Section J 4E Physical and Medical Standards.pdf

Federal Judicial Circuits

Attachment 4(E) CSO Medical Exam and Qualification Standards

CSO MEDICAL EXAM AND QUALIFICATION STANDARDS

1.0 CSO VISION

1.1 Vision

Corrected distant visual acuity required is 20/30, or better, as measured with both eyes viewing (binocular). Complete loss of vision in one eye is disqualifying. Corrected distant visual acuity required is 20/125, or better, in the worst eye. Corrected near vision of 20/40, or better, as measured with both eyes viewing (binocular) is required.

1.2 Color Vision

Ability to distinguish basic colors, as well as shades of color, is required. Color vision testing must be performed utilizing the Ishihara 14 Plate Test. A Farnsworth D-15

Color Test must be performed if there are five (5) or more errors on the Ishihara 14

Plate Test. A score of two (2) or more major errors on the Farnsworth D-15 is disqualifying. Copies of all Ishihara and Farnsworth D-15 test records must be kept on file by the Contractors along with a copy of the CSO-229 examination. The use of X-

Chrom contact lenses or tinted spectacle lenses is not permitted in the testing of color vision.

Farnsworth D-15 testing must be observed and the test results documented by the eye doctor. A copy of the test must be provided to include the graph with cap order test form, the eye doctor’s interpretation & signature on the graph with cap order test form.

Tinted glasses or color vision correcting lenses are not to be used in order to pass the test and must be documented on the graph with cap order test form. A government issued photo ID (driver’s license, passport, military ID) must be checked & verified for the person tested and this verification acknowledged on the graph with cap order test form.

1.3 Peripheral Vision

Normal full peripheral vision is required. Documentation of testing of Peripheral

Vision, both temporal and nasal perimeter scores for each eye is required. Contractor shall provide vision machine testing results documented on testing form for review by the Reviewing Medical Officer, an example is the Titmus 2s Vision Screening Record.

2.0 Hearing

The applicant or incumbent CSO shall be able to hear well enough to safely and efficiently carry out the essential requirements of the CSO position. This includes the ability to adequately comprehend speech during face-to face conversations;

comprehend speech during telephone conversations; comprehend speech during radio transmissions; comprehend speech when the individual cannot see another CSO; hear sounds that require investigation; and determine the source and location of sounds. In order to measure an individual’s ability to perform these essential job functions, the following test procedures are administered.

2.1 Hearing Testing

Initially, all individuals shall be tested UNAIDED using an audiometer for measurement, testing each ear separately under headphones. The equipment and test setting shall meet the standards of the American National Standards Institute (see 29

CFR 1910.95). Auditory acuity in each ear may be demonstrated by documentation of pure tone air conduction hearing thresholds, as specified below:

• In the frequency range from 500 - 2000 hertz (Hz), the pure tone audiometric deficit shall not exceed 30 decibels (dB) in either ear, without the use of hearing aids.

• At 3000 Hz, the pure tone audiometric deficit shall not exceed 40 dB in either ear, without the use of hearing aids.

• At 4000 Hz, the pure tone audiometric deficit shall not exceed 50 dB in either ear, without the use of hearing aids.

Contractor shall provide audiogram tape printout of audiometry results for review.

2.2 Evaluation of Hearing Test Results

2.2.1 If the performance on the above UNAIDED pure tone audiogram meets the standards set forth above in Section 2.1 and the individual does not wear a hearing aid in either ear, no further assessment is needed and the individual is deemed medically qualified under the hearing standard.

2.2.2

If the performance on the above UNAIDED pure tone audiogram does not meet the standards set forth above in Section 2.2 and the individual does not wear a hearing aid in either ear, or the CSO meets the UNAIDED pure tone standard set forth in Section

2.2 but there is a history or evidence of reduced hearing capability, the individual must undergo UNAIDED functional hearing assessments, as described below in Section

2.3. Based on the results of those functional hearing assessments and the recommendations of the reviewing physician, a determination of whether the individual is medically qualified with regard to hearing will be made as follows:

• If the performance on the UNAIDED functional hearing assessments is acceptable, no further assessment is needed and the individual is deemed medically qualified under the hearing standard.

• If the performance on the UNAIDED functional hearing assessment is unacceptable and the individual does not wear hearing aid(s), the following applies:

▪ Applicants in this circumstance may acquire hearing amplification equipment or undergo medical and/or surgical treatment for hearing loss and reapply in the future.

▪ Incumbents in this circumstance will be removed from duty, allowed an opportunity to acquire hearing amplification equipment or pursue medical and/or surgical evaluation and treatment for hearing loss, and then allowed to undergo subsequent functional hearing assessments after a minimum 30 day adjustment period, wearing his/her own hearing aid(s) for at least 8 hours each day as described below in Section 2.3.

