CONFIDENTIAL

DIRECTORATE GENERAL, C.R.P.F., BLOCK NO.1,CGO COMPLEX,LODHI ROAD, NEW DELHI –

110 003.
(MINISTRY OF HOME AFFAIRS)

No. P.VII/I-2008-Pers.I Dated, the 15 December 2008.

STANDING ORDER NO. 04/2008

Subject:- HEALTH CARE SYSTEM IN CENTRAL PARA MILITARY FORCES –

INSTRUCTIONS FOR MEDICAL EXAMINATION AND
CLASSIFICATION OF PERSONNEL IN CPMF’s

In Supersession of Standing Order No. 1/2003 and based on the detailed

instructions issued, from time to time on the subject by the MHA vide their UO letters
mentioned below, following instructions along with guidelines are issued for strict compliance
by all concerned:-
No.I.45024/3/2004_pers-II dated 31/7/2007
No.I.45024/1/2008-Pers-II dated 29/10/2008
No.I-45024/1/2008-Pers-II dated 29/10/2008

APPENDICES

Declaration to be obtained from Individuals before medical examination.

Health Card format
Proforma of medical examination report.
Proforma for certificate to be produced by an appellant challenging the findings for the
AMA/Medical board for review.
E&F Age and Height wise standard weight nomograms for male & female.

AIM

This order lays down instructions/Procedures for carrying out annual medical examination
and classification of combatised officers and other personnel serving in the Central Reserve
Police Force.

2. The instructions are enumerated under the following broad headings:-

 Part-I Policy of Medical Examination and classification
Part-II Instructions and Procedure for Medical Classification
Part-III Disposal of various Medical Board Proceedings.
Part-IV Board technical guidelines for Medical Officers.

PART – I

POLICY OF MEDICAL EXAMINATION

3. GENERAL

The object of Medical Examination is for timely detection of any disease or infirmity that
may still be in a latent (sub-clinical) stage for early intervention with preventive and curative
measures to promote positive health. This will not only make the personnel health conscious
but also enhance their physical ability, professionalism and alertness, so vital for the Armed
Forces, particularly engaged in internal security duties in the prevailing security scenario. Our
Officers and men must be mentally and physically healthy to face any challenge in order to
preserve unity and integrity of the country, to protect life and property of citizens while
simultaneously defending themselves with agility and valor. To expect the troops to remain
healthy and efficient, its leaders must be examples to lead the way while working shoulder to
shoulder with their personnel.

Therefore, all the combatised personnel and officers of all cadres and ranks will be
subjected to medical examination every year. If a CRPF personnel is on deputation to an
organization he should get his AME done at that organization only; however if
infrastructure/MO is not available in that organization, he can get his SHAPE categorization
done in his parent organization. It will be rather their own responsibility to get their own AME
carried out on time. The annual medical examination (AME) up to NGO level will be carried
out by their respective authorized medical attendant (AMA) of the unit or in his/her absence,
by an MO/SMO/CMO, detailed by the concerned DIG(Medical)/CMO IC of administrative
CH/GC Hospital. For routine investigation and treatment, the individual will depend on his
/her AMA and the nearest unit/composit hospital or in its absence under the AMA’s
supervision, at the nearest CH of any CPF/Govt hospital to which his AMA refers him
officially.

For GOs, AME will be carried out by a Board of two doctors one of whom may be
from out side unit of the Force. The Board will be detailed by IG(Medical)/DIG(Medical).
4. Annual Medical Examination (AME)

ANNUAL MEDICAL EXAMINATION.

4.1 A declaration from the individual in proforma as in Appendix-A is to be obtained from

officers each time before AME. In the case of others, such history will be obtained by
the AMA himself and only a gist will be recorded in individual’s health card/proforma.
Thereafter, a complete physical & clinical examination will be done and appropriate
investigations as indicated in proforma (Appendix-c) will be carried out.
4.2 The details of findings, including the medical advice if any, will be entered in the
individual health card of officers and men along with proforma as in Appendix- C.
4.3 In case the AMA/Board feels that some more investigation/treatment is required,
reference may be made to the nearest CPF/Govt. Hospital, where such facilities are
available. Although the AMA/Board would take such reports/opinions into
consideration, the Board’s/AMA’s independent opinion and decision on the matter will
be final. The AMA/Board will suitably advise the Officer/men if a very minor disability
is noted while recording the same in the report as well as Health Card.
4.4 If the AMA of men (NGOs) is of the view that the existing medical category of any one
needs to be changed, he will refer the case with justification to the nearest CRPF
Composite hospital with prior approval from DIG(Medical) or hospital ICs. In case of
non-availability of a Specialist in the concerned field in the said hospital the MO IC may
detail any experienced Medical Officer not less than the rank of CMO (OG) to undertake
an initial assessment of the Officer. Medical category of an individual can be down
graded (Temporary” or Permanent) by a duly constituted medical board. The AMA of
the unit is competent to downgrade the category to temporary LMC for a period not
exceeding 3 months with adequate justification placed in record. Also up gradation of
temporary LMC cases or further continuation in the existing LMC can be done by the
AMA on the basis of specialist’s opinion. However, all such cases shall be put up to the
inspecting medical authority during annual inspection of unit/ GC Hospital for perusal.
For officers, board so detailed will be competent to down-grade the officer but this board
should take specialists opinion into consideration while reaching a conclusion.
4.5 For NGO’s, after clinical examination, necessary investigation and
hospitalization/observation as required, the concerned specialist/CMO will write his/her
opinion with recommendation in Health proforma as in Appendix-B. Based on this
recommendation and if the personnel is to be placed in LMC, the hospital IC will
convene a medical board which will examine the individual along with all relevant
medical documents, assign it s opinion along with final grading on the above proforma,
subject to the approval of the Hospital I/.C or DIG(Medical)_. The initial assessing
specialist./CMO shall invariably be included in the board. He/She will record the details
of AME including the diagnosis, medical category etc on the individual’s Health card.
 The board papers will be submitted to the approving and perusing authority as given
below:-

Sl.No. Group of the Board Detailing Perusing

Officer/men authority Authority
A Commandants & Above IG (Medical) of Director (Medical)
nearest 100 bedded
CH/ Director
(Medical).
B From Inspector up to 2 DIG(Medical)/IC of IG(Medical) of
I/C nearest 50 bedded CH.
100 bedded CH/
Director(Medical).
C Other SOs & ORs DIG(Medical) of -do-
nearest Composite
Hospital

4.6 Personnel away on temporary duty/course/overseas assignments will be subjected to

AME within three months of his/her return from such duties.
4.7 Communicating result of AME
The hospital authorities shall not immediately communicate the medical classification
grading awarded to the individual to him/her until the report/board proceeding is
approved by the competent medical authority. However the individual may be advised
about the nature of the disease/disability and given appropriate advice regarding
treatment/ precautions to be observed. The medical categorization awarded will be
communicated to the individual by his unit/establishment at the earliest but not later than
30(thirty) days from the date of holding the board.

4.8 Medical Category in AME to be incorporated in subsequent ACR

AME of all combatants will be completed by 31 December every year; and be

accordingly planned by the unit/establishment at the beginning of the year. The medical
category recorded in the AME immediately preceeding initiation of the ACR (Annual
Confidential Report) is considered valid, unless it has been changed by the appropriate
medical authorities due to diseases or injury during the intervening period. The AME
must be complete before 15 November in case of personnel due to be included in the
 consideration zone for promotion. This aspect is to be watched and compliance ensured
by the concerned administrative units/establishments.

4.9 Venue

The AME will be conducted by the AMA/Board at a unit/ Force hospital on which the
officers and personnel are normally dependant, unless specifically permitted by Medical
Officer I/C of the respective Group/Composite hospitals in case of others, SOs up to the
rank of SI; and by the Director (Medical) in case of Officers and Inspectors, to undergo
AME at any other Force Hospital, adequately justifying reasons for granting such
permission.

