PWS Appendix I - FPS Medical Standards.pdf

GENERAL SERVICES ADMINISTRATION

FEDERAL PROTECTIVE SERVICE

MEDICAL STANDARDS

THESE STANDARDS ARE APPLICABLE TO THE FOLLOWING POSITIONS:

CRIMINAL INVESTIGATOR/SPECIAL AGENT (GS- 1811)

POLICE OFFICER (GS-083)

PHYSICAL SECURITY SPECIALIST with 318 Authority (GS-080)

Under 5 CFR Part 339 Medical Qualifications Determinations, medical standards may be established for positions with duties that are arduous or hazardous in nature. The medical standards described in this section are required because of the arduous and hazardous occupational, functional and environmental requirements of the positions covered by these standards. The medical standards are provided to aid the Agency medical reviewing physician and the General Services Administration – Federal Protective Service (FPS) 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 the application of 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 constitute grounds for medical disqualification.

These standards 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 standards. 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.

These medical standards are intended to serve as a general guideline for the safe placement into and the continued working in hazardous and arduous job positions within the FPS. Each of the medical standards listed in this document 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.

Revised April 16, 1999

VISION STANDARD

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. CORRECTED DISTANT VISUAL ACUITY

Special Agent and Police Officer must be 20/20 or better, as measured with both eyes viewing.

Physical Security Specialist with 318 Authority Must be 20/30 or better, as measured with both eyes viewing.

2. CORRECTED DISTANT VISUAL ACUITY must be 20/200 or better in the worst eye.

3. DISTANT UNCORRECTED VISION

Special Agent and Police Officer must be 20/125 or better, as measured with both eyes viewing.

must be 20/200 or better in the worst eye.

Physical Security Specialist with 318 Authority No uncorrected distant vision standard.

4. COMPLETE LOSS OF VISION IN ONE EYE is disqualifying.

5. ABNORMAL COLOR VISION with severe color deficiency in any color is generally disqualifying. The use of X-Chrom contact lenses or tinted spectacle lenses are not permitted to be used in the testing of color vision.

6. VISUAL FIELDS must be full with good peripheral vision. Any history of eye disease or any medical condition likely to cause eye disease, such as retinopathy, glaucoma, retinal detachment will require visual field evaluation by optometrist or ophthalmologist.

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, or various volatile compounds may cause an applicant to be disqualified. Any eye condition likely to impact on color vision will require further assessment of color vision.

1. REFRACTIVE SURGICAL PROCEDURES -- Radial Keratotomy, Photorefractive laser surgery (PRK or LASIK), ALK Keratoplasty. These procedures will require an assessment of visual function prior to qualification.

2. CHRONIC CONJUNCTIVITIS

3. PTERYGIUM

4. CORNEAL ABRASIONS

5. CORNEAL DYSTROPHY

6. CORNEAL SCARS

7. CORNEAL ULCERS

8. KERATITIS

9. KERATOCONUS

10. RETINAL DETACHMENT

11. RETINITIS PIGMENTOSA

12. LENS OPACITIES

13. ORTHOKERATOLOGY

14. GLAUCOMA

15. NIGHT BLINDNESS

16. DIPLOPIA (or double vision)

HEARING STANDARD

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

1. In the frequency range from 500 - 2,000 hertz (Hz), the deficit should not exceed 30 decibels in either ear.

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

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

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

OTOLOGICAL CONDITIONS WHICH MAY RESULT IN

DISQUALIFICATION INCLUDE, BUT ARE NOT LIMITED TO, THE

FOLLOWING EXAMPLES:

1. MENIERE’S DISEASE

2. VESTIBULAR NEURONITIS

3. VERTIGO or PAROXYSMAL POSITIONAL VERTIGO

4. ACOUSTIC NEUROMA

5. OTOSCLEROSIS

HEAD, NOSE, MOUTH, THROAT AND NECK STANDARD

Any medical condition that significantly interferes with the individual’s ability to successfully perform essential law enforcement functions, such as speech or breathing, or that has the potential to render the person suddenly incapacitated will generally be disqualifying. All 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 or APHONIA (inability to speak)

