PULHES Factor

Last updated March 15, 2024

PULHES is a United States military acronym used in the Military Physical Profile Serial System. It is used to qualify an enlistee's physical profile for each military skill. Each letter in the acronym (see box below) is paired with a number from 1 to 4 to designate the service member's physical capacity. For instance, the MOS 19D Cavalry Scout requires a physical profile of 111121 or better, indicating that the service member may wear glasses (a "2" in the E category) but otherwise must have no medical, physical, or psychiatric limitations.

Using numbers

Four numerical designations are used to reflect different levels of functional capacity. The basic purpose of the physical profile serial is to provide an index to overall functional capacity. Therefore, the functional capacity of a particular organ or system of the body, rather than the defect per se, is evaluated in determining the numerical designation 1, 2, 3, or 4.

For example, if a military job requires a physical profile of "123123," that means, in order to qualify for that job, a person must have a medical rating of "1" in the area of "Physical capacity or stamina," a medical rating of "2" or better in the area of "Upper extremities," have a medical rating of "3" or better in the area of "Lower extremities," a rating of "1" in the area of "Hearing and Ears," etc.

As for the numerical designators, they generally mean a military medical evaluation of:

An individual having a numerical designation of "1" under all factors is considered to possess a high level of medical fitness.
A physical profile designator of "2" under any or all factors indicates that an individual possesses some medical condition or physical defect that may require some activity limitations.
A profile containing one or more numerical designators of "3" signifies that the individual has one or more medical conditions or physical defects that may require significant limitations. For those applying for military service, this designation is usually a disqualification. For individuals already in the service, the individual should receive assignments commensurate with his or her physical capability for military duty (i.e., limited duty/assignments)
A profile serial containing one or more numerical designators of "4" indicates that the individual has one or more medical conditions or physical defects of such severity that performance of military duty must be drastically limited, and usually disqualifies applicants.

Specific definitions used by the military

These definitions appear to differ somewhat between branches of the military. In general, the categories are the same but criteria for the numerical designators may differ. For Army definitions, see AR 40-501, Table 7-1. The below definitions are derived from Air Force Instruction 48-123 Medical Examinations and Standards "Table 1.1. Physical Profile Serial Chart." and Attachment 3 "HEARING PROFILE".

P. Physical condition

P-1. Free of any identified organic defect or systemic disease.
P-2. Presence of stable, minimally significant organic defect(s) or systemic diseases(s). Capable of all basic work commensurate with grade and position. May be used to identify minor conditions that might limit some deployments to specific locations (i.e. G6PD deficiency).^{[ further explanation needed ]}
P-3. Significant defect(s) or disease(s) are under good control. Capable of all basic work commensurate with grade and position.
P-4. Organic defect(s), systemic and infectious disease(s) which have already undergone an MEB (Medical Evaluation Board).

U. Upper extremities

U-1. Bones, joints, and muscles normal. Able to do hand-to-hand fighting.
U-2. Slightly limited mobility of joints, mild muscular weakness or other musculoskeletal defects that do not prevent hand-to-hand fighting and are compatible with prolonged effort. Capable of all basic work commensurate with grade and position.
U-3. Defect(s) causing moderate interference with function, yet capable of strong effort for short periods. Capable of all basic work commensurate with grade and position.
U-4. Strength, range of motion, and general efficiency of hand, arm, shoulder girdle, and back, includes cervical and thoracic spine severely compromised which has already undergone an MEB (Medical Evaluation Board).

L. Lower extremities

L-1. Bones, muscles, and joints normal. Capable of performing long marches, continuous standing, running, climbing, and digging without limitation.
L-2. Slightly limited mobility of joints, mild muscular weakness, or other musculoskeletal defects that do not prevent moderate marching, climbing, digging, or prolonged effort. Capable of all basic work commensurate with grade and position.
L-3. Defect(s) causing moderate interference with function, yet capable of strong effort for short periods. Capable of all basic work commensurate with grade and position.
L-4. Strength, range of movement, and efficiency of feet, legs, pelvic girdle, lower back, and lumbar vertebrae severely compromised which has already undergone an MEB (Medical Evaluation Board).

H. Hearing (ears)

H-1.Audiometer average level for each ear not more than 25 dB at 500, 1000, 2000 Hz with no individual level greater than 30 dB. Not over 45 dB at 4000 Hz.
H-2. Audiometer average level for each ear at 500, 1000, 2000 Hz, or not more than 30 dB, with no individual level greater than 35 dB at these frequencies, and level not more than 55 dB at 4000 Hz; or audiometer level 30 dB at 500 Hz, 25 dB at 1000 and 2000 Hz, and 35 dB at 4000 Hz in better ear. (Poorer ear may be deaf.)
H-3. Speech reception threshold in best ear not greater than 30 dB HL, measured with or without hearing aid; or acute or chronic ear disease.
H-4 Functional level below the standards of "3".
A3.1.1. Definition: Unaided hearing loss in either ear with no single value greater than:

