Nephrocalcinosis?

What is Mylan 810 used for?

Mylan 810 is Hydrochlorothiazide 12.5 mg. It is a hypertensive/diuretic used to treat high blood pressure and swelling due to excess body water.

Distal renal tubular acidosis?

DefinitionDistal renal tubular acidosis is a disease that occurs when the kidneys don't remove acid properly into the urine, leaving the blood too acidic (called acidosis).Alternative NamesRenal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTACauses, incidence, and risk factorsYour kidneys normally regulate your body's pH by removing acids from the blood and discarding them into the urine.Distal renal tubular acidosis (Type I RTA) is caused by a defect in the kidney tubes that causes acid to build up in the bloodstream.Type I RTA is caused by a variety of conditions, including:AmyloidosisFabry diseaseSickle cell diseaseSjogren syndromeSystemic lupus erythematosusWilson diseaseUse of certain drugs such as amphotericin B, lithium, and analgesicsSymptomsConfusion or decreased alertnessFatigueImpaired growthIncreased breathing rateKidney stonesNephrocalcinosisOsteomalaciaRicketsMuscle weaknessOther symptoms can include:Bone painDecreased urine outputIncreased heart rate or irregular heartbeatMuscle crampsPain in the back, flank, or abdomenSkeletal abnormalitiesSigns and testsArterial blood gas and blood chemistries may suggest metabolic acidosis or electrolyte imbalances, most often low levels of potassium or bicarbonate.Other tests that may be done include:Urine pH, usually greater than 5.0 in patients with this conditionUrinalysis may show increased levels of calcium and potassiumTreatmentThe goal is to restore the normal pH (acid-base level) and electrolyte balance. This will indirectly correct bone disorders and reduce the risk of calcium buildup in the kidneys (nephrocalcinosis) and kidney stones. The underlying cause should be corrected if it can be identified.Alkaline medications such as potassium citrate and sodium bicarbonate correct the acidic condition of the body. Sodium bicarbonate may correct the loss of potassium and calcium.Vitamin D and calcium supplements are usually not given because there may be calcium deposits in the kidneys, even after bicarbonate therapy.Expectations (prognosis)The disorder must be treated to reduce its effects and complications, which can be permanent or life-threatening. Most cases get better with treatment.ComplicationsOsteomalaciaRicketsNephrocalcinosisKidney stonesElectrolyte imbalances, such as low blood potassium levelCalling your health care providerCall your health care provider if you have symptoms of distal renal tubular acidosis.Get help immediately if you develop emergency symptoms, such as:Decreased consciousnessSeizuresSevere decrease in alertness or orientationPreventionThere is no prevention for this disorder.ReferencesSeifter JL. Acid-base disorders. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 119.

Milk-alkali syndrome?

DefinitionMilk-alkali syndrome is an acquired condition in which there are high levels of calcium (hypercalcemia) and a shift in the body's acid/base balance towards alkaline (metabolic alkalosis).Causes, incidence, and risk factorsMilk-alkali syndrome is caused by excessive consumption of milk (which is high in calcium) and certain antacids, especially calcium carbonate or sodium bicarbonate (baking soda), over a long period of time.Calcium deposits in the kidneys and in other tissues can occur in milk-alkali syndrome. Consumption of excessive amounts of vitamin D, which is usually added to milk bought at the supermarket, can worsen this condition.In the past, milk-alkali syndrome was often a side effect of treating peptic ulcer disease with antacids containing calcium. It is rarely seen today, because newer, better medications are available for treating ulcers. A more common scenario today is when someone takes too much calcium carbonate in an attempt to prevent osteoporosis. This syndrome has been reported in persons who take as little as 2 grams of calcium per day.SymptomsThe condition usually has no symptoms (asymptomatic). When symptoms do occur, they are often related to complications, such as kidney problems.Symptoms include:Back, middle of the body, and loin pain (related to kidney stones)Excessive urinationFatigueNauseaOther problems that can result from kidney failureSigns and testsCalcium deposits within the tissue of the kidney (nephrocalcinosis) may be seen on:X-raysComputed tomography (CT scans)UltrasoundOther tests used to make a diagnosis:Electrolyte levelsKidney function blood testsBlood gasBlood calciumlevelTreatmentTreatment involves reducing or eliminating milk and other forms of calcium such as in antacids. If severe kidney failure has occurred, the damage may be permanent.Expectations (prognosis)This condition is often reversible if kidney function remains normal. Severe prolonged cases may lead to permanent kidney failure requiring dialysis.ComplicationsThe most common complications include:Calcium deposits in tissues (calcinosis)Kidney failureKidney stonesCalling your health care providerContact your health care provider if:You drink large amounts of milk and you often use antacids.You have any symptoms that might suggest kidney problems.PreventionMilk-alkali syndrome is now very uncommon because nonantacid treatments for indigestion, gastric ulcers, and peptic ulcer disease have replaced most excessive antacid use.If you do use antacids often, don't drink large amounts of milk, and tell your doctor about your digestive problems. If you are trying to prevent osteoporosis, do not take more than 1.5 grams of calcium per day.ReferencesWysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 266.

Hypercalcemia?

DefinitionHypercalcemia is too much calcium in the blood.Causes, incidence, and risk factorsCalcium is important to many body functions, including:Bone formationHormone releaseMuscle contractionNerve and brain functionParathyroid hormone (PTH) and vitamin D help manage calcium balance in the body. PTH is made by the parathyroid glands -- four small glands located in the neck behind the thyroid gland. Vitamin D is obtained when the skin is exposed to sunlight, and from dietary sources such as:Egg yolksFishFortified cerealsFortified dairy productsPrimary hyperparathyroidism is the most common cause of hypercalcemia. It is due to excess PTH release by the parathyroid glands. This excess occurs due to an enlargement of one or more of the parathyroid glands, or a growth (usually not cancer) on one of the glands.Other medical conditions can also cause hypercalcemia:Adrenal glandfailureBeing bedbound (or not being able to move) for a long period of timeCalcium excess in the diet (called milk-alkali syndrome, usually due to at least 2,000 milligrams of calcium per day)An inherited condition that affects the body's ability to regulate calcium (familial hypocalciuric hypercalcemia)HyperthyroidismKidney failureMedications such as lithium and thiazide diuretics (water pills)Some cancerous tumors (for example, lung cancers, breast cancer)Vitamin D excess (hypervitaminosis D) from diet or inflammatory diseasesHypercalcemia affects less than 1 percent of the population. The widespread ability to measure blood calcium since the 1960s has improved detection of the condition, and today most patients with hypercalcemia have no symptoms.Women over age 50 are most likely to have hypercalcemia, usually due to primary hyperparathyroidism.SymptomsAbdominal:ConstipationNauseaPainPoor appetiteVomitingKidney:Flank painFrequent thirstFrequent urinationMuscular:Muscle twitchesWeaknessPsychological:ApathyDementiaDepressionIrritabilityMemory lossSkeletal:Bone painBowing of the shouldersFractures due to disease (pathological fractures)Loss of heightSpinal column curvatureSigns and testsSerum calciumSerum PTHSerum PTHrP (PTH-related protein)Serum vitamin D levelUrine calciumTreatmentTreatment is directed at the cause of hypercalcemia whenever possible. In more severe cases of primary hyperparathyroidism, surgery may be needed to remove the abnormal parathyroid gland(s) and cure the hypercalcemia.However, if your hypercalcemia is mild and caused by primary hyperparathyroidism, your health care provider will most likely recommend that you not have surgery, but will monitor your condition closely over time.Severe hypercalcemia that causes symptoms and requires a hospital stay is treated with the following:CalcitoninDialysisDiuretic medication, such as furosemideDrugs that stop bone breakdown and absorption by the body, such as pamidronate or etidronate (bisphosphonates)Fluids through a vein (intravenous fluids)Glucocorticoids (steroids)Expectations (prognosis)How well you do depends on the cause of hypercalcemia. Patients with mild hyperparathyroidism or hypercalcemia with a treatable cause do well and do not have complications.Patients with hypercalcemia due to conditions such as cancer or granulomatous disease may not do well, but this is usually due to the disease itself, rather than the hypercalcemia.ComplicationsGastrointestinalPancreatitisPeptic ulcerdiseaseKidneyCalcium deposits in the kidney (nephrocalcinosis)DehydrationHigh blood pressureKidney failureKidney stonesPsychologicalDepressionDifficulty concentrating or thinkingSkeletalBone cystsFracturesOsteoporosisThe complications of long-term hypercalcemia are uncommon today.Calling your health care providerContact your physician or health care provider if you have:Family history of hypercalcemiaFamily history of hyperparathyroidismSymptoms of hypercalcemiaPreventionMost causes of hypercalcemia cannot be prevented. Women over age 50 should see their health care provider regularly and have their blood calcium level checked if they have symptoms of hypercalcemia.You can avoid hypercalcemia from calcium and vitamin D supplements by contacting your health care provider for advice about the dose if you are taking supplements without a prescription.ReferencesBringhurst R, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: Saunders Elsevier; 2008:chap 27.Wysolmerski JJ, Insogna KL. The parathyroid glands, hypercalcemia, and hypocalcemia. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 266.

