attmt__1_Medical_Guidelines_for_CBP_and_ICE_Weapon-carrying_Positions.pdf

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MEDICAL GUIDELINES

FOR

CBP and ICE WEAPON CARRYING POSITIONS

TABLE OF CONTENTS

Cardiovascular System 3

Central and Peripheral Nervous System 5

Chest and Respiratory System 6

Dermatologic 7

Endocrine and Metabolic Systems 8

Gastrointestinal System 9

Genitourinary and Reproductive Systems 10

Head, Nose, Mouth, Throat and Neck 10

Hearing 11

Hematopoetic System 13

Immune System/Allergic Disorders 13

Medication 14

Musculoskeletal System 15

Organ Transplantation and Prosthetic Devices 16

Peripheral Vascular System 17

Psychiatric Disorders 17

Vision 19

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MEDICAL GUIDELINES

Under 5 CFR Part 339 Medical Qualifications Determinations, medical guidelines may be established for positions with duties that are arduous or hazardous in nature. The medical guidelines described in this section are required because of the arduous and hazardous occupational, functional, and environmental requirements of the positions covered by these guidelines. The medical guidelines are provided to aid the

Department’s medical reviewing physicians and agency officials in determining what medical problems may hinder the individual’s ability to satisfactorily perform the actual work without undue risk to himself/herself or others. They are also to be used to ensure consistency and uniformity in medical eligibility determinations.

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

These guidelines will be guided by the considerations set forth in 5 CFR Part 339, Medical Qualifications Determinations. Listed below are examples of medical conditions and/or physical impairments that may be disqualifying. 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 these guidelines.

Final consideration and medical determination may require additional medical information and/or testing that is not routinely required during either the pre-placement or periodic medical examination.

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CARDIOVASCULAR SYSTEM

Any disease or condition, which interferes with cardiac function, is generally 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. PACEMAKERS or PROSTHETIC VALVES are generally disqualifying. Any other condition or post-surgical management that requires the use of coumadin or other anti-coagulants is generally disqualifying.

2. CORONARY ARTERY DISEASE

3. HYPERTENSION that requires the use of any medication to stabilize the blood pressure may be disqualifying. Systolic blood pressure exceeding 140 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 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 fundoscopic 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 recumbent positions.

If there is no history of hypertension and the systolic pressure is marginally elevated (between 140 mm Hg and 150 mm Hg) and the diastolic pressure is below 90 mm Hg on the pre-placement medical examination, no further testing is necessary.

If there is a history of hypertension not currently treated on medication and the systolic pressure is marginally elevated (140 mm Hg to 150 mm Hg) and/or the diastolic pressure is 90 mm Hg or higher, serial blood pressure measurements will be requested and additional diagnostic testing may be requested.

If there is a history of hypertension currently treated with medication and the systolic pressure is above 140 mm Hg and/or the diastolic pressure is above 90 mm Hg or higher, additional documentation and diagnostic testing will be requested.

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Additional diagnostic tests may be required to render a final medical opinion, depending upon the individual’s clinical history, treatment regimen, and the results of the pre-placement examination. The final medical determination will consider the pharmacology of the medication, dosage, and frequency.

4. LEFT BUNDLE BRANCH BLOCK.

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

6. History of MYOCARDIAL INFARCTION.

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

8. VALVULAR HEART DISEASE such as mitral valve stenosis, mitral valve regurgitation, aortic stenosis, mitral valve prolapse, etc. Exceptions may be granted depending upon the current clinical findings and diagnostic studies.

9. DSYRHYTHIMAS: such as ventricular tachycardia or fibrillation, Wolff-Parkinson-

White syndrome, Paroxysmal Atrial Tachycardia with or without block.

10. CEREBROVASCULAR ACCIDENT or TRANSIENET ISCHEMIC ATTACKS.

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

12. ANGINA PECTORIS or chest pain of unknown etiology.

13. CARDIOMYOPATHY from any cause.

14. CONGESTIVE HEART FAILURE.

15. MARFAN’S SYNDROME.

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

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CENTRAL AND PERIPHERAL NERVOUS SYSTEMS

Any disease or condition, which interferes with the central or peripheral nervous system function, may be considered disqualifying. Cases will be reviewed on a case-by-case basis.

