Attachment 3 OIGM 3023.pdf

OIGM 3023, MEDICAL STANDARDS

OFFICE OF INSPECTOR GENERAL

MANUAL CHAPTER 3023

Medical Standards December 2017

Office of Inspector General U.S. Department of Housing and Urban Development

MATERIAL TRANSMITTED

Chapter 3023, Medical Standards, December 2017.

MATERIAL SUPERSEDED

Chapter 3023, Medical Standards, December 2007.

PURPOSE

This chapter prescribes policies and procedures concerning medical standards for the U.S. Department of Housing and Urban Development (HUD), Office of Inspector General (OIG), GS-1811, Criminal Investigator (Special Agent) positions.

SUMMARY OF CHANGES

All sections have been revised.

APPROVED

Helen M. Albert Acting Inspector General

SUMMARY OF CHANGES

This manual chapter has been updated and approved on the following dates to account for the latest changes.

Issue Date Pages Affected Description

OIGM 3023 December 2007 All All sections were changed.

OIGM 3023 December 2017 All Various subsections updated to new medical conditions based on FOH recommendations.

Limited Duty section revised.

Updated to specify annual PEB participation is required for SAs GS-15 and below.

Establishes 5 year refresher requirements for Physical Fitness Training Coordinators.

Medical/Physical Evaluation and Qualification Statement changed to reflect new medical standards

PEB Components changed to reflect the use of push-ups instead of the bench press.

New PEB Training Record Push-up protocols and scoring FLETC protocols and scoring.

TABLE OF CONTENTS

SECTION 23.1. – EMPLOYMENT STANDARD

23.1.1. BACKGROUND

23.1.2. DEFINITIONS

23.1.3. ESTABLISHMENT OF MEDICAL STANDARDS

23.1.4. BASIS FOR MEDICAL STANDARDS

23.1.5. BASELINE MEDICAL EXAMINATION

23.1.6. PERIODIC MEDICAL EXAMINATION

23.1.7. POLICY

23.1.8. POSITION DESCRIPTION

SECTION 23.2 – MEDICAL REQUIREMENTS

23.2.1. PURPOSE

23.2.2. APPLICABILITY

23.2.3. MEDICAL CONDITIONS

23.2.4. FUNCTIONAL CAPABILITIES

SECTION 23.3 – FITNESS FOR DUTY

23.3.1. FITNESS FOR DUTY EXAMINATIONS

23.3.2. FITNESS FOR DUTY DETERMINATIONS

23.3.3. APPLICANT/EMPLOYEE NOTIFICATIONS

23.3.4. RETURN TO DUTY EXAMINATION

23.3.5. APPLICANT/EMPLOYEE RECONSIDERATION AND/OR WAIVER

23.3.6. EMPLOYABILITY DETERMINATION

23.3.7. LIMITED-DUTY ASSIGNMENTS

23.3.8. ASSIGNING EMPLOYEES TO LIMITED DUTY

23.3.9. DRIVING GOVERNMENT OWNED VEHICLES ON LIMITED DUTY

23.3.10. MANDATORY BLOOD TESTS FOR FIREARMS INSTRUCTORS

23.3.11. FORMS AND CERTIFICATIONS

SECTION 23.4 – HEALTH IMPROVEMENT PROGRAM FOR SPECIAL AGENTS... 32

23.4.1. RESPONSIBILITIES

SECTION 23.5 – PHYSICAL EFFICIENCY BATTERY

APPENDIX 23A – MEDICAL/PHYSICAL EVALUATION AND QUALIFICATION STATEMENT

APPENDIX 23B – PEB COMPONENTS

APPENDIX 23C – PEB STANDARDS, SCORING AND TRAINING RECORD

SECTION 23.1. – EMPLOYMENT STANDARD

23.1.1. BACKGROUND

A. The U. S. Office of Personnel Management (OPM) requires that agencies establish medical and physical qualifications for individuals entering and retaining positions that primarily perform arduous duties. HUD OIG applies the medical qualification standards in this chapter to select positions in which arduous duties are assigned, whether as primary or collateral duty, whether the employee encumbering a position is in a career, term, or temporary appointment. This includes, among other things, moderate to arduous physical exertion involving walking and standing, use of firearms, and exposure to inclement weather.

B. Specific medical standards and the medical review program allow HUD OIG to determine whether employees and applicants have any medical condition(s) that would prevent them from performing, with or without reasonable accommodations, the essential duties of the position without posing a significant risk to safety and health of self or others. HUD OIG must determine if an employee’s existing medical condition or health status will be aggravated or worsened by the physical demands or working conditions of the employee’s job or work conditions.

C. Pertinent regulations as set forth in this policy permit agencies to document that they have established appropriate medical qualification standards for entry and retention as law enforcement officers, and that they apply these standards when hiring and retaining them. The series 1811 criminal investigators-special agent (SA) positions at HUD OIG have been determined to be primary or rigorous positions. The OIG is responsible for ensuring that SAs are physically and medically qualified for these positions.

D. Consistent with these demands, the OIG has contracted with Federal Occupational Health (FOH), U.S. Public Health Service (PHS), to provide medical examinations/evaluations and related professional services, including consultation and advisory services. Pertinent medical examinations will be performed by examining physicians and reviewed by a Medical Review Officer (MRO), all of whom are under the aegis of the PHS. The resources of the PHS will also be available to OIG managers who observe or are otherwise made aware of potential crisis situations that may affect the SA’s mental or emotional stability.

