and Border Protection Office of Human Resources Management

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TABLE OF CONTENTS

INTRODUCTION 1

AUDITORY SYSTEM 6

Abnormalities of the Ear Canal 6 Chronic Otitis Externa 6

Chronic Otitis Media...., 6 Equilibrium Disorders 6 Eustachian Tube Dysfunction 7 Hearing Loss (with or without hearing aids) 7 Tinnitus 7

External Tumors 7

CARDIOVASCULAR SYSTEM 8

Arrhythmia 8 Supraventricular Arrhythmia. 8 Ventricular Arrhythmia 8 Heart Block and Bradycardia 8 ST-T Segment Changes 9 .Wolff-Parkinson-White (WPW) Syndrome 9

Coronary Heart Disease 9 Angina 9 Coronary Artery Surgery 9 Myocardial Infarction (History of) 10

Heart Muscle and Pericardium 10

Cardiomyopathy 10 Myocarditis 10 Pericarditis 10

Hypertension 11 Valvular and Congenital Heart Disease ...11

Aortic Regurgitation II Aortic Stenosis 11

Atrial and Ventricular Septal Defect 11 Heart Murmurs 12

Mitral Regurgitation 12 Mitral Stenosis 12

Mitral Valve Prolapse 12 Congenital Heart Disease 12

Valvular Treatment and Replacement 13 Anticoagulation Therapy 13

. CardiacValve Replacement 13 Vascular Disease 13

Aortic Aneurysm (Thoracic or Abdominal) 13 Carotid Artery Disease 13 PeripheralVascular Disease - Arterial 14 Peripheral Vascular Disease - Venous 14

ENDOCRINE AND METABOLIC

SYSTEMS 15

Adrenal Gland Hyperactivity:

Hyperplasia; Hypercortisolism; Adrenal Gland Tumor 15

Diabetes Mellitus 15

Euthyroid Goiter 15 Crystal Related Arthritis (Gout) 16 Hyperparathyroidism: Hypercalcemia 16 Hyperthyroidism 16 Hypocortisolism: Adrenal Insufficiencies 17 Hypoparathyroidism: Hypocalcemia 17 Hypothyroidism 17 Panhypopituitarism 17 Pituitary Tumors 17

GASTROINTESTINAL SYSTEM 18

Diseases/Disorders of Upper Gastrointestinal Tract 18

Gastritis 18

Gastroesophageal Reflux Disease (GERD)/Hiatal Hernia 18 Inguinal, Umbilical, or Ventral Hernia 18 Pancreatitis (acute or chronic) 18 Peptic Ulcer Disease 18

Diseases/Disorders of the Liver and

Biliary Tract- 19 Cirrhosis 19

Gallbladder Disease 19

Hepatitis (History of Acute or Chronic) Other Liver Disease 19

Diseases/Disorder of the Colon, Rectum, Anus 20

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Anal Fissure 20 Diverticulitis/Diverticulosis 20 Fistula 20 Hemorrhoids 20 Inflammatory Bowel Disease 20 Irritable Bowel Syndrome 21 Pilonidal Cyst 21

GENITOURINARY SYSTEM 22

Endometriosis 22 Lower Urinary Diseases/Disorders:

Cystitis, Cystocele in Prolapse, Neurogenic Bladder, 22 Other Male Genital Disorders 22 Pelvic Inflammatory Disease (PID) 22 Pregnancy 23 Prostate Disorder 23 Renal Calculus 23 Renal Dysfunction (Chronic) 23 Uterine Fibroids 24

INTEGUMENTARY SYSTEM 25

Cancer „ 25

Basal and Squamous Cell Carcinoma 25 Cutaneous T Cell Lymphoma 25 Melanoma 25

Collagen Vascular Diseases 25 Lupus Erythematosus 25 Raynaud's Phenomenon 26 Scleroderma 26 Vasculitis/Phlebitis/Purpura 26

Diseases/Infections of the Skin -

Dermatitis 26

Atopic Dermatitis 26 Contact Dermatitis 27 Foot Eczema 27

Hand Eczema 27

Stasis Dermatitis 27

Genetic Conditions 28

Genetic Disorders 28

Infections (Bacterial, Fungal, Viral) 28 Folliculitis/ Pseudo-Folliculitis/Miliaria

/Keloid Folliculitis 28

Fungal Infections/Yeast Infection 28 Hidradenitis Suppurativa 28

Papulosquamous Conditions 29 Psoriasis (without arthritis) 29

Urticaria 29

MUSCULOSKELETAL SYSTEM 30

Amputations 30

Amputation: Thumb 30 Amputation: Single Digit excluding Thumb 30 Amputation: Hand 30 Amputation: Arm - Below Elbow 30 Amputation: Arm - Above Elbow 30 Amputation: Great Toe 31 Amputation: Foot 31 Amputation: Foot and Ankle 31 Amputation: Leg - Below Knee 31 Amputation: Leg - Above Knee 31

Arthritis 32

Osteoarthritis 32

Rheumatoid Arthritis 32 Connective Tissue Disease 32

Spine Disorders (e.g., Disc Diseases / Syndrome) 32

Cervical (Disc or Chronic Sprain) 32 Thoracic and Lumbosacral (Disc or Chronic Sprain) 33