1. Cerebral and cerebellar functions must be normal.

2. The peripheral nervous system and all reflexes must be normal.

3. An individual with a history of seizures controlled on any medication(s) may be disqualified. Evaluation of an individual is subject to the seizure policy outlined below.

SEIZURE POLICY

A history of seizures requires an individual to meet the following criteria before further medical consideration:

1. The individual must present the results of an awake and sleeping electroencephalogram (EEG) following an acceptable, non-medicated, seizure-free period of time. The current EEG must be free of epileptiform abnormalities.

An acceptable period of time will be defined by the prevailing scientific guidelines of medicine, a review of the current medical literature, and the opinions of the individual’s private Neurologist and, if necessary, a Neurologist selected by the Agency.

2. The medical history and/or documentation regarding the etiology of the seizure disorder must be submitted from the private physician (s), if available.

3. The agency may require a complete neuropsychological evaluation prior to further consideration of an individual.

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, BUT ARE

NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. ATAXIA

2. CHOREOATHETOSIS

3. EPILEPSY (See the seizure policy above)

4. HUNTINGTON’S CHOREA

5. MULTIPLE SCLEROSIS

6. MUSCULAR DYSTROPHY

7. NARCOLEPSY

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8. NEUROFIBROMATOSIS

9. PARKINSON’S DISEASE

10. CEREBROVASCULAR ACCIDENT (STROKE)

11. TRANSIENT ISCHEMIC ATTACKS

12. SENSORY DYSFUNTION (smell, touch, taste)

13. MIGRAINE CEPHALGIA

* Any neurological disease or disorder that is not listed above shall be reviewed on a case-by-case basis.

CHEST AND RESPIRATORY SYSTEM

Any disease or condition, which interferes with respiratory function, may be considered disqualifying. Cases will be reviewed on a case-by-case basis.

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

AT ONE SECOND (FEV1) THAT IS LESS THAN 75% OF THE EXPECTED

VALUE.

2. THE FEV1/FVC RATIO SHOULD NOT REFLECT EVIDENCE OF A

SIGNIFICANT OBSTRUCTIVE OR RESTRICTIVE DISORDER.

3. ASTHMA currently controlled on any medication is generally disqualifying. A history of asthma after the age of 12 years must be considered on a case-by-case basis.

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.

5. HISTORY OF CHRONIC BRONCHITIS ASSOCIATED WITH DECREASED PFT

RESULTS.

6. LUNG ABSCESS

7. SPONTANEOUS PNEUMOTHORAX (if recurrent)

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8. EMPHYSEMA

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

10. PULMONARY EMBOLISM

11. PULMONARY INFARCTION

12. TUMORS OF THE LUNG

13. PNEUMONECTOMY (if FEV1 less than 75%)

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

DERMATOLOGIC

Any disease or condition that may cause the person to be unduly susceptible to injury or disease as a consequence of environmental exposures including the sun may be considered disqualifying. Cases will be reviewed on a case-by-case basis.

1. ALBINISM.

2. UNTREATED SKIN CANCER.

3. CHLORACNE: This should be reviewed on a case-by-case basis for its association with toxic exposures.

4. KAPOSI’S SARCOMA.

5. SEVERE CHRONIC DERMATITIS.

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ENDOCRINE AND METABOLIC SYSTEMS

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 is generally 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. ADRENAL DYSFUNCTION (In the form of Addison’s Disease or Cushing’s

Syndrome).

2. THYROID DISEASE (uncontrolled or associated with complications).

Hypothyroidism adequately controlled by hormone replacement may be considered acceptable.

3. PITUITARY DYSFUNCTION.

4. INSULIN DEPENDENT DIABETES MELLITUS

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.

6. DIABETES INSIPIDUS.

GASTROINTESTINAL SYSTEM

The gastrointestinal tract (GI) should be evaluated from the mouth to the anus by the examining physician. Any disorder of the GI tract capable of rendering the individual suddenly incapacitated or incapable of sustaining attention to required tasks, i.e., chronic diarrhea may be considered disqualifying. Cases will be reviewed on a case-by-case basis.

