Oklahoma Administrative Code
Title 270 - Oklahoma Firefighters Pension and Retirement System
Chapter 10 - Firefighters Pension and Retirement Plan
Section 270:10-1-5 - Medical conditions affecting ability to safely perform essential job functions
Universal Citation: OK Admin Code 270:10-1-5
Current through Vol. 42, No. 1, September 16, 2024
(a) Medical conditions that can affect a candidate's ability to safely perform essential job functions shall be designated either Category A or Category B.
(b) Candidates with Category A medical conditions shall not be certified as meeting the medical requirements for entrance into the System.
(c) Candidates with Category B medical conditions shall be certified as meeting the medical requirements for entrance into the System only if they can perform the essential job functions without posing a significant safety and health risk to themselves, members, or civilians.
(d) Candidates with one or more Category B medical conditions present upon entry into the System may be eligible for consideration of a disability pension, whether in the line of duty or not in the line of duty, related to the same Category B condition or conditions listed in the candidate's medical certification, but only to the extent that competent medical evidence is presented to support the certification of said disability request and that such medical evidence supports that the injury, or condition, giving rise to the disability occurred after employment as a firefighter with a participating municipality.
(e) The following describe the Category A and Category B conditions as they relate to a candidate's ability to safely perform the essential job functions of a firefighter:
(1) Head.
(A) Category A medical conditions shall include the following:
(i) Any defect of the skull preventing helmet use or leaving any underlying brain unprotected from trauma.
(ii) Any skull or facial deformity that would not allow for a successful respiratory facepiece fit test.
(iii) Any head condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Deformities of the skull such as depressions or exostoses.
(ii) Deformities of the skull associated with evidence of disease of the brain, spinal cord, or peripheral nerves.
(iii) Loss or congenital absence of any of the bony substance of the skull.
(iv) Any other head condition that may result in a person not being able to safely perform essential job functions.
(2) Neck.
(A) Category A medical conditions shall include the following:
(i) Any neck condition that results in a person not being able to safely perform essential job functions.
(ii) Reserved.
(B) Category B medical conditions shall include the following:
(i) Thoracic outlet syndrome.
(ii) Congenital cysts, chronic draining fistulas, or similar lesions.
(iii) Contraction of neck muscles.
(iv) Any other neck condition that may result in a person not being able to safely perform essential job functions.
(3) Eyes and Vision.
(A) Category A medical conditions shall include the following:
(i) Far visual acuity worse than 20/40 binocular, corrected with contact lenses or spectacles or far visual acuity worse than 20/100 binocular for wearers of hard contacts or spectacles, uncorrected.
(ii) Color perception monochromatic vision resulting in inability to use imaging devices.
(iii) Monocular vision.
(iv) Any eye condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Diseases of the eye such as retinal detachment, progressive retinopathy, or optic neuritis.
(ii) Ophthalmological procedures such as radial keratotomy, Lasik procedure, or repair of retinal detachment.
(iii) Peripheral vision in the horizontal meridian of less than 110 degrees in the better eye or any condition that significantly affects peripheral vision in both eyes.
(iv) Amblyopia.
(v) Any other eye condition that may result in a person not being able to safely perform essential job functions.
(4) Ears and hearing.
(A) Category A medical conditions shall include the following:
(i) Chronic vertigo or impaired balance as demonstrated by the inability to tandem gait walk.
(ii) On audiometric testing, average hearing loss in the unaided better ear, without the aid of a hearing assistance device, worse than 40 decibels (dB) at 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz when audiometric device is calibrated to ANSI Z24.5.
(iii) Any ear condition or hearing impairment that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Unequal hearing loss.
(ii) Average uncorrected hearing deficit at the test frequencies 500 Hz, 1000 Hz, 2000 Hz, and 3000 Hz worse than 40 decibels (dB) in either ear.
(iii) Atresia, stenosis, or tumor of the auditory canal.
(iv) External otitis.
