CHAPTER 1

  GENERAL INSTRUCTIONS

1.1.1. In this section the medical standards of candidates for commissioning into flying, ground duty branches in the IAF are given. For Airmen and NCs (E) also most of these standards will apply.

1.1.2. The basic requirements of medical fitness are essentially the same for all branches, except for aircrew whose visual acuity, anthropometry and certain other physical standards are higher. A candidate will not be assessed physically fit unless the examination as a whole shows that he/ she is physically and mentally capable of withstanding severe physical and mental strain for prolonged periods in any climate in any part of the world.

1.1.3. The results of initial examination are recorded on AFMSF – 2. The medical examination consists of: -

(a) A questionnaire, which is to be carefully and truthfully completed by the candidate and countersigned by the examining medical officer. The importance of all aspects of the questionnaire, including the legal aspect, should be emphasized on all candidates.  Any subsequent detection of disability, not declared earlier, will lead to disqualification at any stage prior to commissioning.

 (b) A complete medical and surgical examination including dental examination and gynecological examination in women.

 (c) An ophthalmic examination, and

 (d) An examination of the ears, nose and throat.

1.1.4. Each M.O/ Specialist conducting part of the examination completes the appropriate section of the form and affixes his/her signature at the end of each section. The President of the Medical Board then assesses the overall fitness of the candidate. To ensure that the results recorded on different candidates are comparable, it is important that standard testing apparatus and procedures are used.

1.1.5. The medical standards spelt out in this section pertain to initial entry medical standards. Continuation of medical fitness will be assessed during the periodic medical examinations held at NDA/ AFA/ AFTC prior to commissioning. If, however, any disease or disability is detected during the training phase, which will have a bearing on the flight cadets subsequent physical fitness and medical category; such cases will be referred expeditiously to IAM (for aircrew)/Specialists of MH under intimation to the office of DGMS (Air): Med -7. At IAM, if the disease or disability is of a permanent nature an early decision for the cadet to continue in the service / branch / stream is to be taken.

CHAPTER 2

 GENERAL MEDICAL AND SURGICAL ASSESSMENT

1.2.1. Every candidate, to be fit for the Air Force, must conform to the minimum standards laid down in the succeeding paragraphs. The general build should be well developed and proportionate.

Surgical Sequelae and Abnormalities

1.2.2. Sequelae of Fractures/ Old injuries. The residual effects of such fractures/ injuries are to be assessed for any functional limitation. If there is no effect on function, the candidate can be assessed fit. Cases of old fractures of spine are unfit. Any residual deformity of spine or compression of a vertebra will be cause for rejection. Injuries involving the trunks of the larger nerves, resulting in loss of function, or scarring, which cause pain or cramps, indicate unsuitability for employment in flying duties. The presence of large or multiple keloids will be cause for rejection.

1.2.3. Scars and Birth Marks. Minor scars for e.g. as resulting from the removal of tuberculous glands do not, per se, indicate unsuitability for employment on flying duties. Extensive scarring of a limb or torso that may cause functional limitation or unsightly appearance should be considered unfit.

1.2.4. Cervical Rib. A well fully developed unilateral cervical rib or a rudimentary large cervical rib with signs or symptoms referable to the rib is a cause for rejection. Rudimentary small cervical rib without signs or symptoms referable to it may be considered fit. However, the defect is to be recorded as a minor disability in the medical board proceedings. Bilateral cervical ribs without any neurovascular compromise will be acceptable.

1.2.5. Asymmetry of the face and head, which will interfere with proper fitting of oxygen mask and helmet, will be a cause for rejection for flying duties.

1.2.6. History relating to operations. A candidate who has undergone an abdominal operation, other than a simple appendicectomy, involving extensive surgical intervention or partial or total excision of any organ is, as a rule, unsuitable for flying duties. Operation involving the cranial vault (e.g.trephining), or extensive thoracic operations such as thoracoplasty make the candidate unfit for flying.

Measurement and Physique

1.2.7. Chest shape and circumference. The shape of the chest is as important as its actual measurement. The chest should be well proportioned and well developed with the minimum range of expansion of 5 cm. Decimal fraction lower than 0.5 cm will be ignored. 0.5 cm will be recorded as such and 0.6 cm and above will be recorded as 1 cm.

