MOD17-TAB A: AMPLIFICATION OF THE MINIMAL STANDARDS

UNCLASSIFIED

MOD17-TAB A: AMPLIFICATION OF THE MINIMAL STANDARDS OF FITNESS FOR

DEPLOYMENT TO THE CENTCOM AOR; TO ACCOMPANY MOD 17 TO

USCENTCOM INDIVIDUAL PROTECTION AND INDIVIDUAL/UNIT DEPLOYMENT

POLICY

1. General. This TAB A accompanies MOD 17, Section 15.C. and provides amplification of the minimal

standards of fitness for deployment to the CENTCOM area of responsibility (AOR). Individuals possessing

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

to being medically cleared for deployment. The list of deployment-limiting conditions is not

comprehensive; there are many other conditions that may result in denial of medical clearance for

deployment based upon the totality of individual medical conditions and the medical capabilities present

at that individual’s deployed location. “Medical conditions” as used here also include those health

conditions usually referred to as dental and behavioral health.

A. Uniformed Service Members must meet Service standards of fitness according to Service

regulations and policies, in addition to the guidance in the parent MOD 17. See MOD 17

REF E, F, G, H, I, JJ.

B. DoD civilian personnel with disqualifying medical conditions could still possibly deploy based

upon an individualized medical assessment and approved medical waiver from the

appropriate CENTCOM waiver authority. All personnel must be able to perform the duties of

their position.

C. DoD Contract personnel will be evaluated for fitness according to MOD 17 and DoDI 3020.41

(REF J).

D. The final authority of who may deploy to the CENTCOM AOR rests with the CENTCOM

Surgeon and/or the Service Component Surgeons’ waiver authority, not the individual’s

medical evaluating entity, deploying platform, or Commander.

E. Regardless of underlying diagnosis, waivers for disqualifying medical conditions will be

considered only if all the following general conditions are met:

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

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

mission execution.

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

deployment in light of the physical, physiological, psychological, and nutritional effects

of assigned duties and location.

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

tests, or significant physical limitations, and does not constitute an increased risk of

illness, injury, or infection.

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

diagnostics or evaluations.

5. The condition is expected to remain stable without consistent medication resupply.

The CENTCOM formulary is a deployed formulary, and not all medications are

available in theater. Medication resupply can be delayed in Theater and is fulfilled

through the Tricare Mail Order Program (TMOP). If the medication is a Controlled

UNCLASSIFIED

Substance, delays in medication resupply are common. Medication must have no

special handling, storage, or other requirements (e.g., refrigeration, cold chain, or

electrical power requirements). Medication must be well tolerated within harsh

environmental conditions (i.e. heat or cold stress, sunlight, etc.) and should not cause

significant side effects in the setting of moderate dehydration.

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

deployed environment, with or without reasonable accommodation, without causing

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

workplace environment must be considered. Further, the member’s medical condition

must not pose a significant risk of substantial harm to the member or others taking

into account the condition of the relevant deployed environment, with particular

consideration of areas of armed conflict in the AOR. See REF I.

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

including protective mask, ballistic helmet, body armor, and chemical/biological

protective garments.

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

medications.

9. The medical condition is not anticipated to significantly impair duty performance

during the duration of the deployment.

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

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

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

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

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

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

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

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

individual’s health requires avoidance of these extremes or conditions, they should not deploy.

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

encouraged for conditions which may impair normal functionality. The evaluating provider should pay

special attention to any conditions which may present a hazard to the individual or others and/or preclude

performing functional requirements in the deployed setting. Also, the type, amount, suitability, and

availability of medications in the theater environment must be considered as potential limitations. Pre-

deployment processing centers may vary in medical examination/screening procedures; individuals

should contact their respective mobilization site for availability of a processing checklist.

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

or military health system resources for health evaluations unless otherwise authorized. Generally,

Defense Health Agency and Military Health System resources are not authorized for the purpose of pre-

deployment or travel medicine evaluations for contractor employees IAW REF J. Local command, legal,

contracting and resource management authorities should be consulted for questions on this matter.

