Health History Guidelines

Permanent Declines by Health Condition

The following conditions are considered permanent

declines. Applications on individuals with any of these

conditions should NOT be submitted.

_ Addison’s disease

_ Adult respiratory distress syndrome (ARDS) with severe

respiratory impairment, greater than one month steroid use

_ AIDS

_ Alcohol abuser (diagnosed; associated with other drug abuse,

medical disease, three or more DWIs or more than one detox

hospitalization)

_ Alzheimer’s disease

_ Amphetamine usage (current history of usage)

_ Amyotropic lateral sclerosis (ALS)

_ Aneurysms

_ Angina (unstable, variant, prinzmetal, vasospastic)

_ Ankylosing spondylitis

_ Anorexia nervosa (up to 5 years decline; individual

consideration thereafter)

_ Aortic arch arteritis

_ Aortic insufficiency

_ Aortic stenosis

_ Aortitis

_ Aplastic anemia

_ Aregenerative anemia

_ Arterial embolism (clot)

_ Arterial occlusion

_ Arteriosclerosis obliterans (ASO)

_ Arteriovenous malformation

_ Arteritis

_ Ataxia telangiectasia

_ Atherosclerosis obliterans

_ Atherosclerosis thrombotic disease

_ Atrial fibrillation – chronic

_ Atrial septal defect (if surgically corrected with complications)

_ Autism

_ Banti’s syndrome (spleen disorder)

_ Bronchiectasis

_ Bladder extropy (congenital malformation of the bladder wall)

Asymptomatic – permanent rider

Symptomatic – decline

_ Cardiac decompensation

_ Cardiomyopathy

_ Cerebral palsy

_ Charcot’s syndrome

_ Charcot-Marie tooth disease (if present)

_ Christmas disease

_ Chronic obstructive pulmonary disease (COPD) (less than 45

years old, smoker, underweight with associated respiratory

disorders or older than 45 and severe form)

_ Cirrhosis of the liver

_ Coarctation of the aorta

_ Cocaine abuser

_ Congenital lymphedema

_ Congestive heart failure (CHF)

_ Cor pulmonale

_ Coronary artery disease (CAD)

_ Coronary heart disease (CHD)

_ Crohn’s disease

_ Curvature of the spine (with pulmonary, cardiac

or spinal cord involvement)

_ Cushing syndrome (caused by bilateral adrenal hyperplasia

or administration of steroids to treat another disorder)

_ Cystic fibrosis

_ Cystic medical necrosis

_ Dejerine type sclerosis

_ Dementia

_ Depressant addiction (current history of addiction

with current usage)

_ Dermatitis herpetiformis (with evidence of significant

immunological compromise)

_ Diabetes mellitus

_ Down’s syndrome

_ Ebstein’s malformation

_ Eisenmenger’s complex

_ Electroconvulsive therapy (ECT administered for a

manic episode resulting in a life-threatening situation)

_ Eosinophilic granuloma

_ Eosinophilic granuloma of bone

_ Esophageal varices (varicose veins in the esophagus)

_ Ehlers-Danlos syndrome

_ Fabry disease

_ Factor VIII or IX deficiency (clotting disorder)

_ Fatty liver

_ Fragilitas ossium

_ Gargoylism

_ Gastric bypass/stapling

_ Gilles de la tourette’s syndrome

_ Glycogen storage disease

_ Hand-Schuller-Christian disease

_ Heart-lung transplants

_ Heavy chain disease

_ Hemiplegia

_ Hemochromotosis

_ Hemophilia A or B

_ Histocytosis X

_ Hodgkin’s disease

_ Hydrocephalus (older than age 20, surgically corrected

with complications or shunt procedure)

_ Hydronephrosis (bilateral or under age 20)

_ Hypersplenism

_ Huntington’s chorea

_ Hypoplastic anemia

_ Idiopathic thrombocytopenia purpura (ITP)

_ Ischemic heart disease

_ Ischemic / ulcerative colitis

_ Kahler’s disease

_ Kartagener’s syndrome (heart is twisted and

in the right chest area)

_ Kidney injury (major injury with history of dialysis)

_ Kidney transplant

_ Letterer-Siwe disease

_ Leukemia

_ Liver abscess (with residuals)

_ Liver transplant

_ Lobstein’s disease

_ Lou Gehrig’s disease

_ Lymphoblastoma

_ Lymphoma

_ Malaria (more than one occurrence, severe complications,

frequent disabling attacks)