2. ARTIFICIAL LARYNX or ESOPHAGEAL SPEECH

3. FACIAL DEFORMITIES that impair breathing or speech

4. TEMPOROMANDIBULAR JOINT SYNDROME

5. NASAL POLYPS that impair breathing or speech

6. RESTRICTED RANGE OF MOTION IN THE NECK

7. NECK MASSES, LYMPHADENOPATHY or TRACHEOSTOMY that impair breathing or speech

CARDIOVASCULAR SYSTEM STANDARD

Any disease or condition which interferes with cardiovascular function and the safe and efficient performance of the job is generally disqualifying. Cases will be reviewed on a case-by-case basis. Cardiology evaluation and/or maximal, symptom-limited exercise stress EKG may be required to determine whether individual is capable of safe and efficient job performance. All medications taken for cardiovascular conditions will be carefully reviewed to insure that they do not compromise job performance and therefore interfere with safe and efficient job performance. Any history of a cardiovascular condition will be evaluated on a case-by-case basis and may require further evaluation.

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.

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 or HISTORY OF MYOCARDIAL

INFARCTION

3. HYPERTENSION that exceeds a systolic blood pressure of 150 and/or diastolic blood pressure of 90 mm Hg with or without medication.

4. ELECTROCARDIOGRAM FINDINGS such as

a. Left Bundle Branch Block

b. Newly acquired Right Bundle Branch Block

c. ST segment alterations

d. Atrioventricular dissociation

e. First Degree A-V Block with PR interval >= 0.3 seconds

f. Second and Third Degree A-V Block

g. Atrial fibrillation or Flutter

h. Bradycardia with heart rate of less than 40 or sinus pauses of 3.0 seconds or longer

5. MYOCARDITIS/ ENDOCARDITIS/ PERICARDITIS

6. VALVULAR HEART DISEASE such as mitral valve stenosis or regurgitation, aortic stenosis or regurgitation

7. DYSRHYTHMIAS: such as Ventricular Tachycardia or Fibrillation, Wolff-

Parkinson-White syndrome, Paroxysmal Atrial Tachycardia with or without block, Atrial Flutter or Fibrillation.

8. CEREBROVASCULAR CONDITIONS such as Cerebrovascular Accident or

Transeint Ischemic Attacks or Carotid Artery Disease

9. PULMONARY EMBOLISM

10. ANGINA PECTORIS

11. CARDIOMYOPATHY

12. CONGESTIVE HEART FAILURE

13. MARFAN’S SYNDROME

14. CONGENITAL ANOMALIES such as Atrial and Ventricular Septal Defect

15. CHRONIC VENOUS INSUFFICIENCY

16. DEEP VEIN THROMBOSIS

17. CHRONIC THROMBOPHLEBITIS

18. OCCLUSIVE PERIPHERAL ARTERIAL DISEASE such as Raynaud’s

19. AORTIC ANEURYSM

20. HISTORY OF SYNCOPE Cardiogenic or vasovagal. May require cardiology evaluation and/or tilt table testing for final determination.

CHEST AND RESPIRATORY SYSTEM STANDARD

Any disease or condition which interferes with respiratory function and safe and efficient job performance may be considered disqualifying. Cases will be reviewed on a case-by-case basis. Pulmonary evaluation, Chest x-ray, maximal, symptom-limited exercise stress EKG, Methacholine challenge test (determination of reversible airway disease or asthma) may be required to determine whether individual is capable of safe and efficient job performance. All medications taken for respiratory conditions will be carefully reviewed to insure that they do not compromise job performance and therefore interfere with safe and efficient job performance.

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

VOLUME AT ONE SECOND (FEV1) THAT IS LESS THAN 70% OF THE

EXPECTED VALUE. Values of less than 70% will be further evaluated and a medical decision may be made on a case-by-case basis.

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

SIGNIFICANT OBSTRUCTIVE OR RESTRICTIVE DISORDER. Values of less than 70% will be further evaluated and a medical decision may be made on a case-by-case basis.

