Attachment_C_-_Medical_Standards.doc

Attachment C - PFPA Contract Security Officer (CSO) Medical Standards Overview Contract Security Officers (CSO) performing services under this contract must be able to respond to immediate, life threatening, and/or hostile situations. The medical and physical fitness standards listed will ensure they possess the degree of physical fitness required to fully perform the required tasks. The Contractor must certify and document that each employee of the uniformed force meets the requirements in this Attachment.

The work under this contract requires frequent and prolonged walking, standing, running, sitting, and stooping, as well as occasional lifting and ascending /descending of stairs (average building has minimum of 14 flights). CSOs are responsible for patrolling and performing emergency operations commensurate with their duties on ALL building floors. In addition CSOs may be required to sporadically move and/or carry objects in connection with emergency/security situations (i.e. people, furniture, luggage, fire extinguishers, etc.). From time to time CSOs may be required to subdue violent or potentially violent persons in conjunction with their duties. Possessing good physical and mental stamina is a basic requirement under this contract. All candidates shall undergo a pre-placement medical examination by a licensed, board-certified medical doctor to ensure the candidate meets the medical standards listed below.

The provisions of this subsection are designed to comply with the provisions set out in the American with Disabilities Act (ADA).

The following medical standards are provided to aid the Agency medical reviewing physician 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. They are also to be used to ensure consistency and uniformity in the application of these standards.

The job requirements for CSO within PFPA are by their nature hazardous and arduous and are performed under variable and unpredictable working conditions. Each of the medical standards listed are subject to the clinical interpretation of the condition by the Agency medical reviewing physician who will incorporate his/her knowledge of the job requirements and environmental conditions in which employees must work. The PFPA program will be periodically evaluated for effectiveness and continued compliance with the law.

Each candidate or current employee will be required to cooperate, participate and comply with the medical evaluation program. Individual medical information will remain confidential at all times.

The medical standards include examples of certain identifiable medical conditions and/or physical impairments that may require the candidate or incumbent to give additional information and require additional testing and or examination to show the ability to perform essential job tasks. Individualized assessments will be made on a case-by-case basis to determine an individual’s ability to meet the performance-related requirements of the positions covered by these standards.

Any other disease, condition or impairment, not specifically listed in the medical standards, which interferes with the safe, efficient and expected performance of the duties and responsibilities, may also require additional medical information and screening. Candidates and incumbents must have no other organic, functional or structural disease; defect or limitation found by the medical officer to clinically indicate a potential hazard to safety and/or is likely to adversely affect safe and efficient job performance.

A candidate that is unable to obtain a driver’s license for any medical reason will not be considered for a PFPA CSO position until such time as the condition is resolved and a driver’s license has been issued. Regardless of the reissuance of a driver’s license the candidate must still meet the medical standards outlined in this manual.

Table of Contents Overview

Table of Contents

Medical Services by Category

1 / Cardiovascular System Standard

2 / Central and Peripheral Nervous Systems Standard

3 / Chest and Respiratory System Standard

4 / Dermatological Standard

5 / Endocrine and Metabolic Systems Standard

6 / Gastrointestinal System Standard

7 / Genitourinary and Reproductive System Standard

8 / Head, Nose, Mouth, Throat and Neck Standard

9 / Hearing Standards

10 / Hematopoietic System Standard

11 / Infectious Disease Policy: Immune System / Allergic Disorders Standards

12 / Medication Standard

13 / Musculoskeletal System Standard

14 / Organ Transplantation and Prosthetic Devises Standard

15 / Peripheral Vascular System Standard

16 / Psychiatric Disorders Standard

17 / Special Subject: Anabolic Steroid Use

18 / Vision Standards

Medical Services by Category

1. History

1.1. General Medical History

1.2. Noise Exposure History

1.3. Occupational History

2. Examination Items

2.1. General Physical Examination

2.2. General Appearance and Vital Signs

2.3. Special Attention To:

2.3.1. Back & Musculoskeletal System

2.3.2. Cardiovascular System

2.3.3. Central Nervous System

2.3.4. Endocrine and Metabolic System

2.3.5. Eyes, Ears, Nose, Mouth, and Throat

2.3.6. Gastrointestinal System

2.3.7. Genitourinary System

2.3.8. Habitus (obesity)

2.3.9. Peripheral Nervous System

2.3.10. Respiratory System

2.3.11. Skin

2.3.12. Thyroid

3. Medical Screens

3.1. Audiogram, Current - 500, 1000, 2000, 3000, 4000, 6000, 8000 Hertz in both ears (per medical examination schedule and yearly for firearms instructors)

