AMEDDApplicantWorksheet-July2012-3.doc

15 back surgery 16 seen a psychiatrist psychologist

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15. Back surgery 16. Seen a psychiatrist, psychologist, social worker, counselor or other professional for any reason (inpatient or outpatient) including counseling or treatment for school, adjustment, family, marriage or any other problem, to include depression, or treatment for alcohol, drug or substance abuse 17. Skin disease: Eczema 18. Skin disease: Psoriasis 19. Skin disease: Atopic Dermatitis 20. Irregular heartbeat, including abnormally rapid or slow heart rates 21. Allergic to bee, wasp, or other insects stings (itching/swelling all over and/or get short of breath) 22. Heart murmur, valve problem or mitral valve prolapsed 23. Allergic to wool 24. Heart surgery 25. Been rejected for military service (temporary or permanent) for medical or other reasons 26. Any other heart problems 27. High blood pressure 28. Discharged from military service for medical reasons 29. Ulcer (stomach, duodenum, or other part of intestine) 30. Received disability compensation for an injury or other medical condition 31. Hepatitis (liver infection or inflammation) 32. Intestinal obstruction (locked bowels), or any other chronic or recurrent intestinal problem, including small intestine or colon problems, such as Crohn's disease or Colitis 33. Detached retina or surgery for a detached retina 34. Surgery to remove a portion of the intestine (other than the appendix) 35. Any other eye conditions, injury or surgery 36. Gall bladder trouble or gall stones 37. Jaundice 38. Missing a kidney 39. Allergy to common food (milk, bread, eggs, meat, fish, or other common food) 40. (Females only) Abnormal PAP smear or gynecological problem 41. (Males only) Missing a testicle, testicular implant, or undescended testicle 42. Broken bone requiring surgery to repair (with or without pins, plates, screws, or other metal fixation devices used in repair) 43. Ruptured or bulging disk in your back or surgery for a ruptured or bulging disk 44. Thyroid condition or take medication for your thyroid 8
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45. Limitation of motion of any joint, including knee, shoulder, wrist, elbow, hip, or other joint 46. Drug or alcohol rehab 47. Kidney, urinary tract or bladder problems, surgery, stones, or other urinary tract problems 48. Sugar, protein, or blood in urine 49. Surgery on a bone or joint (knee, shoulder, elbow, wrist, etc.) including Arthroscopy with normal findings 50. Taking any medications 51. Pain or swelling at the site of an old fracture 52. Perforated ear drum or tubes in ear drum(s) 53. Anemia 54. Ear surgery, to include mastiodectomy or repair of perforated ear drum, hearing loss or need/use a hearing aid 55. Night blindness 56. Arthritis 57. Absence or disturbance of the sense of smell 58. Absence or removal of spleen, or rupture or tear of the spleen without removal 59. Anorexia or other eating disorder 60. Cracked bone or fracture(s) 61. Bursitis 62. Braces (If you wear or are planning on obtaining braces for your teeth, have the orthodontist submit a letter stating that braces will be removed before active duty date) 63. Loss of finger, toe, or part thereof 64. Loss of the ability to fully flex (bend) or fully extend a finger, toe, or other joint 65.
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