How will the body respond to maintain acid- base balance If a strong acid is added to the extracellular fluid?

Normally pH remains relatively constant both outside and inside the cells. Alterations in the acid-base balance are resisted by extracellular and intracellular chemical buffers and by respiratory and renal regulation. In the first place, kidneys and blood buffers attempt to correct metabolic disorders and lungs attempt to correct respiratory disorders. (Brewer 1990) Buffering in blood and extracellular fluid occurs in minutes. Acid or base added to the body enter cells and bone slowly, over hours (Rhoades & Tanner 1995). In human body, respiratory compensation for a metabolic disorder begins within minutes and is complete in 12-24 hours. Metabolic compensation for respiratory disorder (increase of bicarbonate in respiratory acidosis and decrease of bicarbonate in respiratory alkalosis) occurs more slowly: it begins in hours and requires 2-5 days for completion (Brewer 1990). After the compensations, the state of acid-base disturbance can be considered as chronic. The change in pH in blood (produced when acid or base is added) is minimized by chemical buffers, but they do not entirely prevent the pH change (Rhoades & Tanner 1995). In fact, in a disturbance of the acid-base balance, neither buffers nor the respiratory or renal systems are completely successful in correcting pH until the underlying reason for the disorder has been removed (Brewer 1990). A normal adult produces about 300 liters of CO2 daily from the metabolism of foodstuffs. In the blood, CO2 reacts with water to form carbonic acid, which dissociates to H+ and HCO3-. In the lung capillaries they are converted back to CO2 and water and the CO2 is expired. (Rhoades & Tanner 1995). As a secondary respiratory compensation, the lungs react to metabolic acidosis and alkalosis. Metabolic acidosis stimulates breathing causing hyperventilation while metabolic alkalosis suppresses it. These are attempts to correct pH by changing the concentration of carbon dioxide and carbonic acid in the blood. (Rhoades & Tanner 1995) Oxidation of proteins and amino acids produces strong acids, like sulfuric, hydrochloric, and phosphoric acids, in the normal metabolism. These and other non-carbonic (non-volatile) acids are buffered in the body and must then be excreted by the kidneys (Rhoades & Tanner 1995). The most important extracellular buffer is bicarbonate, which usually buffers these non-volatile acids. The kidneys regenerate the bicarbonate used in buffering by excreting hydrogen ions in the urine as ammonium and titratable acids (Brewer 1990). Other major chemical pH buffers in the body are inorganic phosphate and plasma proteins in the extracellular fluid, cell proteins, organic phosphates and bicarbonate in the intracellular fluid, and mineral phosphates and mineral carbonates in bone (Rhoades & Tanner 1995). The kidneys have two important roles in the maintaining of the acid-base balance: to reabsorb bicarbonate from and to excrete hydrogen ions into urine. 4500 mmol of bicarbonate are filtered into the primary filtrate of urine daily, but only 2 mmol of it are finally excreted. 70-80% of bicarbonate is reabsorbed in the first part of proximal tubule, 10-20% in the loop of Henle and 5-10% in the distal tubule and collecting ducts. (Jalanko & Holmberg 1998) Carbonic anhydrase plays an important role in the reabsorption in the proximal tubule. Disturbance in the reabsorption of bicarbonate in the proximal tubule leads to metabolic acidosis, hyperchloremia and alkalotic urine. This disease is named as "type II renal tubular acidosis" (N25.8). (Jalanko & Holmberg 1998) Renal tubules actively secrete hydrogen ions. Most of this takes place in the distal part of the nephron, but active transport of hydrogen ions occurs in the proximal tubule, too. The H-ATPase of the apical cell membrane secretes hydrogen ions into urine. For each hydrogen ion secreted, one bicarbonate molecule is transported to the interstitial fluid, from there it diffuses into the bloodstream. Fifty mmol of hydrogen ions are normally excreted daily. (Jalanko & Holmberg 1998) If the hydrogen ions are not properly secreted into the collecting ducts, the result is metabolic acidosis, hypokalemia, hypocalcemia, nephrocalcinosis and an alkalotic urine. This disease is called "type I renal tubular acidosis" (N25.8). (Jalanko & Holmberg 1998) The maximal hydrogen ion gradient, against which the transport mechanism can secrete H+ ions, corresponds to a urine pH of 4.5 in humans. However, three important molecules remove free hydrogen ions from the tubular fluid permitting more acid to be secreted: H+ is bound to ammonia, phosphate and bicarbonate to form NH4+, H2PO4-, CO2 and H2O. (Ganong 1991) The source of the hydrogen ions secreted by the tubular cells is not completely certain. It is probably produced by dissociation of H2CO3. The acid-secreting cells contain carbonic anhydrase, which facilitates the rapid formation of H2CO3 from CO2 and water. The renal acid secretion is mainly regulated by the changes in the intracellular pCO2, potassium concentration, carbonic anhydrase activity and adrenocortical hormone concentration. (Ganong 1991)

How does the body balance acid and base levels?

In the body, the bicarbonate buffering system is important because it maintains the acid-base homeostasis. In the bicarbonate buffering system, the balance between carbonic acid and bicarbonate is achieved by regulating the hydrogen ion and hydroxide ion concentrations, which can help to keep blood pH of the body at 7.4.

What are the treatments for hypercalcemia?