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, BUTARE

NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. ACUTE AND CHRONIC ACTIVE HEPATITIS

2. ACUTE VIRAL HEPATITIS (After being asymptomatic for three (3) months, the applicant may be re-evaluated).

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3. CROHN’S DISEASE/ULCERATIVE COLITUS/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).

4. COLOSTOMIES

5. ILEITIS either recurrent or chronic.

6. CHOLELITHIASIS either symptomatic or asymptomatic.

7. CHOLECYSTITIS (chronic or recurring).

8. DIVERTICULITIS (symptomatic).

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

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

11. INTESTINAL OBSTRUCTION

12. PANCREATITIS

13. 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 is generally disqualifying 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 is generally disqualifying 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 is generally disqualifying.

The complication of gastroesophageal reflux controlled on antacids will generally be considered acceptable.

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GENITOURINARY AND REPRODUCTIVE SYSTEM

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 is generally disqualifying. 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, are disqualifying. Cases will be reviewed on a case-by-case basis.

CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, BUT ARE

NOT LIMITE TO, THE FOLLOWING EXAMPLES:

1. POLYCYSTIC KIDNEY DISEASE

2. ACUTE or CHRONIC RENAL FAILURE

3. NEPHROTIC SYNDROME

4. SYMPTOMATIC URINARY CALCULI

5. NEUROGENIC BLADDER

6. BERGER’S DISEASE

7. HISTORY OF RENAL VEIN THROMBOSIS

8. UNCORRECTED OBSTRUCTIVE UROPATHIES

9. RENAL TOXICITY FROM ANY CAUSE

HEAD, NOSE, MOUTH, THROAT AND NECK

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 WHICH MAY RESULT IN DISQUALIFICATION INCLUDE, BUT ARE

NOT LIMITED TO, THE FOLLOWING EXAMPLES:

1. MUTISM/APHONIA (inability to speak) is generally disqualifying.

2. ANOSMIA

3. ARTIFICAL LARYNX OR ESOPHAGEAL SPEECH is generally disqualifying.

4. FACIAL DEFORMITIES

5. TEMPOROMANDIBULAR JOINT SYNDROME (moderate to severe cases)

6. NASAL POLYPS THAT SIGNIFICANTLY OBSTRUCT BREATHING

7. RESTRICTED RANGE OF MOTION IN THE NECK

8. NECK MASSES, LYMPHADENOPAHTY OR TRACHEOSTOMY

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• Any other chronic disease or condition, which significantly interferes with speech or breathing and bears, the potential to render the person suddenly incapacitated is generally disqualifying.

HEARING

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.

Border Patrol, Immigration Enforcement Agent, and Deportation Officer:

1. In the frequency range from 500 – 2,000 hertz (Hz), the deficit should not exceed

30 decibels (dB) in either ear.

2. At 3,000 Hz, the deficit should not exceed 40 dB in either ear.

3. HEARING AIDS: The use of any hearing aid to comply with the medical guidelines is unacceptable

4. Binaural hearing is required

Customs and Border Protection Officer:

1. Unaided testing with both ears must test at 25dB or less for the average of the

500, 1000, 2000, and 3000 frequencies.

2. Unaided testing with both ears must test at 45dB or less at the 4000 and 6000

Hz

3. The difference in hearing levels between the better ear and worse ear should not exceed 30dB at the 4000 and 6000 frequency.

4. The difference in hearing levels between the better ear thresholds and worse ear thresholds may not exceed 15dB for the average of 500, 1000, 2000, and 3000 Hz.

5. Use of a hearing aid is not allowed.

ICE: Criminal Investigator, Police Officer, and Physical Security Specialist:

1. In the frequency range from 500 – 2,000 hertz (Hz), the deficit should not exceed

30 decibels (dB) in either ear.