4.10 Procedure for AME

a. The individual officer/personnel undergoing AME will ensure availability of his/her

original Health card and previous year’s AME in proforma B duly certified, while
reporting for AME. No fresh/new Health card will be opened unless a COI has been
conducted and responsibility fixed for loss of the previous health card to the
satisfaction of the concerned controlling Officer.
b. The examining Medical Officer/ Board will endorse the medical categorization on
completion of AME. The MO/Board will also enter the findings/remarks in a register
to be maintained at the unit/Hospital level for record.
c. When ever an individual is already in temporary low medical category (LMC) in any
factor of SHAPE system at the time of AME and his re-categorization medical board
is due within next 3 months, the AME will be suitably advanced so that both are
carried out together. If the gap is 6 months or more, both will be held separately.
d. The medical category in AME will remain valid for one year unless his/her medical
category has been changed, for reasons of subsequent diseases or injury. In that case,
the changed grade will prevail till next AME or reclassification if recommended
earlier for temporary LMC.
e. Officers on deputation with other Govt./PSUs at Delhi will have their AME got done
at their respective Force CH/Station Hospitals at Delhi. Others, who are away from
Delhi will get the same done at the nearest respective CH of any CPF, for which they
shall apply in advance through their administrative authorities.
f. The previous year’s AME report will be made available to the AMA/Medical board
as the case may be, by the unit. It will insist this from the previous unit at the time,
the member of the Force is received in the unit on transfer/attachment. In case the
report is not received, the unit will demand the same in advance, much before AME.
g. The body weight will be checked as per the chart given in Appendix-E/F. Those
found over weight, will be disposed of as per guidelines in Part-III 23.5(e).
4.11 Authority:

The concerned Unit/Office in which an individual is posted when due for AME will
initiate it in a planned manner, taking up with the Medical authority of the concerned
hospital as indicated in Para 4.15 below during January every year. The same will be
done by the Force Directorate (Pers Branch) for Officers/Personnel on deputation to
other organizations. All are required to be examined system wise with grater clinical
details, including ECG, Chest X Ray, GTT, Lipid profile, RFT etc for all men; and USG
abdomen, in addition Gynecological check-up for ladies, as per requirement. Services
from other nearby Govt. Hospitals may be obtained in case facilities are not available at
own force hospitals subject to the condition that these are carried out in the presence of
at least one of the board members. The findings will be recorded in proforma C. It is
the responsibility of the individual as well as the concerned unit Head to ensure that
AME is held on time.

4.12 On conclusion of hospitalization & rest period.

On discharge from hospital as well as on completion of rest period on medical grounds,

an individual will be classified by the AMA in the factors of SHAPE system with which
the illness has a direct bearing. A minimum grade of 3 or less will be essential to resume
duties. All hospitalization/rest period with details of diagnosis, investigations etc and the
sequela if any, will be recorded in individual’s health card. The discharge slip in
original must be sent to the concerned head of the unit for record/regularization of leave.

4.13 Mandatory for the purpose of promotion

Medical Category SHAPE-I will be an essential condition for promotion of all

combatised personnel in all groups/ranks/cadres in the CPMFs. In case of those whose
illness is of permanent nature and who are not SHAPE-I, they will be considered for
promotion by DPC but will be declared unfit for promotion, even if, they are otherwise
fit for promotion. In case of those personnel, whose illness is of temporary nature, after
considering their cases for promotion along with others, if they are otherwise fit, the
DPC will grade them as ‘fit for promotion’ subject to attaining SHAPE-I medical
category. As and when they regain the SHAPE-I medical category, they will be
promoted as per recommendations of DPC. But they will not be entitled to back wages.
However they will retain their seniority.
4.14 The Force personnel above the age of fifty five years placed in the lower medical
category of S1H2A1P1E1(Without hearing aid), S1H1A1P1E2 (dominant eye should
not be worse than 6/9 with correction) and S1H1A1P2E1(for dental reasons only) will be
 treated at par with medical category SHAPE-1 and will be eligible for promotion to the
higher ranks in a normal manner.
4.15 As regards officers, who have been put in lower medical classification by the medical
board/review medical board of S1H1A2P1E1 and S1H1A1P2E1, who are otherwise fit
for promotion, their suitability for promotion will be re-assessed by a board consisting of
the Home Secretary as the Chairman, DG of the concerned Force, ADG(Med), MHA
and a Specialist nominated by DGHS, as Members. The Board will assess the suitability
of the officer, who is otherwise fit for promotion, but is in the above mentioned medical
categories, in consideration of the following parameters:-

a. The Officer is capable of performing the normal duties of the rank to which he is
being promoted.
b. Any defect, disability or discomfort which the officer is suffering from is not
likely to be aggravated by the service conditions.
c. The officers, assessed fit for promotion by the Board will be promoted to the next
higher rank as per the recommendations of the DPC.
d. The Board’s assessment will be final.

4.16 If the actual promotion of Force Officer is delayed because of his/her low medical
category and he/she is required to regain medical category SHAPE-I, the person below
him can be promoted, but the officer will regain his/her seniority immediately on his/her,
promotion, if he regains SHAPE-I medical category within the validity period of the
recommendations of the DPC.

4.17 Relaxation in SHAPE-I Medical Category.

The relaxation in SHAPE-I Medical Category will be admissible to the following two
categories of CPMFs personnel to the extent detailed below:-
a. Official/Personnel wounded/injured during war or while fighting against the
enemy/militant/intruders/armed hostiles/insurgents due to an act of these in India or
abroad will be eligible for promotion while placed in one of the following medical
classification:-

i) Individual Low Medical Factors

(aa) H2 or E2 opr P2(Dental) which will be considered at par with SHAPE-I; and ;
(ab) A2 or P2 or A3
ii) Conbined Low Medical Factors
(aa) H2 and E2 combined and
(ab) H2 or E2 combined with A2,A3 or P2
 b) Officers/men who are wounded/injured during field firings/accidental
firings/explosion of mines or other explosive devices and due to accidents while on
active Government duty in India or abroad will be eligible for promotion in the
following SHAPE Categories:-

i) S1H1A2P1E1 (ii) S1H1A1P2E1 (iii) S1H2A1P1E1

(iv) S1H1A1P1E2 (v) S1H2A1P1E2

PART- II
5. PROCEDURE FOR MEDICAL CATEGORISATION

5.1(a) General
These instructions contain procedures for medical categorization/re-categorization of
the combatised officers and men of the CPF, including deputationists, medical, signal
and Ministerial members of the Forces.

5.1(b) AIM

The aim of such categorization is basically to indicate the functional capacity of the
Force Personnel for better cadre management; while encouraging them to maintain their
general health at an higher attainable standard and adhere to regular treatment, follow up
by the LMC personnel, due incentives are embedded in the system for those maintaining
their health and disincentives for those who do not. A regular and compulsory health
check-up is bound to result in early detection and timely treatment of
diseases/disabilities, there by drastically reducing morbidity and mortality in the Force
while enhancing efficiency.

5.2 PROCEDURE FOR MEDICAL RE-CATEGORISATION

a. Personnel put on low-medical category are required to be reviewed. The

responsibility to bring such Officers/personnel before the AMA/review
board lies with the concerned unit/establishment. No prior approval is
required for holding such reclassification as the concerned hospital/AMA is
already in picture about the expected date of review while conducting the
earlier classification. In case of delay for more than 60 days, prior approval
of the Medical Officer in-charge/ DIG(Medical) of the concerned
administrative Frontier/GC/Sector in the case of ORs; and of IG(Medical)
 of the nearest 100 bedded CH in case of GOs will be taken, forwarding him
the details of the case with reasons for delay.
b. However the previous LMC Category will continue to operate on the
individual during the entire period till the date of reclassification. In case of
negligence on the part of the individual, the concerned DIG(Medical) or IG
(Medical) as the case may be, will refer the matter to the unit commandant
in case of UOs/ORs , to range DIGP in case of SOs and to the Sector IGP in
case of GOs for appropriate action. On receipt of condonation, the
concerned AMA/Medical board will cover up the delay period by the same
medical category as it was operative prior to the due date and award fresh
category for 24 weeks temporary/permanent or upgrade depending on the
current status of the case.

5.3 CLASSIFICATION PRINCIPLES.

Medical classification/reclassification of combatised serving personnel be made after
assessing his/her fitness under 5 sectors of health status, in terms of the code letters
SHAPE’ as under:
S - Psycological
H - Hearing
A - Appendages
P - Physical Capacity
E - Eye sight.

5.4 FUNCTIONAL CAPACITY

Functional capacity for duties in the CPF under each factor will be graded in the scale
from 1 to 5 indicating declining functional efficiency and increasing employability
limitations (For detail guidelines, please refer to Part-IV)
5.5 Functional Capacity Scale

1. Fit for all duties any where

2. Fit for all duties except with limitations in duties involving severe physical/mental
strain. They would also required perfect acuity of vision and hearing.
3. Except S Factor, fit for routine or sedentary duties but have limitations of
employability; both job wise and Terrain wise as spelt out in classification against
each factor as specified in Part-IV.
4. Temporarily unfit for duties in the force on account of hospitalization/sick leave.
5. Permanently unfit for service for any type in the force.
5.6Employability of LMC Personnel:

Posting/job assignment by the competent authority (Pers

Directorate/Frontier/Sector/Range) of personnel under LMC wil be guided by matrix
based on:
a. Medical advice as given in medical report/board proceedings.
b. Job contents.
c. Endorsement in ACR as given by initiating/reviewing/accepting Officer regarding
individual’s demonstrated Physical capacity.

5.7Demonstrated Physical capacity:

Physical capacity of performance of LMC individual shall be suitably endorsed upon in
the health column of ACR by the initiating officer.