For those who do NOT know what Hypercalcemia is, let's start with the basics:Hypercalcemia is a condition that is caused by the elevation of calcium (Ca) in the blood; this elevation is due to high concentrations of calcium in the blood's serum. Calcium concentrations in amounts of 12.0 mg/dL or higher can be life threatening, the elevation of calcium in these amounts require urgent treatment. (Normal blood calcium levels are 9.5-10.5 mg/dL.)Initially, there may be little or no symptoms (asymptomatic) of elevated blood calcium levels. In the beginning, symptoms are often nonspecific and worsen as blood calcium levels rise; symptoms may consist of fatigue/lethargy; irregular heart-rate; visual disturbances; increased urination; Natriuresis (loss of sodium through urination); thirst; nausea/vomiting; anorexia; pancreatitis; stomach cramps/pain; constipation; confusion; erratic/usual behavior; depression; hallucinations; delirium; even renal failure. However, more serious symptoms are seizures/convulsions, coma, and heart failure, which can result in death. Women over the age of 50 are most often affected, but anyone, at any age can be affected. (Hypercalcemia is NOT limited to the human population; cats and dogs can also be affected with this condition. The symptoms of hypocalcemia in animals are even less noticeable in animals; they don't complain or show pain; in fact, in nature they tend to hide their pain, a form of protection, thereby protecting them from other animal attacks. In animals, hypercalcemia symptoms may NOT be treated or cared for, over an extended period of time; thereby, death is more apt to be the resulting outcome of many untreated hypercalcemia cases.)Some causes for Hypercalcemia:Thiazide diuretics can cause a rise in blood calcium levels; other causes are kidney stones; a build-up of calcium in the kidney (Nephrocalcinosis); abnormal function of the parathyroid gland (Paget's disease), which raises the level of the parathyroid hormone causing hyperparathyroidism and primary hyperparathyroidism; gout; being immobilized for extended periods of time; familial hypocalciuric hypercalcemia (a genetic disorder); vitamin D intoxication (toxicity caused by vitamin D2 - ergocalciferol and vitamin D3 - cholecalciferol); high blood-pressure; not drinking enough fluids (dehydration); Granulomatous diseases; parathyroid tumors; HIV/Aids; Addison's disease, and more. However, most often Hypercalcemia is associated with forms of malignancies (types of cancers/ tumors are kidney; hematological; leukemia; myeloma; breast; pulmonary; prostate; bladder; colon; stomach; spinal; neck; liver; spleen…). Hypercalcemia that is caused by a malignancy is hard to treat, without treating the cancer too.Malignancies and primary hyperparathyroidism are responsible for more than 80-90% of hypercalcemia cases. Some cases of hypocalcemia are caused by forms of nonlymphoid neoplasm and varied forms of inoperable carcinomas. Another common cause of hypercalcemia is the over production of the parathyroid hormone which results in hyperparathyroidism. Hypercalcemia resulting from a bone malignancy causes the blood's calcium level to rise; this results as the bone(s) breaks down and dissolves as the calcium is leached from the bone into the blood.Now your question is how is hypercalcemia corrected? I assume by "corrected," you mean emergency treatments and preventative treatments.Treatments for Hypercalcemia in the more acute stages:Hypercalcemia in its more dangerous stages requires hospitalization and symptomatic treatment. Medications are used to lower the body's calcium level; enzyme therapy for Pancreatitis (pancreatic secretory block/Celiac plexus blocks); as well as, managing the side effects caused by some forms of the treatments. Other treatments may include Dialysis; Saline infusion; I.V. Diuretics; Calcitonin; I.V. or oral Etidronate Disodium… (Treating hypercalcemia with diuretics can adversely affect potassium levels, thereby causing serious health effects (excess potassium loss can be life threatening). Some treatments may require the use of a potassium-protecting diuretic, which is used to prevent potassium loss.)The most important treatment for Hypercalcemia is prevention:Prevention should start with an accurate diagnosis, finding its precise underlying cause, and follow-up with an appropriate preventive treatment. Treatment should include diet changes and regulation, diet can be used as a preventive or to remove excess calcium that is already in the system. It can also help prevent and treat excessive amounts of vitamin D, i.e., resulting in vitamin D intoxication which has an effect on hypercalcemia. Over-exposure to sunlight/ultraviolet light can also cause a harmful rise in vitamin D levels; it has the same effect as taking excessive vitamin D supplements. But over-exposure to sunlight/ultra violet light has an additional risk, which may cause melanoma or other forms of skin cancers/malignancies. Hemodialysis can be used to remove excess amounts of calcium and vitamin D from the blood. Also avoiding excessive calcium supplements, calcium based antacids… by those who are susceptible to hypercalcemia attacks.Medication can be beneficial in preventing future attacks; treating chronic hypercalcemia; minor flare-ups; or treating those with a family history of hypercalcemia:Prescriptions drugs can help prevent hypercalcemia attacks in those suffering from on-going chronic high blood calcium levels. Treatments may include the use of diuretic medications -- Furosemide (Delone, Lasix, Lo-Aqua, Furocot); Torsemide (Demadex); Methyclothiazide (Aquatensen, Enduron); Bumetanide (Bumex)... can be useful. Other medications used are Zolendronic acid (Reclast, Zometa, Zomera, Aclasta); Pamidronate (Aredia)… Additional treatments used for hypercalcemia may be associated with malignancies/cancers - Pyrophosphoric acid (Bisphosphonate, Diphosphonate) drugs used to avert the loss of bone mass; and drugs that are used to alleviate symptoms or to increase fluids (hydration) in the body. There is a new treatment for Hypercalcemia; this treatment is called Continuous Arteriovenous Hemofiltration Dialysis (CAVH); this procedure can assist in the support of renal failure and its management. Continuous Arteriovenous Hemofiltration Dialysis is also used removing toxins; waste produces; excess amounts calcium; heavy metals; removing excess medications… from the blood.Hypercalcemia probably means to much calcium. I would say the drug of choice is some sort of acid to leach the calcium out.The above answer is absolutely incorrect, other than the fact that Hypercalcemia does mean too much Calcium in the blood. Hypercalcemia is typically caused by hyperparathyroidism which is often times caused by an enlargement of one or more of the parathyroid glands in the neck, situated behind the thyroid gland.The ONLY way to cure hyperparathyroidism and thus, bring calcium levels back to normal, is to have a parathyroidectomy.

What are the Medical Disqualifications for boot camp?