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E. In March 1995, the FOH conducted a job analysis of HUD OIG SA positions. The job analysis identified both routine (frequently performed) job tasks and critical (though often less frequently performed) job tasks. The FOH determined the physical and mental capabilities necessary to meet those same job tasks (physical requirements); and the FOH iterated medical standards that are consistent with these physical requirements and provided structured guidelines for examining physicians. Based on the FOH analysis, the OIG has concluded that these physical requirements and medical standards are job related, job specific, and necessary in order to satisfy the essential duties of the positions. In June 2016, FOH reviewed the HUD OIG job standards and the components of the medical exam. FOH confirmed that the key duties and general physical attributes identified by this policy are needed for SAs to perform HUD OIG duties satisfactorily. Recommendations by FOH to update the policy and medical exam were incorporated.

23.1.2. DEFINITIONS

A. HUD OIG - FOH Coordinator: An individual in HUD OIG Human Capital Management Division (HCMD), who coordinates the scheduling of SA and applicant medical examinations, consults with the FOH MRO, and staff, and coordinates with other HUD OIG personnel in cases where additional tests or medical documentation is required by the MRO to reach a medical clearance determination.

B. Medical Review Officer (MRO): A contract physician from the PHS, FOH, who reviews medical documentation to determine medical clearances, restrictions, and Physical Efficiency Battery (PEB) waivers for OIG SAs.

C. Physical Efficiency Battery (PEB): The instrument developed by the Federal Law Enforcement Training Center (FLETC) and used in the annual fitness assessment of SAs to measure body composition, cardiovascular endurance, flexibility, agility, and strength. The PEB determines an SA’s level of fitness compared with the general public.

D. Physical Fitness Training (PFT) Coordinator: An individual in each OIG regional office and in OIG headquarters who coordinates the annual fitness assessment and reviews the proposed activities of SAs participating in the HIP program. PFT coordinators are graduates of the FLETC Physical Fitness Coordinator Training Program or an approved equivalent training program.

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23.1.3. ESTABLISHMENT OF MEDICAL STANDARDS

Under 5 CFR Part 339, Medical Qualifications Determinations, medical standards may be established for positions with duties that are arduous in nature. Medical standards are required due to the arduous occupational, functional, and environmental requirements of the positions. The medical standards for OIG SAs are provided to aid the agency MRO and OIG officials in determining what medical problems may hinder the individual's ability to satisfactorily perform their full range of essential duties without undue risk to themselves or others.

Any disease, condition, or impairment not specifically listed in the medical standards, that interferes with the safe, efficient, and expected performance of the essential duties and responsibilities may also constitute grounds for medical disqualification.

The standards will be guided by considerations set forth in 5 CFR Part 339, Medical Qualifications Determinations. Individualized assessments will be made on a case-by-case basis to determine an individual's ability to meet the performance related requirements of positions covered by the standards. Final consideration and medical determination may require additional medical information and/or testing not routinely required during either the baseline or periodic medical examination.

An applicant unable to obtain a driver's license for any medical reason will not be considered for HUD OIG law enforcement positions until such time that the condition is resolved and a driver's license has been issued. Regardless of the reissuance of a driver's license, the employee or applicant must meet the medical standards.

Medical standards are intended to serve as a general guideline for the safe placement into and continued work within arduous HUD OIG law enforcement job positions.

Each of the medical standards is subject to the clinical interpretation of the condition by the agency MRO. The MRO will incorporate his or her knowledge of the job requirements and environmental conditions in which employees must work when making a final decision.

Applicants for Federal employment, as well as current Federal employees, are presumed to be medically qualified unless there is specific medical evidence they are not. For some positions, specific medical standards or requirements are justified because of the arduous nature of the functions to be conducted or circumstances under which those functions are conducted, the need for a high degree of reliability and safety for employees, and a commitment by the employing agency to maintain a high degree of responsibility for public safety. Medical standards are updated and implemented for law enforcement employees and applicants.

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To sustain an agency's decision to not hire, or to impose a job restriction or limitation on an employee, OPM must consider whether the agency has:

1) Documented the degree of the individual's impairment.

2) Weighed the seriousness of the individual's medical condition(s).

3) Identified medication requirement(s).

4) Identified the essential duties the individual would need to perform at work.

5) Identified the environmental, industrial, and occupational conditions under which the job tasks or essential duties would be required to be performed.

6) Considered whether the functional requirements and work conditions would aggravate, accelerate, exacerbate, or permanently worsen any pre-existing medical condition the individual may have.