6. For individuals placed in temporary LMC it is obligatory for them to appear before
the reclassification medical board at the stipulated time as given in the previous medical
board proceedings/medical examination. No early premature review will be allowed
in case of any temporary LMC, irrespective of the duration. In permanent LMC, the
individual will be reviewed after two years. However early review can be requested
provided, the AMA certifies that the individual’s condition has improved materially;
along with a technical report on convincing grounds. This has to be recommended by
the unit commandant certifying normal performance of the individual and this will be
forwarded to the Director (Medical) for graning early review or otherwise.

7. Recording of medical board proceedings:

Due care should be taken in recording al types of medical board proceedings as
prescribed in proforma given in appendix-‘C’. The board will ensure that all columns
are appropriately and completely filled in unambiguous terms. In permanent LMC
cases, assessment of disability percentage shall be reflected on each occasion, including
known aggravating or attributing factors, findings of COI if any. In confirmed, fresh
IHD cases admitted to hospitals, last 14 days charter of duties shall be obtained from the
concerned unit commandant immediately and placed before the subsequent classification
board. When ever any personnel under going medical examination refuses to sign on the
report/ board papers, the contents shall be read over to him/her by the PO in the presence
of two witnesses, different from board members and their signatures obtained in
confirmation thereof. At the same time. The Commanding Officer of the concerned unit
shall be informed in writing.
8. Duration of classification

Temporary classification will be awarded for not more than 24 weeks at a time. The
officer will be due for review after this period and no review will be permissible before
expiry of the initial period of LMC/ observation/ follow-up in any case.

9. Temporary classification in factor will be permissible for a maximum period of 24

weeks. If an individual requires observation beyond permissible period, he/she will be
placed in permanent LMC except in ‘S’ Factor where provision of Para 10 given below
will be applicable. Opinion given by a Specialist for review in Proforma as per
appendix-D will be valid for a period of three months only.

10 All individuals in S-3 factor can be observed on a temporary basis for a maximum period
of 48 weeks in all. He/She will not be placed in S-3 permanent. If after 48 weeks the
individual can not be upgraded to S-2 temporary, he/ she will be down graded to S-5

11. Endorsement of temporary classification of a factor in the profile will be made against
the numeral to which it refers and will consist of the capital letter “I” together with the
figure to indicate weeks for which the temporary grading have been recommended. For
example S1H1A1P1E2(T-24) in case of first grading, S1H1A2(U) (T24+24)P1E1 in
case of second grading or S1H1A4(T-8)P1E1 in case sick leave for 8 weeks or
S1H1A1P4(T-4+4)E1 in the case where a second spell of sick leave has been granted as
in case of IHD (Sick leave) followed by CABG(Sick leave). Temporary classification
can be only for grades 2, 3 and 4 of SHAPE factors.

12. Permanent grading will be denoted only by using the requisite numeral against the
factor e.g. S2, H2 and so on.

13. There are certain diseases or group of diseases, which are not amenable to short term
therapy or quick cure. Some of such diseases are ischeamic heart diseases, hypertension
diabetes mellitus, Peptic Ulcer, Psychiatric and Malignant diseases. Medical experience
and medical literature have shown that a large number of patients suffering from these
type of diseases require prolonged medical treatment and surveillance. It is thus
appropriate for individuals placed in temporary LMC P-3 for diseases such as above, to
be placed in appropriate permanent LMC (P2 or P3) after the initial observation of 24
weeks, depending on their clinical condition.

14.Follow-up of personnel placed in low medical classification:

 Personnel placed in LMC are required to be kept under constant medical supervision
with a view to ensure that there is no deterioration during the period of LMC and that the
treatment as well as other medical advice is regularly followed by the individual. The
follow up will be ensured as under:

a) The concerned Unit/GC hospital will maintain a register of all LMC personnel on
posted strength of the unit and the unit Commandant will provide all the required
information to the AMA. Such information will be sent to the MO IC of the
concerned Unit/GC/Sector by the unit Commandant where no medical officer is
posted.
b) The AMA will make schedule for medical examination of all such personnel, call
or visit them from time to time, enter their personal particulars, nature of
disability, medical category and the date of next review in a register which will
have separate page for each individual. In case of new arrival of LMC cases in the
unit, the information will be forwarded by the H.O.O. within one week to the
AMA for entry into the register.
c) The register will be perused by the unit MO/AMA during first week of every
month along with the individuals in LMC, to complete all entries. It will be
ensured that reclassification medical board is held on due date. In the remarks
column, entry will be made regarding the due date for review, any further
investigation required, treatment advised and the follow up action required to be
taken. Specialist’s consultation will be taken form the nearest Force/Govt.
Hospital if required by AMA.
d) A Separate Case sheet will also be raised in r/o each individual placed in LMC for
monthly follow up. Entries will be made in separate columns such as physical
condition, clinical findings, response to treatment, modification of treatment if
done, investigation results, specialist’s opinion if taken and progress of the case.
e) Required investigations will be carried out and expert opinion required if any will
be obtained well in advance before the date of next review.
f) When an individual in LMC is posted out from the unit, all medical documents
will be forwarded by the Commandant to the receiving unit with a request that
these documents be handed over to the AMA of new unit.
g) Inspecting/visiting Medical Officers during their visits will check that such
registers and case sheets are properly maintained.

15.APPEAL AGAINST THE FINDINGS OF A MEDICAL BOARD.

(i) DG of the Force may consider an appeal against low medical categorization
received from a member of the Force and order the Director (Medical) to
constitute a Review Medical Board. The appeal must be accompanied with
 necessary documents and certificate from Government Hospital stating that he/she
is not suffering from the disease/conditions for which he/she has been categorized
low. Specialists from relevant fields must be associated in the Review Medical
Board, who may be from within the organization or outside the organization.

16.RECLASSIFICATION OF PERSONNEL IN LMC

When one is placed in a medical category lower than SHAPE-ONE, whether temporary
or permanent, it is obligatory on his/her part to appear before a reclassification medical
board on time. It is re-emphasized that it is the responsibility of the unit/establishment in
which the officer is serving to ensure compliance of this mandatory requirement. It will
be ensured by the unit Commandant/OC that if an individual who is due for such
reclassification is not sent on annual leave/long casual leave/temporary out station duty
if the board is due. He can be detailed for a course/temporary duty only after taking
prior permission from the MO IC of the respective Unit /GC/Composite Hospital in case
of SO & ORs and from the Director (Medical) in the case of officers; at least 2 weeks in
advance with adequate justification for either postponing the medical board or for
holding it at the station to which the individual is proceeding on longer attachment duty.

17. When ever a reclassification Medical board/ Examination falls due during the period of
AME, the Individual will undergo reclassification first and the fresh medical category
will be reflected in the AME when held subsequently. When AME falls due before
reclassification both will be held independent of each other and in no circumstances, the
date of reclassification medical board will be changed. In case of permanent LMC
board, it is to be preponed by 3 months to be held first, followed by the AME.

18. RECLASSIFICATION OF PERSONNEL IN LMC FOR MULTIPLE

DISABILITIES.

When ever any members of the Force is in permanent LMC for 2 or more disabilities and
where the reclassification is due for different disabilities within 12 weeks of each other,
the individual will be assessed for all the disabilities together and awarded the deserving
categorization. When one is already in LMC and develops another diseases/disability
within 3 months of being reviewed for the former, he/she may be kept under observation
category for the later disability for a period equal to the un-expired period of the
previous condition so that he/she can be reviewed for both together.
19. If a member of the force is already in medical category S2 (irrespective of whether
temporary or permanent), and shows deteriorating symptoms or is found incapable to
perform the duties, the unit Commandant/H.O.O. may send him to the nearest
 GC/Composite hospital with a detailed behavior report in the format for review earlier
than the scheduled date.

PART- III
20.DISPOSAL OF MEDICAL BOARD PROCEEDINGS

a) Disposal of AME Documents: In case of the GOs and Inspectors, the report will be
sent in duplicate to the range DIGP confidentially by the unit Commandant for further
action, besides keeping a record of medical classification grading, to be entered in the
individual’s ACR. In case of the Commandants, report/proceedings will be directly sent
to the DIG. In case of the SIs and ORs, the report will be maintained by the respective
Company Commanders, in addition to endorsement of the categorization in individuals
confidential card. The same will also be published in the F.O.
b) In the case of Medical Boards, the proceedings in duplicate in respect of Gazetted
Officers and Inspectors will be submitted to the Directorate Pers Branch by the hospital
authorities where the board is held, with one copy to Sector IGP for further
communicating it to the concerned unit. Only the gist and grading will be
communicated to the individual in writing, besides entering the same in his/her health
card and medical register maintained by the hospital. In case of SOs up to SIs and ORs,
the proceedings after approval by the concerned Medical authority, will be sent to the
range DIGP, with a copy to the concerned unit for informing the individual and action as
above.

