Medical and dental fitness for deploying contractors

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1. Fitness is a contract term

Part 158 of title 32 of the Code of Federal Regulations sets Defense Department policy on operational contract support abroad, and section 158.6 sets the medical and dental rules for deploying contractor personnel. Defense contracts that require deploying contractors authorized to accompany the force (CAAF) must include medical and dental fitness standards, and contractors must employ personnel who meet them (32 CFR 158.6(a)(1)). For personnel covered by the Rehabilitation Act of 1973 or the Americans with Disabilities Act of 1990, the standards do not change the legal obligations of Defense components and contractors as employers. Replacing personnel already in theater who are not medically qualified is at the contractor’s cost. Who counts as CAAF is covered in supporting deployed forces under DFARS 252.225-7040.

The geographic combatant commander sets force health protection policies for all forces in the command, and runs a process for reviewing individual requests for exceptions, keeping records of every waiver approved or denied (32 CFR 158.6(a)(2)). Medical fitness procedures, including removing personnel who are no longer medically qualified at the contractor’s expense, are posted on the command’s operational contract support web page and written into contracts (32 CFR 158.6(a)(3)). Unless the contract says otherwise, all medical evaluations and treatment are the contractor’s responsibility (32 CFR 158.6(a)(4)).

2. Screening before deployment

Fitness standards concern a person’s ability to do the tasks of the particular operation and to tolerate the deployed environment (32 CFR 158.6(b)(1)). All CAAF must have a screening medical and dental assessment within 12 months before arriving at the deployment center or approved contractor processing facility (32 CFR 158.6(b)(2)). The contractor’s medical provider conducts it, and should emphasize conditions that could stop the person performing the contract, especially in austere environments. CAAF also receive a health threat and countermeasures briefing from the military service before deploying (32 CFR 158.6(b)(3)).

CAAF found to have a listed condition, or to need extensive preventive dental care, are not medically fit to deploy unless a waiver approves deployment (32 CFR 158.6(b)(4)). People found not medically fit after an individual assessment, including those refused a waiver, may not deploy (32 CFR 158.6(b)(5)). Contracts must require contractors to replace anyone who becomes medically unqualified during performance (32 CFR 158.6(b)(7)). CAAF must complete a post-deployment health assessment at the end of deployment or within 30 days of redeployment (32 CFR 158.6(b)(8)). Personnel who are not CAAF are screened by a government designee where the requiring activity and contract call for it, by class of labor (32 CFR 158.6(b)(6)).

3. What to bring

Personnel who need vision correction must have two pairs of glasses and, where applicable, inserts for a chemical protective mask (32 CFR 158.6(c)(1)). Contact lenses in the field are not recommended and are worn at the person’s own risk (32 CFR 158.6(c)(2)). Apart from force health protection products the government supplies, personnel must deploy with at least a 90-day supply of their required medications, bought at their own expense (32 CFR 158.6(d)). They must be told that deployed medical units are set up for emergency care of healthy adults and cannot provide many medications for chronic conditions. Personnel must also bring comfort items such as spare hearing aid batteries, sunglasses, insect repellent and sunscreen, which Defense sources will not provide (32 CFR 158.6(e)).

4. Immunizations and tests

A list of required and recommended immunizations is produced for each deployment, posted and written into contracts (32 CFR 158.6(f)). CAAF must complete mandatory immunizations, subject to legally required exemptions (32 CFR 158.6(f)(2)). The Defense Department provides theater-specific immunizations and medications not available to the public at no cost during pre-deployment processing, and personnel obtain the rest beforehand. A tuberculosis skin test is required within three months before deployment (32 CFR 158.6(f)(3)). HIV testing is not mandatory unless the combatant commander or the host nation requires it, and then must be within a year before deployment (32 CFR 158.6(g)).

5. Identification

For American citizen CAAF, contractors must obtain a dental panograph. They must also make sure a specimen sample suitable for DNA analysis is on file with the Armed Forces Repository of Specimen Samples for the Identification of Remains (32 CFR 158.6(h)). Contracts must make this a condition of deployment, and contractors verify in the tracking system that the repository has received the sample, or that they have collected it. The repository applies special rules to protect privacy in the samples and any analysis (32 CFR 158.6(h)(3)). Where the repository is not used, the contractor must be able to retrieve identification records within 24 hours for the Armed Forces Medical Examiner if a casualty occurs (32 CFR 158.6(h)(2)).

6. Conditions and waivers

The regulation lists conditions that usually preclude medical clearance, as minimum requirements (32 CFR 158.6(j)). They include chronic conditions needing frequent clinical visits, conditions that could cause sudden incapacitation, and hypertension not controlled with medication or needing frequent monitoring. Others include a recent heart attack or cardiac procedure, no dental exam in the last 12 months, and certain psychiatric conditions. For a person with a listed condition, the contracting officer may grant clearance only after a waiver is approved (32 CFR 158.6(j)(2)). The cognizant medical authority recommends and advises, and the combatant commander is the final authority, except for personnel working with special operations forces.

A contractor that believes an individual can perform the essential duties and tolerate the conditions, with or without reasonable accommodation, may request a waiver through the contracting officer (32 CFR 158.6(k)). The request summarizes a detailed medical evaluation and states the person’s qualifications, position, known hazards and expected need for care. Based on an individual assessment, waivers may be appropriate if five conditions are all met, with or without reasonable accommodation. The condition must be unlikely to have a grave outcome or harm the mission if it worsens, and must be stable. Needed care and medications must be available without the military health system or special handling the theater cannot support. The condition must not need duty limitations that would prevent performance or need accommodation by the Defense component, and no routine evacuation may be needed (32 CFR 158.6(i)). The combatant commander, or designee, decides, except that the theater special operations commander decides for personnel working with special operations forces (32 CFR 158.6(k)(2) and 32 CFR 158.6(k)(3)).

Key terms

Screening assessment	The medical and dental check required within 12 months before arrival for deployment.
Not medically fit	The status that bars deployment unless a waiver is approved.
Force health protection	Command policies and programs to keep deployed forces healthy and ready.
Panograph	A dental record that American citizen CAAF must provide for identification.
Medical waiver	An individual approval to deploy despite a listed condition.

Every statement above links to the document behind it. The full source list for this piece is on the sources page.

This page describes public United States government programs for general information. It is not legal, regulatory or procurement advice, and it does not address the facts of any particular case.

How Sentfore supports this

Healthy teams are a precondition of every deployment. Sentfore works at the delivery end of defense programs in difficult environments, providing secure movement, protective security, facilities and life support. Requirements can be sent through the contact page.