(v) Agenesis or traumatic deformity of the auricle.
(vi) Mastoiditis or surgical deformity of the mastoid.
(vii) Menieres disease, labyrinthitis, or tinnitus.
(viii) Otitis media.
(ix) Any other ear condition or hearing impairment that may result in a person not being able to safely perform essential job functions.
(5) Dental.
(A) Category A medical conditions shall include the following:
(i) Any dental condition that results in a person not being able to safely perform essential job functions.
(ii) Reserved.
(B) Category B medical conditions shall include the following:
(i) Diseases of the jaw or associated tissues.
(ii) Orthodontic appliances.
(iii) Oral tissues, extensive loss.
(iv) Relationship between the mandible and maxilla that interferes with satisfactory postorthodontic replacement or ability to use protective equipment.
(v) Any other dental condition that may result in a person not being able to safely perform essential job functions.
(6) Nose, oropharynx, trachea, esophagus, and larynx.
(A) Category A medical conditions shall include the following:
(i) Tracheostomy.
(ii) Aphonia.
(iii) Any nasal, oropharyngeal, esophageal, or laryngeal condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Congenital or acquired deformity.
(ii) Allergic rhinitis.
(iii) Epistaxis, recurrent.
(iv) Sinusitis, recurrent.
(v) Dysphonia.
(vi) Anosmia.
(vii) Tracheal stenosis.
(viii) Nasopharyngeal polyposis.
(ix) Any other nasal, oropharyngeal, esophageal, laryngeal condition, or obstructive apneas (e.g., sleep apnea), if unresponsive to treatment, that may result in a person not being able to safely perform essential job functions.
(7) Lungs and chest walls.
(A) Category A medical conditions shall include the following:
(i) Active hemoptysis.
(ii) Current empyema.
(iii) Pulmonary hypertension.
(iv) Active tuberculosis.
(v) Obstructive lung diseases (e.g., emphysema, chronic bronchitis, asthma, etc.) with an FEV1/FVC of less than 0.70, with both FEV1 FVC below normal (less than 0.80%) as defined by the American Thoracic Society.
(vi) Hypoxemia - oxygen saturation less than 90% at rest (exercise testing indicated when resting oxygen is less than 94% but more than 90%). Evaluate VO2 max as described by the American College of Sports Medicine (ACSM).
(vii) Asthma, including reactive airway disease requiring bronchodilator or corticosteroid therapyat least once in the previous 2 years. A candidate who has in the past required bronchodilator, corticosteroid, or anti-inflammatory therapy for asthma may be evaluated by a pulmonologist or other expert in asthmatic lung diseases, such as an allergist, and may be determined to no longer have asthma if all the followingcriteria are met:
(I) The candidate denies bronchospasm during exertion, temperature/humidity extremes, or irritant exposures.
(II) The candidate denies the use of bronchodilator rescue medications during exertion, temperature/humidity extremes, or irritant exposures.
(III) The candidate's asthma has not required systemic corticosteroids, emergency room treatment, or hospital admission in the past 2 years.
(IV) If allergic, allergen avoidance or desensitization has been successful.
(V) Spirometry demonstrates adequate reserve (FVC and FEV1 greater or equal to 90 percent) and no bronchodilator response measured off all bronchodilators on the day of testing.
(VI) Normal or negative response to provocative challenge testing [e.g., cold air, exercise (12 METS), methacholine(PC20 greater than 8 is considered normal, as response at dose greater than 8 mg/ml might not be clinically significant), histamine, mannitol, or hypertonic saline, or negative response to exercise challenge.
(VII) Challenge testing shall be performed off all anti-inflammatory medications(e.g., inhaled or oral steroids or leukotriene receptor antagonists) for 4 weeks preceding the test, off all antihistamines (e.g., oral allergy medications) for 1 week, and off all bronchodilators on the day of testing.
(viii) Lung transplant.
(ix) Obstructive sleep apnea with excessive daytime sleepiness, unless all the following criteria are met:
(I) Successful treatment.