1.2.8. Height, Sitting Height, Leg Length and Thigh Length. The minimum height for entry into ground duty branches will be 157.5 cm. 

1.2.9. Minimum height for Flying Branch Acceptable measurements of leg length, thigh length and sitting height for such aircrew will be as under: -

(a) Sitting height     - Minimum 81.50 cm

  - Maximum 96 .0 cm

(b) Leg Length        - Minimum 99.0 cm      

- Maximum 120.0 cm

(c) Thigh Length      - Maximum 64.0 cm

1.2.10. On account of lower age group of NDA candidates a margin of up to 5.0 cm in height, 2.5 cm in leg length (minimum) and 1.0 cm in sitting height (minimum) may be given provided it is certified by the medical board that the candidate is likely to grow and come up to the required standard on completion of his training at NDA. The actual growth is to be confirmed at the time of V term medical at NDA.

1.2.11. Weight

(a) Male Candidates (except NDA candidates). Ideal weight relative to age and height is as depicted in Appendix A to this chapter. For male candidates (except NDA candidates), the maximum permissible variation from the ideal body weight is ± 1SD. Fraction of less than half a Kg will not be noted.

(b) NDA Candidates. For NDA candidates, at entry, the weight chart prescribed by U.P.S.C. placed at Appendix B to this chapter will be applicable. placed at Appendix B to this chapter will be applicable. Fraction of less than half a Kg will not be noted. If a candidate is overweight by more than 10 % of the ideal weight, biochemical parameters will be assessed to rule out any underlying pathology. Candidates with weight between 10 to 20 % of ideal with normal biochemical profile, normal waist circumference (< 94 cm:Males and 89 cm: Females), normal BMI range (M< 25, F< 23) and normal waist to hip ratio (< 0.9: Males and <0.8: Females) may be assessed fit. It must be ensured that all the four obesity parameters mentioned before are normal. Abnormality in any one of them will be a cause for rejection. Genetic factors must also be considered in young age obesity. Skin fold thickness and measurement of body fat with body fat analyzers, where available, may be done. Such candidates, if found fit, would be advised to reduce weight to less than 10% of ideal which should be ensured by the time the candidate joins NDA and subsequently, AFA (this stipulation is also endorsed in the joining instructions of the candidate).  Candidates with weight more than 20 % above the ideal, with or without biochemical abnormalities, or BMI more than 25 or waist circumference more than 94cm, or WHR > 0.9 will be declared unfit.  If a candidate is underweight by more than 10% below the ideal, a detailed history and careful examination to rule out possible causes like tuberculosis, hyperthyroidism, diabetes etc will be carried out.  If no cause is detected the candidate will be declared fit. If any cause is detected the fitness of the candidate will be decided accordingly.

1.2.12. Physical Standards (For Females).

(a) Height. The minimum height acceptable for various branches are as follows:-

(i) Flying Branch - 162.5 cm.

(ii) Medical / Dental branches – 142 cm

(iii) Other Branches – 152 cm

 Note: For other than flying branches only – For candidates belonging to the North East region or hilly regions of Uttaranchal, a lower minimum height of 142 cm will be accepted.

 (b) Weight. Weight should conform to the standards given for height and age as given in Appendix C to this chapter. Variations upto ± 1SD for female candidates are acceptable.

Appendix A

(Refers to para 1.2.11)

MALE IDEAL WEIGHTS IN KG FOR DIFFERENT AGE GROUPS

AND HEIGHTS OF NORMAL INDIVIDUALS

Appendix B

(Refers to para 1.2.11)

 MALE IDEAL NUDE WEIGHTS IN KILOGRAMS FOR DIFFERENT AGE GROUPS AND HEIGHTS FOR NDA CANDIDATES ON ENTRY

(10% VARIATION ON HIGHER SIDE OF AVERAGE ACCEPTABLE)

Appendix C

(Refers to para 1.2.12)

TABLE 5: IDEAL HEIGHT-WEIGHT CHART FOR DIFFERENT AGE GROUPS FOR FEMALE INDIVIDUALS

CHAPTER 3

 CARDIOVASCULAR SYSTEM

1.3.1. Relevant history. History of chest pain, breathlessness, palpitation, fainting attacks, giddiness, rheumatic fever, chorea, frequent sore throats and tonsillitis should be given due consideration in assessment of the cardiovascular system.

