Hospital Corpsman 3 & 2: June 1989

Chapter 9: Physical Examinations

Naval Education and Training Command

Introduction

Any person who enters into the uniformed services must meet certain minimum physical requirements. The Department of Defense has established uniform standards for enlistment, induction, and commissioning. These standards are to assure the physical ability of each member entering the service to perform normally assigned duties. Normally, these physical examinations are done at a Military Entrance Processing Station (MEPS). Although standards are set, some physical defects may be waived. The degree of defect determines how the waiver is granted; whether by the examining physician, or referral to higher authority. In some cases, referral for additional studies or a consultation may be indicated.

In addition, a physical examination is conducted periodically during a member's career to verify his or her health readiness for continued active duty. Note that retention standards are not the same as entrance standards; the prime consideration for retention is the ability to continue active service. The periodic physical examination evaluates the member's current state of health. This includes any history of chronic or unresolved medical complaints from injuries or illness incurred during military service or which existed prior to entrance, that may interfere with the member's ability to reasonably fulfill his or her military function. If the examining medical officer determines a defect exists that he or she cannot adequately evaluate, a consultation or referral for further evaluation may be initiated. If the defect is severe enough, referral to a medical board may be appropriate.

A physical examination is required for application to special programs that include duties that have special physical requirements. The scope and direction of these physical examinations is determined by the special program to which the individual is applying. A physical examination is also required at separation from active duty.

The Navy emphasis on wellness and health promotion is one of the principle elements of the Chief of Naval Operations initiatives on personal excellence and maximum security. The periodic physical examination provides the opportunity to carry out the Navy's program on wellness through health promotion by

1. evaluating conditions that may affect physical fitness,

2. observing for problems and providing medical guidance regarding weight control and nutrition education, and

3. evaluating any developing high blood pressure.

It also provides referral for counseling regarding

1. smoking education,

2. lifestyle habits or other habits or activities exposing the member to risk of injury or illness,

3. management of stress, and

4. a general health risk assessment.

In your capacity as a hospital corpsman, in addition to your technical duties, you will function as the clerical assistant to the medical examiner. To do this, you must be familiar with the administrative regulations that apply to the various physical examinations. You must also ensure the medical records are correct and complete, all tests and laboratory results are recorded, and the completed report of medical examination is properly filed or forwarded according to the various regulations and directives. The purpose of this chapter is to review the required forms and reports, and to provide you with information to ensure the forms are correct and complete. Additionally, this chapter explains some of the tests that you may perform.

Required Forms

Several different forms may be required for recording a physical, but the scope and purpose of the physical dictates which form or forms to use. For example, the preplacement and annual physical evaluation of food service personnel or personnel exposed to hazardous materials can, in most cases, be adequately documented on an SF 600. For personnel routinely exposed to high noise levels, the evaluation is recorded on a DD 2216 (with a DD 2215 as a baseline) and filed in the health record, with a copy to the Navy Environmental Health Center. This section discusses some of the forms that may be required to complete and adequately document a physical examination.

Report of Medical Examination, SF88

The SF 88, Report of Medical Examination, is the principal document for recording a physical examination. Use it whenever a complete physical examination is accomplished. Chapter 16 of the Manual of the Medical Department provides specific details on information for each block to complete this form properly. This section will detail the correct information for areas where most errors occur.

• The most common error is failure to record an officer's designator, a Marine's MOS, or a Navy member's NEC. This item is of particular importance for those members assigned duties with special physical qualification requirements. It is also important when the Report of Medical Examination requires special handling (block 2).

• The gender of the individual must be spelled out in full, not abbreviated (block 7).

• Military time in service includes total time of active and inactive service expressed as number of years and months. The branch of service precedes service time, i.e., USN 4y7m or USMC 4y7m, etc. Leave the civilian block blank unless specifically instructed (block 9).

• For military personnel, leave block 10 blank.