The list of Medical DQ's is long and detailed, and in the end, anything besides being pretty healthy these days will get you DQ'd, even if it's not on the list. All branches are overstaffed, so recruit selection is at a premium, meaning they can pick and choose the best and healthiest of applicants. The Army recently started discharging overweight personnel, as an example.Below is a general list of the most common Medical DQ's, though for most people it's the legal DQ's that ultimately disqualify them, or a combination. This informatoin is from the Army's "Standards of Medical Fitness", though they generally apply to all military service branches, with a few exceptions for the Navy and Marines, which have more stringent requirements for some personnel qualifications. Note that while these aren't permanently disqualifying (there are waivers for anything), they typically are, particularly in a recruiting climate such as currently exists.Thanks and credit goes to the great people at Military.com for making this available.Abdominal organs and gastrointestinal systemThe causes for rejection for appointment, enlistment, and induction are an authenticated history of:a. Esophagus. Ulceration, varices, fistula, achalasia, or other dismotility disorders; chronic or recurrent esophagitis if confirmed by appropriate x-ray or endoscopic examination.b. Stomach and duodenum.(1) Gastritis. Chronic hypertrophic, or severe.(2) Active ulcer of the stomach or duodenum confirmed by x-ray or endoscopy.(3) Congenital abnormalities of the stomach or duodenum causing symptoms or requiring surgical treatment, except a history of surgical correction of hypertrophic pyloric stenosis of infancy.c. Small and large intestine.(1) Inflammatory bowel disease. Regional enteritis, ulcerative colitis, ulcerative proctitis.(2) Duodenal diverticula with symptoms or sequelae (hemorrhage, perforation, etc.).(3) Intestinal malabsorption syndromes, including postsurgical and idiopathic.(4) Congenital. Condition, to include Meckel's diverticulum or functional abnormalities, persisting or symptomatic within the past 2 years.d. Gastrointestinal bleeding. History of, unless the cause has been corrected, and is not otherwise disqualifying.e. Hepato-pancreatic-biliary tract.(1) Viral hepatitis, or unspecified hepatitis, within the preceding 6 months or persistence of symptoms after 6 months, or objective evidence of impairment of liver function, chronic hepatitis, and hepatitis B carriers. (Individuals who are known to have tested positive for hepatitis C virus (HCV) infection require confirmatory testing. If positive, individuals should be clinically evaluated for objective evidence of liver function impairment. If evaluation reveals no signs or symptoms of disease, the applicant meets the standards.)(2) Cirrhosis, hepatic cysts and abscess, and sequelae of chronic liver disease.(3) Cholecystitis, acute or chronic, with or without cholelithiasis, and other disorders of the gallbladder including post-cholecystectomy syndrome, and biliary system.Note. Cholecystectomy is not disqualifying 60 days postsurgery (or 30 days post-laproscopic surgery), providing there are no disqualifying residuals from treatment.(4) Pancreatitis. Acute and chronic.f. Anorectal.(1) Anal fissure if persistent, or anal fistula.(2) Anal or rectal polyp, prolapse, stricture, or incontinence.(3) Hemorrhoids, internal or external, when large, symptomatic, or history of bleeding.g. Spleen.(1) Splenomegaly, if persistent.(2) Splenectomy, except when accomplished for trauma, or conditions unrelated to the spleen, or for hereditary spherocytosis.h. Abdominal wall.(1) Hernia, including inguinal, and other abdominal, except for small, asymptomatic umbilical or asymptomatic hiatal.(2) History of abdominal surgery within the preceding 60 days, except that individuals post-laparoscopic cholecystectomy may be qualified after 30 days.i. Other.(1) Gastrointestinal bypass or stomach stapling for control of obesity.(2) Persons with artificial openings.Blood and blood-forming tissue diseasesThe causes for rejection for appointment, enlistment, and induction are an authenticated history of:a. Anemia. Any hereditary acquired, aplastic, or unspecified anemia that has not permanently corrected with therapy.b. Hemorrhagic disorders. Any congenital or acquired tendency to bleed due to a platelet or coagulation disorder.c. Leukopenia. Chronic or recurrent, based upon available norms for ethnic background.d. Immunodeficiency.DentalThe causes for rejection are for appointment, enlistment, and induction are:a. Diseases of the jaw or associated tissues which are not easily remediable, and will incapacitate the individual or otherwise prevent the satisfactory performance of duty. This includes temporomandibular disorders and/or myofascial pain dysfunction that is not easily corrected or has the potential for significant future problems with pain and function.b. Severe malocclusion that interferes with normal mastication or requires early and protracted treatment; or relationship between mandible and maxilla that prevents satisfactory future prosthodontic replacement.c. Insufficient natural healthy teeth or lack of a serviceable prosthesis, preventing adequate mastication and incision of a normal diet. This includes complex (multiple fixture) dental implant systems that have associated complications that severely limit assignments and adversely affect performance of world-wide duty. Dental implants systems must be successfully osseointegrated and completed.d. Orthodontic appliances for continued treatment (attached or removable). Retainer appliances are permissible, provided all active orthodontic treatment has been satisfactorily completed.EarsThe causes for rejection for appointment, enlistment, and induction are:a. External ear. Atresia or severe microtia, acquired stenosis, severe chronic or acute otitis externa, or severe traumatic deformity.b. Mastoids. Mastoiditis, residual of mastoid operation with fistula, or marked external deformity that prevents or interferes with wearing a protective mask or helmet.c. Meniere's Syndrome. Or other diseases of the vestibular system.d. Middle and inner ear. Acute or chronic otitis media, cholesteatoma, or history of any inner or middle ear surgery excluding myringotomy or successful tympanoplasty.e. Tympanic membrane. Any perforation of the tympanic membrane, or surgery to correct perforation within 120 days of examination.HearingThe cause for rejection for appointment, enlistment, and induction is a hearing threshold level greater than that described in paragraph c below.a. Audiometers, calibrated to standards of the International Standards Organization (ISO 1964) or the American National Standards Institute (ANSI 1996), will be used to test the hearing of all applicants.b. All audiometric tracings or audiometric readings recorded on reports of medical examination or other medical records will be clearly identified.c. Acceptable audiometric hearing levels (both ears) are:(1) Pure tone at 500, 1000, and 2000 cycles per second of not more than 30 decibels (dB) on the average (each ear), with no individual level greater than 35dB at these frequencies.(2) Pure tone level not more than 45 dB at 3000 cycles per second each ear, and 55 dB at 4000 cycles per second each ear.Endocrine and metabolic disordersThe causes for rejection for appointment, enlistment, and induction are an authenticated history of:a. Adrenal dysfunction of any degree.b. Diabetes mellitus of any type.c. Glycosuria. Persistent, when associated with impaired glucose tolerance or renal tubular defects.d. Acromegaly. Gigantism or other disorder of pituitary function.e. Gout.f. Hyperinsulinism.g. Hyperparathyroidism and hypoparathyroidism.h. Thyroid disorders.(1) Goiter, persistent or untreated.(2) Hypothyroidism, uncontrolled by medication.(3) Cretinism.(4) Hyperthyroidism.(5) Thyroiditis.i. Nutritional deficiency diseases. Such diseases include beriberi, pellagra, and scurvy.j. Other endocrine or metabolic disorders such as cystic fibrosis, porphyria, and amyloidosis that obviously prevent satisfactory performance of duty or require frequent or prolonged treatment.Upper extremitiesThe causes for rejection for appointment, enlistment, and induction are:a. Limitation of motion. An individual will be considered unacceptable if the joint ranges of motion are less than the measurements listed below.(1) Shoulder:(a) Forward elevation to 90 degrees.(b) Abduction to 90 degrees.(2) Elbow:(a) Flexion to 100 degrees.(b) Extension to 15 degrees.(3) Wrist: a total range of 60 degrees (extension plus flexion) or radial and ulnar deviation combined arc 30 degrees.(4) Hand:(a) Pronation to 45 degrees.(b) Supination to 45 degrees.(5) Fingers and thumb: inability to clench fist, pick up a pin, grasp an object, or touch tips of at least three fingers with thumb.b. Hand and fingers.(1) Absence of the distal phalanx of either thumb.(2) Absence of distal and middle phalanx of an index, middle, or ring finger of either hand, irrespective of the absence or loss of little finger.(3) Absence of more than the distal phalanx of any two of the following fingers: index, middle finger, or ring finger of either hand.(4) Absence of hand or any portion thereof except for fingers as noted above.(5) Polydactyly.(6) Scars and deformities of the fingers or hand that are symptomatic or that impair normal function to such a degree as to interfere with the satisfactory performance of military duty.