1.3.2. Pulse. The normal pulse rate varies from 60-100 bpm. Persistent sinus tachycardia (> 100 bpm), after emotional factors and fever are excluded as causes, as well as, persistent sinus bradycardia (< 60 bpm), should be referred for specialist opinion to exclude organic causes. Sinus arrhythmia and vagotonia should be also be excluded. 

1.3.3. Candidates are quite prone to develop White Coat Hypertension, which is a transient rise of Blood Pressure, due to the stress of medical examination. Every effort must be made to eliminate the White Coat effect by repeated recordings under basal conditions. When indicated, ambulatory BP recording must be carried out or the candidate admitted to hospital for observation before final fitness is certified.  An individual with BP consistently greater than 140/90 mm Hg shall be rejected.

1.3.4. Evidence of organic cardio vascular disease will be cause for rejection.  Diastolic murmurs are invariably organic. Short systolic murmurs of ejection systolic nature and not associated with thrill and which diminish on standing, specially if associated with a normal ECG and Chest X-Ray, are most often functional. However an echocardiogram should always be done to exclude organic heart disease. In case of any doubt the case should be referred to cardiologist for opinion.

1.3.5. Electro Cardiograms. Assessment of a properly recorded ECG (resting – 14 lead) should be carried out by a medical specialist. Note will be taken of wave patterns, the amplitude, duration and time relationship. At initial entry no abnormalities are acceptable except incomplete RBBB in the absence of structural heart disease, which must be excluded. In such cases, opinion of Senior Adviser or Cardiologist will be obtained.

CHAPTER 4

RESPIRATORY SYSTEM

1.4.1. Pulmonary TB. Any residual scarring in pulmonary parenchyma or pleura, as evidenced by a demonstrable opacity on chest skiagram will be a ground for rejection.

1.4.2. Pleurisy with Effusion. Any evidence of significant residual pleural thickening will be a cause for rejection. Old treated cases with no residual abnormality can be accepted if the diagnosis and treatment was completed more than two year earlier. In these cases, a CT scan chest and fibro optic bronchoscopy with bronchial lavage can be done alongwith USG, ESR, and Mantoux test. If all the tests are normal the candidate may be considered fit.

1.4.3. Bronchitis. History of repeated attacks of cough/ wheezing/ bronchitis may be manifestations of chronic bronchitis or other chronic pathology of the respiratory tract. Such cases will be assessed unfit.

1.4.4.Bronchial Asthma. History of repeated attacks of bronchial asthma/wheezing/ allergic rhinitis will be a cause for rejection.

1.4.5. Radiographs of the chest. Definite radiological evidence of disease of the lungs, mediastinum and pleurae indicates unsuitability for employment in air force.

CHAPTER 5

GASTRO INTESTINAL SYSTEM 

1.5.1. Relevant History. The examiner should enquire whether the candidate has any past history of ulceration or infection of the mouth, tongue, gums or throat.  Record should be made of any major dental alteration.

1.5.2. When discussing a candidate’s medical history the examiner must ask direct questions about any history of heart burn, history of recurrent dyspepsia, peptic ulcer-type pain, persistent diarrhoea, jaundice or biliary colic.

1.5.3. Dental Standards. The following dental standard will be followed:-

(a) Candidate must have 14 dental points and the following teeth must be present in the upper jaw in good functional opposition with the corresponding teeth in the lower jaw, and these must be sound or repairable:-

(i) Any four of the six anteriors, and

(ii) Any six of the ten posteriors

(iii) They should be balancing on both sides. Unilateral mastication

is not allowed.

(iv) Any removable or wired prosthesis are not permitted. 

(b) Candidate whose dental standard does not conform to the laid down standard will be rejected.

(c) Candidate with dental arches affected by advanced stage of generalized active lesions of pyorrhoea, acute ulcerative gingivitis, and gross abnormality of the teeth or jaws or with numerous caries or septic teeth will be rejected.