3. ASTHMA currently controlled on any medication will be evaluated on a case-by-case basis. Exercise-induced asthma requiring medication either before or after exercise is generally disqualifying.

4. PULMONARY TUBERCULOSIS (TB) A recent positive (conversion) TB test that has been treated for at least three weeks is acceptable providing the patient remains under continuing treatment and supervision. A chest x-ray will be required to document the stability of this condition. Evidence of active TB with or without symptoms, chest x-ray findings, or presence of sputum production, or presence of significant lung destruction on chest x-ray in fully treated cases will be evaluated on a case-by-case basis.

5. CHRONIC BRONCHITIS

6. LUNG ABSCESS

7. SPONTANEOUS RECURRENT PNEUMOTHORAX

8. EMPHYSEMA

9. SARCOIDOSIS

10. PULMONARY EMBOLISM

11. PULMONARY INFARCTION

12. TUMORS OF THE LUNG such as Malignant Mesothelioma, Bronchogenic

Carcinoma

13. PNEUMONECTOMY

GASTROINTESTINAL SYSTEM STANDARD

Any disease or condition which interferes with gastrointestinal function and safe and efficient job performance may be considered disqualifying. Cases will be reviewed on a case-by-case basis. All medications taken for gastrointestinal conditions will be carefully reviewed to insure that they do not compromise job performance and therefore interfere with safe and efficient job performance. Any condition that is recurrent with significant diarrhea and/or pain, that limits activity, requires pain medication, or that causes anemia, weakness or significant weight loss may be disqualifying.

1. ACUTE OR CHRONIC HEPATITIS

2. CIRRHOSIS OF THE LIVER

3. CHOLECYSTITIS, CHOLELITHIASIS, or GALLBLADDER DISEASE

4. PANCREATITIS

5. CROHN’S DISEASE, ULCERATIVE COLITIS, REGIONAL ENTERITIS,

ILEITIS, or IRRITABLE BOWEL SYNDROME

6. INTESTINAL OBSTRUCTION

7. DIVERTICULITIS

8. COLOSTOMIES

9. ANAL FISSURES

10. DYSPHAGIA

11. UNTREATED INGUINAL, INCISIONAL, or VENTRAL HERNIA

GENITOURINARY SYSTEM STANDARD

Any disease or condition which interferes with genitourinary function and safe and efficient job performance may be considered disqualifying. Cases will be reviewed on a case-by-case basis. All medications taken for genitourinary conditions will be carefully reviewed to insure that they do not compromise job performance and therefore interfere with safe and efficient job performance.

1. POLYCYSTIC KIDNEY DISEASE

2. ACUTE or CHRONIC RENAL FAILURE

3. NEPHROTIC SYNDROME

4. URINARY CALCULI (KIDNEY STONES) that are symptomatic, recurrent, or that causes kidney dysfunction.

5. RENAL TOXICITY

6. GLOMERULONEPHRITIS or PYELONEPHRITIS

7. RENAL VEIN THROMBOSIS

8. UNCORRECTED OBSTRUCTIVE UROPATHIES

9. NEUROGENIC BLADDER

10. DYSMENORRHEA or ENDOMETRIOSIS that causes chronic and severe pain requiring the frequent use of narcotic medications.

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 or 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.

1. ADRENAL DYSFUNCTION (In the form of Addison's Disease or Cushing's Syndrome). These conditions may be acceptable if present without evidence of disease, such as hypertension, diabetes, hypoglycemia, electrolyte imbalance, or musculoskeletal weakness.

2. THYROID DISEASE (Hypothyroidism or Hyperthyroidism) may be acceptable if adequately controlled and stable for at least one year and is without complications (such as significant weight changes, cardiac arrhythmia, tachycardia, poor exercise tolerance, tremors, heat or cold intolerance, significant swelling, or muscle pain). Documentation of control will include a thyroid profile and a medical report from the treating physician.

3. PITUITARY DYSFUNCTION

4. DIABETES MELLITUS or HYPERGLYCEMIA will require additional medical tests and documentation of treatment to evaluate whether an individual is capable of safe performance of essential job functions.