The agency's medical evaluation and clearance procedures are performed in accordance with the following legislative authorities and references:

Laws

• 5 U.S.C. § 3301 (Civil service; generally)

• 5 U.S.C. §3307 (Competitive service; maximum-age entrance requirements;

exceptions)

• 5 U.S.C. 552a (Privacy Act of 1974)

• 29 U.S.C. 701-7961 (Rehabilitation Act of 1973)

• 29 U.S.C. 1181 et seq. (Health Insurance Portability and

Accountability Act of 1996)

Executive Orders

• Executive Order 11478 (Equal Employment Opportunity in the

Federal Government), as amended by Executive Order 13087

Regulations

• 5 CFR part 300-Employment (general)

• 5 CFR part 339-Medical Qualification Determinations

• 5 CFR part 842-Federal Employees Retirement System

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• 29 CFR 1614.203-Rehabilitation Act

• 29 CFR 1910.1020-Access to employee exposure and medical records

Departmental and OPM Guidance

• OPM/GOVT-10 (employee medical file system records) (see 75 Fed. Reg. 35099 (June 21, 2010).

23.1.4. BASIS FOR MEDICAL STANDARDS

The HUD OIG arduous duty medical standards are based on the functional relationship between (a) certain medical factors, and (b) the time/work volume, physical requirements, environmental, and physical exposure factors which may be required or encountered in the performance of the duties of law enforcement. The expectation is that a SA who meets these standards will be able to carry out his/her tasks safely and effectively.

23.1.5. BASELINE MEDICAL EXAMINATION

A baseline medical examination (BME) is required after an applicant has accepted a conditional offer of employment, to assure the applicant is medically qualified for an arduous duty position.

The MRO will evaluate each BME against the specific medical standard. The MRO will assess the potential effect of any existing medical condition(s) on the employee’s or applicant's ability to safely perform the full range of duties of the position or to work safely in arduous duty conditions.

No applicant or employee will be deemed medically qualified for a position if the MRO determines that the employee or applicant has a medical condition preventing the employee or applicant from safely performing, with or without reasonable accommodation, the full range of duties of the job.

Most often, a BME is administered when an applicant has accepted a conditional offer of employment in their first arduous position covered by the Medical Standards Program (conditional upon being medically qualified). This data can then be compared to subsequent periodic medical evaluation results for determining whether the individual has any significant health trends that may be occupationally related.

A BME may also be administered to an employee who is already in an arduous duty position but has not previously completed an examination under the Medical Standards Program.

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23.1.6. PERIODIC MEDICAL EXAMINATION

The periodic medical examination (PME) is required to periodically determine if an employee's medical condition and history are static and stable and that they remain medically qualified to safely perform arduous duties.

A PME is administered to employees who have completed a baseline medical examination. It is administered in accordance with a set schedule of periodicity of every three years for all SAs, regardless of age.

23.1.7. POLICY

A. All SA applicants must submit to a medical examination as required under this chapter and be certified as fit for duty by the MRO prior to entering on duty as an SA with HUD OIG. An applicant may elect to submit medical information from his or her own medical practitioner for review and consideration by the MRO, or to consult with his or her personal physician at any time, but this will not replace the required PHS medical examination.

B. All incumbent SAs must undergo a medical examination by HUD OIG designated physicians, for the purpose of assessing fitness to continue work in an unrestricted manner. An incumbent SA may elect to submit medical information from his or her own medical practitioner for review and consideration by the MRO, or to consult with his or her personal physician at any time, but this will not replace the required PHS medical examination.

C. Any physical condition identified during the medical examination that would potentially restrict or disqualify an applicant or incumbent from full employment in this position must be documented, along with detailed medical reasoning, so that HUD OIG can engage in a rational discussion of accommodation.

D. Applicants or incumbents who cannot be accommodated or represent a "direct threat" to the health and safety of themselves or others if placed in this position will be disqualified.

E. Applicants who refuse to submit to an examination will not be considered for employment. A SA who refuses to submit to a required medical procedure may be subject to appropriate disciplinary or adverse action. OIG managers will treat such cases as potential performance or conduct problems, and coordinate an appropriate action through the HCMD.

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F. Throughout the examination process and afterwards, the examinee's right to confidentiality will be safeguarded through protection of the confidentiality of medical records.

G. PMEs will be scheduled every three years for all GS-1811s by the HUD OIG – FOH Coordinator.

H. All SAs are to bring with them to the scheduled examination a copy of the HUD OIG Medical/Physical Evaluation and Qualification Statement form (appendix 23A) completed as to the shaded portions.

I. In between regularly scheduled examinations, supervisory SAs may direct an SA to be examined/evaluated by PHS personnel when concerns arise regarding the SA's fitness for duty, or mental or emotional stability for work. In each case, a supervisor will first consult with the MRO and be guided by the MRO’s recommendations. Depending on the issue, special fitness for duty examinations can be conducted either through the regular FOH clinic, or when appropriate, they can be conducted by FOH’s Medical Employability Unit, which specializes in obtaining the consultation of medical specialists outside FOH. Supervisory SAs must notify the Assistant Inspector General for Investigation (AIGI) if they direct SAs to be evaluated between the PME cycles.

J. HUD OIG SAs must inform their supervisory SAs whenever any change in their medical condition may affect the performance of their duties.

K. All costs associated with the required medical examinations/evaluations for SAs or applicants, as set forth above, including travel costs outside the local commuting area, will be borne by HUD OIG. All costs associated with private medical examinations will be borne by the SA or applicant.

L. The medical standards apply to all HUD OIG SA’s GS-1811 positions.

23.1.8. POSITION DESCRIPTION

The GS-1811 positions are both physically demanding and potentially dangerous.