• For incumbents deemed not medically qualified who undergo medical and/or surgical treatment for hearing loss:

▪ If the performance on the subsequent UNAIDED functional hearing assessments is acceptable, the incumbent will be deemed qualified with regard to hearing performance and may be returned to duty.

▪ If the performance on the subsequent UNAIDED functional hearing assessments is unacceptable, the individual remains not medically qualified and may not return to duty.

• For incumbents deemed not medically qualified who acquire hearing amplification equipment, the results of the subsequent AIDED functional hearing assessments performed after a minimum 30 day adjustment period, wearing his/her own hearing aid(s) for at least 8 hours each day will be evaluated and a decision made on whether to allow reinstatement pursuant to Section 2.3 below.

2.2.3

If the performance on the above UNAIDED pure tone audiogram does not meet the standards set forth above in Section 2.1 and the individual wears a hearing aid in one or both ears, the individual must undergo UNAIDED and AIDED functional hearing assessments, as described below in Section 2.3. Based on the results of those functional hearing assessments and the recommendations of the reviewing physician, a determination of whether the individual is medically qualified with regard to hearing will be made as follows.

• If the performance on the UNAIDED and AIDED functional hearing assessments is acceptable, no further evaluation is needed and the individual is deemed medically qualified with or without the use of hearing amplification while on duty.

• If the performance on the UNAIDED functional hearing assessments is unacceptable but the performance on the AIDED functional hearing assessments is acceptable, the individual is deemed medically qualified with the stipulation that the amplification equipment used during the aided functional assessments shall be used at all times while on duty.

• If the performance on the UNAIDED and AIDED functional hearing assessments is not acceptable, the individual is deemed not medically qualified.

If the performance on the UNAIDED pure tone audiogram meets the standards set forth above in Section 2.1 and the individual wears a hearing aid in one or both ears, the individual must undergo UNAIDED and AIDED functional hearing assessments, as described below in Section 2.3.

• If the performance on both the UNAIDED and AIDED functional hearing assessments is acceptable, the individual is deemed medically qualified with or without the use of hearing amplification while on duty.

• If the performance on the UNAIDED functional hearing assessments is unacceptable but the performance on the AIDED functional hearing assessments is acceptable, the individual is deemed medically qualified with the stipulation that the amplification equipment used during the aided functional assessments shall be used at all times while on duty.

• If the performance on the UNAIDED and AIDED functional hearing assessments is not acceptable, the individual is deemed not medically qualified.

Any incumbent who acquires or changes hearing aid equipment during the year

(between the biennial periodic medical reviews) shall report that fact to his or her site supervisor, who then must notify the USMS. Additional assessment may be required to ensure that the individual’s hearing performance remains acceptable.

2.3 Functional Hearing Assessments

2.3.1

Pure tone audiograms provide limited assessment of overall hearing capability. They are useful as an initial screening test, but in circumstances where pure tone performance is poor, or where there is history or evidence of reduced hearing capability despite acceptable pure tone performance, more thorough evaluation is necessary. Functional hearing assessments which measure sound and speech recognition may reveal adequate performance in the presence of substandard pure tone performance. Alternatively, functional assessment may reveal significant hearing deficits suggested by history or other factors but not evident in the pure tone results.

2.3.2

As detailed above in Section 2.2, functional hearing assessments will be used to determine the medical qualification of all individuals who: (1) do not meet the unaided pure tone hearing standard set forth in Section 2.1 or (2) meet the unaided pure tone standard but choose to use hearing amplification or (3) reveal history or evidence of hearing difficulties. The functional hearing assessments will measure the following:

• The individual’s testing records shall clearly document UNAIDED pure tone air conduction audiogram testing at the frequencies 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz and UNAIDED pure tone bone conduction audiogram testing at the frequencies 500, 1000, 2000, 3000, and 4000Hz.

• UNAIDED Speech Reception Threshold shall be 35 dB, or better, in each ear.

Borderline performance may require further assessment. Recorded lists must be used.

• UNAIDED Speech Recognition in quiet shall be 90%, or above, in each ear with a presentation level no greater than 75 dB. Borderline performance may require further assessment. Recorded lists shall be used.

• UNAIDED Speech Recognition in noise tested in sound field shall be 50% or above with a speech presentation level no greater than 75 dB with competing noise 10 dB below the speech presentation level. Borderline performance may require further assessment. Recorded lists shall be used.

• If hearing aid equipment of any type is worn, the following additional assessments are required and are to be performed with the examinee’s own hearing aid or aids in place:

▪ A statement describing the specific type of hearing amplification device(s) used and which ear or ears have been fitted shall be provided by the testing audiologist.

▪ AIDED sound field audiogram using 5% FM warble tones or narrow bands of noise at 250, 500, 1000, 2000, 3000, 4000, 6000 Hz shall be clearly documented in the testing records.

