THE AGENCY FOR INTERNATIONAL DEVELOPMENT

CENTER FOR HUMAN CAPACITY DEVELOPMENT

# GUIDE TO MEDICAL FITNESS STANDARDS FOR APPLICANTS

Applicants must be screened to identify medical conditions, which might
limit their ability to complete their training or might result in
excessive costs for medical care for a preexisting condition.

This guide provides medical fitness standards of sufficient detail to
ensure uniformity in the medical evaluation of applicants for training
programs. Although the guide attempts to generally include all disease
conditions, it is not possible to cover every disease or physical
finding. It is the responsibility of the medical examiner to use sound
medical judgment to determine fitness of those personnel whom have
medical findings not covered precisely by the guide.

If a disqualifying defect listed in this guide is identified but not
considered disqualifying for this particular applicant, the examining
physician should state the reasons why the finding is not likely to
limit performance or cause undue risk during training. In addition,
those conditions indicated as causes for rejection, which can be
corrected by treatment or by spontaneous cure will be reconsidered
following resolution and/or therapy when substantiating studies have
been completed and received.

The medical assessment should be based on the established
classifications given in the following Guide to Medical Fitness.

[MEDICAL CONDITIONS LISTED UNDER EACH HEADING IN SECTION
ONE]{.underline}

[THROUGH SIXTEEN ARE REASONS FOR DISQUALIFICATION UNLESS]{.underline}

[OTHERWISE STATED.]{.underline}

AID 1382 (6-87) Page 1

[CONTENTS]{.underline}

  --------- ---- ---------------------------------------------------------
  SECTION   1    ABDOMEN AND GASTROINTESTINAL SYSTEM

  SECTION   2    BLOOD AND BLOOD-FORMING DISEASES

  SECTION   3    EARS AND HEARING

  SECTION   4    ENDOCRINE AND METABOLIC DISORDERS

  SECTION   5    MUSCULO-SKELETAL SYSTEM

  SECTION   6    EYES AND VISION

  SECTION   7    GENITO-URINARY SYSTEM

  SECTION   8    HEAD AND NECK

  SECTION   9    HEART AND VASCULAR SYSTEM

  SECTION   10   HEIGHT, WEIGHT AND BODY BUILD

  SECTION   11   LUNG AND CHEST WALL

  SECTION   12   MOUTH NOSE, PHARYNX, TRACHEA, ESOPHAGUS AND LARYNX

  SECTION   13   NEUROLOGICAL DISORDERS

  SECTION   14   PSYCHOSES, PHYCHONEUROSES, PERSONALITY DISORDERS,
                 ALCOHOLISH, DRUG DEPENDENCE, ETC.

  SECTION   15   SKIN AND CELLULAR TISSUES

  SECTION   16   SYSTEMIC DISEASES AND MISCELLANEOUS CONDITIONS AND
                 DEFECTS
  --------- ---- ---------------------------------------------------------

[MEDICAL CONDITIONS LISTED UNDER EACH HEADING ABOVE ARE]{.underline}

[REASONS FOR DISQUALIFICATION UNLESS OTHERWISE STATED.]{.underline}

AID 1382 (6-87) Page 2

Section 1

## ABDOMEN AND GASTROINTESTINAL SYSTEM

[Cholecystitis (gall bladder disease)]{.underline} chronic with symptoms
so severe as to interfere with normal activities.

[Cholelithiasis (gall stones)]{.underline}, symptomatic or asymptomatic.

[Cirrhosis]{.underline} demonstrated by abnormal liver function tests
with or without jaundice, or with acites or varices of the esophagus.

[Hepatitis]{.underline}, active or chronic demonstrated by liver
function tests.

[Hernia]{.underline}, symptomatic inguinal, umbilical, hiatal.

[Intestinal tract]{.underline}, megacolon, diverticulitis, ulcerative
colitis, Chron's disease.

[Rectum and anus]{.underline}, stricture, fissure, prolapse,
hemorrhoids.

[Pancreas]{.underline}, acute or chronic disease.

[Spleen]{.underline}, diseases involving, spleenectomy within the last
two years.

[Tumors]{.underline}, benign or malignant. (see section 15)

[Ulcer]{.underline}, stomach or duodenal confirmed by history or X-Ray.

