GUIDE 6 Physical Fitness Assessment (PFA) Medical Readiness

JAN 2023

GUIDE 6

__________________________________

Physical Fitness Assessment

(PFA)

Medical Readiness

_____APPROVED_____

THOMAS P. YAVORSKI

N171 BRANCH HEAD

JAN 2023

Table of Contents

Section 1: Overview Page

1. Medical Clearance…………………………………………………………………………. 3

2. Periodic Health Assessment (PHA) and Deployment-Related Health Assessment

(DHA) ……................................................................................................................. 3

3. Physical Assessment Risk Factor Questionnaire (PARFQ)…………………………… 3

4. Pre-Physical Activity Questions (PPAQ)………………………………………………… 3

5. Responsibilities……………………………………….…………………………………….. 3

6. PRT Injury/Illness…………………………………………………………………………… 6

7. Light Duty (LD) …………………………………………………………………………….. 6

8. Limited Duty (LIMDU)……………………………………………………………………… 7

9. Return to Full Duty…………………………………………………………………………. 7

Section 2: Medical Clearance/Waiver Management

1. Periodicity…………………………………..………………………………………………… 8

2. PFA Medical Clearance/Waiver……………………………………………..…….………. 8

3. BCA Medical Clearance/Waiver……………….…………………………………………… 8

4. PRT Medical Clearance/Waiver……………….…………………………………………… 9

5. MEB Procedures and Requirements……………………………………………………… 9

6. MEBR Review by NPC …………………………………………………………………….. 10

7. Table 1: PFA Medical Waiver Management Chart……………………………………… 11

Section 3: Completing NAVMED 6110/4

1. Member and CFL Information …………………………………………………………….. 12

2. PRT Waiver Information ………………………………………………………………..….. 12

3. BCA Waiver Information……………………………………………………………………. 13

4. AMDR Endorsement…………..………………………..…..………………………………. 13

5. CO Endorsement ……….………………………………………………............................ 14

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Section 1: Overview

1. Medical Clearance. The medical clearance process ensures appropriate screening and

clearance is obtained prior to testing or physical training. The medical screening includes the

annual Periodic Health Assessment (PHA), the semi-annual Physical Activity Risk Factor

Questionnaire (PARFQ) (NAVPERS 6110/3), and Pre-Physical Activity Questions.

2. Periodic Health Assessment (PHA) and Deployment-Related Health Assessment (DRHA).

Sailors must have a current PHA, and, if required, complete any due or overdue DRHA to

include the Post-Deployment Health Assessment (PDHA – DD 2796) or Post Deployment Re-

Assessment (PDHRA – DD 2900) to participate in the PRT portion of the PFA. PDHA must be

completed within 30 days before or after return from deployment. PDHRA must be completed

within 90-180 days after return from deployment. If a full PFA (BCA and PRT) is not

completed due to a delinquent PHA or DRHA, the CO has the authority to assign a “UA” status

in PRIMS.

3. Physical Assessment Risk Factor Questionnaire (PARFQ (NAVPERS 6110/3)). Safety and

health of Sailors will be ensured through proper medical clearance.

a. Members will complete a PARFQ before participating in each PFA cycle. If the PHA is

not current or DRHA is required and is not completed, the member will not be able to complete

the PARFQ.

b. The PARFQ is not required to be completed prior to participating in the BCA if the

member is anticipated to be in a PRT non-participation status (DEP/OP, Validation,

Pregnancy, etc).

c. Sailors who do not meet BCA standards are required to be medically screened prior to

participation in the PRT. Sailor must provide completed PARFQ to HCP to determine

participation in PRT.

d. If there are any responses on the current cycle PARFQ that require a member to be

cleared by a health care provider (HCP) prior to participation, the member is responsible for

providing the command Authorized Medical Department Representative (AMDR) with a

completed PARFQ form and official PFA Medical Clearance/Waiver form (NAVMED 6110/4)

for evaluation and clearance. Sailors without organic medical capabilities adequate to meet

this requirement will take the forms to the Navy Medicine Readiness and Training Commands

(NAVMEDREADTRNCMD) with medical cognizance (MEDCOG) over their command for

AMDR evaluation and clearance. It is the responsibility of the member to ensure the form is

properly routed to their CFL.

