*Army Regulation 40-29
*AFR 160-13
*NAVMEDCOMINST 6120.2A
*CGCOMDTINST M6120.8B

20 October 1989

Effective date: 20 October 1989

UNCLASSIFIED

Medical Service

MEDICAL EXAMINATION OF APPLICANTS FOR UNITED STATES SERVICE ACADEMIES, RESERVE OFFICER TRAINING CORPS (ROTC) SCHOLARSHIP PROGRAMS, INCLUDING 2- AND 3-YEAR COLLEGE SCHOLARSHIP PROGRAMS (CSP), AND THE UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES (USUHS)



SUMMARY of CHANGE

AR 40-29
MEDICAL EXAMINATION OF APPLICANTS FOR UNITED STATES SERVICE ACADEMIES, RESERVE OFFICER TRAINING CORPS (ROTC) SCHOLARSHIP PROGRAMS, INCLUDING 2- AND 3-YEAR COLLEGE SCHOLARSHIP PROGRAMS (CSP), AND THE UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES (USUHS)

This revision--

* Clarifies procedures MTFs will follow when applicants arrive who are not scheduled by DODMERB ( para 2 );

* Permits the use of DD Form 2492 as an exception to SF 93 , Report of Medical History, which will be used to report a medical history to DODMERB (paras 5a and 9b );

* Advises examining facilities of the proper format for addressing medical correspondence to the DODMERB ( para 5c );

* Includes remedial medical information as being prohibited from being mailed Certified or Registered Mail ( para 5e(2)(c) );

* Clarifies procedures examining physicians will follow when applicant must be hospitalized as part of the medical examination ( para 6 );

* Adds additional information about applicants requiring specialty consultations and laboratory procedures before their examinations ( para 7 );

* Redesignates DODMERB Form 6, Report of Dental Examination of DD Form 2480 ( para 9a ); adds a list of abbreviations ( atch 1 );

* Adds an explanation and model entry for blood alcohol testing and urine drug screen ( atch 2, item 29 );

* Rescinds DD Form 2376, Supplemental Statement of Medical History.



1. General provisions:

a. DD Forms 2351 , DOD Medical Examination Review Board (DODMERB) Report of Medical Examination, and 2492 , DOD Medical Examination Review Board (DODMERB) Report of Medical History, will be used to record medical examination results for the DODMERB only. They will not be used to record the results of medical examinations for any other Department of Defense (DoD) medical examination.

b. Every authorized applicant for a United States service academy (Military, Naval, Air Force, Coast Guard, Merchant Marine), ROTC Scholarship Program, or the USUHS, must take a complete medical examination as described in this regulation. Physicians or dentists must not terminate the examination if they not presumable disqualifying defects.

c. An examinee's medical status is determined by the DODMERB. Examining physicians must not recommend waivers. They must not discuss with examinees how their medical findings affect examinee medical qualifications.

d. When the examinee wishes to present certificates from private physicians, or other forms of medical documentation, these documents must be sent to the address shown in paragraph 5c , with the complete examination. If an examinee wishes to submit evidence to rebut a medical disqualification by the DODMERB, the examinee must be advised to submit the material directly to the address in paragraph 5c. Such material should not be submitted to the examining physician, since that physician has not power to take further action.

e. The medical or dental examiner may, in the course of the medical examination or subsequent to it, discuss the findings of the examination with the examinee, parents, or guardians. The discussion must be limited to the medical significance of those findings, and recommendations must be related only to the examinee's health and well-being. The examiner must not relate the significance of any findings to the examinee's medical qualifications or disqualification for a service academy or ROTC scholarship program.

f. The medical or dental examiner must tell the examinee to seek further medical or dental care for any findings that may affect the examinee's health and well-being. As an example, if the blood pressure is elevated, the examinee must be told to see his or her own physician for further evaluation.

2. Authorized Applicants.

Medical examinations are conducted for only those applicants the DODMERB has officially scheduled (Medical Treatment Facility (MTF) will have been officially notified of applicants who have been scheduled at their facility). If unscheduled applicants call or appear in person and request a medical examination, the medical facility will refer them to the DODMERB. The DODMERB notifies applicants of the date and times their examinations have been scheduled.

3. Where Examinations Will Be Performed.

Applicants may take qualifying examinations only at those facilities the DODMERB designate.

4. Scheduling Notification to Examining Facilities.

The DODMERB sends each examining facility a list of applicants scheduled for examination, about 15 days before the examination date. On the examination day, each examining facility will mark a copy of the list to identify any applicants who did not report for examination, and return it to the DODMERB immediately.