Agency activities have always carried the potential for "high-risk" working environments. The positions have substantial productivity demands and hectic scheduling demands. The accompanying physical requirements and medical standards are proportionately rigorous. HUD OIG SAs currently operate in areas where crime, drugs, weapons, and potential for violence exist.

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A. The essential duties of HUD OIG SAs have unique physical or mental demands.

These include, but are not limited to:

1. Interview techniques

2. Investigative report writing

3. Travel on short notice, prolonged sitting/standing

4. Use and carry of Firearms

5. Occupational driving

6. Overt and covert surveillance

7. Non-lethal weapons tactics

8. Suspect apprehension

9. Searches, seizures, and transportation of physical evidence

10. Testimony in Court Proceedings

11. Rigorous firearms training in adverse weather conditions

12. Reality Based training exercises

These duties require moderate to arduous physical exertion involving walking, standing, climbing, carrying, lifting, and exposure to inclement weather, heights, uneven terrain, cramped spaces, poorly lit spaces, etc. Applicants and SAs must possess the following general attributes in order to perform the duties of the position of SA satisfactorily:

1. Arms, hands, legs, and feet sufficiently intact and functioning

2. Comparatively free motion of finger, wrist, elbow, shoulder, hip, and knee joints is required.

3. Good manual dexterity and eye-hand coordination

4. Average strength for age and build

5. Acceptable eyesight

6. Acceptable hearing (even with background noise). Hearing aid allowed.

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7. Normal vocal abilities

8. Emotional and mental stability sufficient to allow work in trying conditions and frequent interaction with the public

9. No exceptional fear of confined spaces or heights

10. Above average poise and good judgment

11. Ability to concentrate intensely

12. Ability to work long periods of overtime

13. No use of mind-altering drugs/medications

B. In general, the SA applicant must have no physical impairments or medical conditions that would prevent the performance of each essential duty as described herein. These include searching crime scenes for evidence, recording crime scenes using photography or sketches, conducting covert and overt surveillance, interviewing uncooperative suspects and providing written reports, administering oaths, carrying and periodically using firearms, serving search warrants and subpoenas, performing searches, and apprehending suspects. The SA must present investigative findings in both oral and written form, and be able to testify before grand juries, courts, and administrative hearings. The SA must be able to analyze criminal intent, activities, and behavior patterns and recommend appropriate action. They must be able to drive government vehicles.

Surveillance work may require maneuvering and use of ladders, working at heights, using and interpreting various hand tools and gauges, performing skilled work with hand tools, and entering into confined spaces. Since work is often conducted in “teams,” the ability to work with other HUD OIG SAs and personnel from other agencies must also be assessed. Any physical or mental condition that would cause the applicant or SA to be a hazard to himself/herself or others is disqualifying.

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SECTION 23.2 – MEDICAL REQUIREMENTS

23.2.1. PURPOSE

A. To satisfy HUD OIG's need to have valid, objective, uniform guidance in the medical selection of employees for the GS-1811 position.

B. To provide standards to ensure that employees in the GS-1811 position are physically and mentally capable of safely and efficiently performing the essential duties and responsibilities of the position.

C. To orient examining physicians to the medical disorders and physical conditions that could render an applicant or employee unable to meet the functional requirements for the position of HUD OIG SA or that could place the employee, coworkers, or the general public at risk.

D. To provide a consistent basis for examining and reviewing physicians to evaluate an applicant's or SA’s fitness for duty.

23.2.2. APPLICABILITY

These standards establish minimal satisfactory physical and medical standards. All SAs are expected to perform the same tasks and should therefore possess the same minimal physical and mental capacities regardless of age, gender, size or genetics.

23.2.3. MEDICAL CONDITIONS

The medical conditions listed below will be considered during the review of the medical history and physical examination of applicants and SAs. They are not intended to be all–inclusive, nor are they meant to establish absolute requirements for HUD OIG SAs. Rather, they are provided to aid the examining physician and to provide guidance in what medical conditions might hinder the SA's ability to satisfactorily perform the essential duties of the job without causing undue risk to themselves or others. The list should also serve to establish consistency in the application of medical criteria for applicants and SAs.

A. Eyesight. Concerns the ability to see and be free of visual problems.

1. Near Vision: Corrected or uncorrected vision must be sufficient to read printed material the size of typewritten characters (maps, schematics, blueprints, indicator gauges, dials).

a. Normal depth perception and peripheral vision required.

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b. Normal contrast sensitivity is needed to rule out problems with night vision.

2. Far Vision: With or without correction, distant visual acuity must be 20/30 or better measured with both eyes viewing. Corrected distant visual acuity must be 20/200 or better in the worst eye. Complete loss of vision in one eye is disqualifying.