• Indicate religious preference in block 16: "P" for Protestant, "C" for Catholic, "H" for Hebrew. Make a notation for specific denominations according to the member's personal desires. This notation is helpful, but not required. Write other religious faiths in full. Use the term "None" only when the individual claims no religious convictions and specifically specifies "None" for this block.

• Complete block 17 for designated aviation personnel, qualified submariners, and divers only.

• Record the height to the nearest one-half inch except for aviation personnel. Record the height of aviation personnel to the nearest one-tenth inch. Record the height in centimeters in parentheses after the height in inches (block 51).

• Record the weight to the nearest pound, followed by kilograms in parentheses (block 52).

• Always record sitting blood pressure and pulse. Record recumbent, standing, and postexercise blood pressure measurements only when required by specific direction or when clinically indicated (blocks 57 and 58).

Review each physical examination for administrative completeness and accuracy. The following entry must be on all reports of medical examination in block 73:

The physical examination has been administratively reviewed for completeness and accuracy.

Signature

Rate

Date

The certification of administrative review can only be completed by one who is thoroughly familiar with the physical examination and the requirements for recording and submitting that report according to established regulations and directives. This review must be accomplished by personnel assigned responsibility for supervision of the clerical completion of the report of physical examination. Personnel unfamiliar with the administrative details in completing the report of medical examination should not supervise this review procedure.

Block 77 must indicate the duties for which the member is or is not found physically qualified to perform. Block 5 applies. Note: Report members being released from active duty as "qualified/not qualified for assignment to full duty at the time of release from active duty (RAD)."

Reports of medical examinations are not complete until the results of any required tests, studies, or referrals for consultation or evaluation have been obtained and recorded on the SF 88. While this is a responsibility of the medical examiner, the certification of administrative review cannot properly be made until the results of these studies have been recorded or referred to on this report. Blocks 73 and/or 74 may be used for this purpose.

The name of the medical and dental examiner must be legibly recorded, including rank and social security number. All reports of medical examination must be signed by a Medical Corps officer. If a physician's assistant or a nurse practitioner did the initial examination, the report of medical examination must be countersigned by a Medical Corps officer.

Report of Medical History, SF93

The SF 93, Report of Medical History, provides a record of complete medical history at the time of a member's reporting for active duty. Subsequent reports of medical history are specifically required to record medical events that have occurred since the last SF 93 was completed. This is the minimum requirement; it is not incorrect to record a review of the member's complete significant medical history, i.e., operations, hospitalizations, etc. Allow the member ample time and provide any necessary assistance to complete this form. Because illegible or incomprehensible abbreviations compromise the value of this report, spell out any abbreviation that may be misinterpreted.

The medical examiner is responsible for completing block 25, including signature, with legible name, rank, and social security number. All entries the medical examiner makes in block 25 must end with the abbreviations of "NCD" (not considered disqualifying) or "CD" (considered disqualifying).

Officer Physical Examination Questionnair, NAVMED 6120/2

The NAVMED 6120/2, Officer Physical Examination Questionnaire, provides the examinee the opportunity to review medical problems, life style, and other medical concerns to assist the medical examiner in adequately reviewing the officer's health status. This form is an adjunct to the SF 93, Report of Medical History. Pending completion of a wellness evaluation form similar to the NAVMED 6120/2, the NAVMED 6120/2 should be used for all personnel, enlisted and officer alike, at the time of periodic medical examinations. Note: Date this report, recording the place of the medical examination and the printed name of the medical examiner.

Special Duty Medical Abstract, NAVMED 6150/2

The NAVMED 6150/2, Special Duty Medical Abstract, represents a source of special information to the medical examiner regarding special physical qualifications the member requires to perform assigned duties. Bring information on the special duty medical abstract to the attention of the medical examiner at the time of each physical examination. Personnel assigned to aviation, submarine, or diving duties, as well as other specialized duties may require examination by a medical officer or Medical Service Corps officer specifically trained to perform the physical examination.

