Attachment 17 Police Officers.pdf

DEFENSE LOGISTICS AGENCY POLICY DOCUMENT

OFFICE OF PUBLIC SAFETY #10-009

PHYSICAL AND MEDICAL QUALIFICATIONS

Issue Date: November 5, 2008 OPR: DES-SO Updated:

I. PURPOSE. This policy document provides guidance for medical evaluations of DLA police officers. It consolidates existing requirements published by the Office of Personnel Management (OPM) and the Department of Defense (DoD). The standards outlined in Appendix A have been consolidated by DLA Occupational Medical & Health based upon OPM and DoD guidelines.

II. POLICY. Medical standards exist and are justified because security force positions are arduous, hazardous, and require a specific level of physical wellness and capabilities to protect personal and to ensure effective security. Initial medical evaluation of DLA security force officer candidates and annual medical evaluation of current security force officers will be conducted in accordance with One Book “Force Protection and Security Operations” to ensure employees can safely perform police-related duties.

III. INFORMATION FOR EMPLOYEES:

Occupational health examinations are performed for two purposes. One purpose is to determine whether an employee, or candidate, can perform the duties of a particular position without harm to themselves, others, or the mission. This is commonly called a fitness for duty examination. An example would be a hearing test to determine whether an individual can hear well enough to perform the duties of the position.

The second purpose is to determine whether the workplace is causing workers injury or illness due to an occupational exposure, often referred to as medical surveillance examinations. An example would be a hearing test to determine whether a worker in a noisy environment has lost hearing ability due to noise exposure. Both of these examples use hearing tests, one for a fitness for duty examination, and the other for medical surveillance. [Reference: DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual, May 2, 2007.]

Occupational health examinations are directly linked to specific position duties and requirements. The actual and expected duties and requirements provide the basis for determining the physical and medical qualifications for that position (fitness for duty). And understanding the potential hazards and exposures of a given position will determine what ongoing medical surveillance should be performed. This document only addresses fitness for duty examination.

An employee may be referred to his/her personal physician for personal health conditions that may limit or restrict the employee’s performance of the job duties, make him/her a hazard to themselves or others, or jeopardize the mission.

ATTACHMENT 17

IV. INFORMATION FOR MEDICAL PERSONNEL:

This document (including Appendices) provides an overview of the police officer position to guide your professional judgment regarding fitness for duty determinations. This document is not intended to be a substitute for professional expertise in the field of occupational health.

Please note that pursuant to the Americans with Disabilities Act of 1990, individuals must be evaluated for a job based on their ability to safely perform the essential job functions with or without reasonable accommodation, not on the basis of the mere presence of a disease or disability. The evaluation must be made on a case-by-case basis. The California Commission on Peace Officer Standards and Training publication, “Medical Screening Manual for California Law Enforcement,” is a useful source for identifying the significance of medical or physical deficiencies. Health professionals should realize that some security force functions may require significantly higher medical standards. Individuals who meet the minimum DoD guidance are not necessarily qualified for all police occupations or functions.

[References: (a) DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual, May 2, 2007, section C3.4.1 “Police Officers and Security Guards.” (b) The California Commission on Peace Officer Standards and Training publication, “Medical Screening Manual for California Law Enforcement,” is available at http://www.post.ca.gov/selection/pdf/MedicalScreenGuideFull2004.pdf ]

Examining medical personnel are to complete Part C of the SF 78-110 “Certificate of Medical Examination,” ending with “Conclusions.” Under “Conclusions” include a listing of medical findings which, in your opinion, would limit – or should restrict - the examinee’s performance of the job duties, make him/her a hazard to themselves, others or jeopardize the mission. If there are limiting medical findings please state whether, in your opinion, further evaluation(s) and/or reasonable accommodation(s) would be appropriate. Please attach continuation pages as needed.

In accordance with 5 CFR Part 339, Medical Qualification Determinations, decisions whether further evaluation(s) and/or reasonable accommodation(s) will be pursued for individuals who do not meet the standards or qualifications will be made by DLA management and Human Resource personnel. The opinion of the examining medical personnel stated in Part C will be reviewed during the decision-making process.