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

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

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However, sovereign laws of some nations within the CENTCOM AOR may prohibit entry of individuals

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

diagnoses that could result in or complicate medical care in theater following evacuation should be

coordinated with and approved by the CENTCOM Surgeon prior to entering the AOR.

6. Per general guidance from MOD 17, section 15.C:

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

DoD contractor employees) deploying to theater must meet medical, dental, and behavioral

health fitness standards for deployment and possess a current Periodic Health Assessment

(PHA) or physical. Fitness specifically includes the ability to accomplish tasks and duties unique

to a particular operation and the ability to tolerate environmental and operational conditions of the

deployed location.

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

Personnel with existing conditions, other than those outlined in this document, may deploy if

either:

1. An approved medical waiver, IAW Section 15.C.3, is documented in the medical

record.

2. The conditions in Para. 1.D.1-1.D.10 are met. To determine stability and assess need

for further care, for most conditions 60 days is considered a reasonable timeframe,

subject to the examining provider’s judgment. The exception to this is noted in paragraph

7.G. Behavioral Health Conditions.

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

severity that may cause an individual to be non-deployable would be too expansive. The medical

evaluator must carefully consider whether the climate, altitude, nature of available food and housing,

availability of medical, behavioral health, dental, surgical, and laboratory services, or whether other

environmental and operational factors may be hazardous to the deploying person’s health. The following

list of conditions should not be considered exhaustive. Other conditions may render an individual

medically non-deployable (see paragraph 6). Medical clearance to deploy with any of the following

documented medical conditions may be granted, except where otherwise noted, IAW MOD 17, Section

15.C. If an individual is found deployed with a pre-existing non-deployable condition and without a waiver

for that condition, a waiver request to remain deployed should be submitted to the respective Component

Surgeon. If the waiver request is denied, the individual will be redeployed out of the CENTCOM AOR.

Individuals with the following conditions and/or therapeutic interventions will not deploy without

an approved waiver:

A. Specific Medical Conditions / Restrictions:

1. Moderate or severe persistent asthma, or other respiratory conditions that have a

Forced Expiratory Volume 1 Second (FEV1) < 50% of predicted, that have required

hospitalization or emergency room visit in the past 12 months, or that require daily

systemic (not inhaled) steroids. Mild intermittent and mild persistent asthma with an

Asthma Control Test >19 does not require waiver.

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

for prior seizure disorder/activity. Persons on a stable anticonvulsant regimen, who have

been seizure-free for one year, may be considered for waiver.

3. Diabetes mellitus, type 1 or 2, on pharmacotherapy or with HgA

C > 7.0.

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

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

last 60 days and HgA1C ≤ 7.0 does not require a waiver if a calculated 10-year

coronary heart disease risk percentage (see paragraph 7.B.7) is less than 15%.

If the calculated 10-year risk is 15% or greater, further evaluation is required prior

to waiver submission. See 7.B.7.

c. Newly diagnosed diabetics will require demonstrated stability, either on oral

medications or with lifestyle changes, before a waiver will be considered.

Confirmation of complete initial diabetic evaluation (eye exam, foot exam,

nutrition counseling, etc.) is required.

4. History of heat stroke or rhabdomyolysis. Those without multiple episodes, persistent

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

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

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

similar to the deployed location.

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

on medications available in theater.

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

diagnosis of the condition.

7. History of stinging insect allergy causing generalized symptoms, IAW Ref JJ.

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

no signs of anaphylaxis or systemic reaction do not require waiver. Generalized

cutaneous-only reactions that occurred prior to the 16

birthday also do not

require waiver.

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

defined as generalized rash or swelling in locations not contiguous with sting site

- occurring after the 16

birthday, should be referred to an allergist for testing.

c. Negative testing results indicate no further therapeutic action is required,

however a waiver should still be submitted for review.

8. Endocrine conditions that are unstable, require laboratory monitoring or specialty

consultation, or require more than routine follow-up. Waiver is not required if condition is

stable, treatment medications are within clinically appropriate dose and effect

parameters, have no special storage requirements, and do not produce side effects

which interfere with the normal performance of duties or require additional medications to

manage side effects. If treatment consists of CSA schedule I-V, such as testosterone, a

waiver for that medication is required, see section I, 8 below.