21. RECOMMENDATION FOR LEAVE ON MEDICAL GROUNDS AND IT’S

APPROVAL
When sick leave has been recommended by the AMA or Medical board on medical
grounds to an individual, approval/counter signature will be required to be done by the
In charge of the concerned Hospital.

PART-IV
DETAILED GUIDELINES ON TECHNICAL STANDARDS TO MEDICAL OFFICERS
FOR CLASSIFICATION OF SERVING COMBATISED PERSONNEL IN THE CPFs

22.FUNCTIONAL CAPACITY & EMPLOYABILITY

“S” FACTOR (PSYCHOLOGICAL)

This factor denotes Psychological aspect and other personality defects, mental acuity,
emotional stability and psychiatric diseases
Numer Functional Capacity Employability
ical limitations
Gradin
g
S-1 Can withstand severe mental stress. May Fit for all duties any
have fully recovered from a psychological where
condition with no likelihood of further
breakdown.
S-2 Can withstand moderate stress. Had Fit for all duties any
suffered from Psychoneurosis, but now where except at high
fully stabilized. Likelihood of breakdown altitude, solitary
under severe mental stress can not be ruled locations and operational
out. duties during IS duty and
hostilities. Not fit for
independent Command
and duty with live fire-
arms.
S-3 Has limited tolerance to stress, recently Fit for only sedentary
recovered from Psychoneurosis or toxic/ duties with limited/
confessional state; or acute psychotic restricted responsibilities
reaction of temporary nature as a result of under close supervision
external causes, un-related to alcohol or in peace/ field area but
drug addiction. only where hospitals
with psychiatric facilities
are available nearby.
Not fit for operational
duties during war or
peace on IS duty or
duties with arms.
S-4 On sick leave/ in hospital Temporary unfit for
force duties.
S-5 Mentally unstable on account of Permanently unfit for
psychological/psychiatric disorders or service.
having psychopathic personality.

22.2 “H” Factor (Hearing)

 This factor covers auditory acuity, ability to hear spoken voice or auditory signals often
against considerable background noise are important in certain trades and operational
situations.

Numer Functional Capacity Employability

ical limitations
Gradin
g
H-1 Has excellent hearing in both ears viz. With Fit for all duties any
back to examiner can hear forced whisper where
at a distance of 6 meters, each ear tested
separately.
H-2 Has excellent hearing in one ear with No limitations in
impaired acuity in the other, partial or physical capacity and fit
complete. With back to the examiner, can for duties in peace or
hear forced whisper at 6 meters with one field areas including IS
ear (+/- 10 decibels) and conversational duties and war any
voice at 1.2 meters or less with the other where except as under:-
ear (60 decibels). a) Not fit for patrol,
scout and laying
ambush.
b) Not fit for duties
which demand keen
hearing acuity in both
ears.
H-3 Is partially deaf in both ears. With back to No limitations in
the examiner can hear conversational physical capacity and fit
voidce at 3 meters with both ears (40 for duties in peace or
decibels), each one tested separately. field areas including
duties during IS duty
and war anywhere
except as under.
a) Not fit for patrol,
scout and laying
ambush in noisy
surroundings.
b) not fit for duties
which demand keen
hearing acuity of both
ears.
H-4 On rest/Leave on medical ground/ in Temporary unfit for
hospital Force duties.
H-5 Hearing acuity below H-3 standard. Permanently unfit for
Force duties.

NOTE: In assessing auditory acuity and assigning the grades under this factor, it is necessary
to remember the following points:

a) An official may be required to achieve the standards laid down against

considerable background noise, in certain trades and operational situations,
although it is not an invariable requirement.
b) The standards set to be achieved under different grades are without the assistance
of hearing aids. Hence, while determining the grade of an official’s disability,
improvement achieved by the use of hearing aids will not be taken into account.
c) Testing will normally be done in the usual way, dealing each ear separately.
Resort to special testing will be made only under specific indications e.g.-
audiometry etc.

When an individual is partially deaf in both ears, he will be examined with neither
ear being dampened and if he can hear conversational voice from a distance of 3
meters (40 decibels), he will be placed in H-3. if the acuity is below this level
even after appropriate treatment he will be placed in category H-5.
ENT Diseases e.g.- sinusitis, tonsillitis etc, not affecting hearing shall be
classified under “P” factor.

‘A’ Factor (appendages)

This covers the functional efficiency of upper and lower limbs (including amputees, loss
of fingers and toes) shoulder girdle, pelvic girdle and associated joints and muscles. A
personnel who may be placed in Grade”2” or “3” of A factor, depending on whether
their disability pertains to upper limbs or lower limbs, totally difference employability
restrictions will be applicable. Hence the person placed in grade 2 or 3 of this factor will
be further divided into classification A-2(U) or A-3(U) if this disability is in the upper
limb(s) and A-2(L)/A-3(L) if this disability is in the lower limbs. This will give a clear
picture of the individual to the administrative authorities to determine his/her suitable
placement.

Numerical Functional Capacity Employability

Grading limitations
A-1 Has full functional capacity though may Fit for all duties any
 be having minor impairments eg.- where
A-1(U) (a) Loss or disability of the terminal -do-
Phalanx of anyone of 5th,4th or 3rd
fingers of dominant hand with other hand
being normal OR,
(b) Loss of terminal Phalanges of 3rd, 4th
fingers of non dominant hand with grip in
same hand being very god and other hand -do-
being normal
A-1(L) Loss of terminal phalanges of 3rd and 4th Fit for duties any where
toe of any one foot except operational/IS
duties/during hostility.
A-2 (U) Has moderate defects in function of Fit for all duties which
upper limbs e.g.- do not involve
(a) Deformity/Disease/Loss of index crawling, running,
finger of dominant hand leading to its jumping long marching,
functional disability. OR, hill climbing and
(b) Loss of terminal 2 Phalanges of 3 rd & handling of weapons.
4th fingers of non-dominant hand, with
reasonable grip retained, and the other
hand being normal OR,
(c) Any other minor disease/disability in
no dominant hand.
A-2(L) Has a defect/disease or disability of a -do-
moderate nature in one limb below knee
capable of marching up to 8 KM and
standing for 2 hours

Note: In case the individual is placed in A2(L), each person’s functional capacity in terms
of employability has to be assessed on the basis of his disability e.g. a person having classical
Symes operation with a good prosthesis is fit for crawling but NOT for jumping.

An individual who is placed in this classification due to an injury/disability/disease will be

fit for duties anywhere except at hilly terrain (Where he has to go up and down the frequently).

A-3 Has major disability or disease in upper Not fit for operational/
A-3 (U) limb like complete loss of hand including Counter insurgency duties.
fingers, or amputation through Can do IS duties without
 metacarpals, or a disease/disability of fire-arm. Area restriction
shoulder in one side not applicable.
A-3 (L) Has a disease or disability above knee on Fit for sedentary duties
one side, including pelvic girdle but only. Not fit for high
should be able to walk up to 5 Km at his altitude/operational/CI/IS
own pace. duties.
A-4 Sick in hospital/rest on medical ground Temporarily unfit for
Force duties.
A-5 Severe derangement of functional Permanently unfit for
efficiency Force duties.

22.4 “P” FACTOR (PHYSICAL CAPACITY)

This factor shall cover to describe in details about the physical capacity, strength,
endurance, mobility, agility and activity of a person, which might be restricted by
Medical /surgical conditions and those which are not covered under other factors. Concessions
are embedded as a function of age under this factor, since stamina and endurance do decrease
with ageing process without any obvious pathology being visible.

Numer Functional Capacity Employability

ical limitations
Gradin
g
P-1 Has full functional capacity and physical Fit for all duties any
stamina where
Minor impairment fully under control, but
has full physical stamina. Fit for all duties any
where but under medical
observation, having no
employability
restrictions.
P-2 Has moderate physical capacity and Fit for duties not
stamina. Suffered from constitutional requiring servere stress.
metabolic/infective disease/operative May have restrictions in
procedures, but now well stabilized. employability at high
altitude (above 2,700
meters/9,000 feet in hilly
terrain and extreme cold
areas).
P-3 Has major disablement with limited Fit for sedentary duties
 physical capacity and stamina not involving undue
stress. May have
restricted employability
as advised by medical
authorities such as :-
a. To avoid places with
high humidity level
75% round the year.
b. Have access to
specialist services near
by.
c. To avoid
driving/handling of
weapons near water,
fire or heavy
machinery.
d. Restricting physical
excess, work in
desert/snow bound
areas etc.
e. Restricting active
participation in
hostilities, counter
insurgency operations
etc. (excluding staff,
logistics and allied
support duties.)
P-4 On sick/ leave on medical ground in Temporarily unfit for
hospital force duties.
P-5 Gross limitations on physical capacity and Permanently unfit for
stamina Force Service.