3. Color Vision: Vision sufficient to distinguish basic colors (ability to identify license plates, suspects, and provide written descriptions of same and to testify to same). SAs will be administered the Titmus Ichihara Color Plates test. If the SA fails the test, the SA will be administered the standard Farnsworth D-15 color vision test. If they fail this test, but can demonstrate they can distinguish red, green, and amber, they are considered qualified to be an SA. This includes the use of the “Yarn” test as a backup test in instances where the SA does not pass the standard Titmus Ichihara or Farnsworth D-15 color vision test. The use of X-Chrom contact lenses or tinted spectacle lenses are not permitted in the testing of color vision. The following are examples of impairments that may affect the individual's ability to perform required tasks:

a. Current cataracts

b. Glaucoma

c. Proliferative retinopathy

d. Retinal detachment

e. Refractive keratoplasty

B. Ears and Hearing Balance. The occupational significance of this area concerns the ability to hear and to maintain body equilibrium. Hearing will be tested using an audiogram. Vestibular function can be tested through established physical examination testing. Concerns include radio/phone communication, surveillance communication, oncoming traffic, tones on indicators, and co-worker communication (especially during complex coordination of multiple parties).

The ability to hear is acceptable if the individual meets the following guidelines:

1. In the frequency from 500-2000 Hz, the deficit should not average more than 30 decibels in either ear.

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2. At 3000 Hz, the deficit should not exceed 40 decibels in either ear.

3. Hearing in both ears is required. Complete loss of hearing in either ear is disqualifying.

4. The use of any hearing aid to comply with the guidelines in a. and b. of this section is acceptable. Note that testing of individuals with digital hearing aids may be impossible in some circumstances. Also, individuals who pass the standard with the use of hearing aids should be identified by the MRO in the official notification as “passing with restriction” and the restriction involves the mandatory use of the hearing aids while working.

5. The applicant or employee will be retested after a noise-free period of at least 15 hours, before the applicant or employee can be disqualified for a hearing loss.

C. Nose, Mouth and Throat. Any abnormalities that would substantially affect breathing or clear speech communication should be identified. There should be a "normal" sense of smell.

D. Heart and Cardiovascular System. The occupational significance of this area concerns the ability of the heart to provide the functional work capacity to meet oxygen demands of physical work tasks. Any condition that would interfere with heart function could render an individual unable to meet the functional requirements for a given task. The following are examples of impairments that may affect a HUD OIG SA’s ability to perform required duties:

1. Angina or coronary heart disease.

2. Cardiomyopathy.

3. Congestive heart failure.

4. ECG abnormalities associated with disease, including arrhythmia.

5. Hypertension (repeated readings which exceed 150 mm Hg systolic and 90 mm Hg diastolic). Agency designated clinics may take serial readings on a given day and, before documenting failure in this test, take readings on three different days in a standing, sitting, and recumbent positon. Note: control with the use of medication is acceptable.

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E. Chest and Respiratory System. The occupational significance of this area concerns lung function, breathing capacity, and freedom from airway obstruction. This is a key area for job performance in terms of the respiratory capacity needed to perform physical tasks and to be free to move about in various environments. Any condition which may significantly interfere with breathing capacity could render the SA unable to meet functional requirements. The following are examples of impairments that may affect the individual's ability to perform required duties:

1. Asthma

2. Chronic bronchitis

3. Bronchiectasis

4. Pneumonectomy

5. Pneumothorax

6. Pulmonary-tuberculosis, active or with significant lung destruction, reduced pulmonary function, if FEVI is less than 65% of vital capacity.

F. Abdomen and Gastrointestinal System. The occupational significance of this area concerns a variety of gastrointestinal disorders that can affect performance of job tasks by imposing severe discomfort. Any functional disorders rendering the applicant incapable of sustained attention to work tasks, e.g., chronic diarrhea and discomfort secondary to such disorders, could render an individual unable to meet the functional requirements (e.g., covert surveillance) of the position of SA. The following are examples of impairments that may affect the individual's ability to perform required duties.

1. Active hepatitis

2. Active peptic ulcer disease (not adequately controlled on medication)

3. Cirrhosis of the liver

4. Chronic inflammatory bowel disease

5. G.I. bleeding

6. Inguinal hernia with potential for incarceration.

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G. Genitourinary and Reproductive System. The occupational significance of this area concerns renal failure and genitourinary dysfunction. Any condition affecting the genitourinary tract rendering an individual unable to meet the functional requirements for the position of SA should be considered in the medical evaluation.

Pregnancy will not disqualify the individual for the position. However, some training and law enforcement assignments associated with this work may require accommodation during pregnancy.

The following are examples of impairments that may affect the individual's ability to perform required duties:

1. Acute and chronic nephritis

2. Nephrosis

3. Obstructive uropathy

4. Polycystic kidney disease

5. Pyelonephritis

6. Recurrent renal calculi

7. Renal failure.

H. Endocrine and Metabolic Systems. The occupational significance of this area concerns any abnormality of the endocrine system that may affect job performance. Any excess or deficiency in hormonal production can produce metabolic disturbances affecting weight, stress adaptation, energy production, and a variety of symptoms such as elevated blood pressure, weakness, fatigue and collapse. Any such disturbance of the maintenance of body functions may affect the ability to meet the functional requirements for this position. The following are examples of impairments that may affect the individual's ability to perform:

1. Adrenal dysfunction

2. Thyroid disease (not controlled and stable)

3. Pituitary dysfunction

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4. Symptomatic hypoglycemia

5. Diabetes mellitus (insulin requiring and evidence of hypoglycemic insulin reactions [e.g., alteration of consciousness] during the past year).