9. Any musculoskeletal condition that significantly impairs performance of duties or

activities of daily living in a deployed environment. If there are concerns, an official

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

request.

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

of duties. Waiver submission should note history, frequency, severity, and functional

impact of headaches, with or without treatment, success of abortive therapies, as well

previous and current treatment regimens. Neurology evaluation and endorsement

encouraged.

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11. Nephrolithiasis, requiring clinical evaluation or intervention in the preceding 12

months, or with most recent imaging showing multiple stones or a single stone >5mm in

size, or a history of more than two episodes in a 12 month period in the last 3 years.

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

Stage II is expected prior to granting a waiver.

13. Pregnancy.

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

(PSG), with a minimum of 2 hours of total sleep time. For moderate and severe OSA, a

compliance report demonstrating at least 4 hours of use per night for greater than 70% of

nights over a 30-day period must be documented. Individuals treated with an oral

appliance require polysomnography that indicates OSA is controlled with its use.

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

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

(AVAPS) is non-deployable.

a. Mild OSA (diagnostic AHI and RDI < 15/hr): No waiver required.

b. Individuals using PAP therapy should deploy with a machine that has

rechargeable battery back-up and sufficient supplies (air filters, tubing and

interfaces/masks) for the duration of the deployment.

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

including mild. Waiver may not be required, but pre-deployment evaluation, which may

include both neurological and psychological components, is required per ref X.

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

deploy once released by a medical provider after 24-hours symptom free.

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

deploy after seven days symptom free and release by a medical provider.

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

including mild) must have neurological and psychological evaluation completed

prior to deployability determination.

16. Weight > 136 kg (300 lb)

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

request should include verification of immunization against encapsulated bacterial

pathogens (pneumococcus, meningococcus, Haemophilus influenza).

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

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

limitations. increased vulnerability to heat injury, and possible requirement for medication

waiver.

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

equipment or appliances (e.g., nebulizers, catheters, spinal cord stimulators), or that

requires periodic evaluation/treatment by medical specialists not readily available at any

theater location.

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

Working Dogs/Contract Working Dogs (see MOD 17, section 15.C.1.G.). Animals

deployed to support behavioral health operations must deploy from CONUS as part of an

official program with full logistic support and uniformed handlers.

B. Cardiovascular Conditions:

1. Symptomatic coronary artery disease.

2. Myocardial infarction within one year of deployment.

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3. Coronary artery bypass graft, coronary artery angioplasty, carotid endarterectomy,

other arterial stenting, or aneurysm repair within one year of deployment.

4. Cardiac dysrhythmias or arrhythmias, either symptomatic or requiring medication,

electro-physiologic control, or automatic implantable cardiac defibrillator or other

implantable cardiac devices.

5. Heart failure or history of heart failure.

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

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

lipids do not require separate waiver except in the following circumstances:

a. Hypertensive urgency or emergency within previous 90 days.

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

c. Total Cholesterol >300, or Triglycerides >1000.

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

risk percentage calculated (online calculator is available at http://tools.acc.org/ASCVD-

Risk-Estimator/). If the individual’s calculated 10-year CHD risk is 15% or greater, the

individual should be referred for further cardiology work-up and evaluation, to include

some form of functional assessment (i.e. graded exercise stress test with a myocardial

perfusion scintigraphy (SPECT scan) or stress echocardiography as determined by the

evaluating cardiologist). Results of the evaluation and testing, along with the evaluating

cardiologist’s recommendation regarding suitability for deployment, should be included in

the waiver request.

C. Infectious Disease:

1. Confirmed Blood-borne diseases (i.e. Hepatitis B, Hepatitis C) which may be

transmitted to others in a deployed environment. Waiver requests for persons testing

positive for a blood borne disease, including positive antigens and viral load positive

members, should include a full test panel for the disease, including all antigens,

antibodies, viral load, and appropriate tests for affected organ systems.

