Manual of the Medical Department (NAVMED P-117): Chapter 15: Medical Examinations

Manual of the Medical Department (NAVMED P-117): Chapter 15: Medical Examinations: Physical Standards

15-49 Extremities

Department of the Navy
Bureau of Medicine and Surgery

(1) The causes for rejection are:

(a) Upper Extremities

(1) Limitation of motion. An individual will be considered unacceptable if the joint ranges of motion are less than the measurements listed below.

(a) Shoulder. Forward elevation to 90 degrees. Abduction to 90 degrees.

(b) Elbow. Flexion to 100 degrees. Extension to 15 degrees.

(d) Hand. Pronation to 45 degrees. Supination to 45 degrees.

(e) Fingers. Inability to clench fist, pick up a pin or needle, or grasp an object.

(2) Hand and fingers

(a) Absence (or loss) of 1/3 of the distal phalanx of either thumb.

(b) Absence (or loss) of distal and middle pha lanx of an index, middle, a ring finger of either hand irre spective of the absence (or loss) of little finger.

(c) Absence of more than the distal phalanx of any two of the following fingers, index, middle, or ring, of ei ther hand.

(d) Absence of hand or any portion thereof ex cept for fingers as noted above.

(e) Hyperdactylia.

(f) Scars and deformities of the fingers or hand which impair circulation, are symptomatic, are so disfiguring as to make the individual objectionable in ordinary social re lationships, or which impair normal function to such a degree as to interfere with the satisfactory performance of military duty.

(3) Wrist, forearm, elbow, arm, and shoulder.

Healed disease or injury of wrist, elbow, or shoulder with re sidual weakness or symptoms of such a degree as to preclude satisfactory performance of duty.

(b) Lower Extremities

(1 ) Limitation of motion. An individual will be considered unacceptable if the joint ranges of motion are less than the measurements listed below:

(a) Hip. Flexion to 90 degrees. Extension to 10 degrees. Abduction to 30 degrees. Rotation to 60 degrees (internal and external combined).

(b) Knee. Full extension. Flexion to 100 degrees.

(d) Toes. Stiffness which interferes with walking, marching, running, or jumping.

(2) Foot and ankle

(a) Absence of one or more small toes of one or both feet, if function of the foot is poor or running w jumping is precluded, or absence of foot w any portion thereof except for toes as noted herein.

(b) Absence (or loss) of great toe or loss of dorsal flexion thereof if function of the foot is impaired.

(d) Clubfoot.

(e) Flatfoot, pronounced cases, with decided eversion of the foot and marked bulging of the inner border, due to inward rotation of the talus, regardless of the presence or absence of symptoms.

(f) Flatfoot, spastic.

(g) Hallux valgus, if severe and associated with marked exostosis or bunion.

(h) Hammer toe which interferes with the wearing of combat service boots.

(i) Healed disease, injury, or deformity including hyperdactylia which precludes running, is accompanied by disabling pain, or which prohibits wearing of combat service boots.

(j) Ingrowing toe nails, if severe, and not remediable

(k) Obliteration of the transverse arch associated with permanent flexion of the small toes.

(l) Pes cavus, with contracted planter fascia, dorsiflexed toes, tenderness under the metatarsal heads, and callosity under the weight bearing areas.

(3) Leg, knee, thigh, and hip

(a) Untreated meniscal tear, loose or foreign bodies within the knee joint, or history of surgical correction of same if:

(1) Within the preceding 6 months.

(2) Six months or more have elapsed since operation without recurrence, and there is instability of the knee ligaments in lateral w anteroposterior directions in comparison with the normal knee or abnormalities noted on x-ray, there is significant atrophy or weakness of the thigh musculature in comparison with the normal side, there is not acceptable active motion in flexion and extension, or there are other symptoms of internal derangement.

(b) Authentic history w medical findings of an unstable a internally deranged joint causing disabling pain a seriously limiting function. Individuals with verified episodes of buckling a locking of the knee who have not undergone satisfactory surgical correction w if, subsequent to surgery, there is evidence of more than mild instability of the knee ligaments in medial, lateral, w anteroposterior directions in comparison with the normal knee, weakness u atrophy of the thigh musculature in comparison with the normal side, a if the individual requires medical treatment of sufficient frequency to interfere with the performance of military duty.

(c) Authenticated history of hip dislocation within 2 years before examination or degenerative changes on x-ray from the old hip dislocation.

(d) Osteochondritis of the tibial tuberosity (Osgood Schlatter disease) if symptomatic or with obvious prominence of the part and x-ray evidence of a separated bone fragment.

(4) General

(a) Deformities d one a both lower extremities which have interfered with function to such a degree as to prevent the individual from following a physically active vocation in civilian life u which would interfere with the satisfactory completion of prescribed training and performance of military duty.

(b) Diseases or deformities of the hip, knee, w ankle joint which interfere with walking, running, a weight bearing.

(c) Pain in the lower back a leg which is intractable and disabling to the degree of interfering with walking, running, and weight bearing.

(d) Shortening of a lower extremely resulting in any limp of noticeable degree.

(1) Arthritis

(a) Active or subacute arthritis, including Marie Struempell type.

(b) Chronic osteoarthritis or traumatic arthritis of isolated joints of more than minimal degree, which has interfered with the following of a physically active vocation in civilian life or which precludes the satisfactory performance of military duty.

(d) Traumatic arthritis of a major joint of more than minimal degree.

(2) Disease of any bone or joint, healed, with such resulting deformity a rigidity that function is impaired to such a degree that it will interfere with military service.

(3) Dislocation, old unreduced; substantiated history of recurrent dislocations of major joints; instability of a major joint, symptomatic and more than mild; u if, subsequent to surgery, there is evidence of more than mild instability in comparison with the normal joint, weakness or atrophy in comparison with the normal side, or if the individual requires medical treatment of sufficient frequency to interfere with the performance of military duty.

(4) Fractures

(a) Malunited fractures that interfere significantly with function.

(b) Ununited fractures.

(c) Any old a recent fracture to which a plate, pin, intramedullary rod, a screws were used for fixation and left in place and which may be subject to easy trauma, i.e., as a tibial plate, etc.

(5) Injury of a bone or joint within the preceding 6 weeks, without fracture or dislocation, of more than a minor nature.

(6) Joint replacement.

(7) Muscular paralysis, contracture, or atrophy, if progressive or of sufficient degree to interfere with military service.

(8) Myotonia congenital confirmed.

(9) Osteomyelitis, active w recurrent, of any bone or substantiated history of osteomyelitis of any of the long bones unless successfully treated 2 or more years previously without subsequent recurrence w disqualifying sequelae as demonstrated by both clinical and x-ray evidence.

(10) Osteoporosis.

(11)Chondromalacia, osteomalacia, or patello-femoral syndrome, manifested by verified history of joint effusion, interference with function, or residuals from surgery.

(12) Osteochondritis Desecrans, if symptomatic.