(7) Intrinsic paralysis or weakness, including nerve palsy sufficient to produce physical findings in the hand such as muscle atrophy or weakness.(8) Wrist, forearm, elbow, arm, or shoulder. Recovery from disease or injury with residual weakness or symptoms such as to preclude satisfactory performance of duty, or grip strength of less than 75 percent of predicted normal when injured hand is compared with the normal hand (non-dominant is 80 percent of dominant grip).Lower extremitiesThe causes for rejection for appointment, enlistment, and induction are:a. Limitation of motion. An individual will be considered unacceptable if the joint ranges of motion are less that the measurements listed below.(1) Hip (due to disease, injury):(a) Flexion to 90 degrees.(b) No demonstrable flexion contracture.(c) Extension to 10 degrees (beyond 0 degrees).(d) Abduction to 45 degrees.(e) Rotation of 60 degrees (internal and external combined).(2) Knee (due to disease, injury):(a) Full extension compared with contralateral.(b) Flexion to 90 degrees.(3) Ankle (due to disease, injury):(a) Dorsiflexion to 10 degrees.(b) Planter flexion to 30 degrees.(4) Subtalar (due to disease or injury): eversion and inversion (total to 5 degrees).b. Foot and ankle.(1) Absences of one or more small toes if function of the foot is poor or running or jumping is prevented; absence of a foot or any portion thereof except for toes.(2) Absence of great toe(s); loss of dorsal/plantar flexion if function of the foot is impaired.(3) Deformities of the toes, either acquired or congenital, including polydactyly, that prevent wearing military footwear or impair walking, marching, running, or jumping. This includes hallux valgus.(4) Clubfoot or Pes Cavus, if stiffness or deformity prevents foot function or wearing military footwear.(5) Symptomatic pes planus, acquired or congenital or pronounced cases, with absence of subtalar motion.(6) Ingrown toenails, if severe.(7) Planter fascitis, persistent.(8) Neuroma, confirmed condition and refractory to medical treatment or will impair function of the foot.c. Leg, knee, thigh, and hip.(1) Loose or foreign bodies within the knee joint.(2) Physical findings of an unstable or internally deranged joint. History of uncorrected anterior or posterior cruciate ligament injury.(3) Surgical correction of any knee ligaments if symptomatic or unstable.(4) History of congenital dislocation of the hip, osteochondritis of the hip (Legg-Perthes disease), or slipped femoral epiphysis of the hip.(5) Hip dislocation within 2 years before examination.(6) Osteochondritis of the tibial tuberosity (Osgood-Schlatter disease), if symptomatic.d. General.(1) Deformities, disease or chronic pain of one or both lower extremities that have interfered with function to such a degree as to prevent the individual from following a physically active vocation in civilian life or that would interfere with walking, running, or weight bearing, or the satisfactory completion of prescribed training or military duty.(2) Shortening of a lower extremity resulting in a noticeable limp or scoliosis.Miscellaneous conditions of the extremitiesThe causes for rejection for appointment, enlistment, and induction are an authenticated history of:a. Arthritis.(1) Active, subacute, or chronic arthritis.(2) Chronic osteoarthritis or traumatic arthritis of isolated joints of more than a minimal degree, which has interfered with the following of a physically active vocation in civilian life or that prevents the satisfactory performance of military duty.b. Chronic Retro Patellar Knee Pain Syndrome with or without confirmatory arthroscopic evaluation.c. Dislocation if unreduced, or recurrent dislocations of any major joint such as shoulder, hip, elbow, or knee; or instability of any major joint such as shoulder, elbow, or hip.d. Fractures.(1) Malunion or non-union of any fracture, except ulnar styloid process.(2) Orthopedic hardware, including plates, pins, rods, wires, or screws used for fixation and left in place; except that a pin, wire, or screw not subject to easy trauma is not disqualifying.e. Injury of a bone or joint of more than a minor nature, with or without fracture or dislocation, that occurred within the preceding 6 weeks: upper extremity, lower extremity, ribs and clavicle.f. Joint replacement.g. Muscular paralysis, contracture, or atrophy, if progressive or of sufficient degree to interfere with military service and muscular dystrophies.h. Osteochondritis dessicans.i. Osteochondromatosis or Multiple Cartilaginous Exostoses.j. Osteoporosis.k. Osteomyelitis, active or recurrent.l. Scars, extensive, deep, or adherent to the skin and soft tissues that interfere with muscular movements.m. Implants, silastic or other devices implanted to correct orthopedic abnormalities.EyesThe causes for rejection for appointment, enlistment, and induction are:a. Lids.(1) Blepharitis, chronic, of more than mild degree.(2) Blepharospasm.(3) Dacryocystitis, acute or chronic.(4) Deformity of the lids, complete or extensive, sufficient to interfere with vision or impair protection of the eye from exposure.b. Conjunctiva.(1) Conjunctivitis, chronic, including trachoma and allergic conjunctivitis.(2) Pterygium, if encroaching on the cornea in excess of 3 millimeters (mm), interfering with vision, progressive, or recurring after two operative procedures.(3) Xerophthalmia.c. Cornea.(1) Dystrophy, corneal, of any type, including keratoconus of any degree.(2) Keratorefractive surgery, history of lamellar and/or penetrating keratoplasty. Laser surgery or appliance utilized to reconfigure the cornea is also disqualifying.(3) Keratitis, acute or chronic, which includes recurrent corneal ulcers, erosions (abrasions), or herpetic ulcers.(4) Vascularization or opacification of the cornea from any cause that is progressive or reduces vision below the standards prescribed below.d. Uveitis or iridocyclitis.e. Retina.(1) Angiomatosis, or other congenitohereditary retinal dystrophy that impairs visual function.(2) Chorioretinitis or inflammation of the retina, including histoplasmosis, toxoplasmosis, or vascular conditions of the eye to include Coats' disease, Eales' disease, and retinitis proliferans, unless a single episode of known cause that has healed and does not interfere with vision.(3) Congenital or degenerative changes of any part of the retina.(4) Detachment of the retina, history of surgery for same, or peripheral retinal injury or degeneration that may cause retinal detachment.f. Optic nerve.(1) Optic neuritis, neuroretinitis, secondary optic atrophy, or documented history of attacks of retrobulbar neuritis.(2) Optic atrophy, or cortical blindness.(3) Papilledema.g. Lens.(1) Aphakia, lens implant, or dislocation of a lens.(2) Opacities of the lens that interfere with vision or that are considered to be progressive.h. Ocular mobility and motility.(1) Diplopia, documented, constant or intermittent.(2) Nystagmus.(3) Strabismus, uncorrectable by lenses to less than 40 diopters or accompanied by diplopia.(4) Strabismus, surgery for the correction of, within the preceding 6 months.(5) For entrance into the USMA or ROTC programs, the following conditions are also disqualifying: esotropia of over 15 prism diopters; exotropia of over 10 prism diopters; hypertropia of over 5 prism diopters.i. Miscellaneous defects and conditions.(1) Abnormal visual fields due to disease of the eye or central nervous system, or trauma. Meridian-specific visual field minimums are as follows:(a) Temporal, 85 degrees.(b) Superior-temporal, 55 degrees.(c) Superior, 45 degrees.(d) Superior nasal, 55 degrees.(e) Nasal, 60 degrees.(f) Inferior nasal, 50 degrees.(g) Inferior, 65 degrees.(h) Inferior-temporal, 85 degrees.(2) Absence of an eye, congenital or acquired.(3) Asthenopia, severe.(4) Exophthalmos, unilateral or bilateral, non-familial.(5) Glaucoma, primary, or secondary, or pre-glaucoma as evidenced by intraocular pressure above 21 millimeters of mercury (mmHg), or the secondary changes in the optic disc or visual field loss associated with glaucoma.(6) Loss of normal pupillary reflex reactions to accommodation or light, including Adie's syndrome.(7) Night blindness.(8) Retained intraocular foreign body.(9) Growth or tumors of the eyelid, other than small basal cell tumors which can be cured by treatment, and small nonprogressive asymptomatic benign lesions.(10) Any organic disease of the eye or adnexa not specified above, that threatens vision or visual function.VisionThe causes for rejection for appointment, enlistment, and induction are:a. Distant visual acuity of any degree that does not correct with spectacle lenses to at least one of the following:(1) 20/40 in one eye and 20/70 in the other eye.(2) 20/30 in one eye and 20/100 in the other eye.(3) 20/20 in one eye and 20/400 in the other eye. However, for entrance into USMA or ROTC, distant visual acuity that does not correct to 20/20 in one eye and 20/40 in the other eye is disqualifying. For entrance into OCS, distant visual acuity that does not correct to 20/20 in one eye and 20/100 in the other eye is disqualifying.b. Near visual acuity of any degree that does not correct to 20/40 in the better eye.c. Refractive error (hyperopia, myopia, astigmatism), in any spherical equivalent of worse than -8.00 or +8.00 diopters; if ordinary spectacles cause discomfort by reason of ghost images or prismatic displacement; or if corrected by orthokeratology or keratorefractive surgery. However, for entrance into USMA or Army ROTC programs, the following conditions are disqualifying:(1) Astigmatism, all types over 3 diopters.