500 Hz	1000 Hz	2000 Hz	3000 Hz	4000 Hz	6000 Hz
25 dB	25 dB	25 dB	35 dB	45 db	45 db

A3.2. H-2 Profile

500 Hz	1000 Hz	2000 Hz	3000 Hz	4000 Hz	6000 Hz
35 dB	35 dB	35 dB	45 dB	55 db	--;db

An H-3 profile is any loss that exceeds the values noted above in the definition of an H-2 profile but does not qualify for H-4.
An H-4 profile is hearing loss sufficient to preclude safe and effective performance of duty, regardless of level of pure tone hearing loss, and despite use of hearing aids. This degree of hearing loss is disqualifying for all military duty.

E. Eyes

E-1. Uncorrected visual acuity 20/200 correctable to 20/20 in each eye.
E-2. Distant visual acuity correctable to not worse than 20/40 in one eye and 20/70 in the other, or 20/30 in one eye and 20/100 in the other eye, or 20/20 in one eye and 20/400 in the other eye.
E-3. Uncorrected distant visual acuity of any degree that is correctable not less than 20/40 in the better eye.
E-4. Visual defects worse than E-3 which has already undergone an MEB or ALC fast track as determined by the DAWG.

S. Psychiatric / Stability

S-1. Diagnosis or treatment results in no impairment or potential impairment of duty function, risk to the mission or ability to maintain security clearance.
S-2. World Wide Qualified and diagnosis or treatment results in low risk of impairment or potential impairment that necessitates command consideration of changing or limiting duties.
S-3. World Wide Qualified and diagnosis or treatment results in high risk due to potential impairment of duty function, risk to the mission or ability to maintain security clearance.
S-4. Diagnosis or treatment results in high to extremely high risk to the military or patient due to potential impairment of duty function, risk to the mission or ability to maintain security clearance and which has already undergone an MEB (Medical Evaluation Board).

Related Research Articles

Hearing loss is a partial or total inability to hear. Hearing loss may be present at birth or acquired at any time afterwards. Hearing loss may occur in one or both ears. In children, hearing problems can affect the ability to acquire spoken language, and in adults it can create difficulties with social interaction and at work. Hearing loss can be temporary or permanent. Hearing loss related to age usually affects both ears and is due to cochlear hair cell loss. In some people, particularly older people, hearing loss can result in loneliness.

Headphones are a pair of small loudspeaker drivers worn on or around the head over a user's ears. They are electroacoustic transducers, which convert an electrical signal to a corresponding sound. Headphones let a single user listen to an audio source privately, in contrast to a loudspeaker, which emits sound into the open air for anyone nearby to hear. Headphones are also known as earphones or, colloquially, cans. Circumaural and supra-aural headphones use a band over the top of the head to hold the speakers in place. Another type, known as earbuds or earpieces, consists of individual units that plug into the user's ear canal. A third type are bone conduction headphones, which typically wrap around the back of the head and rest in front of the ear canal, leaving the ear canal open. In the context of telecommunication, a headset is a combination of a headphone and microphone.

The absolute threshold of hearing (ATH), also known as the absolute hearing threshold or auditory threshold, is the minimum sound level of a pure tone that an average human ear with normal hearing can hear with no other sound present. The absolute threshold relates to the sound that can just be heard by the organism. The absolute threshold is not a discrete point and is therefore classed as the point at which a sound elicits a response a specified percentage of the time.

In acoustics, loudness is the subjective perception of sound pressure. More formally, it is defined as the "attribute of auditory sensation in terms of which sounds can be ordered on a scale extending from quiet to loud". The relation of physical attributes of sound to perceived loudness consists of physical, physiological and psychological components. The study of apparent loudness is included in the topic of psychoacoustics and employs methods of psychophysics.

A hearing test provides an evaluation of the sensitivity of a person's sense of hearing and is most often performed by an audiologist using an audiometer. An audiometer is used to determine a person's hearing sensitivity at different frequencies. There are other hearing tests as well, e.g., Weber test and Rinne test.

Sound localization is a listener's ability to identify the location or origin of a detected sound in direction and distance.

Audiometry is a branch of audiology and the science of measuring hearing acuity for variations in sound intensity and pitch and for tonal purity, involving thresholds and differing frequencies. Typically, audiometric tests determine a subject's hearing levels with the help of an audiometer, but may also measure ability to discriminate between different sound intensities, recognize pitch, or distinguish speech from background noise. Acoustic reflex and otoacoustic emissions may also be measured. Results of audiometric tests are used to diagnose hearing loss or diseases of the ear, and often make use of an audiogram.

An audiogram is a graph that shows the audible threshold for standardized frequencies as measured by an audiometer. The Y axis represents intensity measured in decibels (dB) and the X axis represents frequency measured in hertz (Hz). The threshold of hearing is plotted relative to a standardised curve that represents 'normal' hearing, in dB(HL). They are not the same as equal-loudness contours, which are a set of curves representing equal loudness at different levels, as well as at the threshold of hearing, in absolute terms measured in dB SPL.