2. Must be able to hear the whispered voice at 15 feet with each ear.

3. Binaural hearing (hearing in both ears) is required. Complete loss of hearing in one ear is disqualifying.

4. Use of a hearing aid is not allowed.

CBP: Aviation Enforcement Officer, Technical Enforcement Officer, Customs Patrol Officer, and Marine Enforcement Officer

1. As measured by an audiometer, there should be no loss of 30 or more decibels in each ear at 500, 1000, and 2000 frequencies

2. The individual must be able to hear the whispered voice at 15 feet with each ear, without the use of a hearing aid.

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For All Positions:

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.

OTOLOGICAL CONDITIONS WHICH MAY RESULT IN

DISQUALIFICATION INCLUDE, BUT ARE NOT LIMITED TO,

THE FOLLOWING EXAMPLES:

1. MENIERE’S DISEASE

2. VESTIBULAR NERUONITIS

3. VERTIGO & PAROXYSMALA POSITIONAL VERTIGO

4. ACOUSTIC NEUROMA

5. WEGENER’S GRANULOMATOSIS

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 is generally disqualifying.

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HEMATOPOIETIC SYSTEM

Any hematopoietic disease or condition, which interferes with, the expected performance of these jobs is generally 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. ANEMIA - Generally considered as a:

HEMATOCRIT OF LESS THAN 39% AND A HEMOGLOBIN OF LESS THAN

13.6 gm/dl for MALES

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.)

2. INHERITED CLOTTING DISORDERS (EX. Hemophilia) are generally disqualifying

3. CHRONIC LYMPHANGITIS

4. THROMBOCYTOPENIA OR CLOTTING DISORDER

5. SICKLE CELL ANEMIA

6. SPLENOMEGALY

IMMUNE SYSTEM/ALLERGIC DISORDERS

Any communicable disease, which can directly affect the occupational job performance and/or directly threaten the health and safety others is generally 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. HEREDITARY ANGIOEDEMA

2. GOODPASTURES’ SYNDROME

3. AUTOIMMUNE HEMOLYTIC ANEMIA

4. VASCULITIS

5. HASHIMOTO’S THROIDITIS

6. MYASTHENIA GRAVIS

7. SYSTEMIC LUPUS ERYTHMATOSUS

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MEDICATION

All medication requirements, 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 considerations will enter the medical recommendations:

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

2. POTENTIAL DRUG SIDE EFFECTS

3. DRUG-DRUG INTERACTIONS

4. ADVERSE DRUG REACTIONS

5. DRUG TOXICITY AND ANY MEDICAL COMPLICATIONS ASSOCIATED WITH

LONG-TERM DRUG USE

6. DRUG-ENVIRONMENTAL INTERACTIONS

7. DRUG-FOOD INTERACTIONS

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) or is prescribed for a persistent or recurring underlying condition would generally be considered disqualifying.

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ANABOLIC STEROID USE

Any person currently using anabolic steroids may be disqualified. Note: Anabolic steroids were legislated a controlled substance on February 27, 1991, and now require a physician’s prescription.

MUSCULOSKELETAL SYSTEM

Any condition that adversely impacts on an individual’s movement, agility, flexibility, strength, dexterity, coordination or ability to accelerate, decelerate, and change directions efficiently is generally 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. ARTHRITIS (any etiology) if there is limited joint motion and/or pain.

2. AMPUTATIONS of more than one digit if it directly affects the ability to grip and efficiently handle weapons.

3. AMPUTATIONS OF AN EXTREMITY: any loss of an upper or lower extremity.

Less than five (5) digits on each hand will be evaluated on a case-by-case basis.

4. ANKYLOSING SPONDYLITIS

5. SCOLIOSIS, IF THE LATERAL CURVATURE IS 20 DEGREES OR MORE.

6. MUSCULAR DYSTROPHY

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.

8. DEGENERATIVE DISC DISEASE

9. FIXED LORDOSIS OR KYPHOSIS, which limits mobility and skeletal strength.

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.

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11. SPINA BIFIDA

12. SCIATICA OR OTHER NEUROPATHIES

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, 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.

14. A history of a CHRONIC SPRAIN OR STRAIN OF THE NECK limiting mobility or causing recurring cephalgia (headaches) may be disqualifying.

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

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

CYST

17. Any evidence of a CERVICAL NEUROPATHY including numbness, tingling or loss of motor strength in the upper extremities may be disqualifying.

