The health of officers and military personnel undergoing military service under the contract. The health of officers and military personnel undergoing military service under the contract Health group exercise therapy for military personnel

Service in the army is associated not only with the defense of the homeland, but also with increased physical exertion, which is why certain requirements have been established for the health of military personnel.

After all, the defenders of the fatherland must not only shoot accurately, but also move quickly, as well as master the techniques hand-to-hand combat which presupposes both sufficient preparation and good health.

However, in view of the fact that military service involves many varieties of military professions, a scale of suitability for service has been developed at the legislative level in order to attract citizens to protect their homeland due to their physical capabilities.

What it is

In accordance with the norms of the law, every citizen of the Russian Federation, and a foreign citizen too, have the right to enter military service. At the same time, given that there are quite a lot of military professions, as well as the actual types of troops, and applicants have different levels physical training and health system developed, implying the determination of the state of readiness of the future soldier to perform duties.

That is, in essence, shelf life categories are a scale that determines the readiness and ability of an individual for military service, taking into account his state of health, existing knowledge and level of physical fitness. For example, applicants who, due to their state of health, cannot be drafted into the army in peacetime, but in case of an emergency they can be called up to serve in a civilian specialty, are included in the category of limited fit.

Classification

According to the norms defined in part 2 of article 5.1 of the Federal Law No. 53, the following categories of suitability to military service:

Purpose indicators

At the same time, in accordance with clause 4 of Government Decree No. 565, for each category, they also developed and showed the assignments assigned after examination in accordance with the approved one and which are taken into account when sending recruits to certain types of troops or when appointing to a particular position.

In particular, the stipulated Decree No. 565 provides a list of major diseases, covering diseases internal organs, and problems with the musculoskeletal system, and the psychological level of perception of reality, not to mention the presence of viral infections or genetic abnormalities.

Also within the stipulated the scale of the main physical indicators is given in the context of the requirements for service in certain troops. In particular, weight and height are indicated, as well as permissible deviations in hearing and vision, not to mention injuries and diseases that may affect the ability of a future soldier to perform certain functions already during the performance of immediate duties.

Category A

At the same time, in most cases, upon receipt of the agreed category, future military personnel can deservedly count on serving in elite troops, such as airborne troops and marines.

At the same time, given that in principle there are no ideally healthy people, this class is further divided into four subgroups, which allow us to determine the ability of future soldiers to serve in various troops.

In particular, A1 is the highest score, which is assigned not only for health reasons, but also for external indicators, such as height and weight, given that height is just as important for paratroopers as vision is for tankers. For example, to go to landing troops Applicant's height must be not less than 170 cm and not more than 185 cm, while the weight must be within 90 kg, and not be classified as obesity of the 2nd degree. Also, the future paratrooper must be able to distinguish between whispered speech within 6 meters, which means he must have perfect hearing.

Second degree is assigned if the future soldier is perfectly healthy at the time of the examination, but in accordance with medical documents, he had previously suffered a serious illness or a bone fracture, but without further deterioration in general condition health and contraindications to engage in certain activities. With the A2, the conscript can be employed in tank or rocket troops, and also serve on submarines, of course, subject to the weight and height indicators described above.

Upon receipt third degree some deviations in the state of health are implied, in particular, in vision, which does not require special correction and treatment, which is inherent in limiting the visual field to 20 degrees. Conscripts assigned to this category can be drafted into the internal troops, as well as serve in chemical or rocket.

AND fourth degree assigned for problems with vision exceeding 20 degrees, but on condition that the rest of the physical condition of the soldier is normal, not to mention the standard weight and height. At the same time, A4 implies that the conscript can be involved in any other troops, except for the above, without any restrictions.

B

Category B is assigned if a conscript or soldier has some deviations in physical condition health, as a result of which the occupation of certain positions is contraindicated or unacceptable.

And given that almost all conscripts have deviations in their health to one degree or another, the majority of employees end up in category B, distributed according to their intended purpose.

So, in particular, B1 is assigned if the serviceman suffers from an allergy or other mild disease that is not characterized by a steady loss of physical skills to perform certain actions. Therefore, employees assigned to B1 can be enrolled in both assault brigades and border troops.

Category B2 also implies minor deviations in the general state of health and does not lead to significant restrictions, because with a small percentage of loss of vision, the future soldier can quite successfully be admitted to both the surface fleet and the tank crew, not to mention the national guard or engineering troops.

B3 already imposes some restrictions, which are expressed in the same degree of an allergic reaction, loss of vision or hearing, not to mention excess weight or previous injuries. When the specified category is established, the recruit will not be able to become a paratrooper or submariner, but he will be happy to be enrolled in radio operators or escort brigades, as well as in chemical or engineering troops.

B4, in fact, is practically the last chance to be drafted into the army, given that when establishing the agreed category, there are significant deviations in the general physical condition of recruits. So, in particular, employees may have the consequences of previously received injuries, poor eyesight or hearing, as well as excess weight or small stature. In such a situation, the conscript, as a rule, serves in the security units of radio installations, in the communications and radio engineering troops, or in units specializing in special facilities.

IN

Category B is assigned if the future soldier has a permanent loss of health that prevents him from serving in full force it is in the conditions of the army, which imply readiness to serve almost around the clock, not to mention physical exertion.

As a rule, in the presence of such deviations, they are not recruited for military service, but sent to the reserve on the condition that during hostilities the citizen will be called to fulfill his duty along with all other employees in accordance with the military specialty, which is assigned according to the education at the time certifications or skills.

That is, in fact, in peacetime, a conscript can pay back his debt to his homeland by carrying in the same hospital as an orderly or volunteer among the elderly, not to mention working at a factory for the manufacture of parts or other things necessary in everyday life. In wartime, a soldier with a similar category of fitness can be called up to work in military factories.

G

Category G is assigned to a conscript by a medical commission if the future soldier at the time of the examination was seriously injured or ill and, accordingly, for the restoration of health, he needs a certain time, by means of a delay, for example, for half a year.

That is, in fact, the agreed group is an intermediate decision, which, after the recovery of the conscript, will be changed to A, B or C, depending on the results of treatment and forecasts of future capacity.

D

This category assumes that a citizen unfit for military service under any circumstances and at any time, regardless of further treatment, emergencies or other circumstances.

Indeed, for example, being a mentally disabled citizen, a citizen is unlikely to ever realize the consequences of his actions or the need to use certain strategic steps.