(1) If a PFA medical waiver is not recommended for any portion of the PRT, to include

no recommendation for alternate cardio, the AMDR will document medical clearance on the

bottom of the PARFQ and the NAVMED 6110/4 is not required.

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(2) If a PFA medical waiver is not recommended for any portion of the PRT and the

member is recommended to participate in an alternate cardio event, the AMDR will document

the PARFQ as medically cleared and complete the applicable portions of the NAVMED 6110/4.

(3) If a medical waiver is recommended, the recommendation must be issued on the

NAVMED 6110/4 and routed to the CO for final determination each PFA cycle via the CFL.

The PARFQ will be documented as follows:

(a) Cleared/Waiver Recommended: indicating member is cleared to complete any

portion of the PRT, to include the BCA, but a waiver is recommended for one or more portions.

(b) Not Cleared/Waiver Recommended: indicating all portions of the PRT, to include

the BCA, are recommended to be waived.

4. Pre-Physical Activity Questions (PPAQ). Prior to participation in the PRT and any

organized group PT, the PPAQ must be asked by the CFL/ACFL. Refer to Guide 5 for the

Pre-Physical Activity Questions and additional amplifying information.

5. Responsibilities:

a. Commanding Officer/Officer in Charge (CO/OIC):

(1) CO/OICs with HCPs in their medical department staff must designate an AMDR in

writing, authorizing the AMDR to make recommendations on PFA medical waivers. The CFL

cannot be designated as the AMDR.

(2) Approve or disapprove all command PFA waivers prior to the official command PFA.

(3) Refer members who receive medical waivers for two (2) consecutive PFA cycles for

the same medical condition or three medical waivers in the most recent four (4)-year period for

a medical record review (MRR) via the Medical Evaluation Board (MEB) process. The MEB

process may be conducted via organic medical departments so long as capabilities exist and

there is a process for all required signatures (to include the Convening Authority, if warranted).

Ultimately, the NAVMEDREADTRNCMD with MEDCOG will support all commands within their

area of responsibility in this process, if needed.

b. Authorized Medical Department Representatives (AMDR). The AMDR must be a

physician, adult nurse practitioner, physician assistant, or Independent Duty Corpsman (IDC)

and must be appointed in writing by the CO/OIC of the service member’s unit or MEDCOG

NAVMEDREADTRNCMD/NAVMEDREADTRNUNT. Designated AMDRs are authorized to

make PFA medical recommendations to the CO via NAVMED 6110/4.

(1) AMDR must review all positive PARFQs and recommended medical waivers if

initiated by treating healthcare provider (HCP) that is not an AMDR and complete section four

(4) of the NAVMED 6110/4, final waiver recommendation prior to routing.

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(2) AMDR will facilitate uploading a copy of the NAVMED 6110/4 and/or PARFQ into the

Electronic Health Record prior to returning to the member for further routing.

(3) Prior to being appointed, all AMDRs are directed to complete the AMDR training slide

deck located on the Physical Readiness Program website. This training is recommended to be

reviewed prior to each PFA and at a minimum every calendar year.

c. Non-Military Providers. If a Sailor is treated by a non-military provider (e.g. civilian HCP

that is not working from within the Military Health System), the member must present the

NAVMED 6110/4 to the treating HCP and forward the completed both the NAVMED 6110/4

and PARFQ to the command or MEDCOG NAVMEDREADTRNCMD /

NAVMEDREADTRNUNT AMDR for a military endorsement prior to the CFL forwarding to the

member’s CO/OIC. Alternatively, the Sailor may provide necessary supporting medical

documentation to the AMDR for review and completion of the NAVMED 6110/4 and PARFQ.

