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UNCLASSIFIED

Army Regulation 40 – 502

Medical Services

Medical

Readiness

Headquarters Department of the Army Washington, DC 27 June 2019

SUMMARY

AR 40 – 502

Medical Readiness

This new Department of the Army regulation, dated 27 June 2019—

o Authorizes commander deployment status decisions for specific Medical Readiness Classification and deployment- limiting codes (table 2 – 1 ).

o Incorporates Army Directive 2018 – 11, Update to Redesign of Personnel Readiness and Medical Deployability, dated 10 September 2018 (para 2 – 4 ).

o Incorporates Army Directive 2019 – 07, Army Dental Readiness and Deployability, dated 25 February 2019 (para 2– 4 c ).

o Updates individual medical readiness classification (para 2–4 c ).

o Describes that temporary profiles no longer have assigned physical capacity or stamina, upper extremities, lower extremities, hearing and ears, eyes, psychiatric designation (para 3 – 3 ).

o Redesigns and prescribes the DA Form 3349 (Physical Profile Record) as a single source incorporating all duty limiting conditions and current functional limitations for providers, commanders, and trained staff (paras 3 – 1 and 3– 3 a ).

o Unit commanders will review profiles on Soldiers under their command and make a determination for deployability for all duty limiting conditions not identified by policy (paras 3–6 a and 3–6 e ).

o Requires a physician review and second signature for all permanent profile with a serial of “2” (para 3–6 b (3)).

o Implements DODI 6025.19 and DODI 6490.07; the Assistant Secretary of Defense for Health Affairs memorandum, Subject: Individual Medical Readiness Measure Goal, dated July 15, 2015; and supplements the information provided in AR 220 – 1 (throughout).

o Implements the Commander Portal and clarifies required actions to support Soldier health and welfare, duty assignment, and medical readiness reporting (throughout).

o Incorporates Army Directive 2016 – 07, Redesign of Personnel Readiness and Medical Deployability, dated 1 March 2016 (throughout).

Contents—Continued

• ii AR 40–502 •^27 June
• Responsibilities, page Section II
• Deputy Chief of Staff, G – 1 • 1 – 9, page
• Deputy Chief of Staff, G – 3/5/7 • 1 – 10, page
• The Surgeon General • 1 – 11, page
• Regional health commanders • 1 – 12, page
• Commanders, Army commands, Army service component commands, and direct reporting units • 1 – 13, page
  • Guard • 1 – 14, page Military treatment facilities, the U.S. Army Reserve command surgeon, the Chief Surgeon of the Army National
• Military treatment facilities commanders • 1 – 15, page
• Brigade commanders or equivalent • 1 – 16, page
• Battalion commanders or equivalent • 1 – 17, page
• Unit commanders • 1 – 18, page
• Soldiers and other deployable personnel • 1 – 19, page
• Chapter
• Individual Medical Readiness Key Elements, Standards, Categories, and Goals, page
• Impacts • 2 – 1, page
• Medical readiness appointments and documentation • 2 – 2, page
• Individual medical readiness key elements • 2 – 3, page
• Individual medical readiness classification • 2 – 4, page
• Disposition of individual medical readiness data • 2 – 5, page
• Unit medical readiness standard • 2 – 6, page
• Chapter
• Physical Profiling, page
• General • 3 – 1, page
• Application • 3 – 2, page
• Profiling overview • 3 – 3, page
• Physical profile serial system • 3 – 4, page
• Representative profile serials and codes • 3 – 5, page
• Profiling officer, approving authority, and commander • 3 – 6, page
• Profiling Soldiers who are pregnant • 3 – 7, page
• Postpartum profiles • 3 – 8, page
• Concussion profiles • 3 – 9, page
• Stinging insect allergy • 3 – 10, page
• Cancer in remission • 3 – 11, page
• Responsibility for personnel actions • 3 – 12, page
• Physical profile and the Army Body Composition Program • 3 – 13, page
• Chapter
• Medical Readiness Examinations, Assessments, and Administrative Requirements, page
• General • 4 – 1, page
• Application • 4 – 2, page
• Responsibilities • 4 – 3, page
• Additional evaluations • 4 – 4, page
• Distribution of medical reports • 4 – 5, page
• Documentary medical evidence • 4 – 6, page
• Facilities and examiners • 4 – 7, page
• Objectives of medical examinations • 4 – 8, page
• Recording of medical examinations and required forms • 4 – 9, page
• Physical examinations • 4 – 10, page
• Periodic health assessment • 4 – 11, page
• Separation history and physical examination • 4 – 12, page
• Miscellaneous medical examinations • 4 – 13, page
• Cardiovascular Screening Program • 4 – 14, page

Contents—Continued

AR 40–502 • 27 June (^2019) iii

Military operational hearing test for H3 profile Soldiers • 4 – 15, page 22 Frequency of additional/alternate examinations • 4 – 16, page 22 Deferment of examinations • 4 – 17, page 22

Chapter 5 Deployment and Geographical Area Requirements, page 22 General • 5 – 1, page 22 Deployment, mobilization, and assignment-specific medical requirements • 5 – 2, page 23 Special circumstances • 5 – 3, page 24

Appendixes

A. References, page 25

B. Internal Control Evaluation Checklist, page 31

Table List

Table 2 – 1: Medical readiness classification chart, page 9 Table 2 – 2: Deployment-limiting codes, page 9

Glossary

Chapter 1

General Provisions

Section I

Overview

1 – 1. Purpose This regulation governs individual medical readiness (IMR) requirements and standards; medical readiness processes and policies supporting commander deployability determinations; physical profiles; and medical examinations, periodic health assessments (PHAs), and the Deployment Health Assessment Program (DHAP). In the event provisions or guidance in this regulation conflict with those in AR 40 – 501, this regulation takes precedence. These conflicts will be addressed in the next revision of AR 40 – 501.