(2) Hyperopia over 8.00 diopters spherical equivalent.(3) Myopia over 8 diopters spherical equivalent.(4) Refractive error corrected by orthokeratology or keratorefractive surgery.d. Contact lenses. Complicated cases requiring contact lenses for adequate correction of vision, such as corneal scars and irregular astigmatism.e. Color vision. Although there is no standard, color vision will be tested because adequate color vision is a prerequisite for entry into many military specialties. However, for entrance into the USMA or Army ROTC or OCS programs, the inability to distinguish and identify without confusion the color of an object, substance, material, or light that is uniformly colored a vivid red or vivid green is disqualifying.GenitaliaThe causes for rejection for appointment, enlistment, and induction are:a. Female genitalia.(1) Abnormal uterine bleeding, including menorrhagia, metrorrhagia, or polymenorrhea.(2) Amenorrhea, unexplained.(3) Dysmenorrhea, incapacitating to a degree recurrently necessitating absences of more than a few hours from routine activities.(4) Endometriosis.(5) Hermaphroditism.(6) Menopausal syndrome, if manifested by more than mild constitutional or mental symptoms, or artificial menopause if less than 1 year's duration.(7) Ovarian cysts, persistent, clinically significant.(8) Pelvic inflammatory disease, acute or chronic.(9) Pregnancy.(10) Uterus, congenital absence of, or enlargement due to any cause.(11) Vulvar or vaginal ulceration, including herpes genitalia and condyloma acuminatum, acute or chronic, not amenable to treatment. Such treatment must be given and demonstrated effective prior to accession.(12) Abnormal Pap smear graded LGSIL or higher severity, or any smear in which the descriptive terms carcinoma-in-situ, invasive cancer, condyloma acuminatum, human papilloma virus, or dysplasia are used.(13) Major abnormalities and defects of the genitalia such as a change of sex. A history thereof, or dysfunctional residuals from surgical correction of these conditions.b. Male genitalia.(1) Absence of both testicles, either congenital, or acquired, or unexplained absence of a testicle.(2) Epispadias or Hypospadias, when accompanied by evidence of infection of the urinary tract, or if clothing is soiled when voiding.(3) Undiagnosed enlargement or mass of testicle or epididymis.(4) Undescended testicle(s).(5) Orchitis, acute or chronic epididymitis.(6) Penis, amputation of, if the resulting stump is insufficient to permit normal micturition.(7) Penile infectious lesions, including herpes genitalis and condyloma acuminata, acute or chronic, not amenable to treatment. Such treatment must be given and demonstrated effective prior to accession.(8) Prostatitis, acute or chronic.(9) Hydrocele. Left varicocele, if painful, or any right varicocele.c. Major abnormalities and defects of the genitalia, such as a change of sex, a history thereof, or dysfunctional residuals from surgical correction of these conditions.Urinary systemThe causes for rejection for appointment, enlistment, and induction are:a. Cystitis.b. Urethritis.c. Enuresis or incontinence of urine beyond age 12.d. Hematuria, pyuria, or other findings indicative of renal tract disease.e. Urethral stricture or fistula.f. Kidney.(1) Absence of one kidney, congenital or acquired.(2) Infections, acute or chronic.(3) Polycystic kidney, confirmed history of.(4) Horseshoe kidney.(5) Hydronephrosis.(6) Nephritis, acute or chronic.g. Proteinuria under normal activity (at least 48 hours after strenuous exercise) greater than 200 milligrams (mg)/24 hours, or a protein to creatinine ratio greater than 0.2 in a random urine sample, unless nephrologic consultation determines the condition to be benign orthostatic proteinuria.h. Renal calculus within the previous 12 months, recurrent calculus, nephrocalcinosis, or bilateral renal calculi at any time.HeadThe causes for rejection for appointment, enlistment, and induction are:a. Injuries, including severe contusions and other wounds of the scalp and cerebral concussion, until a period of 3 months has elapsed.b. Deformities of the skull, face, or jaw of a degree that would prevent the individual from wearing a protective mask or military headgear.c. Defects, loss or congenital absence of the bony substance of the skull not successfully corrected by reconstructive materials, or leaving residual defect in excess of 1 square inch (6.45 centimeter (cm) 2 ) or the size of a 25 cent piece.NeckThe causes for rejection for appointment, enlistment, and induction are:a. Cervical ribs, if symptomatic or so obvious that they are found on routine physical examination. (Detection based primarily on x-rays is not considered to meet this criterion.)b. Congenital cysts of branchial cleft origin or those developing from remnants of the thyroglossal duct, with or without fistulous tracts.c. Contraction of the muscles of the neck, spastic or non-spastic, or cicatricial contracture of the neck to the extent that it interferes with wearing a uniform or military equipment or is so disfiguring as to impair military bearing.HeartThe causes for rejection for appointment, enlistment, and induction are:a. All valvular heart diseases, congenital or acquired, including those improved by surgery except mitral valve prolapse and bicuspid aortic valve. These latter two conditions are not reasons for rejection unless there is associated tachyarrhythmia, mitral regurgitation, aortic stenosis, insufficiency, or cardiomegaly.b. Coronary heart disease.c. Symptomatic arrhythmia (or electrocardiographic evidence of arrhythmia), history of.(1) Supraventricular tachycardia, or any dysrhythmia originating from the atrium or sinoatrial node, such as atrial flutter, and atrial fibrillation, unless there has been no recurrence during the preceding 2 years while off all medications. Premature atrial or ventricular contractions are disqualifying when sufficiently symptomatic to require treatment or result in physical or psychological impairment.(2) Ventricular arrhythmias, including ventricular fibrillation, tachycardia, and multi focal premature ventricular contractions. Occasional asymptomatic premature ventricular contractions are not disqualifying.(3) Ventricular conduction disorders, left bundle branch block, Mobitz type II second degree atrioventricular (AV) block, and third degree AV block. Wolff-Parkinson-White Syndrome and Lown-Ganong-Levine-Syndrome associated with an arrhythmia are also disqualifying.(4) Conduction disturbances such as first degree AV block, left anterior hemiblock, right bundle branch block, or Mobitz type I second degree AV block are disqualifying when symptomatic or associated with underlying cardiovascular disease.d. Hypertrophy or dilatation of the heart.e. Cardiomyopathy, including myocarditis, or history of congestive heart failure even though currently compensated.f. Pericarditis.g. Persistent tachycardia (resting pulse rate of 100 or greater).h. Congenital anomalies of heart and great vessels, except for corrected patent ductus arteriosus.Vascular systemThe causes for rejection for appointment, enlistment, and induction are:a. Abnormalities of the arteries and blood vessels, including aneurysms, even if repaired, atherosclerosis, or arteritis.b. Hypertensive vascular disease, evidenced by the average of three consecutive diastolic blood pressure measurements greater than 90 mmHg or three consecutive systolic pressure measurements greater than 140 mmHg. High blood pressure requiring medication or a history of treatment including dietary restriction.c. Pulmonary or systemic embolization.d. Peripheral vascular disease, including Raynaud's phenomenon.e. Vein diseases, recurrent thrombophlebitis, thrombophlebitis during the preceding year, or any evidence of venous incompetence, such as large or symptomatic varicose veins, edema, or skin ulceration.HeightThe causes for rejection for appointment, enlistment, and induction are:a. Men: Height below 60 inches or over 80 inches.b. Women: Height below 58 inches or over 80 inches.Weighta. Applicants for initial appointment as commissioned officers (to include appointment as commissioned warrant officers) must meet the standards of AR 600-9 . Body fat composition is used as the final determinant in evaluating an applicant's acceptability when the weight exceeds the weight tables.b. All other applicants must meet the standards of tables (see "Height and Weight" tables in this section). Body fat composition is used as the final determinant in evaluating an applicant's acceptability when the weight exceeds the weight tables.Body buildThe cause for rejection for appointment, enlistment, and induction is deficient muscular development that would interfere with the completion of required training.Lungs, chest wall, pleura, and mediastinumThe causes for rejection for appointment, enlistment, and induction are:a. Abnormal elevation of the diaphragm, either side.b. Abscess of the lung.c. Acute infectious processes of the lung, until cured.d. Asthma, including reactive airway disease, exercise induced bronchospasm or asthmatic bronchitis, reliably diagnosed at any age. Reliable diagnostic criteria should consist of any of the following elements:(1) Substantiated history of cough, wheeze, and/or dyspnea that persists or recurs over a prolonged period of time, generally more than 6 months.