3.2. Electrocardiogram-Resting

3.3. Pulmonary Function Test-Spirometry (baseline only)

3.4. TB (Mantoux) skin test (baseline only)

3.5. Vision

3.6. Depth perception (seconds of arc)

3.7. Color Discrimination (Ishihara Pseudoischromatic Plate Color Test or a Farnsworth D-15 color vision test.)

3.8. Far and Near Vision Acuity, (uncorrected and corrected, each eye separately, plus together)

3.9. Peripheral Vision (nasal and temporal, each eye separately measured)

4. Laboratory

4.1. Blood Lead, Zinc Protoporphyrin (yearly for Firearms Instructors-Lead surveillance program), Lab Panel (CBC, UA, Chemistry Panel)

4.2. Other blood or urine tests (as determined by the MRO)

5. Clearances

Medical Examination Review includes the medical clearance to participate in a Physical Fitness Program as part of the examination

6. Medical Fitness screening for incumbents not scheduled for an annual medical exam will include a Cardiac Risk Profile, Blood Pressure, Height and Weight, Medical Exam, and a Resting EKG.

1 / CARDIOVASCULAR SYSTEM STANDARD

Any disease or condition that interferes with cardiac function may interfere with the full performance of duties and be considered disqualifying. Cases will be reviewed on a case-by-case basis.

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1.1. PACEMAKERS or PROSTHETIC VALVES, and any condition or post-surgical management that requires the use of Coumadin or other anti-coagulants will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties in the stressful and hazards police environment.

1.2. CORONARY ARTERY DISEASE.

1.3. HYPERTENSION that requires the use of any medication to stabilize the blood pressure may be disqualifying. Systolic blood pressure exceeding 150 and/or diastolic blood pressure exceeding 90 mm Hg may be disqualifying. Confirmation of hypertension will require at least three (3) serial readings of blood pressure. Serial readings must include at least three (3) blood pressure readings taken on different days and should include readings in both arms in a standing, sitting, and recumbent position. Additional testing may be required to render a final medical opinion, including, but not limited to a maximal, symptom-limited exercise stress EKG, dilated funduscopic exam of the eye to detect hypertensive retinopathy, and a cardiologist evaluation to determine whether there exists any contraindication for vigorous intensity physical exercise. Individuals on medication will have to demonstrate the absence of orthostatic hypotension with blood pressure measurements in the sitting, standing, and lying positions. Anti-hypertensive medication will be evaluated to ensure that safe and efficient job performance will not be adversely affected.

1.4. LEFT BUNDLE BRANCH BLOCK.

1.5. MYOCARDITIS/ ENDOCARDITIS/ PERICARDITIS (Active or recently resolved cases). A past history of these diseases may require additional testing to determine the current capabilities.

1.6. History of MYOCARDIAL INFARCTION.

1.7. A history of CARDIAC SURGERY (depending on the procedure and when it was performed).

1.8. VALVULAR HEART DISEASE such as mitral valve stenosis, mitral valve regurgitation, aortic stenosis, mitral valve prolapse, etc.

1.9. DYSRHYTHMIAS: such as ventricular tachycardia or fibrillation, Wolff-Parkinson-White syndrome, Paroxysmal Atrial Tachycardia with or without block.

1.10. CEREBROVASCULAR ACCIDENT or TRANSIENT ISCHEMIC ATTACKS.

1.11. PULMONARY EMBOLISM (within the past six months or if there is a recurrent history or use of anticoagulants.

1.12. ANGINA PECTORIS or chest pain of unknown etiology.

1.13. CARDIOMYOPATHY from any cause.

1.14. CONGESTIVE HEART FAILURE

1.15. MARFAN’S SYNDROME

1.16. CONGENITAL ANOMALIES (case-by-case review of clinical presentation)

2 / CENTRAL AND PERIPHERAL NERVOUS SYSTEMS STANDARD

Any disease or condition, which interferes with the central or peripheral nervous system function, will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Cases will be reviewed on a case-by-case basis. The evaluation will consider the law enforcement requirements of engaging in rigorous and arduous training and hazardous duties including the firing of weapons. Neurological impairment could pose a very real danger to the individual, his or her partner, and the general public.

Cerebral and cerebellar functions must be normal.

2.1. The peripheral nervous system and all reflexes should be acceptable.

2.2. An individual with a history of seizures currently controlled on medication(s) will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Re-evaluation of an individual is subject to the seizure policy outlined below.