1 – 2. References and forms See appendix A.

1 – 3. Explanation of abbreviations and terms See the glossary.

1 – 4. Responsibilities See section II of this chapter.

1 – 5. Records management (recordkeeping) requirements The records management requirement for all record numbers, associated forms, and reports required by this regulation are addressed in the Army Records Retention Schedule-Army (RRS – A). Detailed information for all related record numbers, forms, and reports are located in ARIMS/RRS – A at https://www.arims.army.mil. If any record numbers, forms, and reports are not current, addressed, and/or published correctly in ARIMS/RRS – A, see DA Pam 25 – 403 for guidance.

1 – 6. Medical readiness classification a. Medical readiness classification (MRC) is an administrative determination by healthcare providers using a standard- ized system across the total force. This system enables the commander to measure, achieve, and sustain their Soldiers’ health and ability to perform their wartime requirement in accordance with their military occupational specialty (MOS)/area of concentration (AOC) from induction to separation. Medical readiness is described in chapter 2. b. Commanders administratively use the medical readiness information to determine if a Soldier is deployable and able to perform the unit’s core designed mission or assigned mission in accordance with readiness reporting guidance in AR 220 – 1 and DA Pam 220 – 1. Soldiers are automatically medically deployable in the Medical Readiness System of Record if they are in MRC 1 or 2. This status is automatically uploaded to the readiness reporting system without additional commander action. Commanders can make deployability determinations for readiness reporting on Soldiers who are in MRC 3, with deployment-limiting (DL) 1 and 2, as well as for Soldiers in MRC 4. DL codes 3 to 7 are constrained by policy from deployment, and cannot be overridden by commanders. c. Upon receipt of an assigned mission, the servicing health care providers will evaluate the Soldiers to determine if they meet the combatant command (CCMD) deployment requirements or require a waiver. CCMDs establish their deploy- ment status guidance and processes. CCMD waivers do not influence a Soldier’s medical readiness. Permanent and tem- porary conditions with DL codes 1, 2, and 7 may be evaluated for CCMD waiver requests. Conditions that do not meet CCMD deployment criteria, but otherwise do not require a profile (for example, excessive body mass index) will receive a temporary profile until the CCMD waiver is complete. (1) In making deployability determinations, unit commanders should consider the Soldier’s skills, responsibilities, du- ties, type of mission, and geographic conditions/concerns. Additionally, commanders should ensure close collaboration with unit supporting or military treatment facilities (MTFs) healthcare providers in making their deployability determina- tion. (2) The Commander Portal records deployable personnel determinations for Soldiers with duty limitations and an in- determinate status. The Medical Readiness System of Record feeds the deployability determinations to the Army Readiness

Reporting System. The electronic profiling system annotates on the profile when the commander reviews the Soldier’s profile. (3) Unit commander’s deployable personnel determinations for their Soldiers in MRC 3, DL 1, and DL 2 are independ- ent of the assessment and requirements for deployment medical waivers in accordance with CCMD specific guidance. d. Specific medical readiness criteria are addressed in detail in chapters 2 through 5.

1 – 7. Command application of medical readiness Commanders will make deployability determinations for all Soldiers authorized by policy for their MRC/DL. In making deployability determinations for readiness reporting, unit commanders should consider the classification categories in par- agraph 2 – 4 and collaborate with a healthcare provider for any questions. Unit commanders will not override duty limita- tions or instructions on DA Form 3349 (Physical Profile Record). Healthcare providers do not make or engage directly in deployability determinations for readiness reporting. Profiling officers describe and indicate potentially DL conditions for commander review and consideration in their deployment determination. Readiness is a commanders program. Paragraph 3 – 4 describes the procedure if there is disagreement between the healthcare provider and commander regarding initiating the CCMD waiver process. Commanders will make a deployable or non-deployable determination within the Commander Portal. Readiness reporting criteria and policy are in AR 220 – 1. DA Pam 220 – 1 describes the processes and procedures of readiness reporting including the personnel deployability determinations made with medical readiness and administra- tive personnel data.

1 – 8. Access management and privacy protection DODM 6025.18 authorizes covered entities to release protected health information of Armed Forces personnel for activ- ities deemed necessary and appropriate to military command authorities to assure proper execution of the military mission. This means that the commander or his or her designee may see the reason for profile and the provider may discuss the minimal necessary medical information for the commander to make deployment or other pertinent personnel decisions as part of the military mission. The protected health information “in the reason for profile” will be obscured from other staff with read only access to the Commander Portal to protect patient privacy. Profiling officers will not copy their note from the medical record into the profile for medical instructions; this does not meet the minimum necessary standard.

Section II

Responsibilities

1 – 9. Deputy Chief of Staff, G – 1 The DCS, G – 1 will — a. Recommend medical readiness and personnel policy integration and operational tasks to The Surgeon General (TSG). b. Coordinate medical readiness and personnel policy with appropriate personnel programs and systems. c. Facilitate commander’s management, monitoring, and participation in personnel readiness. Support the implementa- tion of the medical readiness tools and guidance provided by the Office of The Surgeon General (OTSG) to optimally support personnel readiness. d. Implement standardized DHAP processes across the Army for deploying and redeployed Soldiers and Department of the Army Civilians (DACs) to address potential deployment-related physical and behavioral health concerns.