5. Completion and Disposition of Forms:

a. The examining dentist completes DD Form 2480 , DOD Medical Examination Review Board (DODMERB) Report of Dental Examination, according to paragraph 9a , and signs it. The examining physician completes DD Form 2351 ( attachment 2 ), and DD Form 2492 ( attachment 3 ) according to paragraph 9b . The examining physician must sign and date the original DD Forms 2351 and 2492. Also, the medical officer responsible for the examination's accuracy and completeness must sign item 59 on the original DD Form 2351.

b. Within 10 workdays after the examination, the examining facility must send the following to the address in c below:

(1) The original DD Form 2351, properly signed and authenticated (see a above).

(2) Any consultation reports.

(3) Laboratory reports (if any, other than those recorded on DD Form 2351, items 27, 28, and 29).

(4) The DD Form 2492, signed by the examinee and the examining physician.

(5) The SF 520, Clinical Record-Electrocardiographic Record, showing electrocardiographic (ECG) tracings, properly mounted, identified, and interpreted. (Multiple channel ECGs need not be mounted).

(6) DD Form 2480 , properly annotated and signed by the examining dentist ( attachment 4 ).

(7) All dental radiographs (bite-wings and panoramic x-rays) properly processed.

(8) All medical documentation the examinee presented.

(9) Diagnostic dental casts, if required by paragraph 9a(4) , sent in a separate package, marked with the examinee's name and social security number (SSN).

c. All items required by b above must be sent to the DODMERB. Assemble and staple all forms and dental radiograph in the order listed. Address material to: DOD Medical Examination Review Board (DODMERB), USAF Academy CO 80840-6518. DO NOT address mail to Commanding Officer, USAF Academy CO 80840-6518. This result in medical correspondence being routed to the Superintendent's office at the Air Force Academy, where it will be delayed in reaching the DODMERB.

d. The examining facility must keep one complete copy (carbon or duplicate) of each item in b above, except b(8), then dispose of these items according to parent service record disposition standards; e.g., AFR 12-50, volume II.

e. Some helpful hints:

(1) Do:

(a) Mail as many examination reports in one package as possible.

(b) Send packages weighing 12 ounces or less as First-Class Mail.

(c) Send packages weighing over 12 ounces as "Priority" mail.

(d) Staple all papers and x-rays in the upper left corner.

(e) Review all items for legibility and positive identification of the examinee.

(2) Do Not:

(a) Send a letter o transmittal.

(b) Complete or send any Privacy Act Statement ( DD Form 2005 , Privacy Act Statement-Health Care Records).

(c) Send medical examination reports or remedial medical information via Certified or Registered mail.

6. Hospitalization of an Applicant.

When hospitalization is required as part of the medical examination, the applicant may be admitted to a DOD MTF under the authority of appropriate service regulations; e.g., AFR 168-6, AR 40-3 , NAVMEDCOMINST 6320.3, Uniform Military Training and Service Act (62 Stat 604.50 U.S.C., App 451).

7. Civilian Consultation and Additional Evaluations.

When supplemental reports, such as specialty consultations and laboratory procedures, are essential to evaluate an examinee properly, the examining facility should do them whenever possible.

a. If these services are not available, the facility may purchase these services from civilian sources, at government expense, providing funds are available. If funds are not available, or these services cannot be offered because of scheduling, distance, or the like, the examinee must be given the opportunity to travel at his or her own expense to a government facility that can provide these services. In that case, tell the examinee to call the other government facility for an appointment in advance. The examinee may also get these services, at his or her own expense, from a civilian source, and have results sent directly to the address in paragraph 5c . Applicant should be provided SF 513 , Medical Record-Consultation Sheet, which provides pertinent history and specifically delineates the specialty information needed and authorized lab tests required. Invasive or potentially dangerous procedures are not authorized. Communicate with DODMERB in questionable cases.

b. Results of the medical examination should be sent without waiting for supplementary evaluations or their results. Any instructions given to the examinee will be explained on DD Form 2351 . Results of additional tests or evaluations should be sent separately, when they become available.

8. Direct Communications.

The Director, DODMERB, is authorized to communicate directly with the commanders of each designated examining facility about medical examinations, procedures, techniques, deficiencies, and general supervision of medical examination processing. The Director, DODMERB, may send a copy of any correspondence with the examining facilities to the office of primary responsibility of the appropriate Surgeon General office.