Dispute procedure

Despite the fact that the prerogative in determining the category of fitness is assigned to medical commissions, conscripts also have the right, in particular, to appeal against the decision in case of disagreement.

After all, obtaining a category D, for example, reflects not only the state of health, but in some cases can become an obstacle to employment in a prestigious job, given that employers rarely think about what illness caused the refusal to call.

That is why a person who does not agree with the decision of the commission is given the right to receive an examination report and a referral to re-pass the medical commission on the basis of the submitted application.

The following video tells about the classification of the fitness of conscripts for health reasons:

* It is possible to use other disinfectants in accordance with guidelines on their application.

** Only with adenovirus infections.

Annex 8 to the Guidelines (p. 295)

SCROLL

major diseases to determine the group of the state of health of military personnel undergoing military service on conscription

Group I (healthy) military personnel who do not have any diseases or have some deviations in the state of health without a tendency to progress and which do not affect their ability to perform military service duties are included.

These include:

the consequences of diseases and traumatic injuries suffered in childhood without disrupting the functions of organs and systems;

limited forms of vitiligo, pigmented nevus;

curvature of the nasal septum, which does not impede breathing;

slight expansion of the inguinal and umbilical rings without protrusion;

the presence in the lungs of petrificates, a Gon's focus, or limited areas of pneumosclerosis.

This includes military personnel who have chronic diseases without dysfunction of organs and systems or with rare exacerbations that do not limit the ability to perform military service duties.

These include:

moderately pronounced residual effects after myocardial cardiosclerosis, not accompanied by impaired myocardial function;

moderately pronounced pneumosclerosis after inflammatory processes in the lungs without respiratory failure;

chronic bronchitis without respiratory failure in the absence of signs of process activity and exacerbations over the past two to three years;

persistently compensated tuberculosis of the lungs, pleura, lymph nodes in the absence of signs of activity of the process over the past three years;

biliary dyskinesia and chronic cholecystitis in the absence of complaints and exacerbations for three years;

alimentary-constitutional obesity of the 1st degree;

residual effects after bone fractures without a pronounced dysfunction;

uncomplicated dental caries, stage I periodontal disease, enamel hypoplasia, wedge-shaped teeth defects, rhomboid glossitis, increased tooth wear;

chronic vasomotor rhinitis that does not require systematic treatment; chronic adhesive otitis without exacerbations with | minor hearing impairment; chronic I steadfastly compensated tonsillitis;

myopia and hypermetropia without a tendency to progression, mild chronic blepharitis and conjunctivitis, latent strabismus, unilateral ptosis, mild congenital cataract;

consequences of diseases nervous system without focal symptoms;

flat feet 1-11 degrees without symptoms of osteoarthritis;

moderately pronounced hypospadias, epispadias, cryptorchidism, phimosis.

Military personnel who have chronic diseases with moderate dysfunctions of organs and systems, periodic exacerbations and decreased performance are included.

These include:

neurocirculatory dystonia moderately expressed;

organic diseases of the heart muscle that do not interfere with military service;

residual effects of acute diseases of the joints that do not interfere with the performance of service; rheumatism inactive;

chronic obstructive bronchitis with respiratory failure of the 1st degree and (or) the presence of an exacerbation during the last year;

diseases suspected of tuberculosis (conflicts), erythema nodosum, subfebrile condition of unclear etiology, contact with patients with active tuberculosis; hyperergic reactions to tuberculin and past dry pleurisy;

malnutrition;

chronic gastritis, gastroduodenitis, chronic colitis, helminthiases, giardiasis;

chronic cholecystitis, pancreatitis without digestive dysfunction and with rare exacerbations;

neuropsychic instability, neurotic or psychotic reaction, neurosis, drug or other substance abuse without the phenomena of drug addiction, substance abuse or alcoholism;

previous closed injuries of the brain and spinal cord With the phenomena of asthenia;

chronic diseases and the consequences of acute diseases of the peripheral nerves with minor disorders of sensitivity and reflexes;

consequences of injuries of peripheral nerves, persistent non-progressive disorders of sensitivity and reflexes;

other diseases of the central and peripheral nervous system and their consequences that do not prevent military service; *

expansion of the saphenous veins and veins of the spermatic cord, which does not prevent military service;

chronic rhinosinusitis, nasal polyposis, condition after surgery on the paranasal sinuses, chronic decompensated tonsillitis, chronic atrophic or hypertrophic laryngitis;

progressive myopia and hypermetropia, chronic recurrent uveitis, keratitis, iridocyclitis with rare exacerbations that do not interfere with the service;

slightly pronounced trichiasis, eversion of the eyelids, lagophthalmos;

recurrent aphthous stomatitis, cheilitis, leukoplakia;

chronic inflammatory diseases of the genitourinary system that do not prevent military service;

limited forms of eczema in stable remission, chronic furunculosis; primary seronegative and seropositive, secondary fresh syphilis (after specific treatment), not interfering with military service;

chronic forms of streptoderma, rarely recurring, not interfering with military service.

Appendix 9 to the Guidelines (p. 295)

SCROLL

major diseases to determine the group of health status of military personnel undergoing military service under the contract

Group I (healthy) includes persons who do not have any diseases or have some deviations in health, without a tendency to progress and not affecting their ability to perform military duties.

These include:

consequences of traumatic injuries without disruption of the functions of organs and systems;

limited forms of vitiligo, pigmented nevus.

In Group II (practically healthy) includes persons who have chronic diseases without dysfunction of organs and systems or with rare exacerbations that do not limit the ability to perform military service duties.

These include:

malformations of the spine (lumbarization, sacralization), moderately expressed, without dysfunction and in the absence of pain;

mild expansion of the saphenous veins and veins of the spermatic cord;

persistent residual effects after acute diseases of the peripheral nervous system (without a tendency to exacerbate) or the consequences of traumatic injuries of the nerve trunks without pain and without a significant impairment of motor function;

moderately expressed neurocirculatory dystonia;

initial forms of aortic atherosclerosis;

chronic bronchitis without symptoms of pulmonary insufficiency in the absence of exacerbations over the past two years;

consequences of adhesive pleurisy without impaired lung function;

chronic persistently compensated tonsillitis;

steadfastly compensated tuberculosis of the lungs, pleura, lymph nodes without a decline in nutrition and functional disorders, in the absence of an exacerbation of the process over the past two years;

functional disorders of the stomach;

chronic gastritis, chronic colitis, moderately expressed, without a decline in nutrition, in the absence of exacerbations over the past two years;

chronic non-calculous cholecystitis in the absence of complaints and exacerbations over the past five years;

peptic ulcer of the stomach and duodenum in the absence of exacerbations over the past five years;

initial forms of hemorrhoids without bleeding and infringement;

latent form of diabetes mellitus;

obesity I degree;

local forms of lichen scaly and eczema without signs of progression and exacerbations during the last year;

mild forms of ichthyosis without signs of progression.