1 – 10. Deputy Chief of Staff, G – 3/5/ The DCS, G – 3/5/7 will — a. Monitor and ensure the integration of medical readiness policy with current operational readiness reporting policy. b. Facilitate commander’s engagement, monitoring, and participation in IMR programs to maximize Soldier and sub- sequently unit medical readiness. c. Recommend medical readiness policy integration and operational tasks to policy proponent. d. Coordinate operational programs and systems with medical readiness policy, processes, and procedures as described in DA Pam 40 – 502. e. Ensure collaboration between appropriate organizations and activities integral to Army readiness reporting.

1 – 11. The Surgeon General TSG will—

g. Provide clinical readiness, Medical Readiness Systems Of Record, and electronic health record (EHR) training and assistance, as needed. h. Provide proponent oversight of the DHAP within the RHC service area. i. Provide medical readiness support for Reserve Component (RC), Army National Guard (ARNG), and U.S. Army Reserve (USAR) on active duty orders with line of duty (LOD), DHAP support and continuity when transitioning status. j. Conduct staff assistance visits and staff inspection visits at MTFs to ensure standardized DHAP processes and pro- cedures occur in accordance with established guidance. Ensure local DHAP policies and procedures are in place to track individuals with priority self-assessment questionnaires. k. Ensure MTFs have appropriate processes for DHAP related emergent behavioral health referrals and DHAP gener- ated behavioral health referrals through completion of initial appointment. l. Monitor and ensure access to care standards is met for DHAP generated referrals. m. Coordinate with Joint Service MTFs within their regions to ensure Army personnel are able to obtain DHAP screen- ing in the system of record.

1 – 13. Commanders, Army commands, Army service component commands, and direct reporting units The ACOM, ASCC, and DRU commanders will— a. Organize, train, and equip forces and installations to meet and maintain IMR requirements. b. Establish a command expectation that unit commanders and individuals will meet and maintain IMR requirements. Readiness is a commander’s program. c. Establish a forum, or integrate into an existing forum with medical, human resources, and personnel leaders with installation leadership to regularly evaluate the IMR status of Soldiers on the installation. This forum must meet monthly at a minimum. d. Direct the unit command teams or designated representatives to use the Commander Portal to track their unit mem- bers’ profile status, IMR compliance, and requirements. e. Ensure appropriate action is taken regarding units and members with IMR deficiencies. f. Appoint dedicated medical MEDPROS unit administrators and commander clerks at ACOM, ASCC, and DRU head- quarters to track Soldier and unit medical readiness. g. Appoint appropriate approval authorities to grant access to the Commander Portal and ensure users have the required training, correct role designation and unit identification code structure. h. Ensure processes are in place to review the IMR status of every Soldier using the automated Medical Readiness System of Record during in and out-processing through the installation MTF or COMPO specific processes.

1 – 14. Military treatment facilities, the U.S. Army Reserve command surgeon, the Chief Surgeon of the Army National Guard The MTF commanders, the USAR command surgeon, and the chief surgeon of the ARNG are responsible to set policy to— a. Ensure use of the Commander Portal to perform a monthly review of all temporary profiles 240 days or older at the command level. b. Appoint dedicated MEDPROS unit administrators and commander clerks at senior command headquarters to track Soldier and unit medical readiness. c. Maintain adequate capabilities and access to care in order to support Soldier compliance with IMR requirements. Where applicable, commanders will ensure Tri-Service Medical Care (TRICARE) access standards are met in their organ- ization. d. Notify installation commander, senior commander (to include Commanding General, U.S. Army Recruiting Com- mand, The Adjutants General, if applicable), command surgeon, or medical operational leadership immediately when ca- pabilities are not sufficient to keep Soldiers medically ready due to lack of services or access. e. Plan, program, and submit budget requests for funds and procure supplies and equipment to accomplish IMR program requirements. f. Ensure processes are in place to review the IMR status of every Soldier using the automated Medical Readiness System of Record during in and out-processing through the installation MTF or COMPO specific processes. g. Ensure that all IMR-related services for RA and RC members are documented in the Medical Readiness System of Record and the EHR or service treatment record (STR). h. Ensure installation, maintenance, and proper use of programs related to accessing the Medical Readiness System of Record with trained administrators and users.

i. Provide the necessary information technology support to ensure the installation and operation of the Medical Readi- ness System of Record and EHR are functional and meet all security and privacy requirements. j. Be responsible for delegating approval authority for the various medical readiness applications in Medical Opera- tional Data System and maintain oversight and control of user management. k. Establish regional support command (RSC) surgeons and state surgeons responsibility to— (1) Serve as approval authorities by their position for second signature profiles. (2) Support the major subordinate command commanders within their area of operations with medical readiness defi- ciencies and training. (3) Support the Soldier readiness processing requirements. (4) Collaborate with profiling authorities regarding adjudicating the Military Occupational Specialty Administrative Retention Review (MAR2) processes.