(II) Documentation of CPAP compliance, sleep study with an oral appliance, or of sleep study after surgery.
(III) No excessive daytime sleepiness with treatment.
(x) Any other pulmonary condition that results in the candidate not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Pulmonary resection surgery, chest wall surgery, or pneumothorax.
(ii) Pleural effusion.
(iii) Fibrothorax, chest wall deformity, or diaphragm abnormalities.
(iv) Interstitial lung disease.
(v) Pulmonary vascular diseases or history of pulmonary embolism.
(vi) Bronchiectasis.
(vii) Infectious diseases of the lung or pleural space.
(viii) Cystic fibrosis.
(ix) Central or obstructive apnea.
(x) Any other pulmonary condition that may result in a person not being able to safely perform essential job functions.
(8) Heart.
(A) Category A medical conditions shall include:
(i) Clinically significant coronary artery disease, including a history of myocardial infarction, angina pectoris, coronary artery bypass surgery, coronary angioplasty, and similar procedures.
(ii) Cardiomyopathy or congestive heart failure, including signs or symptoms of compromised left or right ventricular function, including dyspnea, S3 gallop, peripheral edema, enlarged ventricle, abnormal ejection fraction, and/or inability to increase cardiac output with exercise.
(iii) Acute pericarditis, endocarditis, or myocarditis.
(iv) Syncope, recurrent.
(v) Any medical condition requiring an automatic implantable cardiac defibrillator, unless the condition no longer requires an automatic implantable cardiac defibrillator, or any medical history of ventricular tachycardia or ventricular fibrillation due to ischemic or valvular heart disease, or cardiomyopathy.
(vi) Third-degree atrioventricular block.
(vii) Cardiac pacemaker, if the candidate is pacemaker dependent.
(viii) Hypertrophic cardiomyopathy or idiopathic hypertrophic subaortic stenosis.
(ix) Heart transplant.
(x) Any cardiac condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Valvular lesions of the heart, including prosthetic valves.
(ii) Recurrent supraventricular or atrial tachycardia, flutter or fibrillation.
(iii) Left bundle branch block.
(iv) Second-degree atrioventricular block in the absence of structural heart disease.
(v) Sinus pause more than 3 seconds.
(vi) Ventricular arrhythmia (history or presence of multi-focal PVC's or non-sustained ventricular tachycardia on resting EKG with or without symptoms); history or presence of sustained ventricular tachycardia with or without symptoms.
(vii) Cardiac hypertrophy.
(viii) History of congenital abnormality.
(ix) Chronic pericarditis, endocarditis, or myocarditis.
(x) Brugada syndrome.
(xi) Long QT syndrome.
(xii) Arrhythmogenic right ventricular cardiomyopathy.
(xiii) Cardiac pacemaker if the candidate is not pacemaker dependent.
(xiv) Coronary artery disease other than listed in (e)(8)(A)(i) of this section.
(xv) Any other heart condition that may result in a person not being able to safely perform essential job functions.
(9) Vascular system.
(A) Category A medical conditions shall include the following:
(i) Hypertension with evidence of end organ damage or not controlled by approved medications.
(ii) Thoracic or abdominal aortic aneurysm.
(iii) Carotid artery stenosis or obstruction resulting in more than 50 percent reduction in blood flow.
(iv) Peripheral vascular disease resulting in symptomatic claudication.
(v) Any other vascular condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Vasospastic phenomena such as Raynaud's phenomenon.
(ii) Thrombophlebitis and varicosities.
(iii) Chronic lymphedema due to lymphadenopathy or venous valvular incompetency.
(iv) Congenital or acquired lesions of the aorta or major vessels.
(v) Circulatory instability as indicated by orthostatic hypotension, persistent tachycardia, and peripheral vasomotor disturbances.
(vi) History of surgical repair of aneurysm of heart or major vessel.
(vii) Any other vascular condition that may result in a person not being able to safely perform essential job functions.