Group III (those with chronic diseases) military personnel who have chronic diseases with moderate dysfunctions of organs and systems, with periodic exacerbations and decreased performance are included.

These include:

atherosclerosis of the cerebral arteries, accompanied by neurasthenic syndrome or symptoms of chronic cerebrovascular insufficiency;

residual effects after cerebrovascular accident;

residual effects after traumatic brain injuries and neuroinfections;

chronic diseases of the peripheral nervous system (sciatica, plexitis, neuritis, polyneuritis, trigeminal neuralgia, etc.) in the presence of exacerbations over the past two years;

epilepsy;

neurosis and asthenic conditions (with a protracted course);

pronounced and persistent forms of neurocirculatory dystonia;

hypertonic disease;

chronic ischemic heart disease;

diseases of peripheral vessels (atherosclerosis obliterans, thromboangiitis, thrombophlebitis);

rheumatism, rheumatic heart disease, residual effects after rheumatic myocarditis;

congenital heart defects;

polyarthritis (infectious-nonspecific and metabolic-dystrophic);

chronic bronchitis in the presence of exacerbations over the past two years; chronic asthmatic bronchitis;

chronic pneumonia; bronchiectasis; pneumosclerosis;

bronchial asthma;

compensated forms of pulmonary tuberculosis (subsiding and inactive forms);

malnutrition;

chronic gastritis with secretory insufficiency;

chronic gastritis with preserved and increased secretion in the presence of exacerbations over the past two years;

peptic ulcer of the stomach and duodenum in the presence of exacerbations over the past five years;

chronic gastroduodenitis, duodenitis;

peptic ulcer of the stomach and duodenum in the presence of exacerbations over the past five years;

chronic colitis (enterocolitis) in the presence of exacerbations over the past two years;

chronic dysentery;

chronic cholecystitis, cholangitis in the presence of exacerbations over the past five years;

cholelithiasis;

chronic pancreatitis;

chronic hepatitis;

polyps (polyposis) of the stomach and intestines;

chronic diffuse glomerulonephritis (or chronic nephritis);

chronic pyelonephritis;

urolithiasis (kidney and ureter stones);

tumors of the genitourinary system;

chronic prostatitis, vesiculitis, epididymitis;

diabetes;

diffuse toxic goiter;

obesity 11-111 degrees;

diseases of the blood and blood-forming organs (anemia, chronic leukemia, erythremia);

phlebeurysm lower extremities with symptoms of venous insufficiency;

hemorrhoids with recurrent course;

spondylarthritis and spondylarthrosis with moderate pain syndrome;

chronic osteomyelitis in the presence of periodically opening fistulas;

chronic diseases of the vascular and retinal membranes of the eyes;

glaucoma;

chronic diseases of the edges of the eyelids, cornea and lacrimal ducts;

macular degeneration;

cataract; clouding of the vitreous body;

chronic purulent mesotympanitis and epitympanitis;

chronic rhinosinusitis (allergic, purulent-polypous);

cochlear neuritis, otosclerosis and other diseases leading to persistent progressive hearing loss;

chronic decompensated tonsillitis;

leukoplakia of the mucous membrane of the lips and oral cavity; hyperkeratosis; diamond-shaped glossitis;

chronic pronounced stomatitis;

scleroderma;

lupus erythematosus, pronounced forms of ichthyosis, scaly lichen, neurodermatitis, eczema;

skin reticulosis; fungal mycosis; Kaposi's angioreticulosis;

skin vasculitis; skin horn; Bowen's disease; Paget's disease;

basalioma;

malignant tumors of any localization.

Appendix 10 to the Guidelines (p. 296)

METHODOLOGY

individual assessment of the nutritional status of servicemen

1. An individual assessment of the nutritional status of military personnel is carried out on the basis of anthropometric measurement data and the determination of body mass index (BMI) (Tables 1-2).

BMI= Body mass. kg

The square of the size of growth, m 2.

3. The nutritional status of military personnel is assessed by body mass index depending on age.

Power status	Body mass index
Power status
Normal
Increased (including obesity)	23 and over	26 and over
Reduced (including insufficient nutrition*)	19.4 or less	19.9 or less

* If the BMI is less than 18.5 for the 18-25 age group and if the BMI is less than 19.0 for the 26-45 age group, nutrition is assessed as insufficient.

Table 1

RELATIONSHIP OF HEIGHT AND BODY WEIGHT IN MILITARY PERSONNEL IN NORM AND WITH DISORDERS

A. At the age of 18-25 years

m 2	Body mass BMI less than 18.5 (under- static	Body mass (reduced	Body mass (normal	Body mass (increased- nutrition)	Body mass (obesity	Body mass (obesity	Body mass (obesity	Body mass more (expect

The square of the size of growth, m 2	Body weight (kg) with BMI less than 18.5 (malnutrition)	Body weight (kg) at BMI 18.5-19.4 (reduced nutrition)	Body weight (kg) at BMI 19.5-22.9 (normal diet)	Body weight (kg) at BMI 23.0-27.4 (increased nutrition)	Body weight (kg) with BMI 27.5-29.9 (obesity 1 stage)	Body weight (kg) with BMI 30.0-34.9 (obesity II stage)	irooool Body weight (kg) with BMI 35.0-39.9 (obesity grade III)	burning table. 1 Body weight (kg) with a BMI of 40.0 or more (obesity stage IV)

The end of the table. 1

Body mass BMI less than 18.5 (under- static	Body mass (reduced	Body mass (normal	Body mass (increased nutrition)	Body mass (obesity	Body mass (obesity	Body mass (obesity	Body mass more (expect




					104,7-122,1

1. Clinical examination is the main component of therapeutic and preventive measures and is a scientifically based system of preventive and therapeutic and diagnostic measures aimed at maintaining, strengthening and restoring human health.