5. DIABETES INSIPITUS

6. PARATHYROID DISORDERS

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 and that is likely to adversely effect the safe and efficient performance of essential job functions is generally disqualifying. An orthopedic evaluation with imaging and/or electrophysiologic (EMG) studies may be necessary to determine the extent of physical limitations. Cases will be reviewed on a case-by-case basis.

1. ARTHRITIS of any type if there is limited joint motion, pain, and/or muscle atrophy that affects the ability to perform essential job functions.

2. AMPUTATIONS of THUMB or INDEX FINGER that affects the ability to perform essential functions, such as involving lethal and non-lethal weapons, handcuffs, etc.

3. AMPUTATIONS OF AN EXTREMITY with any loss of an upper or lower extremity, hand, or foot.

4. SCOLIOSIS with curve greater than or equal to 45 degrees, pain, significant curve progression, or with limitations for physical activity that affects the ability to perform essential job functions.

5. CERVICAL, THORACIC, LUMBAR, LUMOSACRAL DISK DISEASE,

FRACTURES, OR DISLOCATIONS of any type if there is limited joint or gait motion, pain, motor or sensory manifestations, and/or muscle atrophy that affects the ability to perform essential functions, such as limitations of flexibility and strength causing an inability to stand, bend, stoop, carry heavy objects or sit for long periods of time.

6. SPINAL DISORDERS such as Spina Bifida, Spondylolysis, Spondylolisthesis, or Ankylosing Spondylitis which limit mobility, gait, or skeletal strength, or cause pain.

7. SCIATICA, CERVICAL NEUROPATHY, OR OTHER NEUROPATHIES

with evidence of numbness, tingling, loss of motor strength, or limited gait.

8. CHRONIC LOW BACK PAIN with recurrence of pain and/or restricted range of motion or gait that affects the ability to perform essential functions. 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.

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

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 essential law enforcement functions will require documentation from the treating physician that immobilization is no longer required and that no physical limitations are present. Fractures that continue to cause pain, swelling, muscle atrophy, limitation of motion, abnormal gait may be disqualifying.

11. SHOULDER CONDITIONS such as history of multiple dislocations (three or more) without surgical repair or any history of dislocation with current pain, or reduced strength or range of motion, acromioclavicular (AC) separation with current pain, or reduced strength or range of motion.

12. KNEE CONDITIONS with current symptoms such as swelling; pain; reduced range of motion, gait, or strength; or instability that prevents the full range of essential law enforcement functions.

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

HEMATOLOGY SYSTEM STANDARD

Any hematological condition that adversely impacts on an individual’s exercise capacity or ability to perform aggressive law enforcement functions and that is likely to adversely effect the safe and efficient performance of essential job functions is generally disqualifying. A medical evaluation with a maximal, symptom-limited stress EKG may be necessary to determine the extent of physical limitations. Cases will be reviewed on a case-by-case basis.

1. ANEMIA

2. BLEEDING DISORDERS such as genetic bleeding disorders (Hemophilia, von

Willebrand’s disease), acquired bleeding disorders (caused by liver disease or infection) and medications (Coumadin, Heparin) which are likely to cause bleeding with physical confrontation or defensive tactics training.

3. THROMBOCYTOPENIA

4. HEMOGLOBINOPATHIES such as Sickle Cell Disease or Thalassemia which are likely to cause infarction at high altitude, reduce exercise capacity, and prevent working in certain environments.

5. MULTIPLE MYELOMA

6. SYSTEMIC LUPUS ERYTHEMATOSUS

NEUROLOGICAL SYSTEMS STANDARD

Any disease or condition which interferes with the central or peripheral nervous system function and that is likely to adversely effect the safe and efficient performance of essential job functions may be considered disqualifying. A medical evaluation by a neurologist and/or neurolopsychologist may be required. Any condition with loss of motor skills, muscle strength, cognitive function, coordination, or gait; sensory loss (limb, hearing, or vision); tremor; pain, or effect on speech may result in disqualification. Cases will be reviewed on a case-by-case basis.