(10) Abdominal organs and gastrointestinal system.
(A) Category A medical conditions shall include the following:
(i) Presence of uncorrected inguinal/femoral hernia, if symptomatic.
(ii) Any gastrointestinal condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Cholecystitis.
(ii) Gastritis.
(iii) GI bleeding.
(iv) Acute hepatitis.
(v) Hernia including the following:
(I) Uncorrected umbilical, ventral, or incisional hernia if significant risk exists for infection or strangulation.
(II) Significant symptomatic hiatal hernia if associated with asthma, recurrent pneumonia, chronic pain, or ulcers.
(III) Surgically corrected hernia morethan 3 months after surgical correction.
(vi) Inflammatory bowel disease or irritable bowel syndrome.
(vii) Intestinal obstruction.
(viii) Pancreatitis.
(ix) Diverticulitis.
(x) History of gastrointestinal surgery.
(xi) Peptic or duodenal ulcer of Zollinger-Ellison syndrome.
(xii) Asplenia.
(xiii) Cirrhosis, hepatic or biliary.
(xiv) Chronic active hepatitis.
(xv) Any other gastrointestinal condition that may result in a person not being able to safely perform essential job functions.
(11) Metabolic syndrome.
(A) Category A medical conditions shall include the following: Metabolic syndrome with an aerobic capacity less than 12 METs.
(B) Category B medical conditions shall include the following: Metabolic Syndrome with an aerobic capacity 12 METs or greater.
(12) Reproductive system.
(A) Category A medical conditions shall include the following:
(i) Any genital condition that results in a person not being able to safely perform essential job functions.
(ii) Reserved.
(B) Category B medical conditions shall include the following:
(i) Pregnancy, for its duration.
(ii) Dysmenorrhea.
(iii) Endometriosis, ovarian cysts, or other gynecologic conditions.
(iv) Testicular or epididymal mass.
(v) Any other genital condition that may result in a person not being able to safely perform essential job functions.
(13) Urinary system.
(A) Category A medical conditions shall include the following:
(i) Renal failure or insufficiency requiring continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis.
(ii) Chronic kidney disease of Stage 4 or greater (glomerular filtration rate (GFR) less than 1 oz/min (30 ml/min)).
(iii) Any urinary condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Diseases of the kidney.
(ii) Diseases of the ureter, bladder, or prostate.
(iii) Any other urinary condition that may result in a person not being able to safely perform essential job functions.
(14) Spine and Axial Skeleton.
(A) Category A medical conditions shall include the following:
(i) Scoliosis of thoracic or lumbar spine with angle more than or equal to 40 degrees.
(ii) History of spinal surgery fusion of two or more vertebrae or rods that are still in place.
(iii) Any spinal or skeletal condition producing sensory or motor deficit(s) or pain due to radiculopathy or nerve root compression.
(iv) Any spinal or skeletal condition causing pain that frequently or recurrently requires narcotic analgesic medication.
(v) Cervical vertebral fractures with multiple vertebral body compression greater than 25 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (partial, moderate, severe), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or 1 year since surgery.
(vi) Thoracic vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (severe-with or without surgery), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or 1 year since surgery.
(vii) Lumbosacral vertebral fractures with vertebral body compression greater than 50 percent; evidence of posterior element involvement, nerve root damage, disc involvement, dislocation (severe-with or without surgery), abnormal exam, ligament instability, symptomatic, and/or less than 6 months post injury or 1 year since surgery.
(viii) Any spinal or skeletal condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Congenital or developmental malformations of the back.
(ii) Scoliosis with angle less than 40 degrees.
(iii) Arthritis of the cervical, thoracic, or lumbosacral spine.
(iv) Facet tropism, high lumbosacral angle, hyperlordosis, Schmorl's nodes, Scheuermann's disease, spina bifida occulta, spondylolisthesis, spondylolysis, or transitional vertebrae.