Fractures 33

Intra-articular Fractures 33

Malunited Fractures 33 Non-Union Fractures 34

Joint Condition 34

Joint Condition: Shoulder 34

Joint Condition: Elbow 34

Joint Condition: Wrist 34

Joint Condition: Hands and Fingers 35 Joint Condition: Hip 35 Joint Condition: Knee 35 Joint Condition: Ankle 36

Joint Condition: Foot 36

Spinal Abnormalities 36 Scoliosis (Thoracolumbar) 36 Spinal Abnormalities 36

Spinal Fractures and Dislocations 37 Cervical Fractures and Dislocations 37 Lumbar Fractures and Dislocations 37

Thoracic Fractures and Dislocations 37

NEUROLOGICAL SYSTEM 38

Retinal Detachment 52 Stereopsis 52 Strabismus 53 Visual Acuity (Refractive Error):

Astigmatism; Hyperopia; Myopia 53 Visual FieldLoss 53

OTHER CONDITIONS 54

Cancer/Tumors 54

Hematopoietic andClotting Disorders 54 Anemia 54 Sickle CellDisease 54 Clotting Disorders 54 Infectious Disease 54

APPENDIX A List of Essential Agricultural Specialist Job Tasks 55

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INTRODUCTION

PURPOSE OFPHYSICIAN'S MANUAL

The purpose of this manual is to aid the examining physician in making judgments concerning the suitability of individuals for the AgriculturalSpecialist position in the U.S. Customs and Border Protection (CBP). The guidelines included in this manual were developed by a task force of medical specialists (e.g., cardiologists, neurologists) who evaluated the requirementsof the essential tasks for the AgriculturalSpecialistpositionin relation to specific diseases and conditions in each body system (e.g., cardiovascular). These medical specialists used job analysis and ergonomic data to identify the degree of impairment for each disease or condition that would be likely to preclude an individual from safely and effectively performing the job duties.

The role ofthe examining physician is to evaluate the individual's current health status, determine the etiology of any disease or condition, and make a recommendation about the individual's suitability for the Agricultural Specialist position from a medical viewpoint. While the medical guidelines are presented in this manual for use in evaluating the individual's health status, you should remember that these are guidelines. Futureadvancements in medicine may render an appropriate guideline in this manual outdated or no longerjustified at a future date. In addition, there may be other valid medical reasons in a given situation for considering an individual who might be rejected based on the guidelines. Therefore, the final decision as to the ability ofan individual to perform the essential functions ofa job is the responsibility of CBP in conjunction with the physician's evaluation and these medical guidelines

The enactment of federal laws (e.g., Rehabilitation Act of 1973, Americans with Disabilities Act of 1990) prohibits discrimination againsta qualified individual with a disability with regard to employment decisions. A qualified individual with a disability is a person who satisfies the job-related requirements for a specific position and can perform the essential functions of the job with or without reasonable accommodations. It is important that the physician evaluate the health status ofthe individual in relation to the demands of the specific job. The criteriaused in the evaluation should be job-related, consistent with business necessity, and not screen out qualified individuals. The physician should, if needed, assist the CBP in determining whether a reasonable accommodation could be made to enable the individual to perform the essential functions of the job. It is therefore the physician's responsibility to determine whether the individual meets the criteria outlined in the medical guidelines and can perform the essential functions of the job, with or without reasonable accommodations.

While the CBP is not required to hire an individual who would be a direct threat to the health or safety ofthe individual or to others, federal law prohibits the CBP from rejecting an individual solely because of the presence of a disability. An individual may be rejected when there is a significant risk, in other words a high probability,of substantialharm to the health or safety of the individual or to others, or the disability precludes the individual from performing the essential job functions.

The medical guidelines presented in this Physician's Manual were developed with the above conditions taken into consideration. To facilitateease ofuse, the guidelines are organized by body

.. x,m~. . ,(M uocumcumaycontain commerciai/proprietary information andis subject to an disseminate beyondgovernment Do not disseminate this document in any otherformat Do not disseminate this document without the copyright marking intact In addition tothis marking, this document should not be forwarded outside government until the unauthorized copyright marking issue is resolved. May 25,2011 system (e.g., gastrointestinal) and by classification ofdiseases/conditions within each body system. Several conditions (e.g., cancer)areclassifiedunder "Other Conditions."

The medical guidelines for the Agricultural Specialistpositionare presented in the remainderof this manual, along with a table of contents for locating the medical condition/disease.

USEOFGUIDELINES

The Physician's Manual is divided into two sections: (1) Table ofContents which lists the medical conditions and diseases and identifies the pagenumber for each condition/disease; and (2) Medical Guidelines for the Agricultural Specialist job. A complete listing of the essential job tasks for the Agricultural Specialist position is located in Appendix A of the manual. The medical guidelines provide information about the acceptable and disqualifying levels of severity of a disease/condition that impacts an AgriculturalSpecialistjob.

To use the guidelines effectively, the physician must first assess the nature and stability ofany condition/disease identified by the applicant, and then determine whether the individual is acceptable for the job or whether further evaluation is required.