Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

ENTRY TO THE SOUTHCOM AREA OF RESPONSIBILITY IAW SC Reg 40-501

1 

1. General. This attachment accompanies USSOUTHCOM Regulation 40-501 and provides 

amplification of the minimal standards of fitness for entry to the SOUTHCOM area of 

responsibility (AOR) for an anticipated 30 consecutive days or more. Individuals possessing a

disqualifying medical condition must obtain an exception to policy in the form of a medical 

waiver prior to being medically cleared for entry to the SOUTHCOM AOR for an anticipated 30 

consecutive days or more. Failure to do so may result in early return of personnel and their 

dependents from their SOUTHCOM assignment at unit expense. The list of deployment-limiting 

conditions (DLC) is not comprehensive; there are many other conditions that may result in 

denial of medical clearance for entry to the SOUTHCOM AOR for an anticipated 30 consecutive 

days or more based upon the totality of individual medical conditions and the medical 

capabilities present at that individual’s theater location. “Medical conditions” as used here also 

include those health conditions usually referred to as dental, psychological, and/or behavioral. 

A. Uniformed Service Members must meet minimum Service standards of fitness 

according to Service regulations and policies, in addition to the guidance below.

B. DoD civilian personnel with disqualifying medical conditions could enter the AOR for 

an anticipated 30 consecutive days or more based upon an individualized medical 

assessment and approved medical waiver from the appropriate SOUTHCOM waiver 

authority (which shall be consistent with subparagraph 4.g.(3)(c) of DoDD 1404.10 

and The Rehabilitation Act of 1973, as amended).

C. DoD contract personnel will be evaluated for fitness according to DoDI 3020.41. See 

paragraph 6.A and 6.B for additional requirements. 

D. Regardless of underlying diagnosis, waivers for disqualifying medical conditions 

will be considered only if all the following general conditions are met: 

1. The condition is not of such a nature or duration that an unexpected worsening 

or physical trauma is likely to have a grave medical outcome or negative impact 

on mission execution. 

2. The condition is stable and reasonably anticipated not to worsen considering

the physical, physiological, psychological, and nutritional effects of assigned 

duties and location.

3. The condition does not require frequent clinical visits (more than quarterly), 

ancillary tests, or significant physical limitations, and does not constitute an 

increased risk of illness, injury, or infection.

4. There is no anticipated need for routine evacuation out of theater for 

continuing diagnostics or evaluations.

5. Any required, ongoing health care or medications anticipated to be needed are 

available to the applicant in theater within the Military Health System or 

equivalent. Medication must have no special handling, storage, or other 

requirements (e.g., refrigeration, cold chain, or electrical power requirements). 

Medication must be well tolerated within harsh environmental conditions (e.g.,

heat or cold stress, sunlight) and should not cause significant side effects in the 

setting of moderate dehydration. 

6. Individuals must be able to perform all essential functions of the position in the 

theater environment, with or without reasonable accommodation, without causing 

undue hardship. In evaluating undue hardship, the nature of the accommodation 

and the location of the deployment must be considered. Further, the member’s 

medical condition must not pose a significant risk of substantial harm to the 
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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member or others considering the condition of the relevant theater environment, 

with consideration of areas of armed conflict in the AOR. 

7. The medical condition does not prevent the wear of personal protective 

equipment, including protective mask, ballistic helmet, body armor, and 

chemical/biological protective garments.

8. The medical condition does not prohibit required theater immunizations or 

medications.

9. The medical condition is not anticipated to significantly impair one’s duty 

performance.

10. The diagnosis, management, and/or treatment of medical conditions does not 

place an unreasonable burden on deployed medical assets, operational assets, 

or complicate the evaluation of other reasonably-anticipated illnesses or injuries.

11. The individual has not been previously medially evacuated for the same 

condition.

2. Evaluating providers must consider that in addition to the individual’s assigned duties, severe 

environmental conditions, extremes of temperature, high physiologic demands (water, mineral, 

salt, and heat management), poor air quality (especially particulates), limited dietary options, 

sleep deprivation/disruption, and emotional stress may all impact the individual’s health. If 

maintaining an individual’s health requires avoidance of these extremes or conditions, 

they should not enter the AOR for an anticipated 30 consecutive days or more. 