Approved:

Roger McCrady Staff Director, DLA Office of Public Safety http://www.post.ca.gov/selection/pdf/MedicalScreenGuideFull2004.pdf�

APPENDIX A

The following table outlines the Defense Logistics Agency Police Officer Physical and Medical Qualifications with the caveat that professional medical judgment must be exercised and no single reference can provide all information.

Category Standard or Qualification Comments Position duties:

overview

This position requires moderate to arduous physical exertion and/or duties of a hazardous nature. Officers must have the capacity to perform the essential functions of the position including acting as a first responder to all types of emergencies or volatile situations and completing an initial and annual physical fitness test, without risk to themselves or others.

References:

(1) DLA One Book Chapter “Force Protection and Security Operations”

(2) 5 CFR Part 339 – Medical Qualification Determinations.

Driver's License Possess a valid state operator’s license to operate standard vehicles (sedan, pick-ups, etc.).

May not be in a state of suspension or revocation.

Provided for information only. The examining physician is not to make any determinations regarding employee qualification.

Medical Conditions

Be free from medical conditions which may impair the performance of police duties or which might endanger the lives of themselves or others or the mission. Medical conditions include those which may cause either sudden or subtle incapacitation by carrying out, with or without accommodation, the tasks or duties of the position.

Medical condition is any health impairment which results from injury or disease, including psychiatric disease.

Subtle incapacitation is the gradual, initially imperceptible impairment of physical or mental function whether reversible or not which is likely to result in performance or conduct deficiencies.

Sudden incapacitation means abrupt onset of loss of control of physical or mental function.

Category Standard or Qualification Comments Each medical condition for each individual shall be evaluated by the medical provider, using professional judgment, to determine whether the standard is met.

See Appendix B.

References: 5 CFR Part 339 – Medical Qualification Determinations. DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual.

Weapon Be able to maintain control of weapon with no noticeable deficit of muscle strength, particularly in hand-grip and upper extremities, bilaterally.

If available, use of hand-grip dynamometer and/or other diagnostic equipment to quantitatively assess muscle strength may be appropriate following injury or illness.

Hearing In general, pure-tone, unaided, air conduction hearing threshold levels should not exceed 30 decibel (dB) hearing loss on average for each ear at 500, 1000, and 2000 hertz (Hz), with no single level greater than 35 dB hearing loss at these frequencies. Thresholds should not exceed 55 dB at 4000 Hz in each ear.

If the hearing loss exceeds these levels, a full audiologic evaluation should be considered. This evaluation may require a speech-in-noise test with and without hearing aids (if the individual wears them).

Individuals with significant asymmetry should undergo evaluation by an audiologist. The requirement for hearing aids to satisfy the medical requirements of this position is not disqualifying.

Reference: DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual, May 2, 2007, section C3.4 “Police Officers and Security Guards.”

Vision (1) Individuals must be binocular without exception.

(2) Using the individual’s best optical correction, distance vision should be at least 20/30 in one eye and 20/100 in the other, or 20/40 in one eye and 20/70 in the other.

(3) Using the individual’s best optical correction, near vision should be correctable to 20/40 binocularly (both eyes open).

(4) Uncorrected binocular visual acuity - for distance and near vision - should be at least 20/100, but may be 20/200 in situations where soft contact lenses may be worn and the individual has been a successful soft contact lens wearer.

(5) Individuals should be able to discriminate vivid red/green color.

(6) Individuals should have normal muscle balance, defined as the lack of strabismus (greater than 15 diopters), nystagmus, and diplopia.

(7) Individuals should have a minimum total horizontal visual field of 120 degrees and a minimum total vertical visual field of 40 degrees (20 above the horizontal meridian and 20 below the horizontal meridian) in each eye.

(8) Individuals should not have a history of abnormal night vision.

Acuity:

Exceptions to the guidance should be rare;

decreasing visual acuity is directly related to increased risk for errors (such as decisions to shoot or not to shoot), especially in decreased light environments.