Under medical examination of military personnel of the Armed Forces Russian Federation is understood as the system of work of the medical service of military units, formations, military medical units and institutions, aimed at maintaining, strengthening and restoring the health of military personnel and providing for dynamic monitoring of the health of healthy military personnel, military personnel suffering from chronic diseases or who have had acute illnesses, who have risk factors for development chronic diseases, as well as for military personnel whose service is associated with exposure to adverse environmental factors.

Systematic analysis of the state of health of military personnel, the study of their psychological and mental status, morbidity and its causes, the quality and effectiveness of clinical examination.

The main tasks of medical examination of military personnel are timely early detection of signs of diseases, prevention of the risks of their development and the implementation of all medical and preventive measures prescribed for military personnel, including primary and secondary prevention measures.

4. Primary prevention measures are understood as a set of organizational, therapeutic, preventive, hygienic, anti-epidemic and educational measures aimed at preventing diseases by improving the conditions of service and life of military personnel, strict compliance with sanitary standards and the requirements of the regulations of the Armed Forces of the Russian Federation for the deployment of military personnel, organizing their nutrition, water supply, fulfillment of the daily routine and duty time regulations, rational use of days off by military personnel, rest before joining the outfit and after service, timely and complete bringing to each serviceman the prescribed allowances, eliminating or reducing to the established limits the influence of environmentally hazardous natural and anthropogenic factors on the health of servicemen, psychoprophylaxis.

5. Secondary prevention measures include a set of measures aimed at preventing exacerbations and relapses of diseases, as well as the progression of chronic diseases. Timely, complete and adequate treatment of certain diseases (acute tonsillitis, acute respiratory diseases) is also the primary prevention of other more serious diseases (rheumatism, pneumonia, chronic bronchitis).

Elimination of risk factors for the occurrence of diseases can relate to measures of both primary and secondary prevention (for example, smoking cessation is the prevention of lung cancer, chronic obstructive pulmonary disease; the elimination of hypokinesia in healthy military personnel and patients with diseases of the circulatory system is aimed at preventing the development of coronary heart disease) .

Permanent medical monitoring of the living conditions of personnel: accommodation, food, water supply, bath and laundry services for military personnel, as well as daily medical monitoring of military personnel in the process of combat training and at home in order to identify factors that adversely affect the health of military personnel;

Monitoring compliance with the diet of military personnel in the following areas: the first is monitoring the nutrition of healthy and practically healthy military personnel in order to prevent obesity and the development of diseases gastrointestinal tract; second - the right organization diet food military personnel suffering from diseases of the internal organs.

The development of alimentary-constitutional obesity is caused by overeating and drinking alcohol, the discrepancy between the calorie content of the daily diet and the actual energy consumption, violation of the working day, physical inactivity, and uneven unbalanced nutrition.

7. Of universal importance in the prevention of diseases, especially diseases of the circulatory system, is the fight against hypokinesia in military personnel with military specialties in which motor activity is reduced.

Propaganda healthy lifestyle life, including the prevention of drug addiction, substance abuse, alcoholism and smoking, which is organized by the deputy commander of the military unit for work with personnel in cooperation with military law enforcement agencies, the head of the medical service of the military unit and army public organizations operating under the military unit.

9. One of the areas of preventive work in a military unit is psychoprophylaxis. Psychoprophylaxis is understood as a set of measures aimed at preventing the development of mental disorders by preventing the action of pathogenic, primarily psycho-traumatic factors on the body, identifying individuals with signs of neuropsychic instability, prone to personality disorders, alcoholism, drug addiction, early recognition of mental disorders, prevention of chronicity of mental diseases by carrying out medical and recreational activities to needy military personnel.

Along with commanders (chiefs), responsibility for organizing work to preserve and strengthen mental health military personnel are entrusted with:

For counteracting the spread of alcohol and drugs, educational work to prevent drug addiction, substance abuse, alcoholism and smoking among military personnel - to deputy commanders of military units for work with personnel, medical service;

For the identification of persons predisposed to personality disorders, alcoholism, drug addiction - to the deputy commanders of military units for work with personnel, medical service;

Medical contraindications for sports. The list of diseases and pathological health conditions that prevent admission to classes physical culture and sports in educational institutions. Approximate timing of the resumption of physical education and sports after certain diseases and injuries.

The list of diseases and pathological conditions that prevent admission to sports

I. All acute and chronic diseases in the acute stage

II. Features of physical development

A pronounced lag in physical development, which prevents the implementation of exercises and standards provided for curricula; a sharp disproportion between the length of the limbs and the body.
All types of deformations upper limbs, excluding or complicating the possibility of performing various sports exercises.
Severe deformity chest, complicating the functioning of the organs of the chest cavity.
Severe deformity of the pelvis, affecting the statics of the body or violating the biomechanics of walking.
Shortening of one lower limb by more than 3 cm, even with a full gait; pronounced curvature of the legs inward (X-shaped curvature) or outward (O-shaped curvature) with a distance between the internal condyles of the femurs or the internal malleoli of the tibia more than 12 cm.

III. Neuropsychiatric diseases. Injuries of the central and peripheral nervous system.

Mental and non-psychotic mental disorders due to organic brain damage. Endogenous psychoses: schizophrenia and affective psychoses. Symptomatic psychoses and other mental disorders of exogenous etiology.
Persons with a mild short-term asthenic condition after an acute illness are allowed to play sports after a complete cure.
Reactive psychoses and neurotic disorders.
Persons who had acute reactions to stress, adaptation disorders and slightly pronounced neurotic disorders, characterized mainly by emotional, volitional and vegetative disorders, are allowed to go in for sports after a complete cure.
Persons with rare syncope are subject to in-depth examination and treatment. The diagnosis of "neurocirculatory dystonia" is established only in cases where a targeted examination did not reveal other diseases accompanied by disorders of the autonomic nervous system. Even in the presence of rare fainting, such persons cannot be admitted to martial arts, complex coordination, traumatic and water sports.
Organic diseases of the central nervous system (degenerative, tumors of the brain and spinal cord, congenital anomalies and other neuromuscular diseases).
Diseases of the peripheral nervous system (including the availability of objective data without impaired function).
Injuries to the peripheral nerves and their consequences (including mild residual effects in the form of mild sensory disturbances or slight weakening of the muscles innervated by the injured nerve).
Consequences of fractures of the bones of the skull (cranial vault, facial bones, including the lower and upper jaws, other bones) without signs of an organic lesion of the central nervous system, but in the presence of a foreign body in the cranial cavity, as well as a replaced or unreplaced defect in the bones of the cranial vault.
Temporary functional disorders after acute diseases and injuries of the central or peripheral nervous system, as well as their surgical treatment.