3. Evaluation of functional capacity to determine fitness in conditions of physiologic demand is

encouraged for conditions which may impair normal functionality. This includes such things as a

complete cardiac evaluation, to include stress imaging, when there is coronary artery disease or 

an official functional capacity exam (FCE) for orthopedic issues. The evaluating provider should 

pay special attention to any conditions which may present a hazard to the individual or others 

and/or preclude performing functional requirements in the theater setting. Also, the type, 

amount, suitability, and availability of medications in the theater environment must be 

considered as potential limitations. Pre-deployment processing centers may vary in medical 

examination/screening procedures; individuals should contact their respective mobilization site 

for availability of a processing checklist. 

4. The guidance in this document should not be construed as authorizing use of defense health 

program or military health system resources for health evaluations unless otherwise authorized. 

Generally, Defense Health Agency and Military Health System resources are not authorized for 

the purpose of pre-deployment or travel medicine evaluations for contractor employees. Local 

command, legal, contracting and resource management authorities should be consulted for 

questions on this matter.

5. Shipboard operations which are not anticipated to involve operations ashore are exempt from 

the deployment-limiting medical conditions listed below and will generally follow Service specific 

guidance. However, sovereign laws of some nations within the SOUTHCOM AOR may prohibit 

entry of individuals with certain medical conditions. Contingency plans for emergency 

evacuation of individuals with diagnoses that could result in or complicate medical care in 

theater following evacuation should be coordinated with and approved by the SOUTHCOM 

Surgeon prior to entering the AOR for an anticipated 30 consecutive days or more. 

6. The general guidance from SOUTHCOM Reg 40-501 applies to:
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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A. All personnel (uniformed service members, government civilian employees, 

volunteers, and DoD contractor employees) seeking entry for an anticipated 30 

consecutive days or more must be medically, dentally, and psychologically fit 

for entry to the SOUTHCOM AOR and possess a current Periodic Health 

Assessment (PHA) or physical. Fitness specifically includes the ability to accomplish 

tasks and duties unique to a particular operation and the ability to tolerate 

environmental and operational conditions of the theater location.

B. The existence of a chronic medical condition may not necessarily require a waiver to 

enter the AOR for an anticipated 30 consecutive days or more. Personnel with 

existing conditions, other than those outlined in this document, may enter the 

AOR for an anticipated 30 consecutive days or more if either: 

1. An approved medical waiver request form (see attachment A) is 

documented in the medical record with USSOUTHCOM (see attachment C 

for process). Medical waivers are valid for 18-months from the approval 

date. Personnel remaining in the AOR for more than 18-months will require 

a new work-up to determine if they meet entry requirements. If not, a new 

medical waiver will need to be requested.

OR

2. The conditions in paragraph 1.D.1-11 are met. To determine stability and 

assess need for further care, for most conditions 60 days is considered a 

reasonable timeframe, subject to the examining provider’s judgment. The 

exception to this is noted in paragraph 7.G. Behavioral health conditions. 

7. Documented medical conditions precluding medical clearance. A list of all possible diagnoses 

and their severity that may cause an individual to be non-deployable would be too expansive. 

The medical evaluator must carefully consider whether the climate, altitude, nature of available 

food and housing, availability of medical, behavioral health, dental, surgical, and laboratory 

services, or whether other environmental and operational factors may be hazardous to the 

deploying person’s health. The following list of conditions should not be considered exhaustive. 

Other conditions may render an individual medically non-deployable (see paragraph 6). Medical 

clearance to enter the AOR for an anticipated 30 consecutive days or more with any of the 

following documented medical conditions may be granted, except where otherwise noted. If an 

individual is found in the AOR for an anticipated 30 consecutive days or more with a pre-existing 

non-deployable condition and without a waiver for that condition, a waiver request to remain in 

the AOR should be submitted to the respective Component Surgeon. If the waiver request is 

denied, the individual will be redeployed out of the SOUTHCOM AOR. Individuals with the

following conditions will not enter the AOR without an approved waiver: 

A. Specific Medical Conditions / Restrictions:

1. Asthma or other respiratory conditions that have a Forced Expiratory 

Volume-1 < 50% of predicted despite appropriate therapy, that have required 

hospitalization in the past 12 months, or that require daily systemic (not inhaled) 

steroids. 