Color discrimination

: Some higher-skill police functions will require a higher standard, such as passing the Farnsworth D-15 or pseudoisochromatic plates.

Muscle balance

: Some higher-skill police functions will require a higher standard, such as depth perception to at least 40 seconds of arc (point #6 on a Titmus eye testing machine).

Visual field:

Some higher-skill police functions will require a higher standard, such as a total of 100 degrees of total vertical visual field.

Reference: DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual, May 2, 2007, section C3.4 “Police Officers and Security Guards.”

Psychiatric Disorders

Have no presence or history of, or signs associated with, the following diagnoses:

(a) Delirium, dementia, and amnestic and other cognitive disorders.

(b) Major depressive disorder.

(c) Manic-depressive disorder (bipolar).

(d) Dissociative disorders.

Psychiatric disorders, which could affect safe and efficient job performance, require additional evaluation to determine whether the individual is able to safely and successfully perform the essential job functions. The presence of any psychiatric disorders, or a history of such, warrants referral for further evaluation by a psychologist or psychiatrist.

(e) Kleptomania.

(f) Panic disorder and other anxiety disorders (depending upon etiology, duration and severity of clinical expression).

(g) Pathological gambling.

(h) Pyromania.

(i) Schizophrenia and other psychotic disorders.

(j) Personality disorders.

(k) Mental retardation.

(l) Alcohol or drug dependence

(m) Other diagnoses not listed which may impair the performance of duties or which might endanger the lives of themselves or others.

References: DoD 6055.05-M, Occupational Medical section C3.4 “Police Officers and Security Guards.”

The Army Civilian Police and Security Guard Program, Army Regulation 190-56, Effective date: 27 October 2006

Neurologic Chronic headaches, a history of head trauma, cranial defects, and epilepsy are among the neurological disorders that can interfere with performance of police officer and security guard functions.

Epilepsy can be particularly dangerous and the likelihood of an on-the-job seizure must be assessed.

The best method of evaluating this risk is described in pages IX-3 through IX-12 of the “Medical Screening Manual for California Law Enforcement.” The physician must also assess nonseizure-related impairments, such as interictal electroencephalogram discharges (which can cause transient cognitive impairment) or anti-epileptic drug side effects (which cause about 30 percent of patients using them to experience moderate to severe side effects, which can include cognitive impairment, visual effects, and ataxia).

References: DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual, May 2, 2007, section C3.4 “Police Officers and Security Guards.”

Cardio- vascular considerations

Please refer to the referenced document for explanation of determining risk according to the Framingham 10-year risk calculator.

(1) Generally, those individuals with a high 10-year risk, and those with coronary artery disease or coronary artery disease equivalent (peripheral arterial disease, abdominal aortic aneurysm, symptomatic carotid artery disease, diabetes) are candidates for additional testing (usually a treadmill stress test, stress thallium, or stress echo). The occupational medicine physician should consider temporarily disqualifying these individuals from strenuous duties and/or duties that require wearing a respirator (except a mask for escape purposes only), pending the results of evaluation by the workers’ private physicians.

(2) Police and security personnel with intermediate or high 10-year risk should be referred to their primary care provider for risk factor reduction. Risk control should occur prior to undertaking strenuous duties.

(3) If an individual undergoes a therapeutic procedure (catheterization or coronary artery bypass graft), the DOT “Cardiovascular Advisory Panel Guidelines for the Medical Examination of Commercial Motor Vehicle Drivers”1

Police and security personnel are required to respond to emergency situations that may impose significant physical and psychological stress. Such stress may trigger sudden death or MI in the presence of underlying heart disease. For this reason, cardiac risk evaluation may be appropriate for them.

may be useful in determining return-to-work criteria. At a minimum, an individual should have a normal, graded, exercise stress test to 8 metabolic equivalents and receive cardiologist approval to work as a security force member before returning to duty.

Reference: DoD 6055.05-M, Occupational Medical section C3.4 “Police Officers and Security Guards.”