2.3. SEIZURE POLICY

A CSO’s duties may involve searching, apprehending and subduing dangerous felons or terrorists, long hours, stakeouts, firing weapons and other highly stressful, dangerous, and life threatening activities. Access to medication may not be possible. Neurological impairments could pose a very real hazard to the individual, his/her partner, and others; therefore, they will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Conditions that will require additional testing/medical screening include, but are not limited to, the following examples:

2.3.1. ATAXIA

2.2. CHOREOATHETOSIS

2.3. EPILEPSY (See the seizure policy above)

2.4. HUNTINGTON’S CHOREA

2.5. MULTIPLE SCLEROSIS

2.6. MUSCULAR DYSTROPHY

2.7. NARCOLEPSY

2.8. NEUROFIBROMATOSIS

2.9. PARKINSON S DISEASE

2.10. CEREBROVASCULAR ACCIDENT (STROKE)

2.11. TRANSIENT ISCHEMIC ATTACKS

2.12. SENSORY DYSFUNCTION (smell, touch, taste).

2.13. MIGRAINE CEPHALGIA

* All neurological diseases or disorders whether listed above or not shall be reviewed on a case-by-case basis.

3 / CHEST AND RESPIRATORY SYSTEM STANDARD

Any disease or condition, which interferes with respiratory function, will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Cases will be reviewed on a case-by-case basis. Conditions include, but are not limited to, the following examples:

3. 1. FORCED VITAL CAPACITY (FVC) AND/OR FORCED EXPIRATORY VOLUME

AT ONE SECOND (FEV1) THAT IS LESS THAN 70% OF THE EXPECTED VALUE.

3.2. THE FEV1/FVC RATIO SHOULD NOT REFLECT EVIDENCE OF A SIGNIFICANT OBSTRUCTIVE OR RESTRICTIVE DISORDER.

3.3. ASTHMA currently controlled on any medication will be reviewed on a case-by-case basis. The evaluation will consider the law enforcement requirements of engaging in rigorous and arduous training and hazardous duties including the firing weapons. A person may be requested to submit to a methacholine challenge test, exercise stress treadmill test, or other diagnostic assessment prior to making final recommendations.

3.4. ACTIVE PULMONARY TUBERCULOSIS (TB): A history of confirmed TB that has been treated for longer than 6 months is acceptable provided that documentation supports the treatment history. Additionally, diagnostic studies may be required following the case evaluation. Evidence of significant lung destruction in fully treated cases will be evaluated on a case-by-case basis. Any case of active TB would delay medical qualification until a sufficient period of time has passed to render the person non-communicable and documentation must be provided to show evidence of medical regimen compliance.

3.5. HISTORY OF CHRONIC BRONCHITIS ASSOCIATED WITH DECREASED PFT RESULTS.

3.6. LUNG ABSCESS

3.7. SPONTANEOUS PNEUMOTHORAX (if recurrent)

3.8. EMPHYSEMA

3.9. SARCOIDOSIS (if associated with an impaired pulmonary function)

3.10. PULMONARY EMBOLISM

3.11. PULMONARY INFARCTION

3.12. TUMORS OF THE LUNG

3.13. PNEUMONECTOMY ( if FEV1 less than 70%)

• Respiratory disorders not listed above will be reviewed on a case-by-case basis and may require the evaluation by a Pulmonologist.

4 / DERMATOLOGIC STANDARD

Any disease or condition, which may cause the person to be unduly susceptible to injury or disease as a consequence of environmental exposures including the sun, will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Cases will be reviewed on a case-by-case basis.

Conditions include, but are not limited to, the following examples:

4.1. ALBINISM

4.2. SKIN CANCER (examples are Basal Cell carcinoma, Squamous Cell carcinoma, Mycosis fungoides)

4.3. CHLORACNE (This condition should be reviewed on a case-by-case basis for its association with toxic exposures)

4.4. KAPOSI’S SARCOMA

4.5. SEVERE CHRONIC DERMATITIS

5 / ENDOCRINE AND METABOLIC SYSTEMS STANDARD

Any excess or deficiency in hormonal production can produce metabolic disturbances affecting weight, stress adaptation, energy production, and a variety of symptoms or pathology such as elevated blood pressure, weakness, fatigue and collapse. Any condition affecting normal hormonal/metabolic functioning and response that is likely to adversely affect safe and efficient job performance will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Cases will be reviewed on a case-by-case basis. Conditions include, but are not limited to, the following examples:

5.1. ADRENAL DYSFUNCTION (In the form of Addison ’s disease or Cushing ’s syndrome).

5.2. THYROID DISEASE (uncontrolled or associated with complications). Hypothyroidism adequately controlled by hormone replacement may be considered acceptable.

5.3. PITUITARY DYSFUNCTION

5.4. DIABETES MELLITUS

5.5. HYPERGLYCEMIA will require additional tests including but not limited to a glycohemoglobin (or hemoglobin A1C), fasting glucose, and a 3 hour glucose tolerance test before a final medical determination.