The AMDR may require an appointment with the Sailor at their discretion to determine the

appropriateness of the waiver recommendation made by the non-military provider. Use of

telehealth is encouraged for any Sailor not located within 50 miles of the MECOG

NAVMEDREADTRNGCMD.

d. NAVMEDREADTRNCMD NAVMEDREADTRNUNT:

(1) Designate AMDR(s) to conduct PFA medical screenings.

(2) Convene a MEB for members with multiple waivers in coordination with the CFL, as

requested by the CO, determine appropriate course of action, and provide report back to the

Command. (See Table 1: PFA Medical Waiver Management Chart.)

f. Command Fitness Leader (CFL):

(1) Ensure no member participates in the PFA without proper medical

screening/clearance.

(2) Ensure members with positive screens (yes answer to PARFQ) report to

medical for evaluation and clearance.

(3) Review all NAVMED 6110/4 requests and document PFA medical waiver status

prior to forwarding to CO/OIC.

(4) Ensure CO/OIC approved PFA waivers for the current cycle are documented in the

PRIMS.

(5) Inform CO/OIC of members meeting requirements for MEB referral.

(6) Coordinate with command medical department or, if capability does not exist, with

the MEDCOG NAVMEDREADTRNCMD/NAVMEDREADTRNUNT on all members who meet

requirements for MEB review.

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g. Sailors:

(1) Ensure annual PHA and any required DRHA is complete prior to command PFA

cycle.

(2) Complete PARFQ (NAVPERS 6110/3) with accurate information.

(3) Schedule appointment with command or NAVMEDREADTRNCMD/

NAVMEDREADTRNUNT AMDR for any positive PARFQ responses.

(4) Provide PARFQ and NAVMED 6110/4 to AMDR at time of appointment and route to the

CO/OIC for final approval via the CFL.

(5) Ensure honest answers to the pre-physical activity questions are provided when

asked prior to the PRT and any organized group PT.

6. PRT Injury/Illness. The CFL is responsible for reporting any injuries incurred during

organized group PT or the PFA to the Command Safety Officer. Commander, Naval Safety

Center (COMNAVSAFECEN) must be informed if a death occurs during or within one hour of

completion of the PRT or organized group PT.

a. If an injury/illness prevents a member from finishing a PRT, the CFL/ACFL must refer

the member to medical for an evaluation. If medical determines that the member’s

injury/illness was due to the member’s failure to actively participate in a physical conditioning

program, a medical waiver will not be approved. Additionally, if the injury/illness occurred:

(1) During the push-ups, and member did not complete the forearm plank (and it was

determined that the member’s injury was due to non-conditioning), the CFL/ACFL will enter the

amount of properly performed push-ups in PRIMS-2, resulting in a failed PRT.

(2) During the forearm plank, and member did not complete the cardio (and it was

determined the member’s injury was due to non-conditioning), the CFL/ACFL will record the

number of push-ups completed and enter “00:10” (10 seconds) in PRIMS for the forearm

plank, resulting in a failed PRT.

(3) During the run portion, the CFL/ACFL will record the number of push-ups completed

and time of forearm plank prior to injury/illness. The CFL/ACFL will enter 59:59 for cardio in

PRIMS-2, resulting in a failed PRT.

b. If the injury/illness is not due to lack of physical conditioning, the member may be

authorized a Bad Day PRT or be medically waived from the PRT modality which they did not

complete or the entire PRT.