1 Available via the Internet at http://www.fmcsa.dot.gov/documents/cardio.pdf

Arrhythmias Arrhythmias that predispose to or have a risk of cerebral hypoperfusion and impaired consciousness, and/or that require anticoagulation, are generally not compatible with safe performance of the duties of police and security personnel. Security force personnel with pacemakers may be qualified if the underlying disease does not pose a significant risk; they should be evaluated on a case-by-case basis. Implanted defibrillators are generally not compatible with safe performance of the duties of police and security personnel.

Reference: DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual, May 2, 2007, section C3.4 “Police Officers and Security Guards.”

Hypertension (1) Stage 3 (greater than or equal to 180/110). Restricted until less than 140/90, with semiannual recertification.

(2) Stage 2 (160-179/100-109). May be qualified for 3 months if under treatment. Must be temporarily restricted from strenuous duties and/or duties that require participation in a respiratory protection program (RPP) (except a mask for escape purposes only). Must be less than 140/90 within 3 months.

(3) Stage 1 (140-159/90-99). May be qualified for 1 year if under treatment. Must be less than 140/90 at reevaluation. If still Stage 1 at 1 year, may be given one 3-month certification to gain control into normal range.

Patients with hypertension should have a treatment plan for controlling it documented by a physician.

The following guidelines for members with hypertension are adapted from Department of Transportation guidelines.

Reference: DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual, May 2, 2007, section C3.4 “Police Officers and Security Guards.”

Diabetes In general, blood glucose should be under excellent control for an extended period of time and glycosylated hemoglobin should be less than 8.0. In addition, the examinee should have no evidence of end organ damage (nephropathy, neuropathy, proliferative retinopathy), no uncontrolled hypertension, and no history of ketoacidosis or severe hypoglycemia in the previous year.

Because diabetes mellitus can interfere with safe performance of the essential job functions, such a diagnosis should be closely scrutinized.

Reference: DoD 6055.05-M, Occupational Medical Examinations and Surveillance Manual, May 2, 2007, section C3.4 “Police Officers and Security Guards.”

Physical Fitness Pass the DLA physical fitness test which is designed to measure anaerobic/aerobic endurance, agility, and strength.

Security force officers will be tested within a single one hour time frame in the following events.

(a) Execute 19 pushups within 2 minutes.

(b) Run 1.5 mile within 17 minutes, 30 seconds.

Physical fitness and wellness are important to officer safety and effectiveness. The physical fitness test serves to provide a measure of the individual’s preparedness to successfully accomplish physically demanding occupational tasks.

The examining physician is requested to determine that the employee is reasonably likely to complete the physical fitness test without direct harm to themselves. The examining physician is not requested to predict whether the employee is likely to meet the minimum passing standards.

Reference: DLA Office of Public Safety Policy Document #10-005

APPENDIX B

The following section “POLICE OFFICERS AND SECURITY GUARDS” is taken directly from DoD 6055.05-M, OCCUPATIONAL MEDICAL EXAMINATIONS and SURVEILLANCE MANUAL, May 2, 2007, available at http://www.dtic.mil/whs/directives/corres/html/605505m.htm.

C3.4.

POLICE OFFICERS AND SECURITY GUARDS

C3.4.1. General Considerations. Pursuant to section 12101 of title 42, United States Code (Reference (k)), commonly known as the Americans with Disabilities Act of 1990), individuals must be evaluated for a job based on their ability to safely perform the essential job functions with or without reasonable accommodation, not on the basis of the mere presence of a disease or disability. The evaluation must be made on a case-by-case basis. The California Commission on Peace Officer Standards and Training publication, “Medical Screening Manual for California Law Enforcement,”2 is a useful source for identifying the significance of medical or physical deficiencies. Health professionals should realize that some law enforcement functions may require significantly higher medical standards.

Individuals who meet the minimum guidance outlined below are not necessarily qualified for all law enforcement occupations or functions.

C3.4.2.

Special Considerations

C3.4.2.1.

Coronary Artery Disease

C3.4.2.1.1. Police and security personnel are required to respond to emergency situations that may impose significant physical and psychological stress. Such stress may trigger sudden death or MI in the presence of underlying heart disease. For this reason, cardiac risk evaluation may be appropriate for them.