(v) History of infections or infarcts in the spinal cord, epidural space, vertebrae, or axial skeletal joints.
(vi) History of laminectomy or diskectomy or vertebral fractures.
(vii) Any spinal or skeletal condition that may result in a person not being able to safely perform essential job functions.
(15) Extremities.
(A) Category A medical conditions shall include the following:
(i) Bone hardware such as metal plates or rods supporting the bone during healing.
(ii) History of total joint replacement.
(iii) Amputation or congenital absence of upper extremity limb (hand or higher).
(iv) Amputation of either thumb proximal to the mid-proximal phalanx.
(v) Amputation or congenital absence of lower extremity limb (foot or above).
(vi) Chronic nonhealing or recent bone grafts.
(vii) History of more than one dislocation of the shoulder without surgical repair or with history of recurrent shoulder disorders within the last 5 years with pain or loss of motion, and with or without radiographic deviations from normal.
(viii) Any extremity condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) History of shoulder dislocation with surgical repair.
(ii) Significant limitation of function of shoulder, elbow, wrist, hand, or finger, due to weakness, reduced range of motion, atrophy, unequal length, absence, or partial amputation.
(iii) Significant lack of full motion of hip, knee, ankle, foot, or toes due to weakness, reduced range of motion, atrophy, unequal length, absence, or partial amputation.
(iv) History of meniscectomy or ligamentous repair of knee.
(v) History of intra-articular, malunited, or nonunion of upper or lower extremity fracture.
(vi) History of osteomyelitis, septic, or rheumatoid arthritis.
(vii) Any other extremity condition that may result in a person not being able to perform essential job functions.
(16) Neurological disorders.
(A) Category A medical conditions shall include the following:
(i) All single unprovoked seizures and epileptic conditions, including simple partial, complex partial, generalized, and psychomotor seizure disorders other than the seizure disorders meeting all the following conditions:
(I) No seizures for the most recent consecutive 5 years after single unprovoked seizure.
(II) No seizures for the most recent consecutive 10 years if the applicant was diagnosed with epilepsy.
(III) Currently on a stable regimen of antiepileptic drugs for the most recent 5 years, or on no antiepileptic drugs for the most recent 5 years.
(IV) Normal neurological examination results.
(V) Normal brain MRI results.
(VI) Normal awake and asleep photic stimulation and hyperventilation EEG study results.
(VII) A definitive statement from a qualified neurological specialist that the candidate meets these criteria and is neurologically able to perform the essential job functions of a firefighter.
(ii) Ataxias of heredo-degenerative type.
(iii) Cerebral arteriosclerosis as evidenced by a history of transient ischemic attack, reversible ischemic neurological deficit, or ischemic stroke.
(iv) Hemiparalysis or paralysis of a limb.
(v) Multiple sclerosis with activity or evidence of progression within previous 3 years.
(vi) Myasthenia gravis with activity or evidence of progression within previous 3 years.
(vii) Progressive muscular dystrophy or atrophy.
(viii) Uncorrected cerebral aneurysm.
(ix) Dementia (e.g., Alzheimer's and other neuro-degenerative diseases) with symptomatic loss of function or cognitive impairment (e.g., less than or equal to 28 on Mini-Mental Status Exam).
(x) Parkinson's disease and other movement disorders resulting in uncontrolled movements, bradykinesia, or cognitive impairment (e.g., less than or equal to 28 on Mini-Mental Status Exam).
(xi) Narcolepsy with cataplexy.
(xii) Narcolepsy with persistent excessive daytime sleepiness despite medical treatment.
(xiii) Amyotrophic lateral sclerosis (ALS).
(xiv) Any neurological condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Congenital malformations.
(ii) Migraine.
(iii) Clinical disorders with paresis, dyscoordination, deformity, abnormal motor activity, abnormality of sensation, or complaint of pain.
(iv) History of subarachnoid or intraparenchymal hemorrhage.
(v) Abnormalities from recent head injury such as severe cerebral contusion or concussion.