5.6. DIABETES INSIPIDUS

6 / GASTROINTESTINAL SYSTEM STANDARD

The gastrointestinal tract (GI) should be normal from the mouth to the anus by the examining physician. Any disorder of the GI tract capable of rendering the candidate suddenly incapacitated or incapable of sustaining attention to required tasks, i.e., chronic diarrhea will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Cases will be reviewed on a case-by-case basis.

Conditions include, but are not limited to, the following examples:

6.1. ACUTE AND CHRONIC ACTIVE HEPATITIS

6.2. CROHN’S DISEASE / ULCERATIVE COLITIS/REGIONAL ENTERITIS or IRRITABLE BOWEL SYNDROME (Control of these conditions with surgical and/or medication treatments will be reviewed on a case-by-case basis.)

6.3. COLOSTOMIES

6.4. ILEITIS (recurrent or chronic)

6.5. CHOLELITHIASIS (symptomatic or asymptomatic)

6.6. CHOLECYSTITIS (chronic or recurring)

6.7. DIVERTICULITIS (symptomatic)

6.8. DYSPHAGIA from any cause. Control/severity/treatment of these conditions will be reviewed on a case-by-case basis.

6.9. CIRRHOSIS OF THE LIVER (depending upon the degree of severity and the etiology)

6.10. INTESTINAL OBSTRUCTION from any cause

6.11. PANCREATITIS

6.12. AN UNTREATED INGUINAL, INCISIONAL OR VENTRAL HERNIA.

The following clinical scenarios and all other gastrointestinal conditions will be considered on a case-by-case basis:

*A history of bowel resection will require additional screening if there is any evidence of recurrent pain, hemorrhage or any dietary restrictions that might interfere with the performance of the duties and responsibilities.

*A history of gastric resection will require additional screening if there is any evidence (historical or physical) of pain, hemorrhage, fainting episodes or dietary restrictions that might interfere with the performance of the job.

*A history of a symptomatic hiatal hernia resulting in chest pain, gastrointestinal hemorrhage (occult or massive), or respiratory symptoms. The complication of gastroesophageal reflux controlled on antacids will generally be considered acceptable.

7 / GENITOURINARY AND REPRODUCTIVE SYSTEM STANDARD

In general, any dysfunction of the genitourinary or reproductive system that has the capability of interfering with the required tasks or rendering the person suddenly incapacitated will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. The same is true of any functional disorders rendering the individual incapable of sustained attention to work tasks, i.e., urinary frequency and/or significant discomfort secondary to such disorders.

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

Conditions include, but are not limited to, the following examples:

7.1. POLYCYSTIC KIDNEY DISEASE

7.2. ACUTE or CHRONIC RENAL FAILURE

7.3. NEPHROTIC SYNDROME

7.4. SYMPTOMATIC URINARY CALCULI

7.5. NEUROGENIC BLADDER

7.6. BERGER’S DISEASE

7.7. HISTORY OF RENAL VEIN THROMBOSIS

7.8. UNCORRECTED OBSTRUCTIVE UROPATHIES

7.9. RENAL TOXICITY

8 / HEAD, NOSE, MOUTH, THROAT AND NECK STANDARD

A general examination of the head and neck should be performed during the physical examination. Attention should be given to any skull deformities, loss of bony substance or any evidence of past surgery. Cases will be reviewed on a case-by-case basis.

Conditions include, but are not limited to, the following examples:

8.1. MUTISM / APHONIA (INABILITY TO SPEAK)

8.2. ANOSMIA

8.3. ARTIFICIAL LARYNX OR ESOPHAGEAL SPEECH

8.4. FACIAL DEFORMITIES

8.5. TEMPOROMANDIBULAR JOINT SYNDROME (MODERATE TO SEVERE CASES)

8.6. NASAL POLYPS THAT SIGNIFICANTLY OBSTRUCT BREATHING

8.7. RESTRICTED RANGE OF MOTION IN THE NECK

8.8. NECK MASSES, LYMPHADENOPATHY OR TRACHEOSTOMY

*Any other chronic disease or condition that significantly interferes with speech or breathing and bears the potential to render the person suddenly incapacitated, will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties.

9 / HEARING STANDARDS

Any disease or condition, which interferes with the ability to hear, may be considered disqualifying. Cases will be reviewed on a case-by-case basis.