1 – 15. Military treatment facilities commanders The MTF commanders will, in addition to the responsibilities in paragraph 1 – 14 — a. Use the healthcare team to optimize the implementation of the medical readiness requirements by making every visit a readiness visit. b. Ensure the Army healthcare team, in preparation for every visit, will use the Healthcare Portal to validate the IMR status of every Soldier, use the Medical Readiness Assessment Tool to identify Soldiers at risk for becoming non-deploy- able, and review e-Profile for Soldiers active profiles. c. Ensure that the healthcare team addresses any due or overdue medical readiness requirements at the time of the visit or before the Soldier leaves the medical facility. Any deficiencies will be corrected, identified for the healthcare provider, or appointed for appropriate service. Readiness requirements will not delay or impede urgent or emergent care. d. Implement the policies prescribed in this regulation with the processes and procedures described in DA Pam 40 – 502 in the care of all RA and TRICARE Prime Remote Soldiers within their specific health service area and geographic area of responsibility boundaries worldwide. e. Ensure there is a DHAP coordinator appointed in writing, provide the resources, training, and allocated time to assist with tracking deployment readiness. f. Ensure DHAP staff have training on and access to Soldier electronic system of record prescribed in DA Pam 40 – 502. g. Ensure health care providers check Soldiers’ profile status (all COMPOs) in the readiness system of record during each DHAP screening (pre-, post-, and DD Form 2900 (Post Deployment Health Re-assessment (PDHRA))) and make changes/updates, as appropriate. h. Ensure DHAP information is treated confidentially and in accordance with HIPAA and the DODM 6025.18. i. Assist deploying personnel with completion of deployment readiness requirements. To support command readiness programs, the MTF personnel will collaborate with the unit healthcare providers on readiness issues and the DHAP process. j. Ensure review of Soldiers’ priority self-assessment questionnaires and coordinate appointments. k. Ensure collaboration between providers, unit commanders, and CCMD waiver authorities to address specific deploy- ment status issues for Soldiers with an assigned mission.

1 – 16. Brigade commanders or equivalent The brigade commanders or equivalent will— a. Review the unit medical readiness and deployment status of subordinate units. b. Participate in profile review boards as outlined in DA Pam 40 – 502. c. Establish a unit health promotion team as the mechanism to assess gaps in medical readiness and report strategies and actions to the installation Community Health Promotion Council. d. Appoint dedicated MEDPROS unit administrators and commander clerks at brigade headquarters to track Soldier and unit medical readiness. e. Use the Commander Portal to perform a monthly review of temporary profiles lasting 180 days or more as described in DA Pam 40 – 502.

1 – 17. Battalion commanders or equivalent The battalion commanders or equivalent will— a. Review the unit medical readiness and deployment status of subordinate units. b. Mentor unit commanders regarding deployability determinations and command support of medical readiness. c. Participate in profile review boards as outlined in DA Pam 40 – 502.

match, and the deployable senior grade composite level. IMR influences both deployable strength and senior grade com- posite metrics.

2 – 2. Medical readiness appointments and documentation a. RHC commanders will ensure MTFs provide the necessary medical care to Soldiers for IMR currency and documen- tation within the Medical Readiness System of Record. MTFs and supporting medical assets will assist unit commanders to maximize the number of personnel classified as “medically ready” and “fully medically ready” when unit medical assets are not available to supply necessary services. (1) The MTFs providing medical care to Soldiers during basic combat training will update or initiate the IMR status during initial in-processing. The MTFs will update the Soldier’s IMR in MEDPROS within 72 hours from the time of service. (2) The MTFs will not refuse IMR-related appointments for RA Soldiers enrolled in TRICARE Prime Remote. (3) RA Soldiers on active duty status enrolled in TRICARE Prime Remote may utilize the Reserve Health Readiness Program. (4) Commanders will ensure that Soldiers’ IMR requirements are complete as a condition of their selection and attend- ance for Army resident courses. (5) Soldiers in and out-processing through an MTF should be medically ready and current on all IMR elements, prior to clearing the MTF. (6) The fitness for duty examination procedures are described in DA Pam 40 – 502 and will span from profile reviews with command input to formal clinical evaluations to determine if a Soldier meets retention standards. b. All RC Soldiers will provide their unit records custodian, patient administration officer, unit administrator, and/or commander all relevant medical documentation, including civilian and VA health records, regarding their medical readi- ness status. Medical records personnel, designated by component, are responsible to scan any civilian health records or other documentary evidence into the Soldier's EHR and file any paper documents into the STR. Commanders are respon- sible to ensure the personnel systems properly reflect a Soldier's readiness and medical status and take appropriate follow- up action to assist the Soldier to correct any deficiencies. c. The CUSR is a commander’s report. Unit commanders are solely responsible for the accuracy of the information and data in their reports. Unit commanders are responsible for monitoring their Soldiers’ IMR status and ensuring compliance within the Commander Portal. Unit medical assets, when available, are primarily responsible for supporting medical read- iness.

2 – 3. Individual medical readiness key elements The DOD mandates six IMR elements which include: PHA, deployment-limiting conditions, dental readiness, immuniza- tion status, medical readiness laboratory tests, and individual medical equipment. The Army IMR program consists of the six DOD and two additional Army-specific requirements: hearing and vision readiness. To be medically ready, all Soldiers must maintain these eight IMR elements. With regards to the deployment-limiting conditions IMR element, Soldiers must meet AR 40 – 501 retention standards or have completed a boarding action that returned them to duty without a deployment- limiting physical category code. DA Pam 40 – 502 describes the medical administrative processing after completion of a medical or administrative board. Soldiers who do not meet medical retention standards are not medically ready. They should be referred for disability evaluation system processing in accordance with the eligibility provisions of AR 635 – 40, and by DOD disability evaluation system policy (see DODI 1332.18).