2. Confirmed HIV infection. Individuals that are asymptomatic with undetectable viral

load may deploy dependent on host nation requirements.

a. Host nation entry or residence requirements can be found at:

http://travel.state.gov

b. Host nation restrictions cannot be waived through the MOD17 waiver process

3. History of active tuberculosis (TB). Must have documented completion of full treatment

course prior to deployment. Those currently on treatment for TB disease may not deploy.

4. A CENTCOM waiver cannot override host or transit nation infectious disease or

immunization restrictions. Active duty must comply with status of forces agreements;

civilian deployers should contact the nation's embassy for up-to-date information.

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

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

requirements to safely perform duties. Bilateral blindness or visual acuity that is unsafe

for the combat environment per the examining provider.

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

satisfactory period for post-surgical recovery before deployment. There is a large degree

UNCLASSIFIED

of patient variability which prevents establishing a set timeframe for full recovery. The

attending ophthalmologist or optometrist will determine when recovery is complete.

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

procedure.

b. Personnel are non-deployable for three months following uncomplicated

photorefractive keratectomy (PRK) or laser epithelial keratomileusis (LASEK), or

one month for laser-assisted in situ keratomileusis (LASIK) unless a waiver is

granted.

c. Waiver request should include clearance from treating ophthalmologist or

optometrist.

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

completed a medical board and found fit for duty do not require a waiver. Individuals with

sufficient unaided hearing to perform duties safely, hear and wake up to emergency

alarms unaided, and hear instructions in the absence of visual cues such as lip reading

do not require waiver. If ability to perform duties is in question, Speech Recognition In

Noise Test (SPRINT) or equivalent testing should be included to verify this ability.

4. Tracheostomy or aphonia.

5. Patients without a dental exam within 12 months of deployment, or those who are

likely to require evaluation or treatment during the period of deployment for oral

conditions that are likely to result in a dental emergency. Individuals being evaluated by a

non-DoD civilian dentist should use a DD Form 2813, or equivalent, as proof of dental

examination.

6. Orthodontics requiring follow-up or adjustment while deployed. Those with wires in

neutral force and are cleared by the treating orthodontist do not require waiver.

E. Cancer:

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

subspecialist examination and/or laboratory/imaging testing during the anticipated

duration of the deployment.

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

treatment/evaluation during the anticipated duration of the deployment.

3. Cancers which have not been in complete remission for at least a year

F. GASTROINTESTINAL SYSTEM:

1. Inflammatory bowel disease, including, but not limited to: Crohn’s disease; ulcerative

colitis; ulcerative proctitis; regional enteritis; granulomatous enteritis.

2. Chronic hepatitis with impairment of liver function.

3. The presence of any ostomy (gastrointestinal or urinary).

G. Surgery:

1. Any medical condition that requires surgery or for which surgery has been performed

and the patient requires ongoing treatment, rehabilitation or additional surgery/revision.

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

who have not been cleared/released by their surgeon (excludes minor procedures).

UNCLASSIFIED

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

deployment.

4. Special dietary and hygienic requirements resulting from surgery cannot be reliably

accommodated and may be independently disqualifying.

H. Behavioral Health Conditions: Diagnostic criteria and treatment plans should adhere to

the current Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5

as of writing) and current professional standards of care. Waiver submission should

include information on applicant condition, including history and baseline symptoms

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

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

operational environment is notable for lack of support systems, inability to practice

external coping mechanisms, unpredictability, long and stressful work periods, sleep

disruption, lack of privacy, lack of control, and exposure/re-exposure to traumatic and life-

threatening events. See reference KK. Waiver required for all conditions listed below

(list is not inclusive).

1. Behavioral health disorders without demonstrated clinical stability of at least 3 months,

as defined by unchanged treatment, well controlled symptoms, and no expectation of

incapacitation if the condition should relapse or recur.

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

3. Any DSM 5-diagnosed behavioral health disorder, to include personality disorders,

with residual symptoms, or medication side effects, which impair social and/or

occupational performance.

4. Any behavioral health condition that poses a substantial risk for deterioration and/or

recurrence of impairing symptoms in the deployed environment.