Persons who have suffered a closed injury of the brain and spinal cord, with an instrumentally confirmed absence of signs of damage to the central nervous system, can be allowed to play sports no earlier than after 12 months. after complete recovery (traumatic sports are not recommended).

IV. Diseases of the internal organs

Congenital and acquired heart defects.
Rheumatism, rheumatic heart disease (rheumatic pericarditis, myocarditis, rheumatic valvular disease). Non-rheumatic myocarditis, endocarditis. Other heart diseases: cardiomyopathies, organic disorders heart rate and conduction, valvular prolapse (II degree and above, I degree - in the presence of regurgitation, myxomatous valve degeneration, cardiac arrhythmias, ECG changes), ventricular preexcitation syndromes, sinus node weakness syndrome.
Rare single resting extrasystoles and sinus arrhythmia of a functional nature are not a contraindication for sports.

Persons who have undergone non-rheumatic myocarditis without an outcome in myocardiosclerosis, in the absence of cardiac arrhythmias and conduction, against the background of high tolerance to physical activity, can be allowed to play sports after 12 months. after full recovery.
Hypertension, symptomatic hypertension.
Cardiac ischemia.
Neurocirculatory dystonia (hypertensive, hypotensive, cardiac or mixed types) - conditionally allowed.
Chronic non-specific diseases of the lungs and pleura, disseminated lung diseases of non-tuberculous etiology (including diseases accompanied by even minor respiratory dysfunction).
Bronchial asthma.
In the absence of attacks for five years or more, but the persisting altered reactivity of the bronchi, admission to certain sports is possible (sports aimed at developing endurance are not recommended, winter views sports, as well as sports that take place in the halls and are associated with the use of talc, rosin, etc.).
Peptic ulcer of the stomach and duodenum in the acute stage. Peptic ulcer of the stomach and duodenum in remission with digestive disorders and frequent exacerbations in history.
Persons with gastric or duodenal ulcer who have been in remission for 6 years (without digestive dysfunction) may be allowed to play sports (sports aimed at developing endurance are not recommended).
Other diseases of the stomach and duodenum, including autoimmune gastritis and special forms of gastritis (granulomatous, eosinophilic, hypertrophic, lymphocytic), gallbladder diseases and biliary tract, pancreas, small and large intestines, with significant and moderate dysfunction and frequent exacerbations.
Persons with Helicobacter pylori gastritis can be allowed to play sports after appropriate treatment.

Persons with chronic gastritis and gastroduodenitis with minor dysfunction and rare exacerbations, as well as biliary dyskinesia with rare exacerbations, may be allowed to play sports.
Chronic liver disease (including benign hyperbilirubinemia), cirrhosis of the liver.
Diseases of the esophagus (esophagitis, ulcer - until complete recovery; cardiospasm, stenosis, diverticula - in the presence of significant and moderate dysfunction).
Chronic kidney diseases (chronic glomerulonephritis, chronic primary pyelonephritis, nephrosclerosis, nephrotic syndrome, primary wrinkled kidney, renal amyloidosis, chronic interstitial nephritis and other nephropathies).
Pyelonephritis (secondary), hydronephrosis, urolithiasis.
Instrumental removal or independent discharge of a single stone from the urinary tract (pelvis, ureter, bladder) without crushing stones of the urinary system, small (up to 0.5 cm) single calculi of the kidneys and ureters, confirmed only by ultrasound, without pathological changes in the urine, unilateral or bilateral nephroptosis stage I are not a contraindication to playing sports.
Systemic connective tissue diseases.
Joint diseases - rheumatoid arthritis, arthritis associated with spondylitis, ankylosing spondylitis, osteoarthritis, metabolic arthritis, consequences of infectious arthritis.
Persons who have undergone reactive arthritis with complete regression may be allowed to play sports after 6 months. after complete recovery.
Systemic vasculitis.
Diseases of the blood and hematopoietic organs.
Persons with temporary functional disorders after non-systemic blood diseases are allowed to go in for sports after a complete cure.
Persistent changes in the composition of peripheral blood (leukocyte count less than 4.0x109/l or more than 9.0x109/l, platelet count less than 180.0x109/l, hemoglobin content less than 120 g/l).
Malignant neoplasms of lymphoid, hematopoietic and related tissues: lympho-, myelo-, reticulo-sarcomas, leukemias, lymphoses, lymphogranulomatosis, paraproteinemic hemoblastoses (including conditions after surgical treatment, radiation and cytostatic therapy).
A history of acute radiation sickness of any severity, as well as a radiation dose previously received in an accident or accidental exposure that exceeds the annual maximum allowable dose by five times (in accordance with radiation safety standards - 76/87).
Endocrine diseases, nutritional and metabolic disorders (simple goiter, non-toxic nodular goiter, thyrotoxicosis, thyroiditis, hypothyroidism, diabetes mellitus, acromegaly, diseases of the parathyroid glands, adrenal glands, gout, obesity II-III degree).

V. Surgical diseases

Diseases of the spine and their consequences (spondylosis and related conditions, diseases of the intervertebral discs, other diseases of the spine, severe disorders of the position of the spine in the sagittal plane: rachitic kyphosis, tuberculous kyphosis, Scheuermann-May disease, Calve disease; scoliotic disease, severe instability phenomena) .

Persons with non-fixed curvature of the spine in the frontal plane (scoliotic posture) and initial signs of intervertebral osteochondrosis with an asymptomatic course can be admitted to symmetrical sports.

Consequences of fractures of the spine, chest, upper and lower extremities, pelvis, accompanied by dysfunction.
Diseases and consequences of damage to the aorta, main and peripheral arteries and veins, lymphatic vessels: obliterating endarteritis, aneurysms, phlebitis, phlebothrombosis, varicose and post-thrombotic disease, elephantiasis (lymphedema), varicose veins of the spermatic cord (medium and significant severity); angiotrophoneurosis, hemangiomas.
Surgical diseases and lesions of large joints, bones and cartilage, osteopathy and acquired musculoskeletal deformities (intra-articular lesions, osteomyelitis, periostitis, other bone lesions, osteitis deformans and osteopathies, osteochondropathy, persistent contractures of the joints, other diseases and lesions of the joints, bones and cartilage ).
With Osgood-Schlatter disease, the question of the possibility of admission to sports is decided individually.
Chronic or habitual dislocations in large joints that occur with minor physical exertion.
Defects or absence of fingers that impair hand function.
Defects or absence of toes that impair full support, make it difficult to walk and wear shoes (ordinary and sports).
For the absence of a toe on the foot, it is considered the absence of it at the level of the metatarsophalangeal joint. Complete reduction or immobility of the finger is considered as its absence.
Flat feet and other deformities of the foot with significant and moderate impairment of its functions.
In the presence of flat feet of the II degree on one leg and flat feet of the I degree on the other leg, the conclusion is made on the flat feet of the II degree.