2. Seizure disorder, either within the last year or currently on anticonvulsant 

medication for prior seizure disorder/activity. 
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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3. Diabetes mellitus, type 1 or 2, on pharmacotherapy or with HgA1C > 7.0.

a. Type 1 diabetes or insulin-requiring type 2 diabetes.

b. Type 2 diabetes, on oral agents only, with no change in medication 

within the last 90 days and HgA1C ≤ 7.0 does not require a waiver if a 

calculated 10-year coronary heart disease risk percentage (see 

paragraph 7.B.7) is less than 15%. If the calculated 10-year risk is 15% or 

greater, further evaluation is required prior to waiver submission. See B.8. 

for more detailed instructions.

c. Newly diagnosed diabetics will require 90 days of stability, either on 

oral medications or with lifestyle changes, before a waiver will be

considered. They should also have documentation of a complete initial 

diabetic evaluation (eye exam, foot exam, nutrition counseling, etc.).

4. History of Heat stroke. Those without multiple episodes, persistent sequelae 

or organ damage, or episodes within the preceding 24 months may be 

considered for waiver. Waiver should include circumstances of the event(s), and 

functional assessment of current ability to perform rigorous duties in an austere 

environment.

5. Meniere’s disease or other vertiginous/motion sickness disorder, unless 

well controlled on medications available in theater.

6. Recurrent syncope for any reason. Waiver request should include the 

etiology and diagnosis of the condition.

7. History of stinging insect allergy causing generalized symptoms, causing 

a. Local swelling, itching, or redness contiguous with the sting site and 

exhibiting no signs of anaphylaxis or systemic reaction do not require 

waiver. Generalized cutaneous-only reactions that occurred prior to the 

16th birthday also do not require waiver.

b. Severe systemic and anaphylactic reactions, as well as cutaneous 

reactions –defined as generalized rash or swelling in locations not 

contiguous with sting site- occurring after the 16th birthday, should be 

referred to an allergist for testing.

c. Negative testing results indicate no further therapeutic action is 

required; however, a waiver should still be submitted for review.

8. Endocrine conditions requiring replacement or adjustment therapies

must be stable, require no laboratory monitoring or specialty consultation, and 

require only routine follow-up, which must be available in the theater location or 

by specific arrangement. Hormonal preparations must be administered by oral or 

transdermal routes, be within clinically appropriate dose parameters, have no 

special storage requirements, and not produce side effects, which interfere with 

the normal performance of duties or require additional medications to manage.

9. Any musculoskeletal condition that significantly impairs performance of 

duties in a theater environment. If there are concerns, an official functional 

capacity exam (FCE) should be performed, and results included with the waiver 

request.
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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10. Migraine headaches, when frequent or severe enough to disrupt normal 

performance of duties. Waiver submission should note history, frequency, 

severity, and functional impact of headaches, as well previous and current 

treatment regimens. Neurology evaluation and endorsement encouraged.

11. Nephrolithiasis, requiring clinical evaluation or intervention in the preceding 

12 months, or with most recent imaging showing multiple stones or a single stone 

>5 mm in size, or a history of more than two episodes in a 12-month period in the 

last 3 years.

12. Chronic Kidney Disease. A documented prolonged period of stability for 

Stage I and Stage II is expected prior to granting a waiver

13. Pregnancy. NON-WAIVERABLE FOR DEPLOYMENT TO THE 

SOUTHCOM AOR. If a servicemember is to become pregnant while deployed, 

the command is to exercise sound judgment in consultation with a medical 

provider for disposition IAW service regulations. Curtailments for pregnant 

servicemembers are a non-medical administrative process initiated by the 

command to the respective servicemember’s orders issuing authority.

14. Obstructive sleep apnea (OSA). Should be diagnosed with 

polysomnography (PSG), with a minimum of 2 hours of total sleep time. 