[OTHER CONGENITAL OR ACQUIRED ABNORMALITIES]{.underline}

[AND DEFECTS WHICH REQUIRE SPECIAL MEDICAL]{.underline}

[CARE.]{.underline}

AID 1382 (6-87) Page 3

Section 2

## BLOOD AND BLOOD-FORMING TISSUE DISEASES

[Anemias]{.underline}, blood loss anemia, abnormal destruction of RBCs
(hemolytic anemia) faulty RBC production including: hereditary hemolytic
anemia, thalassemia, sickle cell and other clinically significant
hemoglobinopathies.

[Hemorrhagic states]{.underline}, caused b coagulation defect or
vascular instability.

[Leukopenia]{.underline}, chronic or recurrent.

[Myeloproliferative disease]{.underline}, polycythemia, leukemia, etc.

# Hypogammaglobulinemia

# Acquired Immune Deficiency Syndrome & ARC\\

[Malignancies]{.underline}, those conditions associated with the blood
forming elements.

AID 1382 (6-87) Page 4

Section 3

# EARS AND HEARING

[Auditory canal]{.underline}, tumors or obstruction of the ear canal.

[Mastoids]{.underline}, chronic mastoiditis.

[Tympanic membrane (ear drum)]{.underline}, perforation or severe
scarring associated with a hearing level below standards and requiring
hearing apparatus.

OTHER DEFECTS AND DISEASES OF THE EAR REQUIRING FREQUENT AND PROLONGED
TREATMENT.

[Hearing defect]{.underline}, significant hearing loss determined by
audiometer. Use of a hearing aid to bring auditory acuity up to
acceptable standards is permitted.

AID 1382 (6-87) Page 5

Section 4

# ENDOCRINE AND METABOLIC DISORDERS

[Adrenal gland]{.underline}, abnormal function of any degree.

[Diabetes mellitus]{.underline}, requiring insulin and not controlled by
diet, history of acidosis.

[Thyroid]{.underline}, goiter, thyroid nodule (benign or malignant),
hypo or hyperthyroidism.

[Gout]{.underline}, moderate to severe with renal complications, any
gouty condition not controlled by diet or medication.

[Hyperlipidemia]{.underline}, familial.

OTHER ENDOCRINE OR METABOLIC DISORDERS WHICH REQUIRE FREQUENT MONITORING
AND TREATMENT.

AID 1382 (6-87) Page 6

Section 5

### MUSCULO-SKELETAL SYSTEM

[Extremities]{.underline}, congenital or acquired abnormality which
requires frequent observation, evaluation and/or treatment including
prosthetic appliances.

[Arthritis]{.underline}, chronic osteoarthritis or traumatic arthritis,
rheumatoid arthritis documented by laboratory studies or by history.

[Osteomyelitis]{.underline}, any infection involving bone, including
tuberculosis, which is active or recurrent, unless successfully treated
two or more years previously.

[Spine]{.underline}, diseases, abnormalities, or injuries which require
continual treatment or evaluation of the spine and prevent physically
active participation in training. Intervertebral disc herniation or
history of surgical intervention unless two or more years have passed
and no symptoms exist.

[Fractures]{.underline}, any fracture of a bone which has not healed
completely and therefore requires continual treatment.

AID 1382 (6-87) Page 7

Section 6

### EYES AND VISION

# EYES

[Lids]{.underline}, ptosis, growth or tumor, which interferes with
vision.

[Conjunctiva]{.underline}, conjunctivitis, including trachoma
interfering with normal vision.

[Cornea]{.underline}, opacification of the cornea from any cause,
including corneal ulcer, herpetic ulcer.

[Retina]{.underline}, degeneration, detachment of the retina, or
congenital condition that impairs vision.

[Lens]{.underline}, opacities or dislocation of the lens which
interferes with vision.

[Glaucoma]{.underline}, primary or secondary that is not easily
controlled by medication or where vision is significantly affected.

ALL OTHER DEFECTS AND DISEASES WHICH IMPAIR VISION OR REQUIRE CONTINUED
EVALUATION AND TREATMENT.

# VISION

[Distant vision]{.underline}, visual acuity which does not correct to at
least one of the following:

20/30 in one eye and;

20/100 in the other eye.

20/20 in one eye and;

20/400 in the other eye.

AID 1382 (6-87) Page 8

Section 7

### GENITO-URINARY SYSTEM

[Kidney]{.underline}, absence of one kidney unless the remaining kidney
has normal function, cystic or polycystic kidney, chronic infection of
the urinary tract such as pyelonephritis, glomerulonephritis, or
tuberculosis. Any tumor or persistent calculi (stone) which is
identified and symptomatic.