An audiometer is a machine used for evaluating hearing acuity. They usually consist of an embedded hardware unit connected to a pair of headphones and a test subject feedback button, sometimes controlled by a standard PC. Such systems can also be used with bone vibrators to test conductive hearing mechanisms.

Hearing range describes the frequency range that can be heard by humans or other animals, though it can also refer to the range of levels. The human range is commonly given as 20 to 20,000 Hz, although there is considerable variation between individuals, especially at high frequencies, and a gradual loss of sensitivity to higher frequencies with age is considered normal. Sensitivity also varies with frequency, as shown by equal-loudness contours. Routine investigation for hearing loss usually involves an audiogram which shows threshold levels relative to a normal.

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The auditory brainstem response (ABR), also called brainstem evoked response audiometry (BERA) or brainstem auditory evoked potentials (BAEPs) or brainstem auditory evoked responses (BAERs) is an auditory evoked potential extracted from ongoing electrical activity in the brain and recorded via electrodes placed on the scalp. The measured recording is a series of six to seven vertex positive waves of which I through V are evaluated. These waves, labeled with Roman numerals in Jewett and Williston convention, occur in the first 10 milliseconds after onset of an auditory stimulus. The ABR is considered an exogenous response because it is dependent upon external factors.

Noise-induced hearing loss (NIHL) is a hearing impairment resulting from exposure to loud sound. People may have a loss of perception of a narrow range of frequencies or impaired perception of sound including sensitivity to sound or ringing in the ears. When exposure to hazards such as noise occur at work and is associated with hearing loss, it is referred to as occupational hearing loss.

Hearing conservation programs are designed to prevent hearing loss due to noise. Hearing conservation programs require knowledge about risk factors such as noise and ototoxicity, hearing, hearing loss, protective measures to prevent hearing loss at home, in school, at work, in the military and, and at social/recreational events, and legislative requirements. Regarding occupational exposures to noise, a hearing conservation program is required by the Occupational Safety and Health Administration (OSHA) "whenever employee noise exposures equal or exceed an 8-hour time-weighted average sound level (TWA) of 85 decibels (dB) measured on the A scale or, equivalently, a dose of fifty percent." This 8-hour time-weighted average is known as an exposure action value. While the Mine Safety and Health Administration (MSHA) also requires a hearing conservation program, MSHA does not require a written hearing conservation program. MSHA's hearing conservation program requirement can be found in 30 CFR § 62.150, and is very similar to the OSHA hearing conservation program requirements. Therefore, only the OSHA standard 29 CFR 1910.95 will be discussed in detail.

Minimum audibility curve is a standardized graph of the threshold of hearing frequency for an average human, and is used as the reference level when measuring hearing loss with an audiometer as shown on an audiogram.

Hearing, or auditory perception, is the ability to perceive sounds through an organ, such as an ear, by detecting vibrations as periodic changes in the pressure of a surrounding medium. The academic field concerned with hearing is auditory science.

In the United States, the Physical Evaluation Board ("PEB") is a board within each military service that

"determine[s] the fitness of Service members with medical conditions to perform their military duties and, for members determined unfit because of duty-related impairments, their eligibility for benefits pursuant to chapter 61 of Reference (c) [10 USC Chapter 61]...Service members may appeal the decision of the PEB. The PEB process includes the informal physical evaluation board, formal physical evaluation board and appellate review of PEB results."

The tone decay test is used in audiology to detect and measure auditory fatigue. It was developed by Raymond Carhart in 1957. In people with normal hearing, a tone whose intensity is only slightly above their absolute threshold of hearing can be heard continuously for 60 seconds. The tone decay test produces a measure of the "decibels of decay", i.e. the number of decibels above the patient's absolute threshold of hearing that are required for the tone to be heard for 60 seconds. A decay of between 15 and 20 decibels is indicative of cochlear hearing loss. A decay of more than 25 decibels is indicative of damage to the vestibulocochlear nerve.

Occupational hearing loss (OHL) is hearing loss that occurs as a result of occupational hazards, such as excessive noise and ototoxic chemicals. Noise is a common workplace hazard, and recognized as the risk factor for noise-induced hearing loss and tinnitus but it is not the only risk factor that can result in a work-related hearing loss. Also, noise-induced hearing loss can result from exposures that are not restricted to the occupational setting.

Identification of a hearing loss is usually conducted by a general practitioner medical doctor, otolaryngologist, certified and licensed audiologist, school or industrial audiometrist, or other audiometric technician. Diagnosis of the cause of a hearing loss is carried out by a specialist physician or otorhinolaryngologist.

References

Sources

Army Regulation 600-60 Physical Profiling Evaluation System

External links

http://usmilitary.about.com

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