Note : It is envisaged that grading under “P” factor is likely to be fraught with ambiguity,
mainly for the following counts:-

a) Diseases (not considered in other factors) affecting the physical capacity or stamina of a
person owing to any type of medical or surgical condition, whose etiology may be
constitutional metabolic, infective neoplastic or idiopathic are to be considered under
this head.
 b) The effect of therapy, whether medical or surgical, may widely vary from case to case,
although the clinical presentation of the disease state may be similar or identical. The
residual functional incapacity may not be easy to determine, except with experience.
There are continuous changes in the concept of the natural history of disease processes,
necessitating revision of our ideas regarding cure of disease, sequele, and employability
restrictions.

22.5 In view of the above, issue of instructions based upon the prevailing consensus of
medical opinion becomes necessary for guiding the medical officers. Currently the
following instructions are in vogue and will be followed in grading individual suffering
from the under mentioned conditions, utilizing the equivalence between grades 1-5 under
this factor:-

(a) HIGH ALTITUDE PULMONARY OEDEMA (H.A.P.O):

All cases of high altitude pulmonary oedema, after clinical recovery, if there is no
clinical radiological or electro-cardio graphic evidence of residual pulmonary
hypertension will be placed in P-1 category without any restrictions for employment at
high altitude. Officials developing high altitude pulmonary oedema for the second time
will not be graded higher than P-2.

(b) I. ISCHAECMIC HEART DISEASE: The following policy shall be followed:

Clinical condition Classification to be recommended

i) Cases of coronary artery disease P-1
(CAD) with normal CAG, echo and
TMT/Stress Thallium.
ii) CAD with abnormal CAG with P-2(T) to be evaluated regularly for
successful PTCA & Stent; CABG with one year. May be up-graded if
normal systolic LV function and remains as such to P-1 or down
without angina. graded if deteriorates
iii) CAD with abnormal CAG with P-3(T), to be evaluated regularly for
successful PTCA & Stent/CABG but one year. May be up-graded to P-2
with abnormal systolic LV function on improvement or down graded to
(Low ejection fraction). P-5
iv) Cases with congestic Cardiac P-5
failure, dialated cardio-myopathy,
marked enlargement of the heart and
cardiac aneurysm.
 (b) II. OTHER CARDIO-VASCULAR DISEASES.

Valvular Heart Diseases: P-5

Paroxysmal S.V.T P-3, to be up-graded to P-2 after EPS
and Radio-frequency ablation and to
P-1 if remains asymptomatic for one
year.
Permanent Pace-Maker implantation Initially P-3 to be up-graded to P-2 if
remains asymptomatic for one year.

(c) DIABETES MELLITUS

Personnel who are known diabetes or having impaired Glucose Tolerance or those who
have declared themselves to be so and are under treatment should be graded as follows:

P1 Personnel having diabetes or impaired Glucose Tolerance under treatment with Diet
control and or oral Hypoglycemics within following parameters be classified as P1
depending on the health condition and follow-up requirement.
Fasting glucose estimation less than 126mg (Plasma)/dl.
Random or 2 hr Post glucose (75 Gms) or <200Mg (Plasma)/dl. A known diabetic may
be permitted to take his usual dose of OHA/insulin following glucose drink/ full
meals for testing PGBS/PPBS provided that.
Glycosylated Hb(HbA1-c)<7%
Individual is free from any target organ involvement/complications.
Lipid profile within normal limits.
No insulin requirement
No Glycosuria.

The above parameters must be maintained for a minimum period of six months with
fasting and 2 hr Post Prandial sugar every six weeks and Glycosylated HbA1c every 3 months
before the individual is upgraded to P1.

During this period of 24 weeks observation the individual shall be kept labeled as P1(O-24)
and finally upgraded as P-1 as the case may be if he maintains the control consistently.
Keeping the individual under P-1(O-24) will be done only once and need NOT be repeated
every year during AME.
P2: Those who have fasting and Post Prandial as for P1 above for at least 6 months with
HbA1c between 7&8 % on dietary restriction alone or with OHA; provided that there is
no complication or Target organ involvement, including:
No retinopathy of any grade on fundoscopy,
No clinical or electro-physiological evidence of neuropathy.
No neuropathy by clinical, bio-chemical or imaging criteria,
Normal lipid profile.,
Normal ECG,
No History or evidence of cerebro-vascular or peripheral vascular disease.

P3: Those who have uncontrolled fasting and Post-Prandial sugar with OHA bt needing
insulin in smaller dose additionally for control, with HbA1c more than 8% with or
without any Target organ damage; but likely to reverse TOD with proper treatment and
are likely to become non-insulin dependent.

P5: Patients on high dose of insulin, not responding to O.H.A, with complications and Target
organ damage with obvious changes; and complete recovery is unlikely.

For the new cases detected during A.M.E the following procedure should be adopted. The
newly detected case should initially be kept under category P3 (T-12). After 12 weeks if the
individual fully complies and improves with treatment achieving parameters as given above,
he/she be categorized as P2 (T-24) If he does not improves, he/she will continue in P3.

In case of newly detected cases of Impaired Glucose Tolerance, the individual should be
placed in category P2 (T-12) if his parameters are of P2. If there is no CV risk factor or any
target organ involvement, the individual is placed in P-1. If the parameters fall in the category
of P1, then he be labeled as P1(O-24) and then dealt with as given above for further
categorization. In doubtful cases, complete GTT may be undertaken. If required, cases are
hospitalized for 48 to 72 hours for close observation and final decision.

d) HYPERTENSION.

The JNC-7 guidelines about grading of hypertension are given below as a ready reference.
Hypertension, when associated with diabetes mellitus is graded one step ahead to facilitate
urgent intervention/treatment in view of added risk for irreversible target organ damage in
general and IHD in particular.

Grade of Hypertension Blood Pressure

Systolic Diastolic
Normal 120 and 80
Pre-hypertension 120-139 or 80-89
Stage-I hypertension 140-159 or 90-99
Stage-II hypertension >160 >100
-Severe 180-209 110-119
-Very Severe 210 or more 120 or more.

As a general rule the systolic Blood Pressure over 140 or/and diastolic over 90 should be
now regarded as significant and such individuals should ideally be hospitalized for observation
and due investigation before final opinion. BP is measured by the conventional mercury
manometer after making the individual at home and comfortable for at least 30 mints and 2 to 3
repeated readings be obtained. Other cardio-vascular risk factors e.g. Smoking, obesity,
diabetes, poor physical activity, dyslipidemia, micro-albuminuria or GFR <60ml/min, family
history of CV disease be looked for.

i) Cases of hypertension with cardiac, renal and eye involvement who are not stabilized
within 24 weeks treatment and are progressive or near decompensation or
decompensated, will be placed in P-5. If, these have stabilized with treatment and are
not progressive, the individual will be placed in P-3 for 24 weeks at a time to assess
further progress, restricting his employment to sedentary duties only in areas not
involving high altitude or exterminate cold climate.
ii) If complying with regular treatment over a continuous period and the cardiac, renal and
retinopathy changes have become normal; with basal blood pressure consistently
remaining normal or at the most within Stage-1 limit, the individual may be considered
for up-gradation to P-2 with no restriction except rigorous physical exertion.

iii) Cases of hypertension without any cardiac, renal or eye involvement and whose blood
pressure is within border line under treatment, will be placed in P-2 for 24 weeks at a
time to assess progress and finally may be considered for up-gradation to P-1B and then
to P-1 in deserving cases depending on response.

iv) In border line cases, the blood pressure may be checked once every 2 weeks, without
changing the existing category, unless there are indications for such change.

(e) OVER WEIGHT & OBESITY

Take into account the average nude weights according to age and height given in
Appendix-‘F’ to this order. Individuals who are found to be overweight wil be dealt with as
under:
i) If body weight is more than 10% but les than 20% over and above the ideal weight
expected for the height and age, without any symptom/signs of metabolic abnormality,
the official will be advised, in writing, to reduce his weight within 10 weeks under
information to his controlling officer. He/she will be reassessed immediately on
completion of this period.

ii) If the individual fails to reduce weight to the acceptable level even after 10 weeks, he
will be down graded to medical category P2 (T-24) and if he/she reduces weight to the
acceptable 10% limit within this period, the classification proforma will be completed.

iii) If the body weight is in excess of the Ideal Body Weight (IBW) by more than 20%
investigations will be carried out to exclude any metabolic abnormality e.g.- abnormal
GTT/RFT/Lipid profile, IHD, Osteo-arthritis etc. If the officer has no metabolic
abnormality and ECG is normal, he should be examined by a Medical Specialist or in his
absence, an experienced CMO (SG). The latter must decide whether it is due to obesity
or due to increased muscle mass. Bone thickness by measuring the following parameters.

1. Body mass Index (BMI)- Weight (in Kg)

(height in meter)²
Normal range : 20-25.
A person is definitely obese if it is 27 or more.

2. Waist and hip ratio:

Method of measurement of waist: Take a point mid way between the 12 th rib and
upper border of iliac crest on both sides and measure with a tape.