C3.4.2.1.2. The Framingham 10-year risk calculator is probably the most useful single tool to characterize the risk to a police officer or security guard of a cardiac event. The Framingham Risk score uses independent risk factors (age, gender, total cholesterol, HDL cholesterol, systolic blood pressure, treatment for hypertension, and cigarette smoking) to assess an individual’s absolute risk for developing a cardiac event, such as MI or new onset angina, within 10 years.

C3.4.2.1.3. Generally, those individuals with a high 10-year risk, and those with coronary artery disease or coronary artery disease equivalent (peripheral arterial disease, abdominal aortic aneurysm, symptomatic carotid artery disease, diabetes) are candidates for additional testing (usually a treadmill stress test, stress thallium, or stress echo). The occupational medicine physician should consider temporarily disqualifying these individuals from strenuous duties and/or duties that require wearing a respirator (except a mask for escape purposes only), pending the results of evaluation by the workers’ private physicians.

C3.4.2.1.4. Police and security personnel with intermediate or high 10-year risk should be referred to their primary care provider for risk factor reduction. Risk control should occur prior to undertaking strenuous duties.

C3.4.2.1.5. If an individual undergoes a therapeutic procedure (catheterization or coronary artery bypass graft), the DOT “Cardiovascular Advisory Panel Guidelines for the Medical

2 Available via the Internet at http://www.post.ca.gov/selection/pdf/MedicalScreenGuideFull2004.pdf

ATTACHMENT 17

http://www.dtic.mil/whs/directives/corres/html/605505m.htm�

Examination of Commercial Motor Vehicle Drivers”3 may be useful in determining return-to-work criteria. At a minimum, an individual should have a normal, graded, exercise stress test to 8 metabolic equivalents and receive cardiologist approval to work as a security force member before returning to duty.

C3.4.2.2. Arrhythmias

. Arrhythmias that predispose to or have a risk of cerebral hypoperfusion and impaired consciousness, and/or that require anticoagulation, are generally not compatible with safe performance of the duties of police and security personnel. Security force personnel with pacemakers may be qualified if the underlying disease does not pose a significant risk; they should be evaluated on a case-by-case basis. Implanted defibrillators are generally not compatible with safe performance of the duties of police and security personnel.

C3.4.2.3. Hypertension

. Patients with hypertension should have a treatment plan for controlling it documented by a physician. The following guidelines for members with hypertension are adapted from DOT guidelines.

C3.4.2.3.1. Stage 3 (greater than or equal to 180/110)

. Restricted until less than 140/90, with semiannual recertification.

C3.4.2.3.2. Stage 2 (160-179/100-109)

. May be qualified for 3 months if under treatment. Must be temporarily restricted from strenuous duties and/or duties that require participation in a respiratory protection program (RPP) (except a mask for escape purposes only). Must be less than 140/90 within 3 months.

C3.4.2.3.3. Stage 1 (140-159/90-99)

. May be qualified for 1 year if under treatment. Must be less than 140/90 at reevaluation. If still Stage 1 at 1 year, may be given one 3-month certification to gain control into normal range.

C3.4.2.4. Diabetes

. Because diabetes mellitus can interfere with safe performance of the essential job functions, such a diagnosis should be closely scrutinized. In general, blood glucose should be under excellent control for an extended period of time and glycosylated hemoglobin should be less than 8.0. In addition, the examinee should have no evidence of end organ damage (nephropathy, neuropathy, proliferative retinopathy), no uncontrolled hypertension, and no history of ketoacidosis or severe hypoglycemia in the previous year.

C3.4.2.5. Hearing

. Police and security personnel exposed to hazardous noise should be enrolled in a hearing conservation program, with audiometry conducted annually. In general, pure-tone, unaided, air conduction hearing threshold levels should not exceed 30 decibel (dB) hearing loss on average for each ear at 500, 1000, and 2000 hertz (Hz), with no single level greater than 35 dB hearing loss at these frequencies. Thresholds should not exceed 55 dB at 4000 Hz in each ear. If the hearing loss exceeds these levels, a full audiologic evaluation should be considered. This evaluation may require a speech-in-noise test with and without hearing aids (if the individual wears them). Individuals with significant asymmetry should undergo evaluation by an audiologist. The requirement for hearing aids to satisfy the medical requirements of this position is not disqualifying.