(2) If the diagnosis of asthma is in doubt, a test for reversible airflow obstruction (greater than a 15 percent increase in forced expiratory volume in 1 second (FEVI) following administration of an inhaled bronchodilator) or airway hyperactivity (exaggerated decrease in airflow induced by standard bronchoprovocation challenge such as methacholine inhalation or a demonstration of exercise-induced bronchospasm) must be performed.e. Bronchitis, chronic, symptoms over 3 months occurring at least twice a year.f. Bronchiectasis.g. Bronchopleural fistula.h. Bullous or generalized pulmonary emphysema.i. Chronic mycotic diseases of the lung including coccidioidomycosis.j. Chest wall malformation or fracture that interferes with vigorous physical exertion.k. Empyema, including residual pleural effusion or unhealed sinuses of chest wall.l. Extensive pulmonary fibrosis.m. Foreign body in lung, trachea, or bronchus.n. Lobectomy, with residual pulmonary disease or removal of more than one lobe.o. Pleurisy with effusion, within the previous 2 years if known or unknown origin.p. Pneumothorax during the year preceding examination if due to a simple trauma or surgery; during the 3 years preceding examination from spontaneous origin. Recurrent spontaneous pneumothorax after surgical correction or pleural sclerosis.q. Sarcoidosis.r. Silicone breast implants, encapsulated if less than 9 months since surgery or with symptomatic complications.s. Tuberculous lesions.MouthThe causes for rejection for appointment, enlistment, and induction are:a. Cleft lip or palate defects, unless satisfactorily repaired by surgery.b. Leukoplakia.Nose, sinuses, and larynxThe causes for rejection for appointment, enlistment, and induction are:a. Allergic manifestations.(1) Allergic or vasomotor rhinitis, if moderate or severe and not controlled by oral medications, desensitization, or topical corticosteroid medication.(2) Atrophic rhinitis.(3) Vocal cord paralysis, or symptomatic disease of the larynx.b. Anosmia or parosmia.c. Epistaxis, recurrent.d. Nasal polyps, unless surgery was performed at least 1 year before examination.e. Perforation of nasal septum, if symptomatic or progressive.f. Sinusitis, acute.g. Sinusitis, chronic, when evidenced by chronic purulent nasal discharge, hyperplastic changes of the nasal tissue, symptoms requiring frequent medical attention, or x-ray findings.h. Larynx ulceration, polyps, granulated tissue, or chronic laryngitis.i. Tracheostomy or tracheal fistula.j. Deformities or conditions of the mouth, tongue, palate throat, pharynx, larynx, and nose that interfere with chewing, swallowing, speech, or breathing.k. Pharyngitis and nasopharyngitis, chronic.Neurological disordersThe causes for rejection for appointment, enlistment, and induction are:a. Cerebrovascular conditions, any history of subarachnoid or intracerebral hemorrhage, vascular insufficiency, aneurysm, or arteriovenous malformation.b. Congenital malformations, if associated with neurological manifestations or if known to be progressive; meningocele, even if uncomplicated.c. Degenerative and hereditodegenerative disorders affecting the cerebrum, basal ganglia, cerebellum, spinal cord, and peripheral nerves, or muscles.d. Recurrent headaches of all types if they are of sufficient severity or frequency to interfere with normal function within 3 years.e. Head injury.(1) Applicants with a history of head injury with -(a) Late post-traumatic epilepsy (occurring more than l week after injury).(b) Permanent motor or sensory deficits.(c) Impairment of intellectual function.(d) Alteration of personality.(e) Central nervous system shunt.(2) Applicants with a history of severe head injury are unfit for a period of at least 5 years, after which they may be considered fit if complete neurological and neurophysical evaluation shows no residual dysfunction or complications. Applicants with a history of severe penetrating head injury are unfit for a period of at least 10 years after the injury. After 10 years they may be considered fit if complete neurological and neuropsychological evaluation shows no residuals dysfunction or complications. Severe head injuries are defined by one or more of the following:(a) Unconsciousness or amnesia, alone or in combination, of 24 hours duration or longer.(b) Depressed skull fracture.(c) Laceration or contusion of dura or brain.(d) Epidural, subdural, subarachnoid, or intracerebral hematoma.(e) Associated abscess or meningitis.(f) Cerebrospinal fluid rhinorrhea or otorrhea persisting more than 7 days.(g) Focal neurologic signs.(h) Radiographic evidence of retained metallic or bony fragments.(i) Leptomeningeal cysts or arteriovenous fistula.(j) Early post-traumatic seizure(s) occurring within 1 week of injury but more than 30 minutes after injury.(3) Applicants with a history of moderate head injury are unfit for a period of at least 2 years after injury, after which they may be considered fit if complete neurological evaluation shows no residual dysfunction or complications. Moderate head injuries are defined by unconsciousness or amnesia, alone or in combination of 1 to 24 hours duration or linear skull fracture.(4) Applicants with a history of mild head injury, as defined by a period of unconsciousness or amnesia, alone or in combination, of 1 hour or less, are unfit for at least 1 month after injury; after which they may be acceptable if neurological evaluation shows no residual dysfunction or complications.(5) Persistent post-traumatic sequelae, as manifested by headache, vomiting, disorientation, spatial disequilibrium, personality changes, impaired memory, poor mental concentration, shortened attention span, dizziness, altered sleep patterns, or any findings consistent with organic brain syndrome are disqualifying until full recovery has been confirmed by complete neurological and neuropsychological evaluation.f. Infectious diseases.(1) Meningitis, encephalitis, or poliomyelitis within 1 year before examination, or if there are residual neurological defects.(2) Neurosyphilis of any form, general paresis, tabes dorsalis meningovascular syphilis.g. Narcolepsy, sleep apnea syndrome.h. Paralysis, weakness, lack of coordination, pain, sensory disturbance.i. Epilepsy, beyond the age of 5 unless the applicant has been free of seizures for a period of 5 years while taking no medication for seizure control, and has a normal electroencephalogram (EEG). All such applicants will have a current neurology consultation with current EEG results. EEG may be requested by the reviewing authority.j. Chronic disorders such as myasthenia gravis and multiple sclerosis.k. Central nervous system shunts of all kinds.Disorders with psychotic featuresThe causes for rejection for appointment, enlistment, and induction are disorders with psychotic features.Neurotic, anxiety, mood, somatoform, dissociative, or factitious disordersThe causes for rejection for appointment, enlistment, and induction are a history of such disorders resulting in any or all of the below:a. Admission to a hospital or residential facility.b. Care by a physician or other mental health professional for more than 6 months.c. Symptoms or behavior of a repeated nature that impaired social, school, or work efficiency.Personality, conduct, and behavior disordersThe causes for rejection for appointment, enlistment, and induction are:a. Personality, conduct, or behavior disorders as evidenced by frequent encounters with law enforcement agencies, antisocial attitudes or behavior, which, while not sufficient cause for administrative rejection, are tangible evidence of impaired capacity to adapt to military service.b. Personality, conduct, or behavior disorders where it is evident by history, interview, or psychological testing that the degree of immaturity, instability, personality inadequacy, impulsiveness, or dependency will seriously interfere with adjustment in the Army as demonstrated by repeated inability to maintain reasonable adjustment in school, with employers and fellow workers, and with other social groups.c. Other behavior disorders including but not limited to conditions such as authenticated evidence of functional enuresis or encopresis, sleepwalking, or eating disorders that are habitual or persistent occurring beyond age 12, or stammering of such a degree that the individual is normally unable to express himself or herself clearly or to repeat commands.d. Specific academic skills defects, chronic history of academic skills or perceptual defects, secondary to organic or functional mental disorders that interfere with work or school after age 12. Current use of medication to improve or maintain academic skills.e. Suicide, history of attempted or suicidal behavior.Psychosexual conditionsThe causes for rejection for appointment, enlistment, and induction are transsexualism, exhibitionism, transvestitism, voyeurism, and other paraphilias.Skin and cellular tissuesThe causes for rejection for appointment, enlistment, and induction are:a. Acne, severe, or when extensive involvement of the neck, shoulders, chest, or back would be aggravated by or interfere with the wearing of military equipment, and would not be amenable to treatment. Patients under treatment with isotretinoin (Accutane) are medically unacceptable until 8 weeks after completion of course of therapy.b. Atopic dermatitis or eczema, with active or residual lesions in characteristic areas (face, neck, antecubital, and or/popliteal fossae, occasionally wrists and hands), or documented history thereof after the age of 8.c. Contact dermatitis, especially involving rubber or other materials used in any type of required protective equipment.d. Cysts.