5. Any behavioral health condition that requires periodic (beyond quarterly) counseling or

therapy.

6. Chronic insomnia that requires regular or long-term use of any sedative hypnotics /

amnestics, benzodiazepines, and/or antipsychotics. PRN, or as needed, use of

medication for this diagnosis must clarify frequency of actual use.

7. Anxiety disorders requiring use of benzodiazepines for management, or featuring

symptoms of panic or phobia.

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

or when therapy includes use of benzodiazepines without additional anxiety diagnosis.

Waiver submission should note if condition is combat-related, and, if so, comment on

impact that return to the operational environment could have on applicant well-being and

performance.

9. Gender dysphoria, when distressing enough to require treatment. Transgender

without history of, or current requirement for, transition, and not associated with

significant gender dysphoria is not disqualifying and does not require waiver. Underlying

behavioral health, endocrine, and/or surgical issues (as applicable) should be stable and

resolved, and all Service requirements must be met, to include the involvement of, and

clearance by, Service Central Coordination Cell if transition is required. See Ref LL.

Transitioning personnel’s treatment course should be complete, with DEERS marker

change, and an adequate Real Life Experience (RLE) period should have occurred to

ensure stability. Due to complex needs, those requiring or actively undergoing gender

UNCLASSIFIED

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

and stabilization, is completed.

10. Bulimia and anorexia nervosa.

11. Attention Deficit Disorder (ADD)/Attention Deficit Hyperactivity Disorder (ADHD).

Evaluation and diagnosis should be appropriate per DSM 5 criteria, particularly if Class II

stimulants are used for treatment. Specific clinical features or objective testing results

should be included in waiver application for stimulant use. Dosages for medications

should likewise be appropriate per DoHHS-CMS standards (REF MM), and justified by

clinical presentation. Uncomplicated ADD/ADHD stable (treated with 0-1 non-controlled

substance medication) for greater than 3 months without social or occupational impact do

not require a waiver. Substantiated cases not meeting those criteria but with appropriate

dosing may be adjudicated at the Service Component level, provided additional BH

conditions or diagnoses requiring waiver are not present.

12. Behavioral health related hospitalization or self-mutilation within the last 12 months.

13. Suicidal Ideation, behavior or suicide attempt with the last 12 months is strictly

disqualifying.

14. Substance use causing social or occupational disruption or impairment, including

enrollment in a substance abuse program (inpatient or outpatient, service specific

substance abuse program) within the last 12 months, measured from time of discharge /

completion of the program.

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

which will depend on individual patient factors.

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

Service Specific substance abuse programs are not eligible for waiver.

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

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

Naloxone are not intrinsically disqualifying, but require clarification of underlying

SUD issues.

d. Alcohol use disorder requiring pharmacotherapy for maintenance (Disulfiram,

Naltrexone, Acamprosate) cannot be supported.

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

disqualifying.

15. Use of antipsychotics or anticonvulsants for stabilization of DSM IV or DSM-5

diagnoses.

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

antipsychotics, benzodiazepines) for stabilization or any psychotropics which require a

psychiatrist or other specialist to manage.

17. Behavioral health disorders newly diagnosed during deployment do not immediately

require a waiver or redeployment. Disorders deemed treatable, stable, and having no

impairment of performance or safety by a credentialed mental health provider do not

require a waiver to remain in theater.

a. Exceptions include diagnoses featuring manic, psychotic, or significant suicidal

features as determined by local medical personnel. These individuals should be

redeployed at soonest opportunity via medical evacuation with appropriate

escorts and per TRANSCOM guidelines.

b. Diagnoses requiring the prescription of CSA-scheduled controlled substances

will require an approved waiver to obtain routine refills of medication.

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

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

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

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

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

1. Any medication which, if lost, misplaced, stolen, destroyed, or unable to be resupplied,

would result in significant worsening or grave outcome for the affected individual before

the medication could be reasonably replaced.

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

handling/storage requirements, or which has documented side effects, when used alone

or in combination with other required therapy, which are significantly impairing, or which

impose an undue risk to the individual or operational objectives.