[Ureter, bladder, urethra]{.underline}, any infection which does not
respond to treatment or reoccurs with such frequency so as to interfere
with normal function. Stones located in any portion of the urinary
tract.

[Testicles]{.underline}, undescended testicle unless surgically
corrected, epiditimitis, or tumors and cysts involving this organ.

[Prostate]{.underline}, enlargement to such a degree so as to cause
obstruction to urine flow, chronic infection.

[Uterus]{.underline}, enlargement due to fibroids.

[Pregnancy]{.underline}, until satisfactory delivery and no residual
complication.

[Ovaries]{.underline}, cysts or tumors or chronic infections involving
the tubes (salpingitis).

AID 1382 (6-87) Page 9

Section 7 (cont)

[Genitalia]{.underline}, male or female, any abnormality, acquired or
congenital, that will require treatment; this includes cystocele,
rectocele, vaginal cysts, hydrocele, etc.

[Tumor]{.underline}, any tumor, benign or malignant, of the
genito-urinary system.

[ALL OTHER CONDITIONS INVOLVING THE G-U SYSTEM]{.underline}

[THAT WILL INTERFERE WITH NORMAL FUNCTION OR]{.underline}

[REQUIRE EXTENSIVE MEDICAL CARE.]{.underline}

AID 1382 (6-87) Page 10

Section 8

### HEAD AND NECK

[Abnormalities]{.underline}, any injury or congenital changes which
affect normal function.

[Skull]{.underline}, any deformity if associated with evidence of
compromise of brain, spinal cord, or peripheral nerve function.

[Neck]{.underline}, congenital bronchial cleft cyst, spastic contraction
of neck muscles (torticolis), cervical lymph node enlargement.

ALL OTHER CONDITIONS INVOLVING THE HEAD AND NECK THAT PROHIBIT NORMAL
FUNCTION OR WHICH MAY REQUIRE EXTENSIVE MEDICAL CARE.

AID 1382 (6-87) Page 11

Section 9

### HEART AND VASCULAR SYSTEM

[Congenital abnormalities]{.underline}, heart and major vessels unless
such abnormalities have been satisfactorily corrected without prosthesis
and there are no residual or complications of treatment.

[Valvular disease]{.underline}, this includes mitral valve prolapse
which has persistent hemodynamic significance.

[Ischemic myocardial disease]{.underline}, occlusive coronary artery
disease as manifested by any of the following:

-   History of myocardial damage

-   Symptoms of acute or chronic ischemia

-   Electrocardiographic evidence of myocardial ischemia.

[Pericarditis]{.underline}, including constrictive pericarditis unless
surgically corrected.

[Endocarditis]{.underline}, valve deformity with or without myocarditis.

[Hypertrophy (enlargement) of the heart]{.underline}, dilitation for any
reason including congestive failure, parasitic infection (Chaga's
disease), etc.

[Abnormal electrocardiogram]{.underline}, evidence of myocardial
infarctions arrythmias, conduction disorder or defect including second
or third degree heart block, persistent tachycardia or bradycardia.

AID 1382 (6-87) Page 12

Section 9 (cont.)

[Hypertension]{.underline}, manifested by consistent systolic pressure
readings of 160 mm Mg. Or more in a 35 year old person, 140 mm Hg. Or
more in a person under 35 years old, or in a person whose diastolic
pressure remains above 95 mm Mg. At any age. Pre-existing hypertension
well controlled by drug therapy and no evidence of involvement of any
organs may be exempted if verified.

[Acquired diseases of the circulatory system]{.underline}, aneurysms of
major vessels, varicosity's, thrombophlebitis, occlusive disease of
vessels, arterio-spastic diseases, etc.

[Rheumatic fever]{.underline}, evidence of Rheumatic Fever present now
or within the past two years.

[Coronary revescularization]{.underline}, any person who is a candidate
for coronary bypass surgery or who has had such surgery in the past
year.

[ANY CARDIOVASCULAR CONDITION THAT INTERFERES]{.underline}

[WITH NORMAL FUNCTION OR REQUIRES MEDICAL CARE]{.underline}

[AND MONITORING.]{.underline}

AID 1382 (6-87) Page 13

Section 10

### HEIGHT AND WEIGHT

Proportion of height to weight which would limit physical activity or
normal function and place the subject at increased medical risk is
reason for rejection.

The examining physician should include an evaluation of the subject's
physical condition and reject those whose weight exceeds that from the
height/weight table by more than 30 percent.