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7. Light Duty (LD). Individual Sick Slip (NAVMED 6310/1) may be issued by a medical

provider when, due to an injury/illness, a member will not be able to participate in individual or

command/unit PT for a specific amount of time. Per NAVMED P-117, LD is only to be granted

for a maximum of 30 days.. If the illness/injury is expected to be resolved prior to the next

regularly scheduled PFA, medical may grant additional days of LD up to 90 days (maximum of

30 day increments). Anything exceeding 30 days at onset or following two subsequent periods

of reevaluation (90 days total), must follow Limited Duty (LIMDU) procedures. If the issue will

not be resolved prior to the end of the command’s PFA cycle, the member will be required to

obtain a medical waiver documented on the official NAVMED 6110/4 form.

8. Limited Duty (LIMDU). BUMEDINST 6000.19 mandates enrollment into the current LIMDU

tracking portal system when a Service member has a medical condition(s) that is duty limiting

and where return to full duty is anticipated. LIMDU durations must be condition based, not

fixed at six (6) months, and should be considered when full recovery is anticipated to be more

than 30 days. The LIMDU documentation must clearly spell out the member’s PFA limitations.

Unless otherwise stated, the member will be required to participate in BCA. For additional

guidance, see Table 1: PFA Medical Waiver Management Chart.

9. Return to Full Duty. When a member is medically cleared to return to full duty status, the

member is required to participate in the PFA (BCA/PRT). Members who do not participate will

receive a failing score for non-participation (UA) in the portions of the PFA which they were

medically cleared for participation.

JAN 2023

Section 2: Medical Clearance/Waiver Management

1. Periodicity. Medical waivers are valid for one (1) PFA cycle only. Medical waivers granted

for the entire PFA cycle are not to exceed the end of the official Navy PFA cycle(s).If the

expiration date of the medical waiver occurs prior to the end of the command PFA cycle, the

member will be required to complete the PFA. If the expiration of the waiver occurs after the

command PFA cycle, the member may be waived from the PFA events indicated on the

waiver.

2. PFA Medical Clearance/Waiver. The CFL must ensure medical clearance/waivers are

properly documented, signed and entered into PRIMS. The PFA medical clearance/waiver

must be issued on a NAVMED 6110/4 and must include an effective and expiration date.

Standard Form (SF) 600s are not authorized. Instructions for completing the PFA Medical

Clearance/Waiver are provided in Section 3.

a. Members that require medical clearance as indicated by the PARFQ, may be cleared by

the AMDR for participation in the PRT on the bottom of the PARFQ, if no PRT medical waiver

is recommended.

b. PFA medical waivers are authorized for members with an injury, illness or for

members recovering from a surgical or medical procedure, which will prevent them from

participating in an official PFA with the command or prior to the end of the Navy PFA cycle.

c. Individuals who receive a BCA or PRT medical waiver for two consecutive PFA cycles or

three in the most recent four (4)-year period must receive a MRR via the MEB process. See

Table 1: PFA medical waiver management chart for further details. If a MEB or PEB is

required, the results must be entered in the Limited Duty Sailor and Marine Readiness

Tracking (LIMDU SMART) and/or Veterans Tracking Application (VTA).

d. Pregnant and postpartum Sailors do not receive a medical waiver. Refer to Guide 8,

Managing Physical Fitness Assessment Records for Pregnant Sailors for additional guidance.

3. BCA Medical Clearance/Waiver. It is each member’s responsibility to address potential

medical circumstances affecting accurate measurements prior to their official BCA. Once the

command PFA cycle commences, only one official BCA result is authorized. A BCA medical

clearance/waiver may only be recommended by a medical board eligible or certified Physician.

a. BCA medical waiver must be issued on a NAVMED 6110/4 and will require two

physician signatures:

(1) Treating Physician (military or civilian) recommending the waiver; and

(2) AMDR Physician. A military health system physician must endorse the waiver. If

the AMDR is the recommending physician, either another AMDR physician or the supervising

physician’s signature is required.

b. Acceptable reasons for a BCA waiver:

JAN 2023

(1) The inability to obtain an accurate weight (e.g., leg cast) or measurement (e.g., recent

surgery on an area directly involved with the measurements used to calculate BCA).