Persons with flat feet of the 1st degree, as well as of the 2nd degree without arthrosis in the talonavicular joints can be allowed to play sports.
Hernia (inguinal, femoral, umbilical), other hernias of the abdominal cavity. Expansion of one or both inguinal rings with a protrusion of the contents of the abdominal cavity, which is clearly felt at the time of the annular examination, when straining - until complete recovery.
A small umbilical hernia, a preperitoneal wen of the white line of the abdomen, as well as the expansion of the inguinal rings without hernial protrusion during physical exertion and straining are not a contraindication to sports.
Hemorrhoids with frequent exacerbations and secondary anemia, prolapse of stages II-III. Recurrent anal fissures.
Individuals who have undergone surgery for varicose veins veins of the lower extremities, veins of the spermatic cord, hemorrhoidal veins, fissures of the anus, can be allowed to go in for sports if after 1 year after the operation there are no signs of recurrence of the disease and local circulatory disorders.
Protrusion of all layers of the wall of the rectum when straining.
Consequences of injuries of the skin and subcutaneous tissue, accompanied by impaired motor functions or making it difficult to wear sportswear, shoes or equipment.
Immature scars after operations and injuries, due to their localization making it difficult to perform exercise; scars prone to ulceration; scars soldered to the underlying tissues and preventing movements in a particular joint during exercise.
Diseases of the mammary glands.
Malignant neoplasms of all localizations.
Benign neoplasms - until complete recovery.

Persons with temporary functional disorders after surgical treatment of benign neoplasms are allowed to go in for sports after a complete cure.

VI. Injuries and diseases of the ENT organs

Diseases and injuries of the larynx, cervical trachea, accompanied by even minor violations of the respiratory and voice functions.
Curvature of the nasal septum with a pronounced violation of nasal breathing (the operation in such cases is carried out at the age of at least 15 years).
Diseases of the external ear - until a complete cure.
Diseases of the Eustachian tube - until a complete cure.
Purulent unilateral or bilateral epitympanitis or mezatympanitis in all forms and stages.
Persistent residual effects of transferred otitis (persistent cicatricial changes in the tympanic membrane, the presence of perforation of the tympanic membrane).
Otosclerosis, labyrinthopathy, cochlear neuritis and other causes of deafness or persistent hearing loss in one or both ears (normally, in both ears, the perception of whispered speech should be at a distance of 6 m, the minimum allowable decrease in this distance is up to 4 m).
Violation of the patency of the Eustachian tube and a disorder of the barofunction of the ear.
Vestibular-vegetative disorders, even in a moderate degree.
Diseases of the paranasal sinuses - until a complete cure.
Deformations and chronic changes in the state of the tissues of the nose, oral cavity, pharynx, larynx and trachea, accompanied by impaired respiratory function.
Diseases of the upper respiratory tract(nasal cavity polyps, adenoids, decompensated form of chronic tonsillitis) - until complete recovery.
Under chronic decompensated tonsillitis it is customary to understand a form of chronic tonsillitis, characterized by frequent exacerbations (2 or more per year), the presence of tonsillogenic intoxication (subfebrile condition, fatigue, lethargy, malaise, changes in the internal organs), involvement in the inflammatory process of peritonsilic tissue, regional lymph nodes (peritonsillar abscess, regional lymphadenitis).

The objective signs of chronic decompensated tonsillitis include: discharge of pus or caseous plugs from lacunae when pressing with a spatula on the tonsil or when probing it, rough scars on the palatine tonsils, hyperemia and swelling of the palatine arches and their fusion with the tonsils, the presence of festering follicles in the subepithelial layer, an increase lymph nodes along the anterior edge of the sternocleidomastoid muscles.
Ozen.
Complete lack of smell (anosmia).
Persons with temporary functional disorders after exacerbation of chronic diseases of the upper respiratory tract, their injuries and surgical treatment are allowed to play sports after a complete cure.

VII. Eye injuries and diseases

Lagophthalmos, inversion of the eyelids and growth of eyelashes towards the eyeball, causing constant irritation of the eyes; eversion of the eyelids, disrupting the function of the eye, fusion of the eyelids between themselves or with the eyeball, preventing or restricting eye movement, disrupting the function of vision, at least one eye.
Ptosis of the eyelid, impairing the function of vision in one or both eyes.
3. Persistent incurable lacrimation due to a disease of the lacrimal ducts.
Chronic diseases of the conjunctiva, cornea, uveal tract and retina of an inflammatory or degenerative nature with frequent exacerbations.
Diseases of the optic nerve.
Atrophy of the optic nerve.
Severe congenital and acquired (including traumatic)
cataract.
Opacification, destruction of the vitreous body.
Congenital and acquired defects in the development of the membranes of the eye that impair the function of vision.
Afakia.
Changes in the fundus.
Conditions after a penetrating injury to the eye.
Foreign body in the eye, not indicated for extraction.
Limitation of the field of view of one or both eyes by more than 20 °.
Violations locomotive system eye.
Severe nystagmus of the eyeball with a significant decrease in visual acuity.
Concomitant strabismus more than 20 ° - the issue of admission is decided individually.
Violations of color perception - the issue of tolerance is decided individually, depending on the specifics chosen kind sports.
Refractive anomalies: general variant - visual acuity: a) less than 0.6 in both eyes (without correction); b) not less than 0.6 for the best and 0.3 for the worst eye (without correction).

Approximate timing of the resumption of physical education and sports after certain diseases and injuries
(from the beginning of the visit to the educational institution).