▪ AIDED Sound Field speech reception threshold measured with individual facing the signal speaker at a distance of 1 meter shall be 35 dB or better.

Each ear is to be tested separately; the non-tested ear must be adequately occluded with a foam earplug and then covered with a sound attenuating earmuff. AIDED Speech Recognition in quiet tested in sound field shall be

90%, or above, with a presentation level no greater than 75 dB. Each ear is to be tested separately; the non-tested ear must be adequately occluded with a foam earplug and then covered with a sound attenuating earmuff. If the client achieves a score of 90% or better, this phase of the test may be terminated and results reported. If a score of less than 90% is obtained, vary presentation level either up or down as appropriate to achieve maximum score, not to exceed 75 dB HL. Report %/Intensity function.

Borderline performance may require further assessment. Recorded lists shall be used.

▪ Borderline performance may require further assessment. Recorded lists shall be used.

▪ AIDED Speech Recognition in noise tested in sound field shall be 50% or above with a speech presentation level no greater than 75 dB with competing noise 10 dB below the speech presentation level. Borderline performance may require further assessment. Recorded lists shall be used.

2.3.3

In all cases for which functional hearing assessments are required, the results of the above functional hearing tests will be evaluated along with any other information or recommendations provided by the reviewing physician. Some conditions may require a further assessment, even if the results of the above functional tests are within the recommended limits, to ensure that the individual is able to safely perform the essential requirements of the CSO position. Unilateral hearing loss severely disrupts the ability to localize sound, an essential job function. Therefore, unilateral hearing loss is disqualifying.

3.0 Additional Medical Assessment

A final determination of medical qualification for CSOs shall be made pursuant to these additional assessments.

3.1 Cardiovascular System

Any condition that significantly interferes with heart function may be disqualifying.

Examples of conditions that may be disqualifying are hypertension, ischemic heart disease, heart failure, symptomatic peripheral vascular disease and severe varicose veins.

3.2 Blood Pressure Testing

Examples of conditions that may be disqualifying are hypertension with repeated readings that exceed 150 systolic and 90 diastolic. Two additional blood pressure readings, separated by at least 5 minutes, performed after the CSO-229 examination will be required if the blood pressure reading at the time the CSO-229 examination exceeded 150 systolic and 90 diastolic.

3.3 Cardiac Testing

A 12 lead electrocardiogram (EKG) must be performed at the time of the CSO-229 examination. All abnormal EKGs must be reviewed by a board certified cardiologist for medical clearance. A copy of the cardiologist’s report must be attached to the EKG. All examinees will be individually assessed for risk of heart attack and stroke

(cardiovascular disease) using evidence-based best medical practices..

3.4 Respiratory System

Any condition that significantly interferes with breathing capacity (including Obstructive

Sleep Apnea) may be disqualifying. Examinees diagnosed with Obstructive Sleep Apnea who have CPAP treatment recommended shall be required to provide a CPAP compliance report covering, at a minimum, the most recent three (3) month period. This compliance report shall include:

• time span of report

• number of nights CPAP used

• % of nights CPAP used 4 hours or more, and

• Apnea-Hypopnea Index (AHI).

3.5 Gastrointestinal System

Any disease or condition that requires rigid diets may be a disqualifying factor. An ulcer active within the past year may also be disqualifying.

3.6 Genitourinary System Disorders

Any functional disorder rendering the person incapable of sustained attention to work tasks, e.g., urinary frequency and secondary discomfort may be disqualifying.

3.7 Hernias

Inguinal and femoral hernias, with or without the use of a truss may be a disqualifying factor. Other hernias may be disqualifying if they interfere with the performance of the duties of the position.

3.8 Nervous System

Dysfunction of the central and peripheral nervous system that significantly increases the probability of accidents and/or potential inability to perform a variety of physical tasks may be disqualifying.

3.9 Endocrine System

Any functional disorder rendering the person incapable of sustained attention to work tasks may be disqualifying.

3.10 Endocrine System Testing

All examinees diagnosed with Diabetes or Pre-Diabetes shall have a Hemoglobin

A1c test at the time of the medical examination.

3.11 Speech

Permanent and significant conditions that result in indistinct speech may be disqualifying.

3.12 Extremities and Spine

Disorders affecting the musculoskeletal system that significantly prevents the individual from meeting basic movement, strength, flexibility requirements, use of extremities (fingers and toes) and coordinated balance may be disqualifying.

3.13 Hematopoietic System

Any condition or medication that results in a significant bleeding or clotting disorder, reduced immunity, or anemia may be disqualifying.

3.14 Medications

Use of any medication that may interfere with safe and effective job performance, such as narcotics, benzodiazepines, anti-coagulants or any other medication that can interfere with attention, cognitive function, reflexes, or result in subtle or sudden incapacitation may be disqualifying.

3.15 Miscellaneous

Any other disease or condition that interferes with the full performance of duties may be disqualifying.