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 law enforcement duties may be disqualifying.

19. A condition may be disqualifying 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.

ORGAN TRANSPLANTATION AND PROSTHETIC DEVICES

RENAL TRANSPLANTATION may be considered disqualifying unless the applicant is not taking immunosuppressive drugs and is medically cleared by the surgeon who performed the operation to participate in strenuous activities. The applicant must be considered by the surgeon to be capable of withstanding blunt trauma to his/her flanks without a significant probability of untoward personal damage.

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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)

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

PACEMAKERS or PROSTHETIC VALVES are generally disqualifying. Any other condition or post-surgical management that requires the use of coumadin or other anti-coagulants is disqualifying. (See cardiovascular system)

* Other transplantations or prosthetic devices will be considered on a case-by-case basis.

PERIPHERAL VASCULAR SYSTEM

Any condition, which significantly interferes with peripheral vascular function, is generally 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, BUTARE

NOT LIMITED TO, THE FOLLOWING EXAPLES:

1. CHRONIC VENOUS INSUFFICIENCY

2. DEEP VEIN THROMBOSIS

3. CHRONIC THROMBOPHLEBITIS

PSYCHIATRIC DISORDERS

Any disorder which affects normal perceptual judgment and safe and acceptable behavior, or if there is evidence of serious mental impairment, is generally disqualifying.

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

SPECIFIC PSYCHIATRIC DISORDERS THAT MAY BE DISQUALIFYING INCLUDE

BUT ARE NOT LIMITED TO THE FOLLOWING EXAMPLES. 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.

AXIS I DISORDERS:

DELIRIUM, DEMENTIA, AMNESTIC AND OTHER COGNITIVE DISORDERS

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MAJOR DEPRESSION

MANIC-DEPRESSIVE DISORDER

DISSOCIATIVE DISORDERS

KLEPTOMANIA

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

PATHOLOGICAL GAMBLING

PYROMANIA

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).

SEXUAL AND GENDER IDENTITY DISORDER * (Reviewed on a case-by-case basis). Areas of concern include: transsexualism, fetishism, pedophilia, sexual sadomasochism, voyeurism, and transvestic fetishism

AXIS II DISORDERS:

NARCISSISTIC PERSONALITY DISORDER

ANTISOCIAL PERSONALITY DISORDER

DEPENDENT PERSONALITY DISORDER

PARANOID PERSONALITY DISORDER

SCHIZOID PERSONALITY DISORDER

ORGANIC BRAIN SYNDROME

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VISION

Any disease or condition, which interferes with a person’s vision, may be considered disqualifying. Cases will be reviewed on a case-by-case basis.

1. UNCORRECTED DISTANCE VISION

Customs and Border Protection Officer: must be at least 20/100 binocular visual acuity without eyeglasses or contacts.

Border Patrol: must be equal to or better than 20/100 in each eye without correction, i.e. without eyeglasses or contacts.

Criminal Investigator, Police Officer, Physical Security Specialist, Immigration Enforcement Agent, Deportation Officer, Technical Enforcement Officer, and Marine Enforcement Officer: must be equal to or better than 20/200 in each eye.

Customs Patrol Officer: must test at least 20/70 in each eye

2. BINOCULAR DISTANCE VISION

Customs and Border Protection Officer: must be correctable to 20/30.

Border Patrol, Immigration Enforcement Agent, and Deportation Officer:

must be correctable to 20/20.

Criminal Investigator, Police Officer, Physical Security Specialist, Technical Enforcement Officer, and Marine Enforcement Officer: must be correctable to 20/20 in one eye and 20/30 in the other.

Customs Patrol Officer: binocular vision must test at least 20/40 (Snellen) without corrective lenses

3. NEAR VISION

Customs and Border Protection Officer: must test at least 20/40 Snellen, binocular, with or without corrective lenses Criminal Investigator Agent, Police Officer, Physical Security Specialist, Customs Patrol Officer, Technical Enforcement Officer, Marine Enforcement Officer, and Aviation Enforcement Officer: must be sufficient to read Jaeger type 2 at 14 inches or 20/30 Snellen binocular, corrected or uncorrected

4. MONOCULAR VISION

Border Patrol, Criminal Investigator Agent, Police Officer, Physical Security Specialist, Immigration Enforcement Agent, and Deportation Officer:

generally disqualifying.