9. Scope of Examination:

a. Dental Examination:

(1) General Information. The dental officer thoroughly examines the mouth, teeth, and supporting structures of the examinee and records of his or her findings in blue-black or black ink on the DD Form 2480 ( attachment 4 ). While the examining dental officer must inform the candidate of existing deficiencies, pathology, or abnormalities, the examiner is not authorized to advise the examiner whether or not he or she is within dental standards. Therefore, the dental examiner should not point out the specific treatment that might be needed to meet the standards. If such instructions are necessary, the DODMERB must give these instructions to the examinee after evaluating all results of the dental examination. Generally, all dental expenses will be borne by the examinee. Dental radiographs and study casts are authorized to be obtained from the Department of the Army, Navy and Air Force dental facilities at no expense to the examinee.

(2) Dental Radiographs. All examinees receive the Type 2 Dental Examination. This includes both mirror and explorer examination under adequate illumination. Bite-wing radiographs on bite-wing film and a panoramic radiograph are required. When an examinee is wearing a fixed, active orthodontic appliance, excluding retainers on both arches, only a panoramic radiograph is required. Bite-wing x-rays are not needed in these cases. A full mouth x-ray survey should not be performed in place of a panoramic x-ray.

(a) If the examination facility does not have a panoramic x-ray, offer the examinee the opportunity to go to another government facility, traveling at his or her own expense. In such cases, advise the examinee to call for an appointment. As an alternative, the examinee may obtain the panoramic x-ray (and not a full-mouth survey) from a civilian dentist at his or her own expense.

(b) The examining dental officer may obtain additional radiographs (for example, periapical or occlusal views) if it is necessary to demonstrate pathology or other abnormalities.

(c) Identify all radiographs with the examinee's full name and SSN. Process thoroughly, and wash and dry radiographs before sending them to the DODMERB. All x-rays must be of diagnostic quality.

(3) Charting Dental Defects. All dental defects of the examinee are shown on DD Form 2480 . Indicate on the chart (DD Form 2480, item 3) all teeth that are restorable or nonrestorable, missing teeth, teeth replaced, spaces closed, location of cavities, and any defects or abnormalities of the teeth and surrounding structures. Don not chart existing restorations unless they are defective.

(4) Diagnostic Dental Casts. In cases of questionable occlusion, disfiguring spaces between anterior teeth, malformation of the jaw, or malrelation of the jaw, dental casts must be made of maxillary and mandibular dental arches. Leave any existing prosthetic appliances in place when you make impressions. Draw pencil lines across facial surfaces of both casts to show the habitual occlusal relationship. Identify each cast clearly with the examinee's name and SSN, and send both casts to the DODMERB. Indicate on DD Form 2480, item 101, that you are sending casts.

(5) Malocclusion. Any questionable occlusion or definite malocclusion related to an insufficient incisal or masticatory function, the malformation or malrelation of jaws or opposing teeth, or a facial deformity must be noted on the DD Form 2480, item 10. Any additional remarks about the type, degree, or severity of the malocclusion should be added in item 16 ( attachment 4 ).

(6) Orthodontics. If the examinee wears a fixed, active orthodontic appliance, or is undergoing orthodontic treatment that includes an active removable appliance, or is wearing retainer appliances, or has a past history of orthodontic treatment, please note that fact on the DD Form 2480, item 11.

(7) Periodontal Conditions. If significant periodontal disease is present (not simple gingivitis), the location, nature, and severity of the problem must be described on the DD Form 2480, item 13.

(8) Dental Prostheses. The dental examination must include an opinion about the serviceability of all dental prostheses. A serviceable prosthesis must adequately restore masticatory function and appearance, and permit clear speech. Oral tissues supporting the prosthesis must be healthy. Any comments must be recorded on the DD Form 2480, item 12.

(9) Cleft Palate or Cleft Lip. If the examinee as a history of cleft palate or cleft lip, whether repaired or not, your comments must be recorded on the DD Form 2480, items 9d and e, to include existing fistulae or other defects.

b. Medical Examinations:

(1) DD Form 2492 , DODMERB Report of Medical History:

(a) The examinee's complete medical history must be recorded on the DD Form 2492.

(b) The examinee completes the first two lines, all of Section I and II (items 1 through 94), and the Remarks (if necessary) of the DD Form 2492 in his or her own handwriting, using blue-black or black ink or indelible pencil.

(c) The examinee's identification is self-explanatory, but you may help the examinee fill out these in the standard format.