2 – 4. Individual medical readiness classification After evaluating the required IMR elements by viewing e-Profile, the Medical Readiness System of Record and the EHR information, the healthcare team will categorize the Soldier into one of four medical readiness categories listed below and depicted in table 2 – 1. a. MRC 1: Soldiers in MRC 1 are fully medically ready and deployable if they fulfill the following categories: (1) Soldier meets all medical readiness requirements. (2) Soldier is in Dental Class 1 or Dental Class 2 in accordance with AR 40 – 35. (3) Soldier may have a transient illness or minor injury with a profile 7 days or less in duration (for example, upper respiratory infection). (4) Permanent duty limiting condition(s) with a 3 or 4 in the physical, upper, lower, hearing, eyes, psychiatric (PULHES) (PULHES is a United States military acronym used in the Military Physical Profile Serial System) series with a completed board and an assigned physical category code of “S, W, or Y”, if no F, V, or X code (see DA Pam 40 – 502 for physical category codes). Use of certain medications and medical conditions, as established by DOD or CCMD guidance,

will require a CCMD waiver for deployment. Upon receipt of an assigned mission, the servicing healthcare providers will evaluate the Soldier to determine the need for CCMD waivers. Each CCMD establishes the specific deployment status guidance and waiver processes for their area of responsibility. Medical readiness, commander deployability determina- tions, and CCMD waiver requirements are independent of each other. b. MRC 2: Soldiers in MRC 2 are partially medically ready and deployable. Soldier has one or more of the following deficiencies: (1) Hearing Readiness Class 4 (considered overdue with The Defense Occupational and Environmental Health Readi- ness System – Hearing Conservation hearing test greater than 365 days and all RC table of distribution and allowances Soldiers without an audiogram on file). (2) Vision Readiness Class 4 (considered overdue at 15 months). (3) Deoxyribonucleic acid (DNA) not on file with the Armed Forces Repository of Specimen Samples for the Identifi- cation of Remains. (4) Human immunodeficiency virus (HIV) not drawn/validated with Armed Forces Repository of Specimen Samples for the Identification of Remains (within 24 months) without a previous diagnosis of HIV. (5) Routine adult immunization profile immunizations to include hepatitis A; hepatitis B; tetanus-diphtheria or tetanus- diphtheria and acellular pertussis; measles, mumps, and rubella; poliovirus; varicella; influenza (seasonal); and if required, rabies (for personnel as required in accordance with AR 40 – 562). (6) A Soldier who requires, but does not possess individual medical equipment (1 mask insert (1MI), 2 pairs of eye- glasses, military combat eye protection inserts (MCEP – I), medical warning tags, and hearing aid with batteries). (7) A temporary profile 8 to 30 days in duration. Soldiers are deployable with these profiles, however, commanders have the discretion to make a commander’s determination that these Soldiers are non-deployable in the Commander Portal. c. MRC 3: Soldiers in MRC 3 are not medically ready and will default to non-deployable. Soldiers in MRC 3 will be described by one or more of seven DL codes described below and in table 2 – 1 : (1) DL 1 – Temporary profiles greater than 30 days. Soldier is not medically ready and defaults to non-deployable. The commander can make a commander’s determination that these Soldiers are deployable and change the deployability status for all temporary profile(s) greater than 30 days in duration (total time to include extensions) in the Commander Portal. Soldier deployability remains DL 1 as long as there is an active temporary condition identified. Application of CCMD guidance will determine if a CCMD waiver is required for these conditions upon receipt of the assigned mission. (2) DL 2 – Dental Readiness Class 3 conditions. Soldier is not medically ready and defaults to deployable. The com- mander has the discretion to make a commander’s determination that these Soldiers are non-deployable in the Commander Portal. The Soldier remains DL 2 as long as they have a Dental Readiness Class (DRC) 3 e-Profile. Dentists will use e- Profile to describe these conditions to the commander and guide the deployability determination. These conditions must be corrected before a Soldier deploys. (3) DL 3 – Soldier is pregnant or post-partum. Soldier is not medically ready and is non-deployable. The commander cannot deem Soldier deployable until authorized by policy. (4) DL 4 – MAR2. Soldier is not medically ready and is non-deployable. Soldier cannot be deemed deployable by the commander. This includes Soldiers with a permanent profile with a 3 or 4 in the PULHES without a completed MAR board. Soldiers who meet retention standards are eligible for MAR2 process. Soldier will remain DL 4 from when the condition is identified up to when MAR2 process is complete. (5) DL 5 – Soldier is not medically ready and is non-deployable. Soldier cannot be deemed deployable by the com- mander. Soldiers with a permanent profile with a 3 or 4 in the PULHES, who do not meet retention standards without a completed medical evaluation board (MEB)/physical evaluation board (PEB). Soldiers who do not meet retention stand- ards must be referred for Disability Evaluation System (DES) processing. MEB/PEB is appropriate for LOD conditions. Soldiers remain DL 5 from when the condition is identified until they are separated or have completed the MEB/PEB process. (6) DL 6 – Soldier is not medically ready and is non-deployable. Permanent profile with a 3 or 4 in the PULHES without a completed non-duty PEB. Soldiers who do not meet retention standards due to a non-duty related condition can request a PEB. The Soldier will be DL 6 from when the condition is identified until they are separated or have completed the non-duty PEB process. (7) DL 7 – Soldier is not medically ready and is non-deployable. Any profile with a physical category code of V, F, X, or Y. Soldiers in this category may be eligible for a CCMD waiver in accordance with the applicable published CCMD policy. d. MRC 4: Soldiers in MRC 4 are not medically ready. (1) Commanders determine deployment status (default is deployable). (2) Status is unknown. Soldier is deficient in one of the following: (a) PHA (current if administered within past 15 months).