I. Musculoskeletal System. The occupational significance of this area concerns the mobility, stability, flexibility and strength to perform physical job tasks efficiently with minimum risk of injury. Disorders affecting the musculoskeletal system are acceptable if the individual meets the basic movement, strength, flexibility and coordinated balance criteria in the functional requirements for the position of SA. The following are examples of impairments that may affect the individual's ability to perform required duties:

1. Disease or deformity of bones or joints

2. Intervertebral disk

3. Muscle and tendons

4. Previous injury that impairs performance

5. Cervical spine or lumbosacral fusion affecting performance

6. Herniated disc

7. Loss in motor ability from tendon or nerve injury

8. Major extremity amputation

9. Digit loss incompatible with function of a firearm.

J. Hematopoietic and Lymphatic Systems. The occupational significance of this area concerns chronic disorders that may affect overall health in a disabling manner. Any disorder in this area can lead to reduced capability to perform intense physical exertion, or place the individual at undue risk and affect the individual's ability to meet functional requirements for the position of SA. The following are examples of impairments that may affect the individual's ability to perform required duties:

1. Leukemia

2. Severe anemia

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3. Thrombocytopenia or clotting disorders.

K. Nervous System. The occupational significance of this area concerns the functioning of the central and peripheral nervous system. Dysfunction in this area can increase the probability of accidents and/or potential inability to perform a variety of physical tasks, as exemplified in the functional requirement for the position of the HUD OIG SA. The following are examples of impairments that may affect the individual's ability to perform required duties:

1. Epilepsy, not controlled

2. Multiple sclerosis

3. Cerebrovascular disease, including aneurysms, and vascular malformations.

Other disease or disorder of the nervous system producing loss of strength, coordination or other dysfunction impairing full performance, including sequelae of previous injury, infection, or other disease.

L. Malignant Diseases/Communicable Diseases. The occupational significance of the disease must be related to the individual's ability to adequately function and safely perform the physical work tasks of an SA without directly threatening the health or safety of others.

M. Medication. Employees and applicants must have full physical and mental function and a low risk of sudden or subtle incapacitation in order to perform essential duties. Some medications may not be compatible with safe and efficient performance of duties under these conditions. This includes medication with labels warning of drowsiness, dizziness, or cautioning against the use of medication while operating a motor vehicle or machinery.

SAs have the sole responsibility to obtain from their personal physician a “medical clearance” statement when taking prescription medication or otherwise receiving prescribed treatment under a physician’s care, which in the determination of the treating physician, may impair one’s judgment or ability while on duty. The medical clearance statement is required to be obtained by an SA whenever the treating physician prescribes such medication. The medical clearance statement must be on official physician letterhead, signed, and dated by the physician and include:

1. Name of the prescription medication.

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2. Type of medication.

3. Daily dosage.

4. Possible side effects (e.g., drowsiness, dizziness).

5. Restrictions and/or limitations while on prescription medication (e.g., carrying a firearm and/or operating a motor vehicle).

6. Anticipated duration (e.g., days, weeks, or months) of prescription use.

N. Psychiatric Conditions. The occupational significance of this area is concerned with the presence of serious mental diseases, which can adversely affect judgment and perceptive patterns necessary for safe performance of essential duties with consideration given to the occupational hazards, environmental factors and physical demands for the position of an SA. If the examining physician suspects the existence of a psychiatric condition, he or she will note same in the remarks section of the medical examination report and set forth his or her opinion regarding the need for a separate psychiatric examination. All medications taken for psychiatric disorder conditions must be accurately listed in the appropriate section of the medical history, and will be carefully reviewed to ensure that they do not compromise or interfere with safe and efficient job performance. Psychiatric conditions may require a medical review requesting additional information from the treating physician, or the evaluation and report of a psychiatrist, neuro-psychiatrist, or neurologist, before final medical determination and qualification.

O. Mental Stress-Related Disorders and the Workplace. From the occupational physician's standpoint, stress-related disorders represent a continuum from acute and transient states of feeling emotionally "overwhelmed" to somatoform disorders (and malingering) to frank affective, psychotic and anxiety disorders, to neuropsychiatric disease secondary to workplace toxic exposures. Therefore, the first order of business is to define the nature of the problem. From the OIG perspective, and depending on individual circumstances, this may mean referral to a qualified agency occupational physician or a qualified psychiatrist.

Diagnosis and prognosis must be ascertained before employment-related decisions can be addressed. The functional job descriptions for GS-1811 positions (SA) help to define essential job functions that suggest needed "mental" attributes. Such attributes might include abilities to:

1. Maintain concentration over time (e.g., surveillance).

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2. Screen out external stimuli (e.g., study, surveillance).

3. Manage time effectively (e.g., time-pressured goals).

4. Relate to others beyond giving and receiving simple instructions (e.g., multi-agency task force).

5. Handle intense interpersonal contacts (e.g., professional, confidential informant, undercover).

6. Influence people, for example, negotiate (e.g., fraud investigations).

7. Accept and respond appropriately to negative feedback.

8. Comprehend and follow instructions.

9. Perform complex and varied tasks (e.g., arrests).

10. Handle multiple simultaneous tasks (e.g., searches, arrests).

11. Evaluate and make appropriate generalizations and fact-based statements (e.g., testimony).

12. Maintain work pace appropriate with workload.

13. Accept and carry out responsibilities for directing, planning, control over others (i.e., supervisory or management roles).