9.1. In the frequency range 500, 1000, and 2,000 hertz (Hz), the deficit should not exceed 30 decibels in either ear.

9.2. At 3,000 Hz the deficit should not exceed 40 decibels in either ear.

9.3. HEARING AIDS: A PFPA CSO requires full hearing capabilities for the successful performance of essential functions. It is critical that the individual be able to recognize and respond appropriately to nonverbal auditory stimuli, such as the sound of shotgun racking, retreating or approaching footsteps, or the sound of breathing, as well as be able to adequately receive, perceive and react appropriately to speech communication in a variety of situations. Each and every candidate and incumbent will be evaluated and the decision made on a case-by-case basis.

A pure tone audiogram must be performed in an approved soundproof hearing booth that conforms to the American National Standards Institute (ANSI) standards, without hearing aids. The person must be binaural (have hearing in both ears). A whisper test is not acceptable. Additional testing may be required to render a final medical opinion, including, but not limited to, a second audiogram separated by a noise-free period of from 15-40 hours and an Otolaryngologist’s examination.

9.4. Some Otological conditions which will require further evaluation by the MRO:

9.4.1. Meniere’s Disease

9.4.2. Vestibular Neuronitis

9.4.3. Vertigo & Paroxysmal Positional Vertigo

9.4.4. Acoustic Neuroma

9.4.5. Wegener S Granulomatosis

9.4.6. Otosclerosis

*Any other disease or defect of the ear, which adversely affects hearing or equilibrium and which potentially, interferes with the safe and efficient job performance will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties.

10 / HEMATOPOETIC SYSTEM STANDARD

Any hematopoietic disease or condition that interferes with the expected performance of these jobs will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Cases will be reviewed on a case-by-case basis.

Conditions include, but are not limited to, the following examples:

10.1. ANEMIA-- Generally considered as a:

10.1.1. HEMATOCRIT OF LESS THAN 39% AND A HEMOGLOBIN OF LESS THAN 13 gm/dl FOR MALES

10.1.2. HEMATOCRIT OF LESS THAN 33% AND A HEMOGLOBIN OF LESS THAN 12 gm/dl FOR FEMALES

(If anemia does exist but physical performance levels and pulmonary function are normal then this condition may be acceptable.)

10.2. INHERITED CLOTTING DISORDERS (ex. HEMOPHILIA) are will require additional screening.

10.3. CHRONIC LYMPHANGITIS

10.4. THROMBOCYTOPENIA OR CLOTTING DISORDER

10.5. SICKLE CELL ANEMIA

10.6. SPLENOMEGALY

11 / INFECTIOUS DISEASE POLICY

IMMUNE SYSTEM / ALLERGIC DISORDERS STANDARDS

Any communicable disease, which can directly affect the occupational job performance and/or directly threaten the health and safety of others will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Cases will be reviewed on a case-by-case basis.

Conditions include, but are not limited to, the following examples:

11.1. HEREDITARY ANGIOEDEMA

11.2. GOODPASTURE’S SYNDROME

11.3. AUTOIMMUNE HEMOLYTIC ANEMIA

11.4. VASCULITIS A-12

11.5. HASHIMOTO’S THYROIDITIS

11.6. MYASTHENIA GRAVIS

11.7. SYSTEMIC LUPUS ERYTHEMATOSUS

11.8. SPECIAL CONCERNS:

11.8.1. HEPATITIS: A history of chronic or acute active hepatitis B or hepatitis C or any blood born pathogen will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. A finding of unexplained elevated liver enzymes may require additional diagnostic studies before a final medical recommendation is rendered. Cases will be reviewed on a case-by-case basis.

11.8.2. HIV/AIDS: The position of security officer is dangerous and physically demanding. It requires the carrying and use of firearms, immediate response in emergency situations and the rescue of victims under attack. Any candidates or incumbents that have a positive HIV status or AIDS will require additional screening to determine whether they will be able to safely and successfully perform essential duties without presenting a significant risk of substantial harm to the health of themselves or others. Cases will be reviewed on a case-by-case basis.

11.8.3. TUBERCULOSIS: A history of TB that has been appropriately treated for longer than 6 months is acceptable provided that documentation supports the treatment history and the person has a current normal chest x-ray. A person with a positive PPD or Mantoux skin test will be required to have a Chest X-ray and, if indicated, a sputum culture. Cases will be reviewed on a case-by-case basis.

