**OCCUPATIONAL HEALTH SERVICES**

**1. REASON FOR ISSUE:** To issue revised Department of Veterans Affairs
(VA) procedures regarding medical evaluation and medical criteria
policies for motor vehicle operators and incidental operators.

**2. SUMMARY OF CONTENTS/MAJOR CHANGES:** This handbook contains
mandatory VA procedures on occupational health services. The pages in
this issuance replace the corresponding page numbers in VA Handbook
5019, Part IV. These changes will be incorporated into the electronic
version of VA Handbook 5019 that is maintained on the [Office of Human
Resources Management Web site](http://vaww.va.gov/ohrm). Significant
changes include:

a\. The establishment of medical conditions and criteria for the conduct
of medical evaluations for motor vehicle operators and incidental
operators in the Veterans Health Administration who transport patients,
and

[]{.mark}

b\. A revision to the requirement for the frequency of medical
evaluations for motor vehicle operators and incidental operators from 3
to 4-year intervals followed by a physical examination, if necessary, to
conform with provisions of 5 CFR Part 930 Subpart A -- Motor Vehicle
Operators, and to align the frequency of such inquiries of VA employees
who may be working at older ages with those established for volunteer
drivers as set forth in Veterans Health Administration Directive
2004-040, Clearance of Volunteers for Driving Assignments
(<http://vaww1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1130>).

**3. RESPONSIBLE OFFICE:** The Recruitment and Placement Policy Service
(059), Office of the Deputy Assistant Secretary for Human Resources
Management.

**4. RELATED DIRECTIVE:** VA Directive 5019, Occupational Health
Services.

**5. RESCISSIONS:** None.

**CERTIFIED BY: BY DIRECTION OF THE SECRETARY**

**OF VETERANS AFFAIRS:**

/s/Robert T. Howard /s/Paul J. Hutter

Assistant Secretary for Executive in Charge of the Office of

Information and Technology Human Resources and Administration

ELECTRONIC DISTRIBUTION ONLY

### OCCUPATIONAL HEALTH SERVICES

### 

### PART IV. HEALTH MAINTENANCE PROGRAMS, 

### EXAMINATIONS AND VACCINATIONS

### CONTENTS

#### PARAGRAPH PAGE

1\. [OCCUPATIONAL HEALTH MAINTENANCE PROGRAM](#PtIVpar1) IV-1

2\. [TUBERCULIN TESTING PROGRAM](#PtIVpar2) IV-1

3\. [OTHER EXAMINATIONS, TESTS AND VACCINATIONS](#PtIVpar3) IV-3

\[**APPENDICES**\]

IV-A. [EXAMINATIONS, TESTS AND VACCINATIONS](#AppIVA) IV-A-1

\[IV-B. [MEDICAL CONDITIONS AND CRITERIA COVERING MEDICAL
EVALUATIONS](#AppIVA)

[FOR MOTOR VEHICLE OPERATORS AND INCIDENTAL OPERATORS IN THE](#AppIVA)

[VETERANS HEALTH ADMINISTRATION WHO TRANSPORT PATIENTS](#AppIVA)
IV-B-1\]

+--------------------+---------------+---------------------------------+
| **Kinds of         | **For Whom**  | **Requirements**                |
| Examinations,      |               |                                 |
| Tests and          |               |                                 |
| Vaccinations**     |               |                                 |
+--------------------+---------------+---------------------------------+
|                    | Appointees    | As required by the Office of    |
|                    | and           | Personnel Management and VA     |
|                    |               | instructions to determine       |
|                    | other         | eligibility for appointment or  |
|                    | employees     | fitness for duty.               |
+--------------------+---------------+---------------------------------+
| \[\*Medical        | Motor Vehicle | \[Completion of Optional Form   |
| evaluation\]       | Operators and | 345 (OF 345), Physical Fitness  |
|                    | incidental    | Inquiry for Motor Vehicle       |
|                    | operators     | Operators,\] for operators and  |
|                    |               | incidental operators at         |
|                    |               | \[4\]-year intervals followed   |
|                    |               | by \[a medical\] evaluation, if |
|                    |               | necessary. \[For Motor Vehicle  |
|                    |               | Operators and incidental        |
|                    |               | operators in the Veterans       |
|                    |               | Health Administration who       |
|                    |               | transport patients, see         |
|                    |               | appendix B, part IV, of this    |
|                    |               | handbook.\]                     |
+--------------------+---------------+---------------------------------+
| \*Urine tests      | Employees at  | At regular intervals at the     |
|                    | drug          | discretion of the employee      |
|                    | treatment     | health physician.               |
|                    | centers       |                                 |
+--------------------+---------------+---------------------------------+
| Audiological       | Boiler and    | Prior to assignment to duty and |
| examinations       | Utility Plant | repeated at 1-year intervals.   |
|                    | Operators     |                                 |
+--------------------+---------------+---------------------------------+

**\***A. Instructions for the Occupational Healthcare Physician or
Provider:

1\. All of the proposed urine tests will be coordinated with the Chief
of Drug Dependence Treatment Center.