Individuals previously diagnosed with OSA do not require updated or repeat PSG 

unless clinically indicated (i.e., significant change in body habitus, corrective 

surgery or return of OSA symptoms). The condition must not be severe enough 

to pose a safety risk should PAP therapy be unavailable for a significant length of 

time. For moderate and severe OSA, a compliance report demonstrating at least 

4 hours of use per night for greater than 70% of nights over a 30-day period must 

be documented. Individuals treated with an oral appliance require 

polysomnography that indicates OSA is controlled with its use. Complex OSA, 

central sleep apnea, or OSA that requires advanced modes of ventilation such as 

adaptive servo-ventilation (ASV) or average volume assured pressure support 

(AVAPS) is generally non-deployable. Individuals using PAP therapy should 

deploy with a machine that has rechargeable battery back-up and sufficient 

supplies (air filters, tubing and interfaces/masks) for the duration of the 

deployment. Waivers are required as follows:

a. Asymptomatic mild OSA (diagnostic AHI and RDI < 15/hr): With or 

without treatment (PAP or otherwise). No waiver required.

b. Moderate to severe OSA (diagnostic AHI or RDI ≥15/hr), as well as 

symptomatic OSA (i.e., excessive daytime sleepiness) of any severity, 

require waiver as follows: Those individuals with confirmed compliance 

and reliable access to compatible power sources, as well as an absence 

of complex apnea, central apnea, need for advanced ventilation modes 

(as defined above), or additional disqualifying conditions do not require a 

waiver. If any of these factors are not adequately addressed, waiver is 

required.

15. History of clinically diagnosed traumatic brain injury (mTBI/TBI) of any 

severity, including mild. Waiver may not be required, but pre-deployment 
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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evaluation, which may include both neurological and psychological components, 

is needed. 

a. Individuals who have a history of a single mild Traumatic Brain Injury 

may enter the AOR once released by a medical provider after 24-hours 

symptom free.

b. Individuals who have sustained a second mTBI within a 12-month 

period, may enter the AOR if symptom free and released by a medical 

provider after seven days of the incident.

c. Individuals who have had three clinically diagnosed TBIs (of any 

severity, including mild) since their last full neurological and psychological 

evaluation are required to have such an evaluation completed prior to 

deployability determination.

16. BMI > 35 with or without any significant comorbidity. Military personnel in

compliance with Service body fat guidelines do not require a waiver. Morbid 

obesity (BMI > 40 or weight greater than 300 pounds) can generally not be 

supported. Civilians and contractors should submit a body fat worksheet with the 

waiver request. A BMI calculator is located at 

http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm

17. Asplenia, either actual or functional secondary to other medical condition. 

Waiver request should include verification of immunization against encapsulated 

bacterial pathogens (pneumococcus, meningococcus, Haemophilus influenza).

18. Gout, with two or more flares in the preceding year.

19. Multiple Sclerosis. Waiver requests should address stability of condition, 

current limitations. increased vulnerability to heat injury, and possible 

requirement for medication waiver.

20. Any medical condition (except OSA-see 14 above) that requires durable 

medical equipment or appliances (e.g., nebulizers, catheters, spinal cord 

stimulators), or that requires periodic evaluation/treatment by medical specialists 

not readily available at any theater location.

21. Conditions requiring service animals or comfort animals. Does not apply 

to Military Working Dogs/Contract Working Dogs. Animals deployed to support 

behavioral health operations must deploy from CONUS as part of an official 

program with full logistic support and uniformed handlers.

B. Cardiovascular Conditions:

1. Symptomatic Coronary Artery Disease. Also, see B.8.

2. Myocardial Infarction within one year of deployment. Also, see B.8.

3. Coronary Artery Bypass Graft, coronary artery Angioplasty, Carotid 

Endarterectomy, other arterial stenting, or aneurysm repair within one year 

of deployment. Also, see B.8.
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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4. Cardiac Dysrhythmias or Arrhythmias, either symptomatic or requiring 

medication, electro-physiologic control, or automatic implantable cardiac 

defibrillator or other implantable cardiac devices. 