Name disease	Timing	Note
1	2	3
Angina	2-4 weeks	To resume classes, an additional medical examination is necessary, it is necessary to pay special attention to the condition of the heart and its reaction to the load. If there are any complaints about the heart, exclude endurance exercises and avoid exercises that cause breath holding for at least six months. Fear of cooling (skiing, swimming, etc.)
Acute respiratory diseases	1-3 weeks	Avoid refrigeration. Skiing, skating, swimming may be temporarily excluded. In winter, when exercising outdoors, breathe through the nose.
Acute otitis media	3-4 weeks	Swimming is prohibited. Beware of cooling. With vestibular instability, which occurs more often after surgery, exercises that can cause dizziness (sharp turns, somersaults, etc.) are excluded.
Pneumonia	1-2 months	Avoid hypothermia. It is recommended to use more breathing exercises as well as swimming, rowing, skiing
Pleurisy	1-2 months	Endurance exercises and those associated with straining are excluded for up to six months. Swimming, rowing, winter sports are recommended. Regular monitoring is necessary due to the risk of tuberculosis.
Flu	2-4 weeks	It is necessary to monitor the reaction to the load during classes, because. at the same time, it is possible to detect a deviation from the cardiovascular system that was not detected during examination at rest.
Acute infectious diseases (measles, scarlet fever, diphtheria, dysentery)	1-2 months	Only with a satisfactory response of the cardiovascular system to functional tests. If there were changes in the heart, then exercises for endurance, strength, and those associated with straining are excluded for up to six months.
Acute nephritis	2-3 months	Endurance exercises are forever prohibited. in normal kidneys they cause the appearance of protein and cellular elements in the urine. After the start of physical education, regular monitoring of the composition of urine is necessary.
rheumatic heart disease	2-3 months	At least a year they are engaged in a special group. Regular monitoring of the response of the cardiovascular system to physical exercise and for process activity.
infectious hepatitis	8-12 months	Endurance exercises are excluded, regular ultrasound monitoring of structural parameters, biochemical parameters of the liver is necessary.
Appendicitis (after operation)	1-2 months	In the first months, straining, jumping and exercises that put pressure on the abdominal muscles should be avoided. In case of complications after surgery, the timing of the resumption of classes is determined individually.
Fracture of the bones of the limb	3 months	At least 3 months, exercises that give a sharp load on the injured limb should be excluded.
concussion	2-12 months	In each case, permission from a neurologist is required. Exercises with a sharp concussion of the body (jumps, sport games, football, basketball, etc.)
Stretching muscles and tendons	1-2 weeks	The increase in load and range of motion in the injured limb should be gradual.
Rupture of muscles and tendons	At least six months after operational intervention	Preliminary long-term use of therapeutic exercises.

Approximate terms of admission to training and competitions after certain diseases, injuries and surgical interventions in the upper respiratory tract and hearing organs

(V.A. Levando et al. 1985)

	Diseases	Main signs of recovery	Access to training	Access to competition.	Note
1	Angina (except phlegmonous)	Absence of inflammation in the pharynx, pain when swallowing. Normal temperature 3 days. General satisfactory condition. Urine, blood are normal.	12-14 days	12-20 days	For winter and water sports, the terms are extended by 4-5 days
2	Angina phlegmonous (peritonsillar abscess)	The same, but normalization of temperature for 7 days	14-20	20-30	Same, for 7-10 days
3	pharyngeal abscess)	Absence of inflammation in the pharynx. Satisfactory condition. Urine, blood are normal.	10-12	12-14
4	Acute pharyngitis	Same	2-3	4-6
5	ARI (ARVI)	Normal temperature 4-6 days. Urine, blood are normal.	5-8	10-12	Same, for 4-5 days
6	Acute sinusitis, frontal sinusitis, ethmoiditis	Normal temperature 7 days. Disappearance of headaches. Urine, blood, x-ray of the paranasal sinuses are normal.	7-8	10-12	Same, for 7-8 days
7	Acute otitis without perforation	Hearing recovery, normal otoscopic picture	5-10	10-14	Extra care when doing water sports
8	Acute suppurative otitis media with perforation	Termination of purulent flow, scarring of perforation	14-20	20-30
9	Acute mastoiditis	Hearing recovery. Normal otoscopic picture	15-20	25-30	—
10	Paresis of the facial nerve	Full recovery	50-60	75-80	Suspension from water sports
11	Perichondritis of the auricle	Complete disappearance of inflammation	2-5	7-10	Special care in martial arts
12	Furuncle of the nose	Complete disappearance of inflammation. Urine, blood are normal.	2-5	7-10	When practicing water sports, the period is extended
13	Acute labyrinthitis	All sports are prohibited for 1-2 years			—
14	tympanic membrane rupture	Same as in acute otitis			—
15	Laryngeal edema	Sports activities are prohibited until complete recovery. In case of relapse - suspension from sports			—
16	Tonsillectomy	Postoperative period without complications. Absence of inflammation in the throat	25-30	30-40	Special care in water sports, martial arts, weightlifting
17	Adenotomy	Absence of reactive phenomena, restoration of nasal breathing	10-12	12-20	Same
18	Galvanocaustics, cryotherapy of palatine tonsils	Absence of reactive phenomena in the pharynx	5-7	10-12	Same
19	Opening an abscess nasal septum	Absence of inflammation in the nasal septum	7-8	10-14	When doing boxing, wrestling, basketball, the terms are extended
20	Treatment of uncomplicated nasal injuries	Same	2-4	2-4	—
21	Resection nasal septum	No reactive phenomena	5-7	10-12	Suspended from boxing, wrestling, basketball, the terms are lengthened
22	Radical surgery on the maxillary cavity	No reactive phenomena, complete healing of the postoperative wound	14-18	20-25	Suspend from water and winter sports
23	Radical sinus surgery	Same	Same	Same	Suspended from sports for one year. In the future, depending on the state. Winter and water sports sports.
24	Radical surgery on the temporal bone	Same	Same	Same	Same

Features of medical control over the health status of officers and servicemen undergoing military service under the contract are due to the older age of this category of servicemen compared to conscripted servicemen, longer service in the Armed Forces, the specifics of the performance of official duties, the nature of work, increased professional and domestic risk factors (psychogenic, physical, chemical, dyshormonal). On the background age-related changes in various organs and systems, diseases in this category of military personnel become chronic, mutually aggravating, proceed sluggishly and atypically, with exacerbations and complications of the main process.

These features determine the need for examination of military personnel by appropriate medical specialists.