12 / MEDICATION STANDARD

All medication, prescribed or over-the-counter, including psychotropic medication, will be evaluated to ensure that safe and efficient job performance will not be adversely affected. Cases will be reviewed on a case-by-case basis. Each of the following will be taken into consideration:

12.1. MEDICATION(S) (Type and dosage requirements)

12.2. POTENTIAL DRUG SIDE EFFECTS

12.3. DRUG-DRUG INTERACTIONS

12.4. ADVERSE DRUG REACTIONS

12.5. DRUG TOXICITY AND ANY MEDICAL COMPLICATIONS ASSOCIATED WITH LONG TERM DRUG USE

12.6. DRUG-ENVIRONMENTAL INTERACTIONS

12.7. DRUG-FOOD INTERACTIONS

12.8. HISTORY OF PATIENT COMPLIANCE

Medications, such as narcotics, sedative hypnotics, barbiturates, amphetamines, or any drug with the potential for addiction, that is taken for extended periods of time (usually beyond 10 days) will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. The severity of underlying conditions stabilized by medications and the cognitive limitations the medications themselves can cause will also require additional screening to ensure they do not pose a danger to their safety or others when subject to the hazardous environment of a security officer.

13 / MUSCULOSKELETAL SYSTEM STANDARD

Any condition that adversely impacts on an individual’s movement, agility, flexibility, strength, dexterity, coordination or the ability to accelerate, decelerate and change directions efficiently will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Cases will be reviewed on a case-by-case basis.

Conditions include, but are not limited to, the following examples:

13.1. ARTHRITIS (ANY ETIOLOGY) if there is limited joint motion and/or pain.

13.2. AMPUTATIONS of one or more digits if it directly affects the ability to grip and efficiently handle weapons.

13.3. AMPUTATIONS OF AN EXTREMITY: Any loss of an upper or lower extremity. Employees with fewer than five (5) digits on each hand will be evaluated on a case-by-case basis.

13.4. ANKYLOSING SPONDYLITIS

13.5. SCOLIOSIS, if the lateral curve is 20 degrees of more

13.6. MUSCULAR DYSTROPHY

13.7. LUMBOSACRAL INSTABILITY: pain or limitations of flexibility and strength causing an inability to stand, bend, stoop, carry heavy objects or sit for long periods of time.

13.8. DEGENERATIVE DISK DISEASE

13.9. FIXED LORDOSIS OR KYPHOSIS which limits mobility and skeletal strength.

13.10. FRACTURES may require orthopedic evaluation to determine whether functional limitations currently exist. A recent fracture with current immobilization (such as casting, bracing, etc.) of a limb that prevents the performance of the full range of law enforcement duties will require documentation from the treating physician that immobilization is no longer required and that no physical limitations are present.

13.11. SPINA BIFIDA

13.12. CIATICA OR OTHER NEUROPATHIES

13.13. CHRONIC LOW BACK PAIN (by medical history) without demonstrable pathology may be considered disqualifying. Each case will be reviewed in context to the original history of the injury (or whatever the etiology), the response to therapeutic regimes, and the frequency of recurrence, exacerbating factors, and lengths of disability associated with the recurrences combined with the current clinical presentation. Any other documentation submitted or requested will be considered before a medical opinion is generated.

13.14. A history of a CHRONIC SPRAIN OR STRAIN OF THE NECK limiting mobility or causing recurring cephalgia (headaches) will require additional screening to determine whether the individual will have requisite mobility and flexibility.

13.15. Any PROSTHETIC DEVICE will be reviewed on a case-by-case basis.

13.16. Evidence of a CERVICAL RIB, SUBLUXATION, TORTICOLLIS, SYMPTOMATIC THORACIC OUTLET SYNDROME or a BRACHIAL CLEFT CYST

13.17. Any evidence of a CERVICAL NEUROPATHY including numbness, tingling or loss of motor strength in the upper extremities will require review for strength and safety.

13.18. Any medical condition, congenital or acquired, which would interfere with a person’s agility, dexterity, the lifting of heavy objects or the ability to perform the full range of security duties will require additional screening.

13.19. A condition will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties if there is evidence that the general body symmetry may directly interfere with the safe utilization of issued standard and specialty equipment, including but not limited to handguns, shotguns, handcuffs, motor vehicles, etc.

13.20. ORGAN TRANSPLANTATION AND PROSTHETIC DEVISES STANDARD. Transplantations and prosthetic devises may impact the ability to perform required duties and will be evaluated on a case-by-case basis.

13.20.1. RENAL TRANSPLANTATION will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Factors will include whether the individual is taking immunosuppressive drugs, is medically cleared by the surgeon who performed the operation to participate in strenuous activities and capable of withstanding blunt trauma to his/her flanks without a significant probability of untoward personal damage.

13.20.2. OCULAR LENS IMPLANTATION may be acceptable considering an adequate post surgical recovery period and if the visual acuity meets the medical standards. (See vision standards)

13.20.3. COCHLEAR IMPLANTATION is acceptable provided that the candidate meets the hearing standards and can localize sound satisfactorily. (See hearing standards)

13.20.4. PACEMAKERS or PROSTHETIC VALVES and any condition or post-surgical management that requires the use of Coumadin or other anti-coagulants will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. (See cardiovascular standards)

13.21. PERIPHERAL VASCULAR SYSTEM STANDARD. Any condition that significantly interferes with peripheral vascular function may be considered disqualifying. The peripheral vascular system involves the veins and arteries of the legs and arms. Cases will be reviewed on a case-by-case basis.