Height and Weight Tables\*

MEN WOMEN

  -------- -------- --------- --------- --------- -------- -------- --------- --------- ---------
  Height            Small     Medium    Large     Height            Small     Medium    Large

  Feet     Inches   Frame     Frame     Frame     Feet     Inches   Frame     Frame     Frame

  5        2        128-134   131-141   138-150   4        10       102-111   109-121   118-131

  5        3        130-136   133-143   140-153   4        11       103-113   111-123   120-134

  5        4        132-138   135-145   142-156   5        0        104-115   113-126   122-137

  5        5        134-140   137-148   144-160   5        1        106-113   115-129   125-140

  5        6        136-142   139-151   146-164   5        2        108-121   118-132   125-143

  5        7        138-145   142-154   149-168   5        3        111-124   121-135   131-147

  5        8        140-143   145-157   152-172   5        4        114-127   124-138   134-151

  5        9        142-151   148-160   155-176   5        5        117-130   127-141   137-155

  5        10       144-154   151-163   158-180   5        6        120-133   130-144   140-159

  5        11       146-157   154-166   161-184   5        7        123-136   133-147   143-163

  6        0        149-160   157-170   164-188   5        8        126-139   136-150   146-167

  6        1        152-164   160-174   168-192   5        9        129-142   139-153   149-170

  6        2        155-168   164-178   172-197   5        10       132-145   142-156   152-173

  6        3        158-172   167-182   176-202   5        11       135-143   145-159   155-176

  6        4        162-176   171-187   181-207   6        0        138-151   148-162   158-179
  -------- -------- --------- --------- --------- -------- -------- --------- --------- ---------

\*In shoes with one-inch heels and under clothing weighing five pounds
for men and three pounds for women.

AID 1382 (6-87) Page 14

Section 11

### LUNGS AND CHEST WALL

Tuberculous lesions, active tuberculosis or evidence of tuberculosis
within the past two years. Treated and healed tuberculosis which is
demonstrated as inactive by X-ray and laboratory studies is not
disqualifying. The subject should not currently require
anti-tuberculosis treatment.

[Lung]{.underline}, lobectomy for any reason, pneumothorax which has
reoccurred within the past two years regardless of cause, abscess of the
lung bullous emphysema, or bronchopleural fistula.

[Infectious disease]{.underline}, any non-tubercular chronic infection
involving the lungs such as sarcoidosis, histoplasmosis, coccidiomycosis
mycotic infections, chronic lung abscesses.

[Respiratory diseases]{.underline}, asthma requiring frequent medication
and/or requiring hospitalization in the past five years, bronchiectasis,
chronic emphysema, and extensive pulmonary fibrosis.

[Tumor]{.underline}, ay tumor or growth, malignant or benign.

[Chest wall]{.underline}, any deformity causing pulmonary insufficiency.

[ALL OTHER CONDITIONS OF THE CHEST AND LUNGS]{.underline}

[THAT RESULT IN DIFFICULTY IN RESPIRATION AND]{.underline}

[THUS LIMIT ACTIVITY OR REQUIRE EXTENSIVE]{.underline}

[MEDICAL CARE ARE REASONS FOR REJECTION.]{.underline}

AID 1382 (6-87) Page 15

Section 12

### MOUTH, NOSE, THROAT, ESOPHAGUS, LARYNX

[Nose]{.underline}, allergies not controlled by medication, nasal
polyps, perforated nasal septum associated with interference of
function.

[Sinuses]{.underline}, chronic sinusitis requiring frequent medical
attention.

[Pharynx/Larynx]{.underline}, disease condition which results in
ulceration or obstruction, tumor or polyps, laryngeal paralysis which
interferes with swallowing or speech.

[Esophagus]{.underline}, obstruction due to scarring or tumor, varicose
veins associated with portal hypertension.

[Tongue]{.underline}, paralysis affecting speech, tumors.

[ALL OTHER CONDITIONS THAT INTERFERE WITH]{.underline}

[FUNCTION OR REQUIRE CONTINUED MEDICAL CARE.]{.underline}

AID 1382 (6-87) Page 16

Section 13

### NEUROLOGICAL DISORDERS

[Degenerative disorders]{.underline}, cerebral arterial sclerosis,
ataxias, multiple sclerosis, Parkinson's disease, etc.

[Convulsive disorders]{.underline}, all forms of psychomotor or temporal
lobe epilepsy except by history more then five years previous and not
requiring medication for control.