(d) The examinee completes items 1 through 94 and Remarks (the examinee should mark "Not Applicable" or "N/A" in item 9, if appropriate). If item 21 "wear contact lenses or ocular eye retainers," is marked "yes," explain type of lenses or retainers and length of time removed before examination (see attachment 3 ). As the examinee may give vague or imprecise information in the 'Remarks' section, all answers must be carefully reviewed, and the examinee asked to clarify answers, whenever necessary (note that answers in items 1 through 10 do not need remarks). The examiner must elaborate on medical history items that are not adequately explained by examinee.

(e) Some general guides for completing examiner's summary and elaboration of pertinent data:

(1) Do not use the term "usual childhood illnesses." You may group childhood illnesses together, listing each one.

(2) Record the date or age of incident.

(3) Do not use "NS" or "nonsymptomatic" in the history. You may use "NCNS," "no comp, no seq," or "no complications, no sequelae" after items of history.

(4) Elaborate on all items of history answered "Yes" that are not adequately explained by examinee. Number your amplifying responses to correspond to the affirmative responses of DD Form 2492 .

(2) DD Form 2351. attachment 2 gives an item-by-item explanation of DD Form 2351 , with model entries. Complete all items, as specified.

10. Supply of Forms:

a. DD Forms 2351, DD Form 2480 , and 2492 are part of the scheduling package DODMERB sends to lists of applicants provided by the academies, ROTC programs and the USUHS.

b. Local reproduction of blank DD Forms 2351, 2480, 2492 is authorized by the Army, Navy, Coast Guard, and Air Force through the applicable forms manager and reproduction facility. Print DD Form 2480 and 2492 head-to-foot. Print DD Form 2351 face only.

c. The DD Forms listed below are provided to the applicant by DODMERB when remedial medical tests are required; however, a small stock of these forms will be maintained by each medical facility in the event applicants arrive at the medical facility without the appropriate forms to record remedial test results. Local reproduction is authorized based on the specific requirements of the particular agency.

(1) DD Form 2369 , DOD Medical Examination Review Board (DODMERB) Cycloplegic Refraction ( attachment 5 ).

(2) DD Form 2370 , DOD Medical Examination Review Board (DODMERB) Three-day Blood Pressure and Pulse Check ( attachment 6 ).

(3) DD Form 2371, DOD Medical Examination Review Board (DODMERB) Update of Applicant's Medical Examination ( attachment 7 ).

(4) DD Form 2372 , DOD Medical Examination Review Board (DODMERB) Statement of Present Health ( attachment 8 ).

(5) DD Form 2374 , DOD Medical Examination Review Board (DODMERB) Heart Murmur Evaluation ( attachment 9 ).

(6) DD Form 2375 , DOD Medical Examination Review Board (DODMERB) Pulmonary Function Studies ( attachment 10 ).

(7) DD Form 2377, DOD Medical Examination Review Board (DODMERB) Red/Green Color Vision Test ( attachment 11 ).

(8) DD Form 2378 , DOD Medical Examination Review Board (DODMERB) Statement of History Regarding Headaches ( attachment 12 ).

(9) DD Form 2379 , DOD Medical Examination Review Board (DODMERB) Statement of History Regarding Head Injury ( attachment 13 ).

(10) DD Form 2380 , DOD Medical Examination Review Board (DODMERB) Statement of History Regarding Sleepwalking ( attachment 14 ).

(11) DD Form 2381 , DOD Medical Examination Review Board (DODMERB) Statement of History Regarding Motion Sickness ( attachment 15 ).

(12) DD Form 2382 , DOD Medical Examination Review Board (DODMERB) Statement of History Regarding Hay Fever, Sinusitis, Asthma and/or Allergies ( attachment 16 ).

(13) DD Form 2383 , DOD Medical Examination Review Board (DODMERB) Statement of History Regarding Medication ( attachment 17 ).

(14) DD Form 2389, DOD Medical Examination Review Board (DODMERB) Farnswork Lantern Color Vision Test ( attachment 18 ). When locally reproduced, printed head-to-foot.

d. DD Form 2368, DOD Medical Examination Review Board (DODMERB) Service Academy ROTC Medical Qualification Determination; 2373 , DOD Medical Examination Review Board (DODMERB) Notification of Failure to Appear for Service Academy ROTC Medical Examination; and 2503, DOD Medical Examination Review Board (DODMERB) Applicant Overseas Appointment, are stocked and used only by DODMERB.

e. Attachment 19 provides guidelines for conducting certain medical tests; e.g., Reading Aloud Test (RAT), sitting height, Red Lens Test, etc.