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

13.21.1. CHRONIC VENOUS INSUFFICIENCY

13.21.2. DEEP VEIN THROMBOSI

13.21.3. CHRONIC THROMBOPHLEBITIS

14 / ORGAN TRANSPLANTATION AND PROSTHETIC DEVISES STANDARD

Transplantations and prosthetic devises may impact the ability to perform required duties and will be evaluated on a case-by-case basis.

14.1. RENAL TRANSPLANTATION will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Factors will include whether the individual is taking immunosuppressive drugs, is medically cleared by the surgeon who performed the operation to participate in strenuous activities and capable of withstanding blunt trauma to his/her flanks without a significant probability of untoward personal damage.

14.2. OCULAR LENS IMPLANTATION may be acceptable considering an adequate post-surgical recovery period and if the visual acuity meets the medical standards. (See vision standards)

14.3. COCHLEAR IMPLANTATION is acceptable provided that the candidate meets the hearing standards and can localize sound satisfactorily. (See hearing standards)

14.4. PACEMAKERS or PROSTHETIC VALVES and any condition or post-surgical management that requires the use of Coumadin or other anti-coagulants will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. (See cardiovascular standards)

15 / PERIPHERAL VASCULAR SYSTEM STANDARD

Any condition that significantly interferes with peripheral vascular function may be considered disqualifying. The peripheral vascular system involves the veins and arteries of the legs and arms. Cases will be reviewed on a case-by-case basis.

15.1. CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

15.1.1. CHRONIC VENOUS INSUFFICIENCY

15.1.2. DEEP VEIN THROMBOSI

15.1.3. CHRONIC THROMBOPHLEBITIS

16 / PSYCHIATRIC DISORDERS STANDARD

Psychiatric disorders, which could affect safe and efficient job performance will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. All diagnosis must be consistent with the diagnostic criteria as established by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), or any subsequent revisions. Any psychiatric illness not listed here shall be reviewed on a case-by-case basis. Specific psychiatric disorders include but are not limited to the following examples:

16.1. AXIS I DISORDERS:

16.1.1. DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS

16.1.2. MAJOR DEPRESSION

16.1.3. MANIC-DEPRESSIVE DISORDER (BI-POLAR)

16.1.4. DISSOCIATIVE DISORDERS

16.1.5. KLEPTOMANIA

16.1.6. PANIC DISORDER AND OTHER ANXIETY DISORDERS (depending upon etiology, duration and severity of clinical expression)

16.1.7. PATHOLOGICAL GAMBLING

16.1.8. PYROMANIA

16.1.9. SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS (Exceptions may be made in cases of a single episode of schizophrenic reactions associated with an acute illness capable of causing such reaction.)

16.1.10. SEXUAL AND GENDER IDENTITY DISORDERS (Homosexuality is not considered a mental disorder.)

16.2. AXIS II DISORDERS

16.2.1. NARCISSISTIC PERSONALITY DISORDER

16.2.2. ANTISOCIAL PERSONALITY DISORDER

16.2.3. DEPENDENT PERSONALITY DISORDER

16.2.4. PARANOID PERSONALITY DISORDER

16.2.5. SCHIZOID PERSONALITY DISORDER

16.2.6. ORGANIC BRAIN SYNDROME

17 / SPECIAL SUBJECT: ANABOLIC STEROID USE

Any person currently using anabolic steroids will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. Anabolic steroids were legislated a controlled substance on February 27, 1991, and now require a physician’s prescription.

18 / VISION STANDARDS

The occupational significance of this area, at a general level, concerns the ability to see and to be free of visual problems. Any condition, which may interfere with acuity or put the eye at risk, will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties. It is essential that the individual be able to identify the appropriate target in the event contact lens or glasses are lost during an altercation. Cases will be reviewed on a case-by-case basis.

18.1. Distant vision for each eye (monocular) must demonstrate at least 20/20 (Snellen) corrected and 20/200 uncorrected.

18.2. Binocular distant vision must be correctable to 20/20.

18.3. Monocular vision from missing eye due to disease or injury will require additional screening on ability to function in hostile situations safely without assistance.