2\. All positive tests are to be corroborated by at least one other test
with another testing device or by another laboratory.

3\. Care should be exercised to discriminate between medically
prescribed and illicit drugs.

\*B. ***Special Information: Findings*** obtained from the proposed
tests will be kept confidential and will only be used for employment
fitness purposes, as opposed to criminal proceedings.

**NOTE:** *See VA Directive 5383 and VA Handbooks 5383, 5383.1, and
5383.2 for VA Drug-Free Workplace policies.*

\[\*C. Medical Evaluation: Individual facilities must determine how
employees know when they are due for an evaluation in Occupational
Health by identifying who - supervisors, human resources, or the
transportation coordinator - is responsible for notifying an employee
that the must complete an OF 345. Facilities should also develop
procedures to ensure employees turn in the OF 345 to Occupational Health
and are given appointments in Occupational Health.[]{#AppIVA .anchor}

**APPENDIX B. MEDICAL CONDITIONS AND CRITERIA COVERING**

### MEDICAL EVALUATIONS FOR MOTOR VEHICLE OPERATORS AND INCIDENTAL OPERATORS IN THE VETERANS HEALTH ADMINISTRATION

### WHO TRANSPORT PATIENTS

**NOTE:** The provisions of this appendix are to be used in addition to
the requirement for completion of Optional Form 345 (OF 345) described
in appendix A, this part, for the conduct of medical evaluations of
Motor Vehicle Operators and incidental operators who transport patients.
A medical evaluation for these employees is to be conducted initially
and every 4 years thereafter, or following an accident event and at the
discretion of the Occupational Health provider. After age 65, medical
evaluations shall be conducted biennially, and after age 70, annually
for these employees.

1\. Determining whether an employee should drive for VA is based on
available information to include private medical documentation. This
decision may be changed on receipt of additional information concerning
the employee's health status.

2\. Incidental operators include individuals such as Recreation
Therapists, Recreation Therapy Assistants, Social Workers, Nursing
Assistants, Domiciliary Assistants, and others who transport patients as
an incidental duty. In accordance with the provisions of title 5 CFR
339.205, the position description and/or functional statement of
employees who transport patients as an incidental duty must be annotated
to reflect the reason for, and frequency of, the medical evaluation
requirement and a copy provided to the employee.

3\. Occupational Health may decide to permit an employee with a
long-standing safe driving record to continue driving until any
additional needed information is available if:

a\. The employee does not fail any of the standards listed below, and

b\. The employee does not pass certain standards because additional
information is needed pertaining to a remote medical event.

4\. Driving clearance will be temporarily suspended if all information
required to make a final determination is not received within 60 days of
any such request.

5\. Occupational Health clinicians should be aware of standard resources
including a Web site dedicated to transportation medicine
(<http://home.att.net/~NataH/>) and published guidance from the American
Medical Association and the National Highway Transportation Safety
Administration.

6\. The following are the medical conditions and criteria that
Occupational Health clinicians must consider when deciding if an
employee is medically qualified to transport patients.

**NOTE:** *Follow-up physical examination, testing, or other appropriate
action, including denial of driving duties, may be indicated.
Documentation that each of these medical conditions and criteria has
been assessed must be included in the employee medical file.*