5. Heart Failure or history of heart failure. 

6. Blood pressure and lipids should be considered and treated in the context of 

overall cardiac risk, for which a waiver may be required (see B. 7). Isolated 

hypertension or lipids do not require separate waiver except in the following 

circumstances: 

a. Hypertensive urgency or emergency within previous 90 days.

b. 3-day average SBP > 140, DBP > 90.

c. Total Cholesterol >300, or Triglycerides >1000

7. Civilian personnel who are 50 years of age or older who have a 10-year CHD 

risk percentage calculated of 15% or greater (online calculator is available at 

http://tools.acc.org/ASCVD-Risk-Estimator/) will be referred for further cardiology 

work-up and evaluation, to include at least one of the following: graded exercise 

stress test with a myocardial perfusion scintigraphy (SPECT scan) or stress 

echocardiography as determined by the evaluating cardiologist. Results of the 

evaluation and testing, along with the evaluating cardiologist’s recommendation 

regarding suitability for deployment, should be included in a waiver request to 

enter the AOR. 

C. Infectious Disease:

A SOUTHCOM waiver cannot override host or transit nation infectious disease or 

immunization restrictions. Active duty must comply with status of forces 

agreements; civilian deployers should contact the nation’s embassy for up-todate information.

1. Blood-borne diseases (Hepatitis B, Hepatitis C, HTLV) that may be 

transmitted to others in a theater environment. Waiver requests for persons 

testing positive for a blood borne disease should include a full test panel for the 

disease, including all antigens, antibodies, viral load, and appropriate tests for 

affected organ systems. 

2. Confirmed HIV infection personnel are not non-deployable solely for the 

reason that they are HIV-positive. Decisions on the deployability of HIV 

personnel will be made on a case by-case basis and must be justified by the 

Service member's inability to perform the duties to which he or she would be 

assigned. Note that some nations within the SOUTHCOM AOR have legal 

prohibitions against entering their country(ies) with this diagnosis. Please refer to 

paragraph 1.D.1-11 for additional requirements.

3. Latent tuberculosis (LTBI). Individuals who are newly diagnosed with LTBI 

by either TST or IGRA testing will be evaluated for TB disease with at least a 

symptom screen and chest x-ray and will have documented LTBI evaluation and 

counseling for consideration of treatment. Those with untreated or incompletely 

treated LTBI, including those with newly diagnosed LTBI, previously diagnosed 

LTBI, and those currently under treatment for LTBI will be provided information 

regarding the risks and benefits of LTBI treatment during deployment. Individuals 
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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meeting the above criteria do not require a waiver for entry to the SOUTHCOM 

AOR for an anticipated 30 consecutive days or more. Active duty TST convertors 

who have documented completion of public health nursing evaluation for TB 

disease and counseling for LTBI treatment described above may enter the AOR 

without a waiver if all Service specific requirements are met. 

4. History of active Tuberculosis (TB). Must have documented completion of 

full treatment course. Those currently on treatment for TB disease may not enter 

the AOR. 

5. SARS CoV-2 (COVID-19). Completion of vaccine series is no longer required 

but recommended. Those currently diagnosed with COVID-19 disease should not 

enter the AOR until after 10 days from onset of symptoms AND at least 24 hours 

after symptoms subside. Be advised that testing may be required prior to entry to 

the AOR.

D. Eye, Ear, Nose, Throat, Dental Conditions:

1. Vision loss. Best corrected visual acuity which does not meet minimum 

occupational requirements to safely perform duties. Bilateral blindness or visual 

acuity that is unsafe for the theater environment per the examining provider.

2. Refractive eye surgery. Personnel who have had laser refractive surgery 

must have a satisfactory period for post-surgical recovery before entering the 

AOR. There is a large degree of patient variability which prevents establishing a 

set timeframe for full recovery. The attending ophthalmologist or optometrist will 

determine when recovery is complete.

a. Personnel are non-deployable while still using ophthalmic steroid drops

post procedure. 

b. Personnel are non-deployable for three months following 

uncomplicated photorefractive keratectomy (PRK) or laser epithelial 

keratomileusis (LASEK), or one month for laser-assisted in situ 

keratomileusis (LASIK) unless a waiver is granted.

c. Waiver request should include clearance from treating ophthalmologist 

or optometrist.