14. The needed attributes must be considered by the occupational physician when evaluating a GS-1811 applicant or employee and when providing informed medical recommendations to HUD OIG officials.

P. Any disease or condition that may cause the individual to be unduly susceptible to injury or disease because of environmental exposures that impair the safe and efficient performance of essential job duties may be considered disqualifying.

Cases will be reviewed on a case-by-case basis.

1. Any condition which restricts functions or movement.

2. Examples of impairment include albinism, severe chronic dermatitis, cosmetic disfigurements, scleroderma, and severe skin infection.

Q. It may be found that an individual has two or more medical conditions, where each one in and of itself is not sufficiently disabling to disqualify the person for

P a g e | 18 employment. However, the combination of medical or physical conditions may collectively hinder the individual's functional capacity to perform activities relating to law enforcement functions. This could place the individual at personal risk or at risk to others. If so, the examining physicians will so indicate in their findings.

23.2.4. FUNCTIONAL CAPABILITIES

The following functional capabilities relate to the position of the HUD OIG SA:

A. Aerobic Capacity. Aerobic Capacity is defined as the ability to uptake and use oxygen. It is the best overall indicator of physical fitness and is important for sustaining physical activity and for quick recovery following physical exertion.

This metabolic expenditure can be measured in METS (Metabolic Equivalent of Tasks); one MET being equivalent to the metabolic energy expenditure at rest.

The FOH identified the following as MODERATE or HEAVY MET expenditure:

1. Apprehension, lethal and non-lethal defense tactics, performing searches, and performing arrest maneuvers. HEAVY (7-9 METS)

2. Carrying boxes, lifting packs of ammunition, carrying surveillance equipment, and lifting and carrying boxes of files (50 pounds). HEAVY (7-9 METS)

3. Climbing ladders, sometimes while holding equipment, overhead work, and positioning for covert surveillance. MODERATE (5-7 METS)

4. Functional Requirement for selection: Ability to exercise at the 10 METS level.

B. Muscular Strength. Muscular Strength is the maximum ability to exert force, generally expressed as the amount of weight that can be pushed, pulled or lifted.

Strength can be measured as a function of the force generated, such as the total mass lift, or as the amount of force generated against a calibrated resistance.

Strength can be “dynamic,” where the mass or weight is moved, or “static,” (isometric) where nothing moves and a gauge is used to determined force.

1. The job analysis revealed several tasks requiring muscular strength. The maximum weight that is "routinely" lifted is the repetitive lifting of boxes full of files (50 pounds).

2. Functional Requirement for selection: Capacity to lift 50 pounds from 6 inches off floor to 36 inches (the average height of a van).

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C. Muscular Endurance. Muscular Endurance is defined as the ability to perform repeated sub-maximal muscle contractions over time.

1. The job analysis revealed multiple tasks that require "considerable walking, bending, and climbing" under unpredictable and frequently unfavorable environmental conditions.

2. Functional Requirement for selection: Ability to demonstrate repetitive bending and climbing.

D. Flexibility. Flexibility is defined as the ability to move a body part through a range of motion.

1. Lack of flexibility in the lower back and hamstring muscles have been correlated to back injury. Loss of flexibility becomes increasingly important with age, especially in populations that sit, stand and walk for long periods of time on a routine basis.

2. Functional Requirement for selection: Demonstrate flexibility of the lower back and hamstrings.

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SECTION 23.3 – FITNESS FOR DUTY

23.3.1. FITNESS FOR DUTY EXAMINATIONS

A fitness for duty evaluation may be indicated when an employee’s ability to perform full function of his or her position is compromised or encumbered by a medical/psychological event, condition, or disorder.

An employee may be required to undergo a fitness-for-duty exam. There are two situations that may necessitate a fitness for duty examination:

• If an employee, on his or her own, raises a legitimate medical condition as an affirmative defense for a time and attendance, conduct, or performance deficiency.

• If management has a direct question and demonstrated proof of an employee's capacity to safely and effectively meet the physical or medical (including mental health) requirements of their arduous duty position.

It is the employee’s responsibility to carry out the functional requirements of his/her job in a professional, efficient, and timely manner. Failure to do so may result in adverse action, up to and including termination. HUD OIG must exhaust all performance and conduct issues to the furthest degree prior to requesting a fitness for duty examination. Expert guidance from HCMD is highly recommended. If an employee contends that time and attendance, conduct, or performance failure are due to medical causes, it is the responsibility of the employee, at his or her expense, to offer sufficient information from valid and reputable medical sources to substantiate the medical claim that is presented.

Fitness-for-duty exam requests must be submitted to the HCMD in writing through the SAC. This request should include specific examples relevant to the medical standard in question. If the employee does not have a valid or current periodic medical examination on file, then one may be ordered immediately. The employee may be asked to submit medical documentation relevant to his or her ability to perform safely and efficiently. If the employee refuses to be examined or to submit medical documentation, the agency will act on the basis of the information it has available or action will be taken based on the employee's performance or conduct in light of currently available information or medical knowledge. This may in turn be a management rather than a medical determination.

If the need for a fitness-for-duty exam is warranted, the HCMD will coordinate with the SAC in setting up the exam through the MRO.