(2) A medical condition or medical therapy which has been newly diagnosed, worsened

in severity, or an increase in medication dosage which is known to result in weight gain.

Note-1: If a member is approved for a BCA medical waiver, the bike alternate cardio option

cannot be used. An official BCA must be conducted in order to determine a cardio score for

the bike.

Note-2: The inability to exercise is not a valid reason for a BCA medical waiver.

4. PRT Medical Clearance/Waiver. A PRT medical clearance/waiver may only be

recommended by a properly appointed AMDR utilizing the official NAVMED 6110/4. A Sailor’s

treating HCP who is not an AMDR may initiate the NAVMED 6110/4, however, the form must

be routed to the command AMDR for review and final recommendation. The HCP and/or

AMDR are to conduct an appropriate evaluation to determine if a PRT medical waiver is

warranted for one or multiple PRT modalities (push-up, plank, cardio).

5. MEB Procedures and Requirements. Members with multiple PFA medical waivers must be

referred for further review via the MEB process. The MEB findings must document whether

Sailor’s condition(s) are duty limiting, whether they meet current retention standards (i.e.,

DODI 6130.03 Volume 2), and must include a final disposition. Additionally, the MEB findings

must be documented in LIMDU SMART, via completion of NAVMED 6100/5 and will represent

the MEB report (MEBR). The purpose of the MEB is to evaluate medical conditions resulting

in a member's inability to successfully complete the Navy PFA. A MEB will be conducted for

Sailors who:

a. Receive a PFA medical waiver for the same medical condition for two (2) consecutive

PFA cycles that resulted in the member not participating in the BCA; or a cardio event and at

least one (1) muscular endurance event; or two (2) muscular endurance events.

b. Receive three PFA medical waivers in the most recent four (4)-year period for any

medical condition that resulted in the member not participating in the BCA; or a cardio event

and at least one (1) muscular endurance event; or two (2) muscular endurance events.

c. Meet PFA MEB requirements; prior to completion of each PFA cycle, the CFL is required

to inform the CO on any member that meets these requirements. Once notified by the chain of

command, the member must report to the command medical department or the MEDCOG

NAVMEDREADTRNCMD / NAVMEDREADTRNUNT, which initiates the MEB. The CFL will

coordinate with the respective medical department regarding the members who require an

MEB review (MEBR). The MEBR will be provided to the unit CO via their designated

deployability coordinator and should include the following:

(1) If the member is returned to medically unrestricted duty. Member will be required to

participate in the next regularly scheduled PFA; or

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(2) If the member requires additional time to recover from medical condition and will be

waived from the PFA for a specific period of time, such as LIMDU; or

(3) If the member is referred to PEB, see Table 1: PFA Medical Waiver Management

Chart for additional guidance.

6. MEBR Review. As per OPNAV 1300.20 and DODI 1332.45, PERS-454 maintains

authority to direct dispositions at any time. PERS-454 has access to LIMDU SMART and thus

full visibility to MEB findings (to include disability and LIMDU evaluations) and final disposition

as documented by MEB providers on NAVMED 6100/5.

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TABLE 1: PFA MEDICAL WAIVER MANAGEMENT CHART

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Section 3: Completing NAVMED 6110/4

1. Member and CFL Information. This section is to be completed by the member:

a. Command Name: Full name of the command

b. UIC/RUIC: Five digit code

c. CFL/POC: Name of CFL or ACFL

d. CFL Telephone No: Phone number of CFL or ACFL

e. Reason for referral: (check all that apply)

(1) Positive PARFQ Screening

(2) Expired PFA

(3) Age>=50. (“Yes” if 50 years old or older and “No” if less than 50 years of age)

(4) Two Consecutive PRT Waivers (“Yes” if waived from any portion of PRTs)

(5) Injury/Illness. The member acquired in injury during Physical Training (PT) or

while participating in the PRT.