Method of Measurement of Hip: Take upper point of greater Trochanter of Femur on

both side and measure the circumference with tape.
Normal range: 0.6 to 0.9 %
A person has definite central obesity if it is more than 0.9%

3. Skin fold thickness:

It is measured with the help of Caliper.
Normal range of Sub-Scapular skin fold: 18-20mm
-Triceps skin fold thickness: 12-15mm.

All the above measurements will decidedly determine whether increased weight is
due to obesity or due to increased muscle mass/bone thickness. If it is due to obesity the
individual should be down graded to medical classification p-2(T-24). If the individual
 fails to reduce his weight to ideal level by 48 weeks, he/she shall be placed in P-2
permanent and if does not comply by 72 weeks, in P-3 Permanent.

(f) ALCOHOL DEPENDENCE

Alcohol dependence and drug abuse are recognized as behavioral/psychiatric problems

in ICD-10. These are incompatible with service/ethos in Armed Forces and all such
cases should be invalidated/weeded out of service unless the patient shows an
unequivocal determination to give up the use of alcohol/drug for good in the shortest
time span. There is well laid down procedure for disposal of such patients of Alcohol
dependence/drug abuse. However it doe not meet the organizational interests of forces
where a large number of men are alcohol dependent and still continue to stay. In view of
the above following instructions for disposal of Alcohol dependence/ drug abuse cases
may be strictly adhered to:-

i) Alcohol dependence/drug abuse cases will be observed in temporary LMC in S-3(T-24)

initially if showing favorable response to treatment.

ii) If during the period of such observation vide 2(a) his condition relapses again, he should
be placed in S-5 and invalidated out of service.

iii) After six months of observation in LMC in S-3(T-24), if his behavioral/abstinence report
is complimentary and his observation in hospital shows sign of abstinence (There should
not be any symptom/sign of withdrawal when no alcohol/drug are allowed during the
period of observation in psychiatric ward) he/ she should be upgraded to category S-2(T-
24).

iv) During this period of observation in S-2(T-24) if the controlling officer of patent refers
him to psychiatrist with adverse behavioral report/remark and patient shows signs of
relapse, he should be placed in S-5.

v) After 6 months of observation in S2(T-24) if the report as above is complimentary and

patient shows signs of alcohol abstinence he should be upgraded to S1.
vi) If after up-gradation to S-1, the patient shows any time any sign of relapse and referred
by Controlling Officer/AMA to psychiatrist with adverse remarks in his report, then also
patient should be placed in S-5.

g) TUBERCULOSIS:
 Fresh cases of tuberculosis on domiciliary anti-TB treatment should be placed in P-3 for six
months initially with further extension of same till the drug regimen lasts. After
treatment is completed, the individual be kept in P2 for 12 weeks if the disease is
completely healed without residual fibrosis or with minimal fibrosis not affecting
functional capacity before upgrading to P1.

If residual fibrosis or pleural thickening occurs with impairment of Pulmonary function

after usual course of treatment, the individual will have to be down graded to P3 for
24 weeks and if after that period, his assessment shows no improvement, he be put in
permanent P3 category, to be dealt with as per Para 7 above.

Resistant cases of tuberculosis or tuberculosis with HIV positive or with severe impairment
of pulmonary function or requiring surgery for complications of tuberculosis,
possible treatment should be given and individual placed in P5.

h) MALIGNANCY & ORGAN TRANSPLANT CASES.

For the period of active treatment in OPD individual be kept in P3 or P4 on rest. After
completion of treatment individual be categorized as per assessment of his physical/mental
condition. The terminal cases will be put in P3 permanent category.

g) HIV/AIDS CASES:

Individuals who are only HIV positive but asymptomatic will be categorized P-2 &
required to be observed periodically. Those who are HIV positive and symnptomatic with or
without opportunistic infection (AIDS disease), shall be assessed on their physical/medical
condition and placed in P-3 permanent if ambulatory to facilitate continued ARTV, provided
that they fully co-operate with management plan. If the disability percentage goes beyond
50%, individual will be placed in P-5

The medical classification for HIV positive personnel will be done as provided below:-

P1 HIV Positive Asymptomatic Fit for all duties

Not on ART anywhere
CD4,CD8 Count normal
Other Parameters like Viral load
Normal
P2 HIV Positive Fit for all duties
Weight Loss more than 10% anywhere except at
CD4(Above 200 Cells/Microlitre) difficult and solitary
 CD8, Count within normal range locations, preferably
Total Lymphocyte Count above where ART facilities
1200/mm3 are available
Minor Mucocutaneous
Manifestations/minor infections
With or without ART
P3 HIV Positive Fit for sedentary duties
Weight loss more than 10% only and only at
CD4 Count less than 200 Cells/ locations were advance
Microlitre medical facilities are
Viral load more than 50,000 copies, available.
Unexplained chronic,
Diarrhea/fever more than 1 month.
Opportunistic infections:-
(1) Pulmonary TB (2) Oral thrush
(3) Herpes Zoster more than 1
month (4) Leukoplakia etc on ART
P4 Hospitalization/leave due to HIV Temporary UNFIT for
related diseases/AIDS Force duties.
P5 Unsatisfactory response to ART, Permanently UNFIT
(CD4 count less than 200 for any type of service,
cells/microlitre with ART) invalidation.
HIV wasting syndrome.
Disabling Neurological/Psychiatric
problems
Disseminated Tuberculosis
Poor Physical endurance
Malignancies associated with AIDS
Functional disability more than 50%

j) MISCELLANEOUS CONDITIONS TO BE CONSIDERED FOR P2:

a) Asymptomatic undescended testis which is entirely intra abdominal, varicocele and

Hydrocele(Treated or of a mild degree); healed trachoma, traumatic rupture of the
tympanic membrane, healed/closed perforation, loss of teeth but fitted with suitable
dentures and dental points>14, depending on the limitations.
b) Cases of non-ulcer dyspepsia where no abnormality was detected on G/E evaluation.
c) Cases of non-incapacitating Asthma, chronic bronchitis and emphysema should
normally be placed in P-3 but may be considered for P-2 depending on clinical condition
and disease behavior.
d) Cases of Primary Hypothyroidism are placed in P2 provided that:
(i) T3,T4 &TSH confirm diagnosis and there is no other underlying cause found.
(ii) Individual continues to be euthyroid on oral thyroxin hormone replacement.
(iii) T3,T4 &TSH levels remain within normal limits consistently for 6 months of
observation..

Note: While recommending employment restrictions for officers placed in P-2 the following
conditions will be given due consideration.

If disability is due to adverse effects of extreme cold on earlier occasion, or gout, arthritis,
sciatica syndrome or chronic bronchitis, certain dermatological conditions and so on
prohibition on employment in extreme cold areas will be restricted.

With history of persistent pulmonary hypertension, head injury, fits amoebic hepatitis
chronic bronchitis, asthma, Ischeamic Heart disease, essential hypertension etc,
restrictions on employment in high altitude (above 2700 meters) may be required.

In disability is due to past h/o Ischeamic heart disease, obesity, sequele of head injury etc,
restrictions may have to be imposed on employment in mutinous areas, duties
involving strenuous exercise, prolonged route march, long patrolling, running etc.

k) DISABILITIES TO BE CONSIDERED UNDER P-1 WITHOUT

EMPLOYABILITY RESTRICTIONS.

1. Asymptomatic Dyslipidemia
Detected incidentally during routine evaluation and,
There is no cardio-vascular risk factor or obesity,
Has normal thyroid function (T2,T4,TSH w.n.1)
No indication for drug therapy.

2. Asymptomatic hyper uricaemia (>7mg/dl)

No symptom of Gout
Individual has modifiable food habits and is amenable to change
No indication for drug therapy

3. Asymptomatic ECG abnormality

 Detected incidentally during routine evaluation and,
There is absence of any risk factor or symptom/sign of cardio- vascular disease,
No underlying cause is detected on cardio-vascular evaluation
Must be under constant evaluation from time to time, not later than every 2 years or less
if indicated.

4. Ventricular or supra-ventricular ectopics

Detected incidentally during routine evaluation and,
There is absence of any risk factor or symptom/ sign of cardio-vascular disease,
No underlying cause is detected on cardio-vascular evaluation.

5. Asymptomatic cervical spondylosis/ Low back-ache.

With no neurological deficit or vascular insufficiency,
Normal spinal movement
No sciatica.

6. Cholelethiasis
Consistently asymptomatic,
No complication of Gall-stone disease.
7. Chronic carriers of HBV & HCV with normal LFT and no evidence of Chronic
Liver disease.

8. Benign Hyper Plasia of Prostate (BHP)

Symptoms well controlled on drugs,
There is no complication of BHP disease.