3. Blood modifiers:

a. Therapeutic Anticoagulants: warfarin (Coumadin), rivaroxaban (Xarelto),

apixaban (Eliquis).

b. Platelet Aggregation Inhibitors or Reducing Agents: clopidogrel (Plavix),

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

Prasugrel (Effient), Pentoxifylline (Trental), Cilostazol (Pletal), Ticagrelor

(Brilinta). Note: Aspirin use in theater is to be limited to individuals who have

been advised to continue use by their healthcare provider for medical reasons;

such use must be documented in the medical record.

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

erythropoietin (Epogen, Procrit).

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

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

hydroxyurea, mercaptopurine, etc.), alkylators (cyclophosphamide, melphalan,

chlorambucil, etc.), antiestrogens (tamoxifen, etc.), aromatase inhibitors (anastrozole,

examestane, etc.), medroxyprogesterone (except use for contraception), interferons,

etoposide, bicalutamide, bexarotene, oral tretinoin (Vesanoid).

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

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

adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade),

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

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

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

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

b. Stimulants: methylphenidate (Ritalin, Concerta),

amphetamine/dextroamphetamine (Adderall), dextroamphetamine (Dexedrine),

dexmethylphenidate (Focalin XR), lisdexamfetamine (Vyvanse), modafinil

(Provigil), armodafinil (Nuvigil), etc.

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

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

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

transition do not require a waiver.

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

hydrocodone (Lortab, Norco, Vicodin), hydromorphone (Dilaudid), meperidine

(Demerol), tramadol (Ultram), etc.

UNCLASSIFIED

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

cannabinol (CBD oil), etc. Note that possession or use may be a criminal offense

in the CENTCOM AOR.

f. Anorexiants: phendimetrazine (Adipost), phentermine (Zantryl, Adipex-P), etc.

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

Testim), oxymetholone (Anadrol-50), methyltestosterone (Methitest), etc.

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

(Prolixin), quetiapine (Seroquel), aripiprazole (Abilify), lurasidone (Latuda), ziprasidone

(Geodon), olanzapine (Zyprexa), etc.

9. Antimanic (bipolar) agents: e.g., lithium.

10. Anticonvulsants, used for seizure control or behavioral health diagnoses.

a. Anticonvulsants (except those listed below) which are used for non-behavioral

health diagnoses, such as migraine, chronic pain, neuropathic pain, and post-

herpetic neuralgia, are not intrinsically deployment-limiting as long as treated

conditions meet the criteria set forth in this document and accompanying MOD

16. No waiver required. Exceptions include:

b. Valproic acid (Depakote, Depakote ER, Depacon, divalproex, etc.).

c. Carbamazepine (Tegretol, Tegretol XR, etc.).

d. Lamotrigine (Lamictal)

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

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

13. Insulin

14. Injectable medications of any type require waiver, excluding medroxyprogesterone

acetate (Depo-Provera) and EpiPens. Strongly recommend requesting waiver over

modifying route of administration when treatment is stable and effective.

8. CONTACTS FOR WAIVERS (See also MOD 17, Para. 15.C.3.C.)

A. CENTCOM. CENTCOM.MACDILL.CENTCOM-HQ.MBX.CCSG-WAIVER@MAIL.MIL; CML:

813.529.0361/0348; DSN: 312.529.0361/0348

B. AFCENT. SG.CLINOPS@AFCENT.AF.MIL; CML: 803.717.7101; DSN: 313.717.7101

C. ARCENT. USARMY.SHAW.USARCENT.MBX.SURG-WAIVER@ARMY.MIL; CML: 803.885.7946;

DSN: 312.889.7946

D. MARCENT. MARCENT.WAIVERS@USMC.MIL; CML: 813.827.7175; DSN: 312.651.7175

E. NAVCENT. C5FMEDW[email protected]VY.MIL; CML: 011.973.1785.4558; DSN: 318.439.4558

F. SOCCENT. SOCCENT[email protected]; CML: 813.828.7351; DSN: 312.968.7351