C3.4.2.6. Vision

3 Available via the Internet at http://www.fmcsa.dot.gov/documents/cardio.pdf

. Vision screening may be adequate for preplacement, periodic, and termination examinations. Optometry referral is not required unless indicated by poor vision or an inability to properly assess the vision. When an examinee’s vision is worse than indicated below, the individual will most likely not be able to safely perform the essential job functions. The examining physician should consider this in his or her assessment.

C3.4.2.6.1. Individuals must be binocular without exception.

C3.4.2.6.2. Using the individual’s best optical correction, distance vision should be at least 20/30 in one eye and 20/100 in the other, or 20/40 in one eye and 20/70 in the other, and near vision should be correctable to 20/40 binocularly (both eyes open). Uncorrected binocular visual acuity should be at least 20/100, but may be 20/200 in situations where soft contact lenses may be worn and the individual has been a successful soft contact lens wearer. Exceptions to this guidance should be rare;

decreasing visual acuity is directly related to increased risk for errors (such as decisions to shoot or not to shoot), especially in decreased light environments.

C3.4.2.6.3. Individuals should be able to discriminate vivid red/green color.

Some higher-skill law enforcement functions will require a higher standard, such as passing the Farnsworth D-15 or pseudoisochromatic plates.

C3.4.2.6.4. Individuals should have normal muscle balance, defined as the lack of strabismus (greater than 15 diopters), nystagmus, and diplopia. Some higher-skill law enforcement functions will require a higher standard, such as depth perception to at least 40 seconds of arc (point #6 on a Titmus eye testing machine).

C3.4.2.6.5. Individuals should have a minimum total horizontal visual field of 120 degrees and a minimum total vertical visual field of 40 degrees (20 above the horizontal meridian and 20 below the horizontal meridian) in each eye. Some higher-skill law enforcement functions will require a higher standard, such as a total of 100 degrees of total vertical visual field.

C3.4.2.6.6. Individuals should not have a history of abnormal night vision.

C3.4.2.6.7. The U.S. Navy Medical Matrix provides the baseline Navy-required examination.

C3.4.2.7. Psychiatric Disorders

. Psychiatric disorders, which could affect safe and efficient job performance, require additional evaluation to determine whether the individual is able to safely and successfully perform the essential job functions. The presence of any psychiatric disorders, or a history of such, warrants referral for further evaluation by a psychologist or psychiatrist.

C3.4.2.8. Neurological Problems

. Chronic headaches, a history of head trauma, cranial defects, and epilepsy are among the neurological disorders that can interfere with performance of police officer and security guard functions. Epilepsy can be particularly dangerous and the likelihood of an on-the-job seizure must be assessed. The best method of evaluating this risk is described in pages IX-3 through IX-12 of the “Medical Screening Manual for California Law Enforcement.” The physician must also assess nonseizure-related impairments, such as interictal electroencephalogram discharges (which can cause transient cognitive impairment) or anti-epileptic drug side effects (which cause about 30 percent of patients using them to experience moderate to severe side effects, which can include cognitive impairment, visual effects, and ataxia).

End copy of section “POLICE OFFICERS AND SECURITY GUARDS” from DoD 6055.05-M, OCCUPATIONAL MEDICAL EXAMINATIONS and SURVEILLANCE MANUAL, May 2, 2007, available at http://www.dtic.mil/whs/directives/corres/html/605505m.htm.

http://www.dtic.mil/whs/directives/corres/html/605505m.htm�

APPENDIX C

Sample Standard Form 78 (for DLA Police)

I. PURPOSE. This policy document provides guidance for medical evaluations of DLA police officers. It consolidates existing requirements published by the Office of Personnel Management (OPM) and the Department of Defense (DoD). The standards outlined in Appendix A have been consolidated by DLA Occupational Medical & Health based upon OPM and DoD guidelines.