9. Fracture of non-weight bearing bones, stress factures & Sprains.

When there is no pain persisting,
There is no restriction of Joint mobility

10.Varicose veins
No pain/ swelling/ulcer
Uncomplicated.

11.operated cataract
- Corrected vision up to 6/9 BE with glasses not exceeding +/-3.5D
- Uncomplicated IOL

DEMONSTRATED PHYSICAL CAPACITY AND ENDURANCE

 For assessing endurance and physical efficiency, the Cooper’s 12 minute Run/ Walk test*
will be conducted for GOs and Inspectors up to 57 years of age. For NGOs, the performance
report in his/her annual JD&PET will be taken into account.

*The Run / Walk Tests

Such tests measure the basic endurance as well as the aerobic fitness of an individual,
having positive correlation with his/her maximum oxygen consumption capacity (VO2).

Coopers 12 minutes Run/ Walk test.

The subject in this case is asked to run (also permitted to walk in between if wishes) for 12
minutes on a level surface and the maximum distance covered is noted to correlate for his/her
maximal oxygen uptake capacity. The results of these tests are interpreted as under with due
regard to one’s age and sex. It is not only a good measure of fitness but also an excellent
indicator of progress in physical performance. This test is considered most suitable in our
setting.

INTERPRETATION:
Age range ( In Years) Minimum expected distance must be
covered to be certified as qualified:
Male Female
Up to 25 2.8 2.4
26 to 35 2.4 2.0
36 to 45 2.0 1.75
45 to 57 1.75 1.6

(Adapted from Cooper, 1968)

The above yardstick should be applied rationally with due regard for the age of an
individual; the criteria being, younger the age, more is the distance to be covered. Beyond 57
years, the running may not be insisted upon. It may be left to the choice of the Officer whether
he opts for this or his/her physical Capacity/Stamina be ascertained by employing other tests.

22.6 “E” Factor (Eye Sight) acuity:

This covers acuity of vision, colour vision and field of visions of an individual. A service in
the Central Police Forces is concerned with safety of public life, property and therefore high
grade of colour perception is considered essential.

Numerical Functional Capacity Employability

 Grading limitations
E-1 Must have a good eye sight and Fit for all duties any
high colour perception with no where
ocular pathology. If corrected with
conventional spectacles for Myopia
or Hypermetropia, power not to
exceed 7 diopters.
Corrected vision must be:
Better Eye Worse
Eye
a. 6/6 or 6/36
b. 6/9 or 6/24
c. 6/12 or 6/12
E-2 Moderate eye sight: Corrected Fit for duties
vision with conventional spectacles anywhere excepting
for myopia or manifest jobs which required
hypermetropia not exceeding 3.5 very accurate and
diopters. frequent/rapid firing.
Corrected vision must be:
6/9 6/60
(Or less if other eye is aphakic or
absent)
E-3 Adequate eye sight for ordinary Fit for duties any
purpose. Corrected vision with where except duties
conventional spectacles or contact requiring
lenses. firing/driving.
(a) 6/24 6/36
(b) 6/18 Other eye
completely
Blind or absent.
E-4 In hospital/on leave/rest on medical Temporarily unfit for
ground force duties.
E-5 Acuity of vision below E-3 grade Permanently unfit for
Force Service.

Those diseases of eye not affecting vision must be assessed under “P” factor.

Intraocular – Lens (IOL)- Implantations in Aphakics and their disposal:

 Bilateral aphakic and bilateral contact lens wearers will be placed in this grade irrespective
of their visual acuity as long as it is not below E-3 grade.

All aphakics, weather uniocular or binocular, after IOL implantations, should be observed
in E-3(T) for a period of one year in two spells of six months each. If it is well
tolerated with good visual return/binocular vision, and the field or vision, interlobular
pressure and fundus are normal wherein corrective glasses required are not more than
– 3.5 D in any axis then the following principles and sequence are to be followed:

(a) Uniocular Aphakics (other eye being normal)

i) Left eye with IOL (In Right handed man) - E1 Clasification
ii)Right eye IOL (In Rt. Handed man) - E2 (Permanent)
(b) Biocular Aphakics with IOL both eyes - E2(Permanent)
(c) Biocular Aphakics with one eye IOL and other
Eye with or without contact lens but
Correctable to 6/12 or more - E3(Permanent)
(d) Biocular Aphakics with IOL in one eye
And other eye being absent or with no vision - E3(Permanent) may be awarded but only
to highly skilled or professional individuals. In the routine course, such individuals are to be
invalided out of service. Exceptional reasons for awarding E-3 classification should be
specifically mentioned by the approving authorities.

3. Bilateral aphakics- individuals with Bilateral Contact lenses.

(a) E-3 Category: First 6 months (irrespective of the degree of visual acuity and binocular
vision, but not below the visual standard of E-3, which is 6/24 vision in the better eye
and 6/60 or better but lower than E-2 standard vision in the worse eye)
(b) E-2 Category: (Permanent):
Thereafter (Provided the visual standard is that of E-2 which is 6/12 vision in the better eye and
6/30 or better but lower than E-1 standard in the worse eye along with good binocular
vision).
(c) E-1 Category: Not to be granted to bilateral- Contact- lenses wearer under any
circumstances.
Unilateral Aphakics- Individuals with Unilateral Contact –Lens:

E-1 Category can be granted but only If vision in the better eye is 6/12 or
by an Ophthalmologist at a better and vision in the worse eye
composite hospital 6/12 or better along with excellent
Biocular vision.
4. Defective colour vision: Those with defective colour vision will be categorized E-5

23. SPECIAL REFERENCE FOR LADY OFFICERS IN RELATION TO GYNAE/

OBSTETRICS STATUS (G 1-5) IN ADDITION TO SHAPE CATEGORY.

G-1 No obstetrics or Gynecological problem Fit for duties any

where
G-2 1st & 2nd Trimester of Pregnancy Fit for routine duties
premenopausal/post menopausal not requiring exertion
syndrome Hormone replacement of running, long
therapy causing no disability OR walking jumping,
Minor disability/discomfort due to climbing. PT Parade
fibroid/ovarian tumor/cyst. PID and such other duties.
G-3 Dysfunctional uterine bleeding Fit for duties other
controlled with treatment. than Counter
Pregnancy with complications like insurgency.
Hypertension, PET, Diabetics bad
Obstetrics history etc. Fit only for sedentary
Pre menopausal/ Post menopausal duties with treatment
syndrome with severe disability. facilities existing
Hormone replacement therapy with nearby.
complication causing severe disability.
Pelvic inflammatory disease (PID) with
severe disability.
Uncontrolled cases of D.U.B moderate
disability due to any Gynae/Obst
problem.
The officer should normally be placed
in G-4 on the completion of 34 weeks of
pregnancy.
G-4 Delivery and confinement/ Temporarily unfit
hospitalization/rest/ leave on medical
grounds
G-5 Severe incapacitation due to Sequels to Permanently unfit for
Gynae/Obst. Problem not amenable to service.
treatment. Required to be
invalided out.
Note: 1. All the above conditions should be suitably assessed depending on disability
and graded accordingly after taking specialist opinion for their employability
and restriction of duties/areas etc.

2. The categorization in G-2 and G-3 initially shall be in temporary grade and
only after the treatment is completed or on confinement, LMC may be given
after assessing the disability.

3. Disability due to these gynecological problems will also reflect in ‘P’ factor.

Sd/- 15/12/2008
(V.K.Joshi )
DIRECTOR GENERAL,CRPF

No. P.VII/I-2003-Pers.I Dated,the 15 December 2008

Copy forwarded to :

The Addl.DG,NWZ & East Zone CRPF.

All Sector IsG (including Ops IsG/ RAF/SAF) CRPF and Director/ IGP
ISA
The IG(Medical) Composite Hospital, New Delhi/Hyderabad/ Guwahati &
Jammu.
All Range DIsGP,CRPF,including Ops DIsGP/ RAF/SAF
The DIsGP(Medical) Composite Hospital CRPF Pallipuram/Chennai/
Bangalore/Pune/Nagpur/Neemuch/Gandhinagar/Ajmer/Rampur/Allahabad/
Muzafarpur/Sindri/Silchar/Bhopal/Bhubaneshwar/Bilaspur/Imphal.
All DIsGP,GC,CRPF including SWS/CWS/. Principal CTCs. & RTCs
All Commandants including Signal BNs CRPF.
Sd/- 15/12/2008
(Ramesh Chandra )
DIGP (Pers)

INTERNAL
Sr. PS to DG/ADG
IsGP (Pers & HQ)/(Ops & Trg)/(Prov & Works)
Director (Medical)
DIsGP Pers/Adm/Ops/Trg/Legal/Commn.
All Sections of the Dte.
*salesh
 APPENDICES
Appendix –‘A’
DECLARATION BY THE OFFICIAL TO BE EXAMINED FOR SHAPE
CATEGORISATION.