Figure 2-1. DD FORM 2351, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) REPORT OF MEDICAL EXAMINATION





Figure 2-2. Item-By-Item Explanation For Filling Out DD Form 2351





Figure 2-2. Item-By-Item Explanation For Filling Out DD Form 2351-Continued





Figure 2-2. Item-By-Item Explanation For Filling Out DD Form 2351-Continued





Figure 2-2. Item-By-Item Explanation For Filling Out DD Form 2351-Continued





Figure 2-2. Item-By-Item Explanation For Filling Out DD Form 2351-Continued





Figure 2-2. Item-By-Item Explanation For Filling Out DD Form 2351-Continued





Figure 3-1. DD FORM 2492, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) REPORT OF MEDICAL HISTORY--MALE





Figure 3-2. DD FORM 2492 Reverse, MAR 87





Figure 3-3. DD FORM 2492, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) REPORT OF MEDICAL HISTORY--FEMALE





Figure 3-4. DD FORM 2492 Reverse, MAR 87





Figure 4-1. DD FORM 2480, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) REPORT OF DENTAL EXAMINATION





Figure 4-2. DD FORM 2480 Reverse, NOV 86





Figure 5-1. DD FORM 2369, DOD MEDICAL EXAMINATION REVIEW BOARD CYCLOPEGIC REFRACTION





Figure 6-1. DD FORM 2370, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) THREE-DAY BLOOD PRESSURE AND PULSE CHECK





Figure 7-1. DD FORM 2371, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) UPDATE OF APPLICANT'S MEDICAL EXAMINATION





Figure 8-1. DD FORM 2372, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) STATEMENT OF PRESENT HEALTH, FEB 86





Figure 9-1. DD FORM 2374, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) HEART MURMUR EVALUATION, MAY 85





Figure 10-1. DD FORM 2375, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) PULMONARY FUNCTION STUDIES, MAY 85





Figure 11-1. DD FORM 2377, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) RED/GREEN COLOR VISION TEST, MAY 85





Figure 12-1. DD FORM 2378, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) STATEMENT OF HISTORY REGARDING HEADACHES





Figure 13-1. DD FORM 2379, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) STATEMENT OF HISTORY REGARDING HEAD INJURY





Figure 14-1. DD FORM 2380, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) STATEMENT OF HISTORY REGARDING SLEEPWALKING





Figure 15-1. DD FORM 2381, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) STATEMENT OF HISTORY REGARDING MOTION SICKNESS





Figure 16-1. DD FORM 2382, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) STATEMENT OF HISTORY REGARDING HAY FEVER, SINUSITIS, ASTHMA AND/OR ALLERGIES





Figure 17-1. DD FORM 2383, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) STATEMENT OF USE REGARDING MEDICATION





Figure 18-1. DD FORM 2489, DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB) FARNSWORTH LANTERN COLOR VISION TEST





Figure 18-2. FARNSWORTH LANTERN COLOR VISION TEST - INSTRUCTIONS





Figure 19-1. Attachment 19


Glossary

Abbreviations

ANSI

American National Standard Institute

ASA

American Standards Association

BAT

Blood Alcohol Test

cm

--Centimeters

CSP

College Scholarship Program

CT

Cover Test

o

Degree

DOD

Department of Defense

DODMERB

Department of Defense, Medical Examination Review Board

DPA-V

Depth Perception Apparatus --Verhoeff

ECG

Electrocardiographic

EKG

Electrocardiogram

FALANT

Farnsworth Lantern

GU

Genitourinary System

HIV

Human Immune Virus

Hz

Hertz

ISO

International Standards Organization

mm

Millimeters

MTF

Medical Treatment Facility

NCNS

No Complications, No Sequelae

NE

Not Examined

NPC

Near Point of Convergency

NS

Nonsymptomatic

OTC

Over the Counter

PA

Physician Assistant

PAS

Privacy Act Statement

PC

Point of Convergence

PCNP

Primary Care Nurse Practitioner

POC

Professional Officer Course

RAT

Reading Aloud Test

RBC

Red Blood Cell

ROTC

Reserve Officer Training Corps

SSN

Social Security Number

UDS

Urine Drug Screen

USUSH

Uniformed Services University of the Health Sciences

VTA-ND

Vision Test Apparatus -- Near and Distant

VTS-CV

Vision Test Set -- Color Vision

WBC

White Blood Cell

WHNS

Well Healed, No Sequelae

Terms

This section contains no entries.

Special Terms

This section contains no entries.