5. DEPTH PERCEPTION

Customs and Border Protection Officer, Technical Enforcement Officer, Marine Enforcement Officer, and Aviation Enforcement Officer: must be normal.

Border Patrol, Immigration Enforcement Agent, and Deportation Officer:

must be equal to or better than 70 seconds of arc.

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Criminal Investigator, Police Officer, and Physical Security Specialist: must be less than or equal to 100 seconds of arc; or greater than or equal to 50 on the Shepard Frye depth perception test

6. PERIPHERAL VISION

All Positions: must be normal. In normal, full binocular vision (full peripheral vision), horizontal field is about 180 degrees and the vertical field is 120 – 130 degrees.

7. COLOR VISION

All Positions: must be normal. Acceptable measure of color discrimination is the Ishihara color (14 plates). X-Chrome lenses are not acceptable to the DHS as a means of correcting color deficiencies.

OPHTHALMOLOGIC CONDITIONS WHICH MAY RESULT IN DISQUALIFICATION

INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING EXAMPLES:

Ophthalmologic conditions, which are particularly susceptible to environmental exposures such as sunlight, dusts, fumes, various volatile compounds may cause an applicant to be disqualified.

1. REFRACTIVE SURGICAL PROCEDURES (i.e. Radial Keratotomy, Photorefractive surgery [laser], Keratoplasty, LASIK Surgery, etc.)

These operative procedures are considered acceptable provided that the individual’s vision meets the above standards post-operatively and an acceptable recovery time period since the time of the operation has occurred. The individual must be free of post-operative complications. The results of an eye examination by a board-certified Ophthalmologist will be required to insure that vision is not impeded due to post-operative complications such as infection, glare, and contrast-sensitivity.

Customs and Border Protection Officer, Border Patrol, Criminal Investigator, Police Officer, and Physical Security Specialist: LASIK must have been done within the past 2 – 3 months

2. CHRONIC CONJUNCTIVITIS

If it causes viral impairment and/or increased susceptibility to environmental exposures, which could interfere with the job performance, this condition may result in a medical disqualification.

3. PTERYGIUM

This condition is generally disqualifying if vision is impaired by the growth.

4. CORNEAL ABRASIONS

Because this condition may interfere with visual acuity, it is generally disqualifying. An Ophthalmologist must determine the degree of impairment.

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5. CORNEAL DYSTROPHY

This condition is generally disqualifying if the individual cannot meet the outlined DHS visual standards. Varying degrees of this condition could sufficiently impair the visual acuity, which may result in a medical disqualification.

6. CORNEAL SCARS

This condition is generally disqualifying if the individual cannot meet the DHS visual standards. Varying degrees of this condition could sufficiently impair the visual acuity, which may result in a medical disqualification.

7. CORNEAL ULCERS

This condition is generally disqualifying since essential duties of the position could further exacerbate the condition, in addition to the condition causing impairments of the visual acuity. This condition must be treated and cleared by an Ophthalmologist before any further consideration s given to the individual.

8. KERATITIS

Any visual impairment associated with keratitis that is likely to interfere with job performance is generally disqualifying.

9. 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. If the visual acuity is currently corrected to the above standards, then the individual would be considered acceptable.

10. RETINAL DETACHMENT

This condition is generally disqualifying due to the serious visual obstruction.

11. RETINITIS PIGMENTOSA

12. LENS OPACITIES

This condition could be considered disqualifying if the individual cannot meet the DHS visual standards.

13. GLAUCOMA

This condition is generally disqualifying if there is any impairment of peripheral vision. An individual with a diagnosis of glaucoma established by a physician other than an ophthalmologist may be disqualified, until an evaluation by an ophthalmologist has been conducted and reviewed by the medical reviewing physician.

* Any other ocular disease or disorder not listed above will be reviewed on a case-by-case basis.