+------------+---------------------------------------------------------+
| **Medical  | **Medical Criteria.**                                   |
| C          |                                                         |
| ondition** |                                                         |
+------------+---------------------------------------------------------+
| Vision     | Visual acuity and visual field testing must be          |
|            | completed on all drivers.                               |
+------------+---------------------------------------------------------+
| Hearing    | Must be able to successfully pass a voice               |
| Loss       | discrimination or "whisper" test. If there is a         |
|            | question of hearing loss, an audiometric test may be    |
|            | ordered. Hearing loss must be no greater than an        |
|            | average of 40dB at 500, 1000, and 2000 Hz in the better |
|            | ear with or without hearing aides.                      |
+------------+---------------------------------------------------------+
| Diabetes   | Employees with a clinical diagnosis of                  |
|            | insulin-dependent diabetes mellitus must have a         |
|            | hemoglobin A1C of less than 8 and have no symptoms of   |
|            | dizziness or fatigue that might suggest the presence of |
|            | hypo- or hyperglycemic episodes during the past six     |
|            | months                                                  |
|            |                                                         |
|            | .                                                       |
+------------+---------------------------------------------------------+
| Substance  | Employees with a history of substance abuse must        |
| Abuse      | provide documentation of being followed in a treatment  |
|            | program and provide documentation of abstinence for 1   |
|            | year.                                                   |
+------------+---------------------------------------------------------+
| Epilepsy   | Employees must have no history or clinical diagnosis of |
|            | epilepsy requiring treatment in the last three years.   |
|            | Isolated seizures in the distant past do not            |
|            | necessarily represent a disqualifying condition.        |
+------------+---------------------------------------------------------+
| Range of   | Range of motion in the neck must be greater than 45     |
| motion of  | degrees of rotation to both right and left.             |
| head and   |                                                         |
| neck       |                                                         |
+------------+---------------------------------------------------------+
| Hy         | Blood pressure no greater than 160 over 95 without      |
| pertension | evidence of acute hypertensive effects or               |
|            | hypertension-related symptoms.                          |
+------------+---------------------------------------------------------+
| Syncope    | Syncope, except when postural hypotension is the cause, |
|            | must be absent.                                         |
+------------+---------------------------------------------------------+
| Ischemia   | Employees may have no clinical diagnosis of active      |
|            | cardiovascular disease as defined by symptoms (angina), |
|            | a history of myocardial infarction within the last      |
|            | year, or other evidence such as non-invasive diagnostic |
|            | testing documenting cardiovascular disease. Note: The   |
|            | later testing is not a requirement but may be conducted |
|            | in individuals who appear at high risk for acute        |
|            | cardiovascular events.                                  |
+------------+---------------------------------------------------------+
| V          | Employees may have no current clinical diagnosis of     |
| entricular | ventricular arrhythmias, excluding random premature     |
| A          | ventricular contractions.                               |
| rrhythmias |                                                         |
+------------+---------------------------------------------------------+
| Pacemaker  | Every six months the employee must provide              |
|            | documentation that his or her pacemaker is functioning  |
|            | adequately.                                             |
+------------+---------------------------------------------------------+

  ----------------- -----------------------------------------------------
  **Medical         **Medical Criteria**
  Condition**       

  Check for an      Employees with an IDC cannot be cleared to transport
  implantable       patients.
  cardioverter      
  defibrillator     
  (ICD)             

  Heart Block       Employees may have no current clinical diagnosis of a
                    complete heart block or new bundle branch block.

  Aortic Stenosis   Employees with this condition must provide
                    documentation of an evaluation by a cardiologist
                    documenting valve area. Asymptomatic employees with
                    moderately severe stenosis require clinical judgment
                    for clearance. Those with symptoms, declining
                    ventricular function, or who are in need of valve
                    replacement (ARV) cannot be medically cleared.

  Ejection Fraction If there is evidence of heart disease, consider the
                    employee's ability to assist passengers in and out of
                    vehicles.

  Chronic           A clinical diagnosis of moderate to severe COPD with
  Obstructive       a FEV1 of less than 40 percent is considered a
  Pulmonary         disqualifying condition.
  Disorder (COPD)   

  Use of            Use of containerized oxygen is a disqualifying
  containerized     condition.
  oxygen            

  Narcolepsy and/or In the presence of narcolepsy and sleep apnea, the
  sleep apnea       employee must provide documentation of adequate
                    treatment as confirmed by a sleep study.

  Neuromuscular     The employee must be able to coordinate all four
  Impairments       extremities and have no evidence of nystagmus.
                    Amputees should be evaluated on an individual basis
                    to determine if they can safely transport patients.

  Stroke            A clinical diagnosis of a cerebral vascular accident
                    is considered a disqualifying condition, as is the
                    presence of transient ischemic attacks in the
                    presence of an underlying disorder that remains
                    active. Completed distant strokes resulting from AV
                    malformations or aneurysms do not automatically
                    disqualify from transporting patients.

  Meniere's Disease Unstable or active Meniere's disease is considered a
                    disqualifying condition.

  Intra-Atrial      A clinical diagnosis of IACD is considered a
  conduction delay  disqualifying condition.\]
  (IACD)            
  ----------------- -----------------------------------------------------

###