2. PRT Waiver Information. To be completed by the AMDR/HCP. PRT medical waivers may

be recommended by IDCs, Physician Assistant and civilian specialist. IDC or a properly

credentialed physician, adult nurse practitioner, or physician assistant (e.g. AMDR/HCP)

a. PRT Waiver. Indicate which PRT event is being recommended for a PFA

medical waiver and the date the waiver will expire. Date of waiver may not exceed the current

Navy PFA cycle.

(1) Push-ups

(2) Forearm Plank

(3) Cardio event

(4) Waiver expiration date

b. PRT Modifications. Use this section to indicate which alternate cardio the

member is cleared to participate in for current PFA. If member is waived from cardio and this

section is left blank, member is not authorized to participate in an alternate cardio option.

(1) Concept 2 Rower

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(2) Treadmill

(3) Stationary Bike

(4) Swim

c. Physical Training (PT) portion indicates whether member is cleared to participate in:

(1) Command /Unit PT and FEP

(2) Individual PT

(3) AMDR/Treating Provider Name. Printed Name.

(4) AMDR/Treating Provider Signature. Signature block.

(5) Date. Date recommendation is made.

3. BCA Waiver Information

This section is reserved for BCA medical waiver recommendations and if granted, requires two

different signatures. The Treating Physician may only be completed by the physician treating

the underlying condition related to the BCA. See Section 1, paragraph 9. BCA Medical

Waiver for BCA waiver requirements.

a. Waiver. “Yes” if recommended and “No” if not recommended.

(1) AMDR/Treating Physician Signature.

(2) AMDR/AMDR Supervisor Signature. If the AMDR is provider recommending the

BCA medical waiver, the AMDR’s supervisor signature is also required.

(3) Reason per OPNAVINST 6110.1series. See Section 1, paragraph 9 for

BCA waiver requirements. Inability to exercise is not a valid reason for a BCA waiver. Check

all that apply:

(a) Inability to obtain BCA measurement explanation.

(b) Medical Treatment/Therapy

b. BCA Waiver Expiration Date. Date the waiver expires. May not cross over PFA

cycle dates.

4. Authorized Medical Department Representative (AMDR) Endorsement. This section is to

be completed by the AMDR. All sections must be completed.

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a. Member Cleared. “Yes”, if no waiver is recommended. “No”, if PFA medical waiver is

recommended.

b. PRT Waiver Recommended. “Yes” if waiver is recommended, “No” if not.

c. BCA Waiver Recommended. (Can only be recommended by an AMDR physician),

“Yes if recommended, “No if not.

d. Is member in LIMDU? “Yes” if member is currently in the LIMDU status, “No” if not.

e. LIMDU Expiration Date. Date the LIMDU will expire or become inactive.

f. AMDR Name. Print name clearly.

g. AMDR Signature. Print clearly.

h. Date. (DD/MMM/YYYY)

5. CO Endorsement. PRT and BCA medical waivers must be approved by the CO/OIC before

CFL enters waiver into PRIMS. CO/OICs have authority to request a second look on whether

member requires a medical waiver for the PRT or BCA portion for the entire PFA cycle prior to

approving a medical waiver.

a. Waiver Status. To be completed by CFL, prior to the CO/OIC signature:

(1) Number of waivers in last four (4) years. Include the number of waivers

documented in PRIMS-2 in the most recent four-year period plus the current waiver.

(2) Meet MEB requirements? “Yes” or “No” If the current waiver is approved, will the

member require a MEB? Include the current waiver in the count.

(3) CFL Signature: CFL signs here.

(4) Date: Date signed by the CFL.

b. PRT Waiver Approved. “Yes” if approved, “No” if disapproved.

c. BCA Waiver Approved. “Yes” if approved, “No” if disapproved.

(1) Member CO/OIC Signature: Signature of CO/OIC.

(2) Date: Date CO/OIC approved or disapproved the waiver.