[Migraine headaches]{.underline}, those headaches which respond poorly
to treatment and result in incapacitation.

[Paralysis]{.underline}, incapacitation, congenital or acquired, if
subject is unable to care for himself or where therapy or appliances are
required.

[Peripheral nerve disorder]{.underline}, neuralgia which is chronic and
of an intensity that is incapacitating, polyneuritis, neurofibromatosis.

[NEUROLOGICAL CONDTIONS THAT LIMIT FNCTION]{.underline}

[AND THE ABILITY TO COMPLY WITH TRAINING]{.underline}

[PROGRAMS OR REQUIRE ETENSIVE MEDICAL CARE.]{.underline}

AID 1382 (6-87) Page 17

Section 14

[PSYCHOSES, PSYCHONEUROSES, PERSONALITY]{.underline}

[DISORDERS, DRUG DEPENDENCE, ETC.]{.underline}

[Psychoses]{.underline}, current behavior suggestive of a psychosis or
by history unless of a brief duration and at least three years have
elapsed since recovery.

[Psychoneuroses]{.underline}, neurotic symptoms or behavior which
impairs occupation or interpersonal effectiveness, depressive state
which is or was sufficiently severe to require hospitalization or
therapy.

[Personality disorders]{.underline}, personality inadequacy which will
seriously interfere with adjustment.

[Drug dependencies]{.underline}, this includes all illegal drugs and the
state o alcoholism which is characterized b repeated and excessive abuse
of alcohol which interfere with normal functions. Recovering alcoholics
who have a period of sobriety for more than three years may be
considered for training if continued participation in a form of
treatment can be assured.

[OTHER PSYCHIATRIC CONDITIONS WHICH INTERFERE]{.underline}

[WITH EXPECTED ACTIVITIES OR THOSE WHICH MAY]{.underline}

[INVOLVE OR AFFECT OTHERS ARE REASONS FOR]{.underline}

[DISQUALIFICATION.]{.underline}

AID 1382 (6-87) Page 18

Section 15

### SKIN DISORDERS

[Lupus erythematosis]{.underline}, discoid or systemic which is not
controlled or is aggravated by sunlight.

[Psoriasis]{.underline}, if extensive and requiring frequent medical
attention.

[Pemphigus]{.underline}, familial and vulgaris, especially when in
bullious form and requiring extensive medical care.

[Fungal]{.underline} any of the fungal infections which are chronic and
unresponsive to treatment.

[Eczema, atopic dermatitis]{.underline}, if symptomatic and unresponsive
to treatment.

[Malignancies]{.underline}, basal cell, squamous cell, or malignant
melanoma cancers which have not been adequately treated, leukemia cutis.

[OTHER CHRONIC DISORDERS OF THE SKIN OF A]{.underline}

[DEGREE OR NATURE WHICH REQUIRE FREQUENT]{.underline}

[OUTPATIENT TREATMENT OR INTERFERE WITH NORMAL]{.underline}

[FUNCTION.]{.underline}

AID 1382 (6-87) Page 19

Section 16

### SYSTEMIC DISEASES AND OTHER CONDITIONS

[Tuberculosis]{.underline}, active tuberculosis in any form or location
except treated or spontaneously healed lesions for more than one year
under supervised treatment.

[Sarcoidosis]{.underline}, unless the manifestations of the disease are
limited to hilar adenopathy and the condition has been stable for more
than two years.

[Allergies]{.underline}, all forms of skin, respiratory, rhinitis
allergies that require constant medical evaluation, treatment or
desensitization.

[Parasitic infections]{.underline}, this includes schistosomiasis,
filariasis, trypanisomiasis, amebiasis, hookworm, and other similar
parasitic infections until successfully treated.

[Tumors]{.underline}, for this purpose, tumor includes all malignancies
and benign lesions which interfere with normal function, require
extensive medical treatment or surveillance and have the potential for
increased morbidity or mortality.

[Malignancies]{.underline}, this includes lymphomas, leukemia, Hodgkins
disease, etc.

[Venereal]{.underline}, any acute or chronic venereal disease such as
Syphilis, Gonorrhea, Lymphogranuloma Benereum, Acquired Immune
Deficiency Syndrome (AIDS), etc. The finding of a positive blood test
for syphilis following the adequate WHO treatment is not in itself
considered evidence of chronic venereal disease.

AID 1382 (6-87) Page 21