3. Hearing loss. Service members must meet all Service-specific requirements.

Individuals must have sufficient unaided hearing to perform duties safely, hear 

and wake up to emergency alarms unaided, and hear instructions in the absence 

of visual cues such as lip reading. If there is any safety question, Speech 

Recognition in Noise Test (SPRINT) or equivalent is a recommended adjunct.

4. Tracheostomy or aphonia. 

5. Dental. Patients without a dental exam within 12 months of deployment, or 

those who are likely to require evaluation or treatment during the period of 

deployment for oral conditions that are likely to result in a dental emergency. 

Individuals being evaluated by anon-DoD civilian dentist should use a DD Form 

2813, or equivalent, as proof of dental examination. Orthodontics requiring 

follow-up or adjustment while deployed. Those with wires in neutral force and are 

cleared by the treating orthodontist do not require waiver.
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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E. Cancer:

1. Cancer for which the individual is receiving continuing treatment, or which 

requires frequent subspecialist examination and/or laboratory testing during the 

anticipated duration of the deployment.

2. Precancerous lesions that have not been treated and/or evaluated and that 

require treatment/evaluation during the anticipated duration of the deployment.

3. All cancers should be in complete remission for at least a year before a waiver 

is submitted.

F. Surgery:

1. Any medical condition that requires surgery (e.g., unrepaired hernia) or for 

which surgery has been performed and the patient requires ongoing treatment, 

rehabilitation, or additional surgery to remove devices (e.g., external fixator 

placement).

2. Individuals who have had surgery requiring follow up during the deployment 

period or who have not been cleared/released by their surgeon (excludes minor 

procedures).

3. Individuals who have had surgery (open or laparoscopic) within 6 weeks of

deployment.

4. Cosmetic, bariatric, or gender reassignment procedures are disqualifying until 

fully recovered with all follow-up and revisions complete, to include adjuvant 

counselling, medical treatment, and Service requirements. Special dietary and 

hygienic requirements cannot be reliably accommodated and may be 

independently disqualifying.

G. Behavioral Health Conditions: 

Diagnostic criteria and treatment plans should adhere to Diagnostic and 

Statistical Manual of Mental Disorders, Fifth edition text revision (DSM-5-TR) and 

current professional standards of care. Waiver submission should include

information on applicant condition, including history and baseline symptoms of 

known disorders, severity of symptoms with and without treatment, and likelihood 

to recur or deteriorate in theater if exposed to operational activity. 

1. Psychotic and bipolar-spectrum disorders are strictly disqualifying and 

are incompatible with military service. 

2. Any DSM-5-TR-diagnosed behavioral health disorder, to include personality 

disorders with residual symptoms, or medication side effects, which impair social 

and/or occupational performance. 

3. Any behavioral health condition that poses a substantial risk for deterioration

and/or recurrence of impairing symptoms in the theater environment. 
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4. Any behavioral health condition which requires periodic (beyond quarterly) 

counselling or therapy.

5. Chronic insomnia that requires regular or long-term use of sedative 

hypnotics/amnestics, benzodiazepines, and/or antipsychotics. 

6. Anxiety disorders requiring use of benzodiazepines for management or

featuring symptoms of panic or phobia.

7. Post-Traumatic Stress Disorder, when causing impairment or not completely 

treated or when therapy includes use of benzodiazepines without additional 

anxiety diagnosis. Waiver submission should note if condition is combat-related, 

and, if so, comment on impact that return to theater could have on applicant wellbeing and performance.

8. Gender dysphoria, when distressing enough to require treatment. 

Transgender without history of, or current requirement for, transition, and not 

associated with significant gender dysphoria is not disqualifying and does not 

require waiver. Underlying behavioral health, endocrine, and/or surgical issues 

(as applicable) should be stable and resolved, and all Service requirements must 

be met, to include the involvement of, and clearance by, Service Central 

Coordination Cell if transition is required. Transitioning personnel’s treatment 

course should be complete, with DEERS marker change, and an adequate RealLife Experience (RLE) period should have occurred to ensure stability. Due to 

complex needs, those requiring or actively undergoing gender transition are 

generally disqualified until the process, including all necessary follow-up and 

stabilization, is completed.