Table 2 – 2 Deployment-limiting codes — Continued Code Description DL 2 DRC 3 DL 3 Pregnancy and postpartum DL 4 Permanent profile indicating MAR2 needed (W) DL 5 Permanent profile indicating MEB needed DL 6 Permanent profile indicating non-duty related action is needed DL 7 Permanent profiles with a deployment/assignment restriction code (F, V, X, or Y)

2 – 5. Disposition of individual medical readiness data a. MEDPROS is the medical system of record for all medical readiness data elements. b. All Army personnel (all COMPOs), regardless of TRICARE enrollment, and deploying DACs maintain up to date IMR data. MEDPROS does not automatically receive DACs Defense Occupational Environmental Health Readiness Ap- plication – Hearing Conservation data and must be manually entered upon selection for deployment. c. IMR services completed in the electronic health record must be updated in the Medical Readiness System of Record within 72 hours of completion.

2 – 6. Unit medical readiness standard Refer to DODI 6025.19 for DOD current goal and category requirements. The Army’s unit medical readiness standard is 90 percent or above in medical readiness categories 1 and 2.

Chapter 3

Physical Profiling

3 – 1. General This chapter prescribes a system, which is further described in DA Pam 40 – 502, for classifying individuals according to functional abilities; documents key aspects of medical readiness; and outlines the administrative management of Soldiers with duty limiting conditions. Healthcare providers will evaluate every Soldier at every medical encounter to identify and appropriately profile potential duty limitations in e-Profile on DA Form 3349. The DA Form 3349 is primarily a commu- nication tool between the profiling officer, the Soldier, and the commander to address duty limitations. The Soldier’s profiling officer, the Soldier, and the commander collaborate to identify duty limiting conditions, describe functional lim- itations, capabilities, physical training requirements and assign appropriate duties. Physical profiles serve to protect and maintain the Soldier’s health by minimizing risk of further injury and illness. In all cases, command teams are teammates in Soldier readiness and utilization. They will make assignments to employ the Soldier and achieve the mission within the limitations described in the profile. The profiling officer will identify all duty limiting conditions in e-Profile, place an emphasis on what the Soldier can do during the profiled period and document restrictions completely but with minimum necessary restrictions. The profiling officer will determine if a Soldier is available to take a regular or modified Army Physical Fitness Test (APFT) with either a temporary or permanent profile. The commander will review all physical pro- files for all Soldiers in their command through the Commander Portal. Healthcare providers will review the Soldier’s profile for all existing conditions in the system of record, during patient encounters. This will establish and maintain clear communication between the healthcare provider, Soldier, and commander. AR 40 – 501 is the Army regulation describing the medical standards of fitness that the profiling officer will utilize and cite when they issue profiles for duty limiting conditions.

3 – 2. Application The physical profile system is applicable to members of any component of the Army throughout their military Service, whether or not the Soldier is on active duty.

3 – 3. Profiling overview a. DA Pam 40 – 502 describes the preparation of the DA Form 3349. The electronic profiling system of record is e- Profile. Profiling officers will complete an e-Profile for all temporary profiles greater than 7 days, and all permanent