Please record your

answer
1. Where you examined for any major
ailment or hospitalized during last
one year?
2. Are you a Patient of :
a. Hypertension (High Blood
pressure)
b. Ischaemic heart disease?
c. Diabetes Mellitus?
d. Chronic
cough/Br.Asthma/COPD?
e. Epilepsy (Fits)?
f. Persistent Headache
g. Mental instability?
3. Have you suffered from Giddiness at
any time?
4. Have you suffered from chest
pain./Palpitation.
5. Did you ever suffered from
Tuberculosis?
6. Your (a) Appetite
(b) Sleep
7. Smoking habit ( if yes, no. of
cigarettes per day).
8 Alcohol intake (if yes, average
quantity per day)
9. Any accident/injury/major surgery
undergone so far?
10 Have you been transferred recently
or under orders of transfer? If so
your
a. Previous Unit
b. New Unit.
 It is further certified that the above facts stated by me are true to my best knowledge and
belief. I have not suppressed any fact concerning my health condition ever in past and as is at
present.

Place:
Date:
Signature_______________________
Name____________________
Rank___________
IRLA/F.NO.____________________
Designation______________________
Unit:____________________
 Appendix – ‘B’
INDIVIDUAL HEALTH CARD

HEALTH CARD
IRLA/FORCE NO.____________________________________

Rank___________________________________________________
Name____________________________________________________
Unit______________________________________________________

TABLE – I ( 10 PAGES)
RECORD OF OPD TREATMENT OF DISEASES WHICH LEAVE RESIDUAL DISABILTY/NEEDS
ATTEND.C/REST FOR MORE THAN SEVEN DAYS.

1 2 3 4 5
DATE PLACE DISEASE REMARKS SIGNATURE
CATEGORIZ
ATION

TABLE – II
RECORD OF ADMISSION IN HOSPITAL

1 2 3 4 5 6 7 8
Station Date of Date of Durati Disease Particula Categ Signature of
admission discharg on rs/ orizati medical
e disease/ on officer
disabilit
y

TABLE –III
ANNUAL MEDICAL CHECK UP AND CATEGORISATION
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
Station Unit Date Hei Wt( Chest Wai Pu S H A P E Fina Reason in brief if categ
down graded Signature
ght Kg) st/ lse (Psy (Hea (A (Phy (Eye l MOs
(cm hip & chol ring) pp sical Sigh cate
s) rati BP ogic en capa t) gori
o al) da city) zatio
ge n
s)
 TABLE – IV
RECORD OF VACCINATION TAKEN
Primary vaccination (eg. BCG): Taken Not taken

Tetanus toxoid: Date last Taken:

Hepatitis – B Taken Not taken

Any other optional Vaccination (Please specify):

 APPENDIX- ‘C’
MEDICAL EXAMINATION PROFORMA FOR OFFICERS AND MEN IN CRPF

1. Name :
2. IRLA/Force No.:
3. Age : 4. Sex: M/F
5. Height (Cms) : 6. Weight(Kg) : 7. Chest (Not for ladies): On Expiration :
On full inspiration :

8. Abdominal girth: 9. Trans-trochanteric grith :

10. Ration (8/9):

S PSYCHOLOGICLA ASSESSMENT AS LAID DOWN

i) Any past history of psychiatric illness, if so details:

ii) Any history of breakdown/ outburst or taking wrong decisions, indecisiveness leading to
public reaction or castigation of civil authority.
iii) History of any alcoholic/ drug abuse.
iv) History of Head injury/infective/ metabolic en-cephalopathy.
v) Objective psychometric scale if any applied and result there of:

CATEGORISATION : S-1 /S-2/ S-3/ S-4/ S-5

H HEARING

i) Normal in both ears v) Auroscopy-

ii) Moderate defect in one ear vi) Rennie’s Test-
iii) Partial defect in both ears vii) Weber’s Test-
iv) Any other combinations viii) Audiometry(if indicated)

CATEOGRISATION : H-1/ H-2/ H-3

A APPENDAGES

i) Upper limb
ii) Lower Limb
iii) Any loss/infirmity in any joint or part must be indicated in detail.

CATEGORISATION: A-1(U), A-2(U), A-3(U)

A-1(L), A-2(L), A-3(L)

P: PHYSICAL
General examination:
Distance covered in 12 minutes run/walk (Meters):
Body built : BP (mmHg) :
 Tongue : Pulse/mt : Anaemia :
Temp(c) :
Cyanosis :
Icterus : Respiration :
Oedema :
Clubbing :
Koilonychia :
Lymph glands palpable: Tonsils :
JVP : Teeth/Denture : Thyroid :
Throat :
Spleen : Liver :
C.V.S. : E.C.G.: Required after age of 45 years.
S1 Blood sugar : If applicable
S2 Urine exam : In all cases.
Hb% : In all cases.
Murmur if any:

R-System: Any deformity of Chest: Percussion

Breath sounds Adventitious sounds

C.N.S. Higher functions: Memory (Recent & Remote)

Intelligence
Personality
Orientation (Time, Place & Person)
Cranial
Meningeal sign if any- Nerves

Motor System Nutrition of muscles Wasting-

Tone
Coordination
Abnormal movement/fasciculation
Power
DTR
Plantar- Abdominal&Cremasteric Refle-
Cerebellar Sign Gower’s Sign
Sensory System-
Reflexes- Foberg’s Sign- SLR Finger-Toe Test
Skull & Bone
Addomen: General: Any mass palpable any other abnormality
Piles/ Fissure- Fistula- Prolapse rectum

INVESTIGATION:
Hb%
Urine examination for all ages
ECG after age of 45 years: Blood sugar if applicable and for all above 45 years.
 Any other investigation as deemed necessary by examining Medical Board.(i.e. X-Ray Chest,
Lipid Profile, Glycosylated Hb etc.)

I Agree/Do not Agree to under go HIV test Signature

CATEGORISATION: P1/ P2 / P3

“E” Factor (Eye sight/Vision)

Distant Vision
Near Vision
Colour Vision
Field of vision
Any other pathology
IOL

CATEGORISATION : E1/ E2/ E3

FINAL CATEGORISATION

ADVICE/EMPLOYABILITY
RESTRICTIONS IF ANY

(NAME OF MEDICAL OFFICER):/BOARD MEMBERS : DESIGNATION/UNIT

 APPENDIX-‘D’
PROFORMA FOR CERTIFICATE TO BE PRODUCED BY AN APELLANT CHALLANGING THE
FINDINGS OF AMA/MEDICAL BOARD REQUESTING FOR REVIEW.

I, Dr.___________________________________ certify that I have examined Shri/Smt/Kumari

____________________________________., aged__________years of Unit__________ who has been
categorized in ___________ due to _________________________________. After careful examination and
investigation , it is opined that S/He is not suffering from__________________________. To arrive at this
decision, I have examined the relevant of medical documents and conducted necessary investigations.

Seal
Date:

Signature of Medical officer/civil Surgeon

Name/Designation-------------
Reg. No.______________________
Hospital________________________
 APPENDIX-‘E’

Male Average Nude Weight in Kilograms for Different Age Groups and Heights (10% variation on
Either Side of Average Acceptable)
Height in Age in Years
cms
15-1718-2223-2728-3233-3738-4243-4748-50
156 48495152.553.55454.555
158 495052545555.55656.5
160 505153555656.585757.5
162 5152.554.55657055858.559
164 52.553.555.557.55959.56060.5
166 53.555575960.56161.562
168 5556.558.560.5626363.564
170 56.55860626464.56565.5
172 586061.563.565.56666.567.5
174 59.56163.565.567.56868.569
176 6162.565676969.57071
178 62.56466.568.570.571.57272.5
180 6465.56870.572.5737474.5
182 6667.569.572747575.576.5
184 677071.5747676.577.578
186 6970.57375.57878.57980
188 70.5727577.679.5808182
190 7273.57678.580.5818283

* The body weights are given in this chart corresponding to height (in cms) on even numbers only. In respect
of height in between the principle of ‘Average’ will be utilized for calculating body weights. For calculating
average weight of those above the age of 50 years, 0.71 Kg may be added for each 5 years of age in the
corresponding height group.
 Appendix – ‘F’
Female Average body Weights in Kilograms for Different Age Groups & height
(10% variation on either Side of Average Acceptable)

Height in Age in Years

Cms
20253035404550
148 38.54142.5444546.547
150 40.541.543.545464748
153 4243.545.546.54848.549.5
155 4344.54647.54949.550
158 4546.54849.550.551.552
160 4647.54950.551.552.553
163 47.5495152525455
165 4950.552.55455.55657.5
168 50525455.5575859

* The body weights are given in this chart corresponding to height(in cms) on even numbers only.
In respect of heights in between the principle of ‘Average’ will be utilized for calculating body
weights.

* For calculating average weight of those above the age of 50 years, 0.71 Kg may be added for each
5 years of age in the corresponding height group