An employee must meet minimum standards of physical and psychological fitness to work with a defense contractor in CENTCOM. Typically, when an employee is hired, there is a pre-employment physical. During that physical, medical professionals will examine the claimant and take blood and urine samples. After the physical is passed, the employee may begin working for the defense contractor.
Importantly, these standards of fitness also apply to a defense contractor’s employee who was injured on the job. At some time during the disabled employee’s treatment, a question will arise as to whether an employee can return to the same job the employee performed at the time of injury. To re-deploy to CENTCOM for work with a defense contractor, the employee must again satisfy the physical fitness requirements. Consequently, when assessing an ongoing disability, a potentially-determining issue is whether the defense contractor can pass a re-deployment physical.
To pass a physical means that the employee meets the minimum standards of fitness established by the Department of Defense and the Code of Federal Regulations (32 C.F.R. 158.7). Previously, I wrote about this subject. However, because of the published “MOD THIRTEEN” and the “Amplification of MOD THIRTEEN,” which are shortened titles, it is important to review these minimum standards again.
Understandably, the guidelines are lengthy. After all, they apply to “medical conditions” that include physical, dental, psychological and emotional issues that an employee may suffer. As such, the topic of non-deployable medical conditions will stretch over multiple posts on this blog.
Medications That May Preclude Re-Deployment:
Today’s post focuses on the medications that can preclude deployment. Use of any of the following medications “is disqualifying for deployment, unless a waiver is granted:”
- Any medication which, if lost, misplaced, stolen, or destroyed, would result in significant worsening or grave outcome for the affected individual before the medication could be reasonably replaced.
- Any medication which requires 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.
- Blood modifiers:
- Therapeutic Anticoagulants: warfarin (Coumadin), rivaroxaban (Xarelto).
- Platelet Aggregation Inhibitors or Reducing Agents: clopidogrel (Plavix), anagrelide (Agrylin), Dabigatran (Pradaxa), Aggrenox, Ticlid (Ticlopidine), Prasugrel (Effient), Pentoxifylline (Trental), Cilostazol (Pletal). 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.
- Hematopoietics: filgrastim (Neupogen), sargramostim (Leukine), erythropoietin (Epogen, Procrit).
- Antihemophilics: Factor VIII, Factor IX.
- 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).
- Immunosuppressants: e.g., chronic systemic steroids.
- Biologic Response Modifiers (immunomodulators): e.g., abatacept (Orencia), adalimumab (Humira), anakinra (Kineret), etanercept (Enbrel), infliximab (Remicade), leflunomide (Arava), etc.
- Antiretrovirals used for Pre-Exposure Prophylaxis (PrEP): e.g. tenofovir disoproxil fumarate/emtricitabine (Truvada), tenofovir alafenamide (Vemlidy).
- Any CSA Schedule I-V controlled substance, including but not limited to the following:
- Benzodiazepines: lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium), flurazepam (Dalmane), clonazepam (Klonopin), etc.
- Stimulants: methylphenidate (Ritalin, Concerta), amphetamine/dextroamphetamine (Adderall), dextroamphetamine (Dexedrine), dexmethylphenidate (Focalin XR), lisdexamfetamine (Vyvanse), modafinil (Provigil), armodafinil (Nuvigil), etc.
- 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 generally require a waiver.
- Narcotics/narcotic combinations: oxycodone (Oxycontin, Percocet, Roxicet), hydrocodone (Lortab, Norco, Vicodin), hydromorphone (Dilaudid), meperidine (Demerol), tramadol (Ultram), etc.
- Cannabinoids: marijuana, tetrahydrocannabinol (THC), dronabinol (Marinol), etc. Note that possession or use may be a criminal offense in the CENTCOM AOR.
- Anorexiants: phendimetrazine (Adipost), phentermine (Zantryl), etc.
- Androgens and Anabolic Steroids: testosterone (Axiron, AndroGel, Fortesta, Testim), oxymetholone (Anadrol-50), methyltestosterone (Methitest), etc. Preparations used in accordance with standards outlined . . . above do not require separate waiver. All injected preparations require waiver.
- Antipsychotics, including atypical antipsychotics: haloperidol (Haldol), fluphenazine (Prolixin), quetiapine (Seroquel), aripiprazole (Abilify), etc.
- Antimanic (bipolar) agents: e.g., lithium.
- Anticonvulsants, used for seizure control or psychiatric diagnoses.
- Anticonvulsants (except those listed below) which are used for non-psychiatric 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 THIRTEEN. No waiver required. Exceptions include:
- Valproic acid (Depakote, Depakote ER, Depacon, divalproex, etc.).
- Carbamazepine (Tegretol, Tegretol XR, etc.).
- Lamotrigine (Lamictal)
- Varenicline (Chantix).
- Botulinum toxin (Botox): Current or recent use to control severe pain.
- Insulin and exenatide (Byetta).
- Injectable medications of any type, excluding epinephrine (Epipen), though underlying allergy may require separate waiver.
The list of medications can be found in the “Amplification of MOD THIRTEEN.” Because the Amplification lists some, but not all, of the DEA-identified controlled substances, it is important to consider the effect of those medications, too. The following hyperlinks will take you to the various schedules of controlled substances identified in the Code of Federal Regulations: Schedule I (21 C.F.R. 1308.11), Schedule II (21 C.F.R. 1308.12), Schedule III (21 C.F.R. 1308.13), Schedule IV (21 C.F.R. 1308.14), and Schedule V (21 C.F.R. 1308.15).
In short, The medications that an injured Defense Base Act employee is taking must be considered when determining the jobs that an injured worker can perform. If the employee is taking one of the identified medications, then the employee may not re-deploy to CENTCOM.