Annual Certificate of Physical Condition, NAVMED 6120/3

The NAVMED 6120/3, Annual Certificate of Physical Condition, is principally an administrative form used by NROTC students, midshipmen, and others enrolled in officer training programs, and for inactive reservists. The member completes this form annually and submits it to his or her administrative office during the years between periodic physical examinations. A Medical Department representative (MDR) to the specific program manager reviews the certificate. When appropriate, the MDR orders the member to a more thorough physical examination if there is an indication of injury or illness that may impair the member's ability to report to active duty.

Types of Physical Examinations

Each member of the armed services requires a physical examination at certain times in his or her career. The first of these is the enlistment, appointment, or commissioning physical examination, and the last is the separation physical examination. In addition to these two, there could be several more depending on the length of service or special requirements. All physical examinations must have the following tests or procedures performed: serologic test for syphilis and HIV (HTLV III) screen; urinalysis, to include protein, sugar, and microscopic examination; visual acuity; and dental examination.

Routine Physical Examinations

Essentially, there are three types of routine physical examinations; the entrance, the retention or periodic, and the examination incident to separation. Chapter 15 of the Manual of the Medical Department provides explicit instructions on when and how a physical examination is to be conducted.

Enlistment, Appointment, and Commissioning

In addition to the tests required for all physical examinations, the first examination upon entering naval service must also include an audiogram; a chest x-ray; and tests for color vision, blood type and Rh factor, G6PD deficiency, and sickle cell hemoglobin trait. Officer candidates must also have a baseline EKG performed, and all females must have a pregnancy test before entrance into naval service. Most of these physical examinations are performed at Military Entrance Processing Stations (MEPS).

Routine/Periodic Examinations

Because of the demanding nature of, or the inherent risk associated with some occupational fields, personnel in these fields require a physical examination at set intervals. Also, because of the increased incidence of certain disease processes in older age groups, the frequency of examination should increase in relation to the age of the individual. Routine/periodic physical examinations are performed as per articles 15-52 and 15-53 for officer and enlisted members, respectively.

Routine/periodic physical examinations for officers are performed every 4 years within 30 days of the officer's date of birth at ages 24, 28, 32, 36, and then annually. All officers assigned to duty requiring frequent aerial flights require an annual flight physical examination within 30 days of the anniversary of the officer's birth. Flag and general officers are to receive an annual physical examination within 30 days of the anniversary of the officer's birth, regardless of age. Enlisted members are to receive a physical examination at the time of reenlistment and annually, beginning at age 36, within 30 days of the anniversary of the member's birth date. Aviation personnel and others directed by appropriate authority are to receive a physical examination annually. Enlisted divers require a physical examination at ages 18, 21, 24, 27, 30, 32, 34, and then annually beginning at age 36; saturation and experimental divers and divers with a sickle cell hemoglobin trait require an annual physical. Members undergoing occupational exposure to ionizing radiation require triennial physical examinations as outlined in NAVMED P-5055. Submariners may receive their physical examinations in conjunction with any other routine or periodic physical examination. Encourage females under the age of 36 to request annual physical examinations as outlined in the Manual of the Medical Department, articles 15-52(9) and 15-84.

Release from Active Duty (RAD)

Before release from active duty, every member must receive a thorough physical examination. If the separation is incident to an evaluation by a medical board, the medical board report serves as the document for the physical examination. The physical examination for release from active duty shall include the following: audiogram, serologic test for syphilis, urinalysis, chest x-ray, visual acuity and color vision, dental examination, and tuberculin skin test, unless otherwise contra-indicated. A pelvic examination for females shall also be included.

Each member is required to read the following statement at the time of examination for release from active duty:

"You are being examined incident to your separation from active duty. If you feel you have a serious defect or condition that interferes with the performance of your military duties, advise the examining physician. If you are considered by the physician to be not physically qualified for separation, you will be referred for further evaluation, and if indicated, appearance before a medical board. If, however, you are found physically qualified for separation, any defects will be recorded in item 74 of the Report of Medical Examination, SF 88. Such defects, while not considered disqualifying for military service, may entitle you to certain benefits from the Veterans Administration. If you desire further information in this regard, contact the VA office nearest your home after your separation." The member shall also sign the following entry in item 73 of the SF 88: "I have been informed of and under- stand the provisions of article 15-56(3) of the Manual of the Medical Department."