profiles and can complete temporary profiles for illness and injuries for less than 7 days. Healthcare providers may use DD Form 689 (Individual Sick Slip), unless restricted by other policy, for short-term, minimally limiting injuries and illnesses, less than or equal to 7 days in duration. During medical encounters, healthcare providers will evaluate every Soldier for potential duty limitations or arrange for such evaluations to be completed. b. In certain mission conditions, e-Profile may be unavailable. If the e-Profile is unavailable the profiling officer will issue a DD Form 689 and describe the duty limiting medical condition/s (less than or equal to 7 days) to the commander. There is no longer a paper option alternative to e-Profile. Printed copies are only for the Soldier’s personal record. The creation and generation of a DA Form 3349 is required in e-Profile. The commander is required to review Soldiers profiles in the Commander Portal. c. The DA Form 3349 contains all of a Soldier’s current duty limiting conditions with built-in communication links between the profiling officer and commander. This form lists all permanent and temporary conditions in a single document. Only permanent conditions modify the PULHES. Profiling officers will evaluate all Soldiers with duty limiting conditions for Section 4: Functional Activities. Any permanent limitation in the functional activities section will either require a disability evaluation referral or initiate the RC medical disqualification process according to their duty status (see AR 635 – 40). Soldiers with permanent duty limitations that meet retention standards and prevent them from performing all physical tasks for their MOS/skill level per Smartbook DA Pam 611 – 21 (https://www.milsuite.mil/book/groups/smartbookdapam611-21), but that do not impair their abilities to any functional activities (DA Form 3349, section 4), will be referred to the MAR2 in accordance with AR 635 – 40 and DA Pam 611 – 21. The signature of the approval authority will provide an initiation date of the appropriate medical or administrative board or review. (1) To improve standardization across the enterprise, OTSG will be the responsible agent for profile templates for common medical instructions and physical readiness training capabilities. (2) Profiles will be maintained as long as the Soldier has duty limitations or a medical condition that needs to be com- municated to the commander, or is directed by AR 40 – 501. Profiling officers will document these limitations by condition. Each condition will have only one set of instructions active at any given time. The profile officer associated with each condition will support the provider issuing a profile for a specific condition and will support the commander and com- mander communication. (3) MTF commanders, the USAR command surgeon, the chief surgeon of the ARNG, and state surgeons will possess approval authority, and may delegate it to other physicians within their commands. The USAR RSC surgeons will be approval authorities by the nature of their position. (4) There is no mandatory recovery period after a profile prior to a record APFT. The profiling officer in coordination with the provider will determine if a Soldier is available for an APFT for each condition, with the latest date to take the APFT identified on the profile. When a Soldier is not available for a record APFT, the profiling officer will extend the profile through the recovery period. This is a description of the Soldier’s capabilities to take a full or alternate event APFT and not proscriptive. d. The unit commander will review all profiles of Soldiers in their command. After reviewing a profile the unit com- mander— (1) Addresses any questions or concerns, including when their observations of the Soldier’s performance is inconsistent with the profile, with the profiling officer. (2) If necessary, has the authority to request a fitness for duty evaluation to include a profile review and second opinion from another profiling officer. Input from the original profiling officer will ensure a comprehensive review and informed opinion. The applicable profile delegation authority will implement a consistent process to ensure timely completion of all requested command reviews, minimizing the impact on readiness. If the original profile deemed the Soldier non-deploya- ble, then the Soldier will remain non-deployable until the fitness for duty evaluation or profile review is completed. (3) Makes deployability determinations in the Commander Portal for MRC 4, MRC 3, DL 1 and 2, and when not constrained by policy. (4) Should extend reasonable consideration to profile restrictions even after expiration if the environment or mission has prevented prompt follow up. (5) Should exercise due diligence in requiring Soldiers to take and APFT following any temporary conditions that have affected the Soldier’s ability to maintain optimal physical fitness and formulate their APFT policy according to command and leadership policy. e. A profiling officer writes a temporary profile to describe temporary duty limitations or a medical condition that needs to be communicated to the commander, or is required per AR 40 – 501. Profiling officers will describe duty limitations, capabilities, and physical readiness training guidance for each reason for profile affecting the Soldier. Each temporary reason for profile must be written for the full duration of the limitations, up to 90 days. Extensions must be linked to the previous profile to maintain an accurate description of the total length of time the Soldier has had a profile for that reason.

(1) The DD Form 689 is not a substitute for a profile but a means of communication, management, and disposition of short-term acute, minor, self-limited illnesses and medical conditions that are expected to resolve quickly and do not limit the functional capabilities of the Soldier beyond 7 days. Temporary profiles of less than 7 days duration will convey more information for short-term conditions. (2) DD Form 689s are not a profiling tool, and will not change the Soldier’s PULHES. (3) The disposition section of DD Form 689 describes various short-term scenarios as described in the prescribing policy, AR 40 – 66. (4) The initial military training sick slip has transitioned to a series of templates in e-profile. The initial military training sick slips are no longer valid. (5) Conditions with functional limitations expected to last more than 7 days will be entered into the e-Profile as a temporary profile for IMR accountability and tracking.

3 – 4. Physical profile serial system a. The basis for the physical profile serial system is to identify the function of body systems and their relation to military duties. The functions of the various organs, systems, and integral parts of the body are all considered. Since the analysis of the individual's medical, physical, and mental status plays an important role in assignments and welfare of other Soldiers, not only must the functional grading be executed with great care, but clear and accurate descriptions of medical, physical, and mental deviations from normal are essential. b. In developing the physical profile serial system, body systems or regions were been divided into six factors desig- nated as PULHES: physical/systemic; upper extremity and spine; lower extremity and spine; hearing; eyes; and psycho- logical. For each factor, a numerical designation (serial) of 1, 2, 3, or 4 indicates the overall functional capacity for that system or region. The functional capacity of a particular system or region of the body, rather than the defect per se, will determine the appropriate serial. DA Pam 40 – 502 describes the use of the physical profile serial system. c. Soldiers who are medically ready may have health conditions that do not meet the specific CCMD deployment guid- ance. If the healthcare provider and commander concur that the Soldier is able to deploy, the CCMD policy will describe the initiation of the CCMD waiver process. When medical healthcare providers and unit commanders disagree on the deployment status of a Soldier, the decision to request a CCMD waiver will be raised to the first O – 6 in the Soldier’s chain of command (or higher approving authority) and the hospital commander. Both the first O – 6 and hospital commander will review both medical and unit commander recommendations to make the final decision whether to seek a CCMD waiver to deploy the Soldier. CCMD deployment guidance is developed to protect both the Soldier’s health and wellbeing and the mission. Guidance is continually updated and is based on consideration of DODIs. The commander will ensure implemen- tation with these individual medical requirements in accordance with all applicable DODIs, to include DODI 6490.07. To the extent that the information within this chapter is inconsistent with later published DOD guidance, DOD guidance will be followed.

3 – 5. Representative profile serials and codes To facilitate the assignment of individuals after they have been given a physical permanent profile serial and for statistical purposes, code designations have been adopted to represent certain combinations of physical limitations or assignment guidance as described in DA Pam 40 – 502. The alphabetical coding system will be utilized and the appropriate code(s) will be recorded on the DA Form 3349. The profile form will be completed as described in DA Pam 40 – 502. The numerical designations serials for each profile factor and the code system are presented DA Pam 40 –^ 502.