(vi) Provoked seizure.
(vii) Any other neurological condition that may result in a person not being able to safely perform essential job functions.
(17) Skin.
(A) Category A medical conditions shall include the following:
(i) Metastatic or locally extensive basal or squamous cell carcinoma or melanoma.
(ii) Any dermatologic condition that would not allow for a successful respiratory facepiece test.
(iii) Any dermatologic condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Skin conditions of a chronic or recurrent nature (e.g., eczema, cystic acne, or psoriasis) that cause skin openings or inflammation or irritation of the skin surface.
(ii) Surgery or skin grafting.
(iii) Mycosis fungoides.
(iv) Cutaneous lupus erythematosus.
(v) Raynaud's phenomenon.
(vi) Scleroderma (skin).
(vii) Vasculitic skin lesions.
(viii) Atopic dermatitis/eczema.
(ix) Contact or seborrheic dermatitis.
(xi) Albinism, Darier disease, ichthyosis, Marfan syndrome, neurofibromatosis, and other genetic conditions affecting the skin.
(xii) Folliculitis, pseudo-folliculitis, miliaria, keloid folliculitis.
(xiii) Hidradenitis suppurativa, furuncles, carbuncles, or Grade IV acne (cystic).
(xiv) Mechanobullous disorders (including epidermolysis bullosa, Hailey pemphigus, porphyria, and/or pemphigoid).
(xv) Urticaria or angioedema.
(xvi) Any other skin condition that may result in a person not being able to safely perform essential job functions.
(18) Blood and blood-forming organs.
(A) Category A medical conditions shall include the following:
(i) Hemorrhagic states requiring replacement therapy.
(ii) Sickle cell disease (homozygous).
(iii) Clotting disorders.
(iv) Any other hematological condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Anemia.
(ii) Leukopenia.
(iii) Polycythemia vera.
(iv) Splenomegaly.
(v) Any other hematological condition that results in a person not being able to safely perform essential job functions.
(vi) History of thromboembolic disease.
(19) Endocrine and metabolic disorders.
(A) Category A medical conditions shall include the following:
(i) Type 1 diabetes mellitus unless a candidate meets all of the following criteria:
(I) Is maintained by a physician knowledgeable in current management of diabetes mellitus on a basal/bolus (can include subcutaneous insulin fusion pump) regimen using insulin analogs.
(II) Has demonstrated over a period of at least 1 year the motivation and understanding required to closely monitor and control capillary blood glucose levels through nutritional therapy and insulin administration. Assessment of this shall take into consideration the erratic meal schedules, sleep disruptions, and high aerobic and anaerobic workloads intrinsic to firefighting.
(III) Has dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale.
(IV) Has normal renal function based on a calculated creatinine clearance greater than 60 mL /min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg of protein or greater than or equal to 300 mg of albumin per gram of creatinine in a random sample).
(V) Has no automatic or peripheral neuropathy. Peripheral neuropathy is determined by diminished ability to feel the vibration of a 128 cps tuning fork or the light touch of 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy might be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.
(VI) Has normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METS) by ECG and cardiac imaging.
(VII) Has a signed statement from an endocrinologist knowledgeable in management of diabetes mellitus as well as the essential job functions and hazards of firefighting as described in Section 270:10-1-7 of the administrative rules that the candidate is (1) is being successfully maintained on a regimen consistent with (19) (i) (I) and (II), (2) has achieved stable control of blood glucose as evidenced by hemoglobin A1C consistently less than 8 when monitored at least twice yearly and shall include evidence of a set schedule for blood glucose monitoring and a thorough review of the data from such monitoring, (3) does not have an increased risk of hypoglycemia due to alcohol use of other predisposing factors, (4) has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the preceding 1 year, with no more than one episode of severe hypoglycemia in the preceding 5 years, and (5) is certified not to have a medical contraindication to firefighting training and operations.