Give each member released from active duty a signed, legible copy of the SF 88, Report of Medical Examination.

Special Physical Examinations

In addition to the occupational fields discussed previously, certain types of duty require a special physical examination before start of duty. These requirements are predicated on the basis of lack of adequate medical facilities, psychosocial consideration, extreme risk, or any combination of the above. For example, Antarctic Expedition (Operation DEEP FREEZE) personnel must have a preplacement physical examination to include psychiatric and psychological evaluations. Specific details are delineated in chapter 15 of the Manual of the Medical Department. Some other duties that require preplacement examinations are Fire Fighting Instructor Duty, State Department Duty, duty with a Correctional Custody Unit, and Recruit Company Commander. A determination of not physically qualified for special duty does not necessarily mean that the individual is not qualified for continued duty; he or she is probably still qualified for continued routine duty.

Occupational Health Medical Surveillance Examinations

The Navy uses many materials in its workplaces, some of which are hazardous. To minimize the risk associated with these hazardous substances, the Navy developed the Navy Occupational Safety and Health (NAVOSH) Program, part of which is the medical surveillance program.

Medical surveillance examinations assess the health status of individuals as it related to their work. Although not truly physical examinations in the sense of this chapter, these surveillance examinations produce specific information in regards to an individual's health during actual or potential exposure to hazardous materials, i.e., the Asbestos Medical Surveillance Program (AMSP). Specific guidelines are provided in NAVMEDCOMINST 6260.3 and OPNAVINST 5100.23. Another example is the Occupational Noise Control and Hearing Conservation Program. Personnel who work in areas of high sound generation must be evaluated periodically for hearing loss. Specific guidance is provided in NAVMEDCOMINST 6260.5 and OPNAVINST 5100.23.

Test Procedures and Equipment

Some of the equipment and procedures used to gather information for a physical examination should be common knowledge to all hospital corpsmen, i.e., vital signs, venipuncture, and height and weight. Others require the technical expertise of someone specifically trained, i.e., advanced serological testing, or pressure and oxygen tolerance testing. You can learn most of the remaining tests, procedures, and equipment easily through on-the-job training or short courses of instruction. Some of the intermediate level procedures are described in this chapter.

Vision

Since to a great extent the perception of form and contour is the essence of all vision, an estimation of the acuity of the form sense is the most practical assessment of the sensitivity and efficiency of the eye. Therein lies the importance of the visual acuity, a measure of the smallest retinal image whose form can be appreciated.

Throughout the Navy, there are two accepted methods for testing visual acuity: the Armed Forces Vision Tester, or the Snellen chart and Jaeger cards. The Snellen charts test distant visual acuity; the Jaeger cards, near visual acuity. The Armed Forces Vision Tester does both plus several other functions.

Snellen Charts

Probably the most familiar of the visual testing equipment, Snellen charts are the preferred method for testing distant visual acuity; it can test both monocular and binocular visual acuity. The Manual of the Medical Department, chapter 15, section VIII, provides specific details and conditions for testing with the Snellen charts, some of which follow:

• If the examinee wears corrective lenses, have him or her remove them before the examination. Test the examinee first without corrective lenses and then test with corrective lenses in place.

• Hang the chart on the wall so the 20/20 line is 64 inches from the floor. Direct the examinee to stand 20 feet from the chart. Test each eye individually, then both eyes together. Do not allow the examinee to squint or tilt his or her head.

• With the gradation of the size of the letters advocated by Snellen, the visual acuity is expressed according to his classical formula V = d/D, where d is the distance at which the letters are read, and D is the distance at which the letters should be read. Therefore, record the smallest line read on the chart from the 20-foot distance as the vision, i.e., 20/20, 20/200.