Medical monitoring of the state of health of officers and servicemen undergoing military service under a contract in the course of their daily activities is carried out by selective individual questioning about the well-being of officers during combat training, about their state of health, complaints, and conducting some functional tests. The greatest attention is paid to persons with an increased risk of diseases, as well as those under dispensary dynamic observation.

An effective form of medical control over the health status of officers and servicemen serving under contract is an in-depth medical examination, which is carried out in the fourth quarter of the year. An in-depth medical examination of officers and military personnel under contract, under the age of 40, who are not under dispensary dynamic supervision, is carried out by a doctor of a military unit. According to medical indications, the necessary laboratory, functional, x-ray studies and consultations with specialists from medical institutions are carried out.

Officers and military personnel serving under a contract, over the age of 40, as well as persons under dispensary dynamic observation, are examined with the obligatory participation of the necessary medical specialists of medical institutions according to individual plans developed by the head of the medical service of the military unit with taking into account the recommendations of medical specialists.

Before a medical examination of officers and military personnel serving under a contract, the head of the medical service of the military unit writes in the officer’s medical book a brief epicrisis on the results of medical observation in the past year, on diseases suffered during the year, their consequences, and for military personnel under dispensary dynamic observation, - about the course of the underlying and concomitant diseases, exacerbations of the disease, labor losses over the past year, and also evaluates the completeness and effectiveness of the treatment and preventive measures taken. The doctor of the military unit studies the opinion of the subject about the dynamics of his health, conditions of service and life.

The mandatory volume of an in-depth medical examination of officers and military personnel undergoing military service under a contract includes:

fluorography of the chest organs;

general blood and urine tests; in addition, for persons over 40 years of age - a study of blood sugar, total cholesterol and triglycerides in the blood;

electrocardiographic study - once every two years, and for people over 40 years old - annually; on suspicion of ischemic disease the heart is an ECG - a study with a stress test;

measurement of intraocular pressure in persons over 40 years of age - once every two years;

anthropometry (determination of body weight, height, circumference of the chest and abdomen; spirometry, dynamometry);

examination by a doctor of a military unit (specialist doctor);

examination by a dentist.

A medical examination of the officers of the administration of the formation and military units that do not have doctors and are stationed in the same garrison with the omedb, VG, is carried out in their outpatient departments, or in the garrison military clinic.

If military personnel have complaints, risk factors for diseases, manifestations of diseases, the doctor of the military unit appoints them the necessary additional laboratory, instrumental studies, consults them with the appropriate specialist. According to the conclusion of a specialist, additional studies are carried out for the serviceman, consultations with other specialists, if necessary, an inpatient examination in a medical institution is prescribed by a specialist.

At the end of the in-depth medical examination, the head of the medical service of the unit writes down the health status group in the medical book (form 2), and if a disease is detected, the diagnosis, the physical fitness group, and also prescribes the necessary treatment and preventive measures to those in need.

Military personnel over 40 years of age, as well as persons under dispensary dynamic observation and undergoing an in-depth medical examination by specialists, an entry in the medical book about the health status group, physical fitness group, main and concomitant diseases, about medical and recreational activities assigned to the military personnel, done by a medical specialist.

According to the results of a medical examination, officers and military personnel serving under a contract are divided into the following health status groups:

Group I - "healthy" - these are people who do not have diseases or their remote manifestations, the consequences of acute diseases and injuries, as well as military personnel who have some functional and morphological abnormalities without a tendency to progression that do not affect performance and ability to perform military service obligations;

Group II - "practically healthy" - servicemen who have been diagnosed with diseases without disrupting the functions of organs and systems that do not limit the ability to perform military service duties. This group also includes people who have had acute illnesses, injuries, injuries, and who have manifestations of their consequences that do not significantly reduce performance, as well as people with periodically exacerbated chronic diseases;

Group III - "having chronic diseases". This group includes military personnel who have chronic diseases with moderate dysfunctions of organs and systems and periodic exacerbations that reduce performance. This group also includes people who have the consequences of injuries, poisoning, surgical interventions and other influences of external factors that reduce performance. Servicemen assigned to the third group of health status are subject to dispensary dynamic observation. On an individual basis, military personnel of the third group of the state of health are assigned the terms of control medical examinations (examinations) and the necessary medical and recreational measures.

The list of major diseases to determine the group of the health status of military personnel undergoing military service under the contract is given in Appendix 9 of the Guidelines for the medical support of the Armed Forces of the Russian Federation in peacetime.

Based on the data on the health status groups of officers and military personnel undergoing military service under a contract, as well as the requirements of the Manual on Physical Training and the Guidelines for the Medical Support of Physical Training, they are divided into the following groups of physical training:

Group I - under the age of 30;

Group II - aged 31 to 35 years and transferred for health reasons from the first group;

Group III - aged 36 to 40 and transferred for health reasons from the first and second groups;

Group IV - aged 41 to 45 and transferred for health reasons from the first, second and third groups;

Group V - aged 46 to 50 and transferred for health reasons from other groups;

VI - aged 51 and over.

Persons with a health status group "practically healthy" are engaged in physical training groups: at the age of 30-35 years - in III; 36-40 years - in IV; over 45 years old - in the exercise therapy group.

At the end of the calendar year, according to the results of medical examination of military personnel, incl. Based on the results of an in-depth medical examination, the head of the medical service of the military unit analyzes differentially the dynamics of the health status of the officers, military servicemen under contract and conscription, evaluates the completeness and effectiveness of the treatment and preventive measures carried out during the year, and reports the summarized materials in a report to the commander of the military unit. In the report 1 / honey. and annual report in form 3 / honey. the head of the medical service of the formation is provided with data on the completeness and quality of the in-depth medical examination of military personnel, on the effectiveness of medical examinations of military personnel.

The report to the commander of the unit reflects the following questions:

the number of those surveyed compared with the payroll of the military unit;

data on the state of health of military personnel, and the causes of morbidity, as well as on persons in need of dispensary dynamic observation, incl. about those lagging behind in combat training, who need medical and recreational measures, inpatient examination and treatment, sanatorium treatment, and medical examination;

characteristics of changes in the state of health of military personnel compared with the data of the previous in-depth medical examination with explanations of the reasons for these changes;

evaluation of the effectiveness of therapeutic and preventive measures carried out for Last year, as well as measures to be taken to improve the conditions of military service and the life of military personnel;

a list of military personnel who have not passed an in-depth medical examination, as well as those who are subject to a stationary examination and examination by the IHC.

Control medical examinations of military personnel,