1. TRANSIENT ISCHEMIC ATTACKS or CEREBROVASCULAR

ACCIDENT (STROKE)

2. HEAD TRAUMA

3. MIGRAINE and other headaches that interferes with performance of essential job functions (such as sensory changes) or that require medication that is either frequent, sedating, or that is likely to interfere with essential job functions.

4. EPILEPSY with a history of past or current seizures requires additional medical documentation that this condition is unlikely to adversely effect the safe and efficient performance of essential job functions.

5. SYNCOPE

6. CEREBRAL PALSY

7. HISTORY OF MENINGITIS

8. ALZHEIMER’S or other degenerative dementia disorders

9. DEGENERATIVE SPINAL CORD DISORDERS

10. MULTIPLE SCLEROSIS

11. HUNTINGTON’S CHOREA

12. AMYOTROPHIC LATERAL SCLEROSIS

13. HYDROCEPHALUS

14. PARKINSON’S DISEASE

15. MYASTHENIA GRAVIS

16. CRANIAL NEUROPATHIES such as Tic Douloureux, Trigeminal Neuralgia

17. PERIPHERAL NEUROPATHIES such as Carpal Tunnel Syndrome (Median nerve), Foot Drop (Peroneal nerve), Diabetic and Alcoholic Neuropathy

18. NARCOLEPSY

19. HAND TREMOR

PSYCHIATRIC DISORDERS STANDARD

Any disorder which affects judgment, cognitive function, or the safe and efficient performance of essential job functions, is generally disqualifying. Medical conditions may require the medical review by a psychologist, neuropsychologist, neurologist, and/or a psychiatrist for final medical determination of qualification. 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. All psychiatric conditions will be reviewed on a case-by-case basis.

1. DELIRIUM, DEMENTIA, AMNESTIC AND OTHER COGNiTIVE

DISORDERS

2. MAJOR DEPRESSION

3. MANIC-DEPRESSIVE DISORDER or Bi-Polar Disorder

4. PANIC DISORDER AND OTHER ANXIETY DISORDERS

5. SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS

DERMATOLOGY 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, or which results in restricted functioning or movement and thereby impairs the safe and efficient performance of essential job functions may be considered disqualifying. Cases will be reviewed on a case-by-case basis.

1. ALBINISM.

2. SEVERE CHRONIC DERMATITIS such as eczema or psoriasis.

3. COSMETIC DISFIGUREMENTS such as severe scars or burns which results in restricted flexibility, grip, movement, etc.

4. SCLERODERMA

5. SEVERE SKIN INFECTION

CANCER STANDARD

Any medical condition that impairs the ability to safely and efficiently perform essential job functions will generally be disqualifying. Cases will be reviewed on a case-by-case basis. Further consideration will be given under the following circumstances.

1. The cancer has a high cure rate.

2. The cancer has stabilized without metastases.

3. The Oncologist declares the individual to be a complete responder with no evidence of active disease.

4. There is no evidence of medication, surgical, or radiation side effects present.

5. There is no evidence of immune suppression as a result of the treatment.

6. The cancer is in remission with low likelihood of recurrence.

1. SMALL CELL (OAT CELL) CARCINOMA OF THE LUNG

2. PANCREATIC CANCER

3. RENAL CARCINOMA

4. HEPATIC CARCINOMA

5. ADRENAL CARCINOMA

6. METASTATIC CARCINOMA

7. LEUKEMIA/LYMPHOMA

8. NEOPLASIA OF THE CENTRAL NERVOUS SYSTEM

MEDICATION STANDARD

All medication requirements, including psychotropic medication, will be evaluated to ensure that safe and efficient job performance will not be adversely affected by their use.

Cases will be reviewed on a case-by-case basis. Each of the following considerations will be reviewed in order to make a medical determination.

1. Medication type and dosage requirements

2. Potential drug side effects and adverse reactions

3. Potential drug-drug interactions

4. Drug toxicity

5. 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, barbituates, 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.

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.

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.

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

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