18.4. Depth Perception must demonstrate stereopsis of at least 100 seconds of arc.

18.5. Visual fields must be full and Peripheral Vision must be normal (e.g., normal nasal peripheral vision would be35 to 45 degrees, and temporal would be 80 to 90, for a total lateral peripheral vision of 115 to 135 degrees.) Any history of eye disease or any other medical condition likely to cause eye disease, such as retinopathy, glaucoma, retinal detachment will require visual field evaluation by optometrist or ophthalmologist.

18.6. Color vision must be sufficient to demonstrate normal color vision either by passing the Ishihara Pseudoischromatic Plate Color Test or a Farnsworth D-15 color vision test. X-Chrome lenses or tinted spectacle lenses are not acceptable as a means for correcting color deficiencies.

18.7. Conditions that will require additional screening include, but are not limited to, the following examples:

18.7.1. Ophthalmologic conditions, which are particularly susceptible to environmental exposures such as sunlight, dusts, fumes, various volatile compounds will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties.

18.7.2. REFRACTIVE SURGICAL PROCEDURES (i.e., LASIK, Radial Keratotomy, Photorefractive surgery [laser], Keratoplasty, etc.) In order to determine to determine the qualification and suitability of a candidate or employee who has undergone radial keratotomy and other types of vision correction surgery the individual will be required to:

18.7.2.1. Complete a self-reporting vision questionnaire to determine whether there have been any visual changes since his or her eye surgery, i.e. increased difficulty driving at night; increased difficulty seeing at night; lights at night appear unfocused, like a Starburst; bright lights at night make it harder to see, seeing bands of light at night, like a halo; needing glasses to drive at night only; increased difficulty distinguishing objects at a distance with similar color or shape, etc.; and

18.7.2.2. Obtain a current and complete eye examination by a board certified ophthalmologist addressing post-surgical complications and sequelae, including (but not limited to) susceptibility to:

18.7.2.2.1. Corneal rupture due to blunt force trauma (with respect to the structural integrity and weakening of the cornea, the level of acceptable risk may be directly related to the number and depth of corneal incisions required to achieve myopic correction);

18.7.2.2.2. Contrast sensitivity;

18.7.2.2.3. Impaired vision with glare;

18.7.2.2.4. Loss of visual acuity since the radial keratotomy was performed;

18.7.2.2.5. Corneal scarring and infection, etc. Any visual abnormality regardless of its association with the radial keratotomy surgery should be identified. Any ophthamological evaluation must be based on reasonable medical probability and generally accepted medical practice and principle.

18.8. If there are no significant visual changes, complications, or distortions associated with radial keratotomy that may jeopardize safe and efficient job performance, then the MRO should waive the existing medical standard.

18.8.1. CHRONIC CONJUNCTIVITIS. Due to the possible visual impairment and/or increased susceptibility to environmental exposures, which could interfere with the job performance, this condition will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties.

18.8.2. PTERYGIUM. This condition will require additional screening to determine if vision is impaired by the growth.

18.8.3. CORNEAL ABRASIONS. Because this condition may interfere with visual acuity, an Ophthalmologist must determine the degree of impairment.

18.8.4. CORNEAL DYSTROPHY. Varying degrees of this condition could sufficiently impair the visual acuity. It will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties.

18.8.5. CORNEAL SCARS. Varying degrees of this condition could sufficiently impair the visual acuity; it will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties.

18.8.6. CORNEAL ULCERS. Essential duties of the security officer position could further exacerbate this condition, in addition to the condition causing impairments of the visual acuity. Therefore, this condition must be treated and cleared by an Ophthalmologist before a candidate is considered. Incumbents will need to meet with the MRO.

18.8.7. KERATITIS. Any visual impairment associated with keratitis that is likely to interfere with job performance will require additional screening to determine whether the individual will be able to safely and successfully perform essential duties.

18.8.8. KERATOCONUS. This condition causes a cone shape to the cornea and results in major changes in the refracting power of the eye, which necessitates frequent changes in the eyeglass prescriptions. The visual acuity of the individual needs to be currently corrected to the above standards.

18.8.9. RETINAL DETACHMENT. Due to the seriousness of this visual obstruction additional screenings will be necessary to determine whether the individual will be able to safely and successfully perform essential duties.

18.8.10. RETINITIS PIGMENTOSA

18.8.11. LENS OPACITIES. Individuals will need to be screened to determine if they can meet the PFPA vision standards

18.8.12. GLAUCOMA. This condition will require additional screening by an ophthalmologist to determine whether there is any impairment of peripheral vision since this would affect the individual’s ability to safely and successfully perform essential duties.

18.8.13. NIGHT BLINDNESS

NOTE. Candidates/employees must have no other organic, functional [or] structural disease, defect [or] limitation found by the agency medical officer to clinically indicate a potential hazard to safety and/or it is likely to adversely affect safe and efficient job performance.