9. Bulimia and anorexia nervosa. 

10. Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder 

(ADHD). Evaluation and diagnosis should be appropriate per DSM-5-TR criteria, 

particularly if Class II stimulants are used for treatment. Specific clinical features 

or objective testing results should be included in waiver application for stimulant 

use. Dosages for medications should likewise be appropriate and justified by 

clinical presentation.

11. Behavioral health hospitalization or non-suicidal directed violence (selfharm) within the last 12 months.

12. Suicidal Ideation or Suicide Attempt within the last 12 months is strictly 

disqualifying

13. Substance use causing social or occupational disruption or impairment, 

including enrollment in a substance abuse program (inpatient or outpatient, 

service specific substance abuse program) within the last 12 months, measured 

from time of discharge /completion of the program.

a. A post-treatment period of demonstrated stability is required, the length 

of which will depend on individual patient factors.
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

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b. Substance use disorders (SUD), not in remission and/or actively 

enrolled in Service Specific substance abuse programs are not eligible for 

waiver.

c. SUD requiring regular use of reversal agents or antagonists (Naloxone, 

Suboxone, Methadone) cannot be supported. Single-dose issuances of 

Naloxone are not intrinsically disqualifying but require clarification of 

underlying SUD issues.

d. Alcohol use disorder requiring pharmacotherapy for maintenance 

(Disulfiram, Naltrexone, Acamprosate) cannot be supported.

e. Alcohol use disorders requiring random testing or other monitoring are 

disqualifying.

14. Use of antipsychotics or anticonvulsants for stabilization DSM-5-TR

diagnoses.

15. Use of 3 or more psychotropics (e.g., antidepressants, anticonvulsants,

antipsychotics, benzodiazepines) for stabilization, or any psychotropics which 

require a psychiatrist or other specialist to manage to manage.

16. Behavioral health disorders without demonstrated clinical stability of at 

least 3 months, as defined by (1) no significant recent deterioration in clinical 

condition, (2) no significant impairment in work or interpersonal functioning, (3) 

no significant risk of sudden incapacitation should condition relapse or recur, (4) 

no morbid, suicidal, or homicidal ideation, intent or plan, and (5) likely to impact 

immediate family. Recent changes in treatment regimen, including 

discontinuation, should be explained and support clinical stability as above.

17. Behavioral health disorders newly diagnosed during deployment do not 

immediately require a waiver or redeployment. Disorders that are deemed 

treatable, stable, and having no impairment of performance or safety by a 

credentialed mental health provider do not require a waiver to remain in theater.

a. Exceptions include diagnoses featuring manic, psychotic, or 

significant suicidal features. These individuals should be redeployed at 

soonest opportunity via medical evacuation with appropriate escorts and 

per TRANSCOM guidelines.

b. Diagnoses requiring the prescription of CSA-scheduled controlled 

substances will require an approved waiver to obtain routine refills of 

medication.

H. Medications – Recently discontinued medications are considered to have had valid 

clinical indications and should include verification of control of underlying conditions and 

reason for cessation. Medications included as “PRN”, or as needed, must include a 

description of typical use. Any of the following medications (specific medication or class 

of medication) is disqualifying for deployment, unless a waiver is granted:

1. Any medication, which, if lost, misplaced, stolen, or destroyed, would result in

significant worsening or grave outcome for the affected individual before the 

medication could be reasonably replaced. 

2. Any medication requiring periodic laboratory monitoring, titrated dosing, or

special handling/storage requirements, or which has documented side effects, 
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when used alone or in combination with other required therapy, which are 

significantly impairing, or which impose an undue risk to the individual or 

operational objectives.

3. Blood modifiers:

a. Therapeutic Anticoagulants: warfarin (Coumadin), rivaroxaban 

(Xarelto), apixaban (Eliquis).

b. Platelet Aggregation Inhibitors or Reducing Agents: clopidogrel 

(Plavix), anagrelide (Agrylin), Dabigatran (Pradaxa), Aggrenox, Ticlid 

(Ticlopidine), Prasugrel (Effient), Pentoxifylline (Trental), Cilostazol 

(Pletal), Ticagrelor (Brilinta). Note: Aspirin use in theater is to be limited to 

individuals who have been advised to continue use by their healthcare 

provider for medical reasons; such use must be documented in the 

medical record.

c. Hematopoietics: filgrastim (Neupogen), sargramostim (Leukine),

erythropoietin (Epogen, Procrit).

d. Antihemophilics: Factor VIII, Factor IX, Factor Xa.