_ Malignant melanoma (stage II or III, Clark level III, IV or V)

_ Marchiafava-Micheli syndrome

_ Marfan’s syndrome

_ Marijuana usage (current or past history in conjunction

with other drugs, relapse)

_ Medullary sponge kidney (unilateral with history

of infections, or bilateral)

_ Mental retardation (severe, emotionally unstable

seizures or psychiatric impairments)

_ Milroy’s disease

_ Mitral insufficiency

_ Mitral stenosis

_ Mixed connective tissue disease

_ Mongolism

_ Mucopolysaccaridosis

_ Multiple myeloma

_ Multiple sclerosis

_ Muscular dystrophy

_ Myocardial infarction (MI)

_ Myocardial ischemia

_ Narcotic use/addiction

_ Nephrocalcinosis

_ Nephrosclerosis

_ Neurofibromatosis (malignant, single or multiple)

_ Niemann-pick disease

_ Osteitis fibrosa cystica (multiple cysts or history)

_ Osteitis fibrosa cystica disseminate

_ Osteitis fibrosa cystica generalisata

_ Osteogenesis imperfecta

_ Pacemakers

_ Pancreatitis (chronic with enzymes and medications)

_ Pancytopenia

_ Paralysis

_ Paranoid disorder

_ Paraplegia

_ Parkinson’s disease

_ Paroxysmal noctural hemoglobinuria

_ Periarteritis nodosa

_ Permanent Declines by Disorder, continued

_ Peripheral occlusive arterial disease (POAD)

_ Pituitary dwarfism

_ Plasmacytoma

_ Pneumocystitis carinii pneumonia (PCP)

_ Polio myelitis (acute with loss of bladder or bowel control,

requiring wheelchair)

_ Polyarteritis

_ Polycystic kidney

_ Polycythemia vera

_ Porphyria (diagnosed less than 5 years prior to application)

_ Premature ventricular contractions (if symptomatic and treated

with encaid/encainide or tambocor)

_ Primary pulmonary hypertension

_ Primary sclerosing cholangitis

_ Pseudocysts (if multiple cysts are present)

_ Pseudohemophilia

_ Pseudotumor cerebri (if surgically corrected

with shunt present or residual complications)

_ Psittacosis (with extensive respiratory involvement)

_ Psoriatic arthritis (with spine involvement, gold injections)

_ Psychedelics usage (current or past history: LSD, PCP)

_ Pulmonary heart disease (chronic or acute)

_ Pulmonic insufficiency

_ Pulmonic stenosis

_ Pulseless disease

_ Quadraplegia

_ Renal agenesis (unilateral kidney absence) (if under age 20;

over age 20 and symptomatic or abnormal renal functions)

_ Rhabdomyosarcoma

_ Sarcoma

_ Scleroderma (systemic, diagnosed or suspected)

_ Sick sinus syndrome

_ Sickle cell anemia

_ Sleep apnea (surgery suggested or advanced condition

with cardiac or pulmonary complications)

_ Spina bifida (older than age 20; surgically corrected

with recurrent symptoms or surgeries needed)

_ Splenomegaly (congestive)

_ Spurway’s disease

_ Stimulant usage (current or past history)

_ Stroke

_ Sturge-Weber syndrome

_ Sudden infant death syndrome (SIDS) (must be

off monitor two years before consideration)

_ Suicide attempt

_ Syndrome X

_ Systemic lupus erythematosis

_ Takaysu’s disease

_ Tetrology of fallot

_ Thalassemia major

_ Thrombocytopenia (if cause is known)

_ Total anomalous pulmonary venous connection

_ Tourette’s syndrome

_ Transient ischemic attack (TIA)

_ Transposition of the great vessels

_ Transsexualism

_ Tricuspid atresia

_ Tricuspid insufficiency (if surgically repaired,

annuloplasty or other valve repair)

_ Tricuspid stenosis

_ Trisomy 21 syndrome

_ Truncus arteriousus

_ Turner’s syndrome (less than age 25 or evidence

of cardiovascular disease)

_ Valve replacement

_ Vascular hemophilia

_ Ventricular arrhythmias

_ Ventricular septal defect (if surgically corrected

with complications)

_ Von Hipple-Lindau syndrome (malignant or evidence

of renal carcinoma)

_ Von Willebrand’s disease

_ Waldenstrom’s macroglobulinemia

_ Wegener’s granulomatosis

_ Wilson’s disease

_ Zollinger-Ellison syndrome (multiple tumors)