(1) Cysts, other than pilonidal, of such a size or location as to interfere with the normal wearing of military equipment.(2) Pilonidal cysts, if evidenced by the presence of a tumor mass or a discharging sinus. History of pilonidal cystectomy within 6 months before examination is disqualifying.e. Dermatitis factitia.f. Bullous dermatoses, such as Dermatitis Herpetiformis, pemphigus, and epidermolysis bullosa.g. Chronic Lymphedema.h. Fungus infections, systemic or superficial types, if extensive and not amenable to treatment.i. Furunculosis, extensive recurrent, or chronic.j. Hyperhidrosis of hands or feet, chronic or severe.k. Ichthyosis, or other congenital or acquired anomalies of the skin such as nevi or vascular tumors that interfere with function or are exposed to constant irritation.l. Keloid formation, if the tendency is marked or interferes with the wearing of military equipment.m. Leprosy, any type.n. Lichen planus.o. Neurofibromatosis (von Recklinghausen's disease).p. Photosensitivity, any primary sun-sensitive condition, such as polymorphous light eruption or solar urticaria; any dermatosis aggravated by sunlight such as lupus erythematosus.q. Psoriasis, unless mild by degree, not involving nail pitting, and not interfering with wearing military equipment or clothing.r. Radiodermatitis.s. Scars that are so extensive, deep, or adherent that they may interfere with the wearing of military clothing or equipment, exhibit a tendency to ulcerate, or interfere with function. Includes scars at skin graft donor or recipient sites if the area is susceptible to trauma.t. Scleroderma.u. Tattoos that will significantly limit effective performance of military service or that are otherwise prohibited under AR 670-1 .v. Urticaria, chronic.w. Warts, plantar, symptomatic.x. Xanthoma, if disabling or accompanied by hyperlipemia.y. Any other chronic skin disorder of a degree or nature, such as Dysplastic Nevi Syndrome, which requires frequent outpatient treatment or hospitalization, or interferes with the satisfactory performance of duty.Spine and sacroiliac jointsThe causes for rejection for appointment, enlistment, and induction are:a. Arthritis.b. Complaint of a disease or injury of the spine or sacroiliac joints with or without objective signs that has prevented the individual from successfully following a physically active vocation in civilian life or that is associated with pain referred to the lower extremities, muscular spasm, postural deformities, or limitation of motion.c. Deviation or curvature of spine from normal alignment, structure, or function if -(1) It prevents the individual from following a physically active vocation in civilian life.(2) It interferes with wearing a uniform or military equipment.(3) It is symptomatic and associated with positive physical finding(s) and demonstrable by x-ray.(4) There is lumbar scoliosis greater than 20 degrees, thoracic scoliosis greater than 30 degrees, and kyphosis or lordosis greater than 55 degrees when measured by the Cobb method.d. Fusion, congenital, involving more than two vertebrae. Any surgical fusion is disqualifying.e. Healed fractures or dislocations of the vertebrae. A compression fracture, involving less than 25 percent of a single vertebra is not disqualifying if the injury occurred more than 1 year before examination and the applicant is asymptomatic. A history of fractures of the transverse or spinous processes is not disqualifying if the applicant is asymptomatic.f. Juvenile epiphysitis with any degree of residual change indicated by x-ray or kyphosis.g. Ruptured nucleus pulposus, herniation of intervertebral disk or history of operation for this condition.h. Spina bifida when symptomatic or if there is more than one vertebra involved, dimpling of the overlying skin, or a history of surgical repair.i. Spondylolysis and spondylolisthesis.j. Weak or painful back requiring external support such as a corset or brace; recurrent sprains or strains requiring limitation of physical activity or frequent treatment.Systemic diseasesThe causes for rejection for appointment, enlistment, and induction are:a. Amyloidosis.b. Ankylosing spondylitis.c. Eosinophilic granuloma when occurring as a single localized bony lesion and not associated with soft tissue or other involvement should not be a cause for rejection once healing has occurred. All other forms of the Histiocytosis X spectrum should be rejected.d. Lupus erythematosus and mixed connective tissue disease.e. Polymyositis/dermatomyositis complex.f. Progressive Systemic Sclerosis, including CRST (calcinosis, Raynaud's phenomenon, sclerodactyly, and telangiectasis) variant. A single plaque of localized scleroderma (morphea) that has been stable for at least 2 years is not disqualifying.g. Reiter's Disease.h. Rheumatoid arthritis.i. Rhabdomyolysis.j. Sarcoidosis, unless there is substantiated evidence of a complete spontaneous remission of at least 2 years duration.k. Sjogren's Syndrome.l. Tuberculosis.(1) Active tuberculosis in any form or location, or history of active tuberculosis within the previous 2 years.(2) One or more reactivations.(3) Residual physical or mental defects from past tuberculosis that would preclude the satisfactory performance of duty.(4) Individuals with a past history of active tuberculosis MORE than 2 years prior to enlistment, induction and appointment are QUALIFIED IF they have received a complete course of standard chemotherapy for tuberculosis. In addition, individuals with a tuberculin reaction 10 mm or greater and without evidence of residual disease are qualified once they have been treated with chemoprophylaxis.(5) Vasculitis such as Bechet's, Wegener's granulomatosis, polyarteritis nodosa.General and miscellaneous conditions and defectsThe causes for rejection for appointment, enlistment, and induction are:a. Allergic manifestations. A reliable history of anaphylaxis to stinging insects. Reliable history of a moderate to severe reaction to common foods, spices, or food additives.b. Any acute pathological condition, including acute communicable diseases, until recovery has occurred without sequelae.c. Chronic metallic poisoning with lead, arsenic, or silver, or beryllium or manganese.d. Cold injury, residuals of, such as: frostbite, chilblain, immersion foot, trench foot, deep-seated ache, paresthesia, hyperhidrosis, easily traumatized skin, cyanosis, amputation of any digit, or ankylosis.e. Cold urticaria and angioedema, hereditary angioedema.f. Filariasis, trypanosomiasis, schistosomiasis, uncinariasis, or other parasitic conditions, if symptomatic or carrier states.g. Heat pyrexia, heatstroke, or sunstroke. Documented evidence of a predisposition (including disorders of sweat mechanism and a previous serious episode), recurrent episodes requiring medical attention, or residual injury (especially cardiac, cerebral, hepatic, and renal); malignant hyperthermia.h. Industrial solvent and other chemical intoxication.i. Motion sickness. An authenticated history of frequent incapacitating motion sickness after the 12th birthday.j. Mycotic infection of internal organs.k. Organ transplant recipient.l. Presence of human immunodeficiency virus (HIV-I) or antibody. Presence is confirmed by repeatedly reactive enzyme-linked immunoassay serological test and positive immunoelectrophoresis (Western Blot) test, or other DOD-approved confirmatory test.m. Reactive tests for syphilis such as the rapid plasma reagin (RPR) test or venereal disease research laboratory (VDRL) followed by a reactive, confirmatory Fluorescent Treponemal Antibody Absorption (FTA-ABS) test unless there is a documented history of adequately treated syphilis. In the absence of clinical findings, the presence of reactive RPR or VDRL followed by a negative FTA-ABS test is not disqualifying if a cause for the false positive reaction can be identified and is not otherwise disqualifying.n. Residual of tropical fevers, such as malaria and various parasitic or protozoal infestations that prevent the satisfactory performance of military duty.o. Rheumatic fever during the previous 2 years, or any history of recurrent attacks; Sydenham's chorea at any age.p. Sleep apnea.Tumors and malignant diseasesThe causes for rejection for appointment, enlistment, and induction are:a. Benign tumors (M8000) that interfere with function, prevent wearing the uniform or protective equipment, would require frequent specialized attention, or have a high malignant potential.b. Malignant tumors (V10), exception for basal cell carcinoma, removed with no residual. In addition, the following cases should be qualified if on careful review they meet the following criteria: individuals who have a history of childhood cancer who have not received any surgical or medical cancer therapy for 5 years and are free of cancer; individuals with a history of Wilm's tumor and germ cell tumors of the testis treated surgically and/or with chemotherapy after a 2-year disease-free interval off all treatment; individuals with a history of Hodgkin's disease treated with radiation therapy and/or chemotherapy and disease free off treatment for 5 years; individuals with a history of large cell lymphoma after a 2-year disease-free interval off all therapy.MiscellaneousAny condition that in the opinion of the examining medical officer will significantly interfere with the successful performance of military duty or training may be a cause for rejection for appointment, enlistment, and induction.

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