4. Antineoplastics (oncologic or non-oncologic use): e.g., antimetabolites 

(methotrexate, hydroxyurea, mercaptopurine, etc.), alkylators 

(cyclophosphamide, melphalan, chlorambucil, etc.), antiestrogens (tamoxifen, 

etc.), aromatase inhibitors (anastrozole, examestane, etc.), 

medroxyprogesterone (except use for contraception), interferons, etoposide, 

bicalutamide, bexarotene, oral tretinoin (Vesanoid).

5. Immunosuppressants: e.g., chronic systemic steroids.

6. Biologic Response Modifiers (immunomodulators): e.g., abatacept 

(Orencia), adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), 

infliximab (Remicade), leflunomide (Arava), azathioprine (Imuran), etc.

7. Any CSA Schedule I-V controlled substance, including but not limited to the 

following:

a. Benzodiazepines: lorazepam (Ativan), alprazolam (Xanax), diazepam

(Valium), flurazepam (Dalmane), clonazepam (Klonopin), etc.

b. Stimulants: methylphenidate (Ritalin, Concerta),

amphetamine/dextroamphetamine (Adderall), dextroamphetamine 

(Dexedrine), dexmethylphenidate (Focalin XR), lisdexamfetamine 

(Vyvanse), modafinil (Provigil), armodafinil (Nuvigil), etc.

c. Sedative Hypnotics/Amnestics: zolpidem (Ambien, Ambien CR), 

eszopiclone (Lunesta), zaleplon (Sonata), estazolam (Prosom), triazolam 

(Halcion), temazepam (Restoril), etc. Note: single pill-count issuances for 

operational transition do not generally require a waiver.

d. Narcotics/narcotic combinations: oxycodone (Oxycontin, Percocet, 

Roxicet), hydrocodone (Lortab, Norco, Vicodin), hydromorphone 

(Dilaudid), meperidine (Demerol), tramadol (Ultram), etc.

e. Cannabinoids: marijuana, tetrahydrocannabinol (THC), dronabinol 

(Marinol), cannabinol (CBD oil), etc. Note that possession or use may be 

a criminal offense in the SOUTHCOM AOR.

f. Anorexiants: phendimetrazine (Adipost), phentermine (Zantryl, AdipexP), etc.
Attachment B: MOD 3 AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR 

ENTRY TO THE SOUTHCOM AREA OF RESPONSIBILITY IAW SC Reg 40-501

13

g. Androgens and Anabolic Steroids: testosterone (Axiron, AndroGel, 

Fortesta, Testim), oxymetholone (Anadrol-50), methyltestosterone 

(Methitest), etc.

8. Antipsychotics, including atypical antipsychotics: haloperidol (Haldol), 

fluphenazine (Prolixin), quetiapine (Seroquel), aripiprazole (Abilify), lurasidone 

(Latuda), ziprasidone (Geodon), olanzapine (Zyprexa), etc.

9. Antimanic (bipolar disorder) agents: e.g., Lithium.

10. Anticonvulsants, used for seizure control or behavioral health

diagnoses.

a. Anticonvulsants (except those listed below) which are used for nonbehavioral health diagnoses, such as migraine, chronic pain, neuropathic 

pain, and post-herpetic neuralgia, are not intrinsically deployment-limiting 

if treated conditions meet the criteria set forth in this document. No waiver 

required. Exceptions include: Valproic acid (Depakote, Depakote ER, 

Depacon, divalproex, etc.). Carbamazepine (Tegretol, Tegretol XR, etc.).

Lamotrigine (Lamictal), 

11. Dopamine agonists: Ropinirole (Requip), pramipexole (Mirapex), etc.

12. Botulinum toxin (Botox): Current or recent use to control severe pain.

13. Insulin and exenatide (Byetta).

14. Injectable medications of any type require waiver, excluding 

medroxyprogesterone acetate (Depo-Provera). Strongly recommend requesting 

waiver over modifying route of administration when treatment is stable and 

effective.

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