(ii) Insulin- requiring Type 2 diabetes mellitus, unless a candidate meets all the following criteria:
(I) Is maintained by a physician knowledgeable in current management of diabetes mellitus.
(II) Has demonstrated over a period of at least 3 months the motivation and understanding required to closely monitor and control capillary blood glucose levels through nutritional therapy and insulin administration. Assessment of this shall take into consideration the erratic meal schedules, sleep disruption, and high aerobic and anaerobic workloads intrinsic to firefighting.
(III) Has a dilated retinal exam by a qualified ophthalmologist or optometrist that show no higher grade of retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale.
(IV) Has normal renal function based on a calculated creatinine clearance greater than 60 mL/min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg protein or greater than or equal to 300 mg of albumin per gram creatinine in a random sample).
(V) Has no autonomic or peripheral neuropathy. (Peripheral neuropathy is determined by diminished ability to feel the vibration of 128 cps tuning fork or the light touch of a 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.
(VI) Has normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METS) by ECG and cardiac imaging.
(VII) Has signed statement from an endocrinologist knowledgeable in management of diabetes mellitus as well as the essential job functions and hazards of firefighting as described in Section 270:10-1-7 of the administrative rules that the candidate is (1) maintained on a stable insulin regiment and has demonstrated over a period of at least 3 months the motivation and understanding required to closely monitor and control capillary blood glucose levels despite varied activity schedules through nutritional therapy and insulin administration, (2) has achieved stable control of blood glucose as evidenced by Hemoglobin A1C less than 8 when monitored at least twice yearly, which must include evidence of a set schedule for blood glucose monitoring and a thorough review of the data from such monitoring, (3) does not have an increased risk of hypoglycemia due to alcohol use or other predisposing factors, (4) has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the preceding 1 year with no more than one episode of severe hypoglycemia in the preceding 5 years, and (5) is certified not to have a medical contraindication to firefighting training and operations.
(iii) Any endocrine or metabolic condition that results in a person not being able to safely perform job functions.
(B) Category B medical conditions shall include the following:
(i) Diseases of the adrenal gland, pituitary gland, parathyroid gland, or thyroid gland of clinical significance.
(ii) Nutritional deficiency diseases or other metabolic disorder.
(iii) Diabetes mellitus, not on insulin therapy, but controlled by diet, exercise, and/or hypoglycemic agents unless all the following are met:
(I) Has achieved a stable blood glucose as evidenced by Hemoglobin A1C level less than 8 during the prior 3-month period.
(II) If on oral hypoglycemic agents, has had no episodes of severe hypoglycemia (defined as requiring assistance of another) in the preceding year.
(III) Has dilated retinal exam by a qualified ophthalmologist or optometrist that shows no higher grade of diabetic retinopathy than microaneurysms, as indicated on the International Clinical Diabetic Retinopathy Disease Severity Scale.
(IV) Has normal renal function based on a calculated creatinine clearance greater than 60 mL /min and absence of proteinuria. (Creatinine clearance can be calculated by use of the Cockroft-Gault or similar formula. Proteinuria is defined as 24-hour urine excretion of greater than or equal to 300 mg protein or greater than or equal to 300 mg of albumin per gram of creatinine in a random sample).
(V) Has no autonomic or peripheral neuropathy. Peripheral neuropathy is determined by diminished ability to feel the vibration of a 128 cps tuning fork or the light touch of a 10-gram monofilament on the dorsum of the great toe proximal to the nail. Autonomic neuropathy can be determined by evidence of gastroparesis, postural hypotension, or abnormal tests of heart rate variability.
(VI) Normal cardiac function without evidence of myocardial ischemia on cardiac stress testing (to at least 12 METS) by ECG and cardiac imaging.
(iv) Any other endocrine or metabolic condition that may result in a person not being able to safely perform essential job functions.
(20) Systemic diseases and miscellaneous conditions.
(A) Category A medical conditions shall include the following:
(i) Any systemic condition that results in a person not being able to safely perform essential job functions.
(ii) Reserved.