Jaeger Cards

Use Jaeger cards to test near vision but only when the Armed Forces Vision Tester is not available. There are six paragraphs on each card. Each paragraph is printed in a different size type and labeled as J-1, J-2, . . . , or J-6.

When testing the examinee, hold the card at a distance of 13 inches (30 cm) from the examinee and tell the examinee to read the paragraphs. Record the visual acuity as the smallest type comfortably read and the distance, i.e., J-2 at 30 cm.

Armed Forces Vision Tester

The Armed Forces Vision Tester (AFVT) is a semiportable machine that has the capability to test near and distant visual acuity, horizontal and vertical phorias, and steropsis (depth perception). It consists of two rotating drums that hold illuminated slides for the various tests. The handles on the side of the machine rotate the drums to change the slide. A scoring key and instruction manual are provided with the machine. The Manual of the Medical Department also provides detailed instruction on the use of the AFVT.

Color Vision Testing

The Manual of the Medical Department requires that all applicants for entrance into the naval service receive a color vision test. The Navy has two methods of testing color discrimination: the Farnsworth Lantern Test (FALANT), and the pseudoisochromatic plates (PIP). The FALANT is the preferred, and in many cases the only acceptable, method for testing color vision.

Farnsworth Lantern Test

The Farnsworth Lantern Test was devised as a means to pass personnel with normal color vision and those with a mild degree of color blindness. The Farnsworth Lantern is a machine with a light source directed at the examinee. What the examinee sees is two lights in a vertical plane, either red, green, or white, shown in varying combinations, i.e., red and green, red and red, etc. Have the examinee identify the color combinations from top to bottom at a distance of 8 feet; the examiner rotates the drum to provide the different combinations. There are a total of nine different combination that the examinee must identify.

On the first run of nine lights, if the examinee correctly identifies all nine, the FALANT is passed. If the examinee incorrectly identifies any of the lights, either top, bottom, or both, do two additional runs of nine lights without interruption. The score is the average number of incorrectly identified lights of the second two runs. If the average score is 1 or less, the FALANT is passed. If the score is 2 or more, the FALANT is failed. If the score is 1.5, repeat the test after a 5-minute break. Do not retest scores of 2 or more as this will invalidate the test procedure. NOTE: If the examinee wears corrective lenses for distant vision, he or she should wear them during this test.

Pseudoisochromatic Plates

Use pseudoisochromatic plates to determine color vision only if the FALANT is not available. Personnel so tested must be retested with the FALANT at the first activity they report to that has a Farnsworth Lantern. Two sets of plates are available: the 18-plate test and the 15-plate test, each of which has one demonstration plate not used for scoring.

When administering the PIP examination, hold the plates 30 inches from the examinee. Allow two seconds for each plate identification, and do not allow the examinee to touch the plates. To pass the 18-plate test, the examinee must identify a minimum of 14 of the 17 test plates; for the 15-plate test, a minimum of 10 of the 14 test plates. Record the score in block 64 of the SF 88 as Passed PIP or Failed PIP, with the number of correct responses, i.e., Passed PIP 17 of 17 or Failed PIP 10 of 17.

Audiograms

Hearing of all applicants for enlistment, appointment, or commissioning is tested by audiometers calibrated to either American Standards Association (ASA) or International Standards Organization (ISO) standards. All audiometric tracings or audiometric readings recorded on reports of medical examination or other medical records will be clearly identified with "Results ASA-1951" or "Results ISO-1964." Audiometric testing should be performed only by personnel who have been certified in the use of audiometric testing equipment.

References

1. Manual of the Medical Department (MANMED), chapter 15

    

2. Military Personnel Manual (MILPERSMAN)

    

3. Marine Corps Personnel Manual (MARCORPERSMAN)

    

4. SECNAVINSTs 1850.3 and 1850.4 series

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