3 – 6. Profiling officer, approving authority, and commander a. Profiling officers. MTF commanders, ARNG chief and state surgeons, and the USAR command surgeon and RSC surgeons may designate physicians, dentists, physical therapists, optometrists, podiatrists, audiologists, chiropractors, nurse practitioners, nurse midwives, licensed clinical psychologists, licensed clinical social workers, and physician assis- tants as profiling officers. Under no circumstances will a special forces medic or independent duty corpsman serve as a profiling officer. The designating authority will ensure that those designated are thoroughly familiar with the contents of this regulation, AR 40 – 501, and DA Pam 40 – 502. The profile will identify the profiling officer and associated duty limi- tations and any indicated medical or administrative boards. Permanent profiles will be maintained as long as the Soldier has duty limitations and medical conditions not meeting retention standards necessitating provider communication with the commander. The profiling officer will link and extend temporary profiles as long as there are duty limitations. Profiling officers will not write temporary or permanent profiles for themselves. Profiling officer limitations are as follows:

(1) Physicians. No limitations except for temporary profiles that exceed 6 months cumulative for each single condition and referral to a specialist is clinically indicated or required by policy (see para 3–3 e ). All permanent profiles require two signatures. (2) Dentists, optometrists, physical therapists, chiropractors, occupational therapists, audiologists, podiatrists, physi- cian assistants, nurse midwives, nurse practitioners, licensed clinical psychologists, and licensed clinical social work- ers. These healthcare providers have limitations awarding temporary and permanent profiles as described in DA Pam 40 – 502. (3) Athletic trainers. Athletic trainers in command specified settings will have limited profiling authority, under the supervision of their physician or physical therapist, to award short-term temporary profiles up to 7 days in duration. They may extend the profile an additional 7 days. A healthcare provider will complete any profiling beyond 14 days (total). Significant illnesses or injuries that are not expected to heal in this period should be referred to the appropriate specialty healthcare provider to prevent any delay in care. All profiling by athletic trainers will be constrained to specifically de- signed templates for the musculoskeletal system in e-profile. (4) Other Department of Defense physicians. In those instances where a Soldier does not have access to an Army MTF, with access to a DOD or other service’s medical facility (Navy, Air Force), the profiling officer may be from another Service for all temporary profiles of 6 months or less. (5) Regular Army and Reserve Component on active duty participating in TRICARE Prime Remote, Ready Reserve (troop program unit, Active Guard Reserve), individual mobilization augmentee, Individual Ready Reserve and Inactive National Guard and Army National Guard Soldiers. These Soldiers may have specific temporary or permanent profiles completed via the current agencies contracted to provide these medical services. Regardless of component, contracted healthcare providers will have established points of contact for the transition of responsibility and management of Soldier profiles. Many Soldiers in these categories receive their routine medical care from civilian healthcare providers. Medical recommendations from these healthcare providers will support and inform accurate, complete, and comprehensive profiles from DOD military, civilian, or contracted providers. b. Profile preparation. (1) The profile will list the profiling officer, reason for profile, and key descriptors on the same line of the form. (2) The profiling officer will write and/or extend with linking the profile as long as there are duty limitations. (3) Permanent “2” physical profiles will require physician review and second signature. This must not be the same person as the first signature. (4) Permanent “3” or “4” physical profiles require an approving authority signature, as defined below. (5) A single physical profile may cover multiple conditions. Profiling officers do not assume responsibility for other conditions written by other providers when they add a new reason for profile. c. Approving authority. MTF commanders, ARNG chief and state surgeons, and the USAR command surgeon, may authorize physicians as approving authority. USAR RSC surgeons are designated approval authorities by position. (1) The approving authority must be a physician. (2) The designating officer will ensure that the approval authorities are thoroughly familiar with the contents of this regulation, DODI 1332.18, AR 635 – 40, AR 40 – 501, and DA Pam 40 – 502. (3) The approval authority ensures that profiles are appropriate for entry into DES; the signature of the approval au- thority initiates the administrative review or boarding action. d. Chief clinical officer or deputy commander for medical services as appointed by the military treatment facility com- mander. Serves as the senior approving authority within the MTF. e. Unit commander. Reviews profiles on Soldiers under their command and make a deployability determination for all duty limiting conditions not limited by policy.

3 – 7. Profiling Soldiers who are pregnant a. Pregnancy profile guidance. The intent of pregnancy provisions is to protect the health of the Soldier and fetus while ensuring productive employment of the Soldier. Common sense, good judgment, and cooperation must prevail between policy, Soldier, and Soldier's commander to ensure a viable program. The pregnancy profile guidance includes mandating an occupational health interview to assess risks to the Soldier and fetus, additional duty restrictions to reduce exposure to solvents, lead, and fuels that may be associated with adverse pregnancy outcomes. Profiles for Soldiers who are pregnant will authorize the wear of non-permethrin treated duty uniforms. Post-partum profiles describe the convalescent leave and recovery process as the Soldier returns to full duty and authorize the continued wear of permethrin free uniforms during lactation. The process and procedure of pregnancy, permethrin, and post-partum profiling is described in DA Pam 40 – 502. The profiling system templates are necessary to create a temporary profile beyond 90 days. Soldiers who are trying to get pregnant may be issued permethrin free uniforms with medical approval authorizing the wear of the uniform as described in DA Pam 40 – 502.