(B) Category B medical conditions shall include the following:
(i) Connective tissue disease, such as dermatomyositis, systemic lupus erythematosus, scleroderma, and rheumatoid arthritis.
(ii) History of thermal, chemical, or electrical burn injury with residual functional deficit.
(iii) Documented evidence of a predisposition, or history of, heat illness, rhabdomyolysis, metabolic acidosis, or exertion-related incapacitation.
(iv) Any other systemic condition that may result in a person not being able to safely perform essential job functions.
(21) Tumors and malignant diseases.
(A) Category A medical conditions shall include the following:
(i) Malignant disease that is newly diagnosed, untreated, or currently being treated.
(ii) Any tumor or similar condition that results in a person not being able to safely perform essential job functions.
(B) Category B medical conditions shall include the following:
(i) Benign tumors.
(ii) History of CNS tumor or malignancy.
(iii) History of head and neck malignancy.
(iv) History of lung cancer.
(v) History of GI or GU malignancy.
(vi) History of bone or soft tissue tumors or malignancies.
(vii) History of hematological malignancy.
(viii) Any tumor or similar condition that may result in a person not being able to safely perform essential job functions.
(22) Psychiatric conditions.
(A) Category A medical conditions shall include the following:
Any psychiatric condition or substance abuse problem, or a history of either, if, after a current evaluation by a psychiatrist, it is determined that the candidate is not able to safely perform the essential job functions.
(B) Category B medical conditions shall include the following:
(i) Any psychiatric condition or substance abuse problem, or history of either, if, after a current evaluation by a psychiatrist, it is determined that the candidate is able to safely perform the essential job functions.
(ii) A requirement for any medication that increases an individual's risk of heat stress or otherwise interferes with the ability to safely perform essential job functions.
(23) Chemicals, drugs, and medications.
(A) Category A medical conditions shall include the following:
(i) Use of narcotics, including methadone.
(ii) Use of sedative -hypnotics.
(iii) Use of drugs that prolong the prothrombin time, partial thromboplastin time or INR.
(iv) Use of beta-adrenergic blocking agents, high dose diuretics, or central acting antihypertensive agents (e.g., clonidine).
(v) Use of respiratory medications, such as inhaled bronchodilators, inhaled corticosteroids, systemic corticosteroids, theophylline, or leukotriene receptor blockers/antagonists (e.g., montelukast).
(vi) Use of any chemical, drug, or medication that results in a person not being able to safely perform essential job functions.
(vii) Evidence of illegal drug use detected through testing conducted in accordance with the Substance Abuse and Mental Health Service Administration (SAMHSA).
(viii) Evidence of clinical intoxication or measured blood alcohol level that exceeds the legal definition of intoxication according to the AHJ at the time of medical evaluation.
(ix) Use of high dose corticosteroids for chronic disease.
(x) Use of anabolic steroids.
(B) Category B medical conditions shall include the following:
(i) Use of cardiovascular agents.
(ii) Use of Stimulants.
(iii) Use of psychiatric medications.
(iv) Use of other than high-dose systemic corticosteroids.
(v) Use of antihistamines.
(vi) Use of muscle relaxants.
(vii) Use of leukotriene receptor antagonists (e.g., montelukast) to treat allergies that do not affect the lower respiratory system.
(viii) Use of any other chemical, drug, or medication that results in a person not being able to safely perform essential job functions.
Added at 10 Ok Reg 1063, eff 3-23-92 through 5-28-93 (emergency); Added at 13 Ok Reg 1601, eff 5-28-96; Amended at 14 Ok Reg 2918, eff 7-11-97; Amended at 21 Ok Reg 2132, eff 6-26-04; Amended at 23 Ok Reg 22, eff 8-4-05 (emergency); Amended at 23 Ok Reg 1307, eff 5-25-06; Amended at 24 Ok Reg 1560, eff 6-11-07
Disclaimer: These regulations may not be the most recent version. Oklahoma may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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