A. Orientation for Examining Physician. A proper examination of applicants and employees requires the physician to relate the physical examination and medical

P a g e | 21 history to the demands of the job. Accordingly, the examining physician should be provided the following for his or her study by the HUD OIG - FOH coordinator:

1. Position description for HUD OIG SAs.

2. Performance Appraisal Criteria.

3. This chapter, including description of job duties, physical requirements, functional capabilities and medical standards.

4. If the applicant or employee has been under medical treatment, this fact should be communicated to the examining physician by the applicant or employee. The results of the examination should take into account the examiner's understanding of the diagnosis, treatment, and rehabilitation provided by the treating physician. If inconsistencies exist between the examining and the treating physician's diagnosis and/or conditions, the examining physician should make a concerted effort to account for such inconsistencies and to discuss their implications for the person's employability.

B. Medical Examinations. Medical examinations of applicants and employees will be performed by a physician designated by the agency. To retain impartiality, applicants and employees are not allowed to provide all data and exam information from their personal physician in lieu of the examination and testing by the agency-designated physician. The applicant or employee may provide test results, data, or exam information from their personal physician to supplement, or in lieu of, the agency-designated physician conducting those specific tests/examinations. The agency must review and consider all such documentation supplied by the individual's personal physician or practitioner.

23.3.2. FITNESS FOR DUTY DETERMINATIONS

Examining Physician's Findings. After the examining physician has completed the physical examination and has reviewed all laboratory results, his or her findings should be recorded on the FOH Qualification Statement, which is the last page of the HUD- OIG Medical/Physical Evaluation and Qualification Statement (see Appendix 23A).

The Qualification Statement will indicate whether the SA or applicant, in the opinion of the examining physician, is fit for duty with HUD OIG, or unfit, or temporarily unfit for duty due to a specific medical condition(s). The MRO will review the results of all SA and applicant medical examinations and either concur or non-concur with the opinion

P a g e | 22 of the examining physician, on the Qualification Statement, as to the individual's fitness for duty. The MRO will not recommend the employee's return to the arduous duty position if any medical condition is present that may potentially affect the individual's ability to safely perform all the essential duties of the job. The MRO will coordinate the results of all medical examinations with the HUD OIG - FOH Coordinator, HCMD. The HUD OIG – FOH Coordinator will then notify the applicants or SAs of the medical findings. The MRO will retain all medical reports.

23.3.3. APPLICANT/EMPLOYEE NOTIFICATIONS

A. Applicants. Applicants who are determined fit for duty will be notified by HUD OIG and an “enter-on-duty” date will be established. Applicants who are determined unfit for duty will be notified and provided specific reasons for the determination. If elected to do so, applicants will have 30 days to present additional information to the MRO for consideration. In no case will an applicant be hired without concurrence as to fitness for duty by the MRO.

B. Employees. SAs who are determined fit for duty will be notified by OIG. In all cases where it has been determined that the SA is unfit for duty, or that certain job duties should be limited or restricted, HUD OIG Special Agents in Charge (SAC) or the Deputy Assistant Inspectors General for Investigation will take the following steps in descending order:

1. Take immediate action necessary to protect life and property. If determined to be necessary by the supervisor or the Deputy Assistant Inspector general for Investigation (DAIGI), this will include rescission of law enforcement authority and retrieval of the SAs issued and/or authorized firearms and intermediate weapons.

2. MRO prepares a letter notifying the HUD OIG - FOH Coordinator, HCMD, of the examining physician’s and MRO's findings and recommendations. If clinically appropriate, the MRO forwards a request for additional evaluation and/or examination in a letter addressed to the HUD OIG - FOH Coordinator, who will then notify the SA’s SAC and provide the SAC with a copy of the MRO letter.

3. The SA will be directed by his/her SAC to make an appointment with their personal physician within 30 - 60 days of this notification for any additional evaluation or examination deemed necessary by the examining physician and

MRO.

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4. HUD OIG headquarters recognizes that in scheduling appointments with physicians and/or medical specialists there may be cases in which the 30 - 60 day time period cannot be met due to full diagnostic schedules, non-availability of medical technical personnel, etc. In such cases, a written explanation for the delay from the SA’s personal physician and/or medical specialist, to include a request for a 30-day extension must be provided on the physician’s official letterhead. The DAIGI will review these extension requests on a case-by-case basis.

In cases where the MRO asserts that the SA is presently unfit for duty, he or she will be placed on approved administrative leave pending completion of required examination/evaluations and review of the additional medical documentation by the MRO. Any duty limitations and/or restrictions imposed by the MRO may not be rescinded without written concurrence of the MRO.

5. The Director of HCMD and the Counsel to the Inspector General must be consulted to determine appropriate administrative action to be taken if the SA refuses to submit to a required medical examination or any other evaluation/examination recommended by the MRO; or if the MRO cannot subsequently certify the SA for unrestricted return to duty within a reasonable period of time. Proper consideration will be given to reasonable accommodation alternatives in deciding appropriate action in the latter situation.

6. Individuals seeking such accommodations must submit to the medical examination required by the OIG. They may produce any additional medical documentation to support the request.

C. Documentation. Evaluation and/or examination results will be documented on the personal physician’s office letterhead and include; date of exam, original signature of the personal physician or…