1.5.4 Gastro-Duodenal disabilities. Candidates who are suffering or have suffered, during the previous two years, from symptoms suggestive of chronic indigestion, including proven peptic ulceration, are not to be accepted, in view of the exceedingly high risk of recurrence of symptoms and potential for incapacitation. Any past surgical procedure involving partial or total loss of an organ (other than vestigial organs/ gall bladder) will entail rejection.

1.5.5 Diseases of the Liver. If past history of jaundice is noted or any abnormality of the liver function is suspected, full investigation is required for assessment. Candidates suffering from viral hepatitis or any other form of jaundice will be rejected. Such candidates can be declared fit after a minimum period of 6 months has elapsed provided there is full clinical recovery; HBV and HCV status are both negative and liver functions are within normal limits.

1.5.6 Disease of spleen. Candidates, who have undergone splenectomy, are unfit, irrespective of the cause for operation. Splenomegaly of any degree is a cause for rejection.

1.5.7. Hernia. A candidate with a well-healed hernia scar, after successful surgery, will be considered fit six months after surgery, provided there is no potential for any recurrence and abdominal musculature is good.

1.5.8. Abdominal Surgery.

(a) A candidate with well-healed scar after conventional abdominal surgery will be considered fit after 6 months of successful surgery provided there is no potential for any recurrence of the underlying pathology and abdominal wall musculature is good.

(b) A candidate after laparoscopic cholecystectomy will be considered fit three months after successful surgery. 

1.5.9. USG Abdomen: Disposal of cases with incidental ultrasonographic findings like fatty liver, small cysts, haemangiomas, septate gall bladder etc., will be based on clinical significance and functional capacity.

CHAPTER 6

UROGENITAL SYSTEM

 1.6.1. Relevant History. Enquiry should be made about any alteration in micturition, e.g. dysuria or frequency. Recurrent attacks of cystitis; pyelonephritis and haematuria must be excluded. Detailed enquiry must be made about any history of renal colic, attacks of acute nephritis, any operation on the renal tract including loss of a kidney, passing of stones or urethral discharges. If there is any history of enuresis, past or present, full details must be obtained.

1.6.2. Urine Examination.

(a) Proteinuria. Proteinuria will be a cause for rejection, unless it proves to be orthostatic.

(b) Glycosuria. When glycosuria is detected, a blood sugar examination (Fasting and after 75 g glucose) and Glycosylated Hb is to be carried out, and fitness decided as per results. Renal glycosuria is not a cause for rejection.

(c) Urinary Infections. When the candidate has history or evidence of urinary infection it will entail full renal investigation. Persistent evidence of urinary infection will entail rejection.

(d) Haematuria. Candidates with history of haematuria will be subjected to full renal investigation.

1.6.3. Glomerulonephritis.

(a) Acute. In this condition there is a high rate of recovery in the acute phase, particularly in childhood. A candidate who has made a complete recovery and has no proteinuria may be assessed fit, after a minimum period of one year after full recovery.

(b) Chronic. Candidate with chronic glomerulonephritis will be rejected.

1.6.4. Renal Colic and Renal Calculi. Complete renal evaluation is required.  Candidates with renal calculi will be rejected.

1.6.5. Absence of Kidney. All candidates found to have congenital absence of one kidney or who have undergone unilateral nephrectomy will be rejected. Presence of horseshoe kidney will entail rejection. Solitary functioning kidney with diseased, non-functional contralateral kidney will entail rejection. Crossed ectopia, unascended kidney(s) will be a cause for rejection.

1.6.6. Undescended Testis. Bilateral undescended testis / atrophied testis will be a cause for rejection. Unilateral undescended testis, if entirely retained in the abdomen, is acceptable. If it lies in the inguinal canal, at the external ring or in the abdominal wall, such cases may be accepted after either orchiectomy or orchipexy operation. In all doubtful cases surgical opinion must be obtained regarding fitness.

1.6.7. Hydrocele or Varicocele. These should be properly treated before fitness is considered. Minor degree of varicocele should not entail rejection.

CHAPTER 7

ENDOCRINE SYSTEM 

1.7.1. Generally any history suggestive of endocrine disorders will be a cause for rejection.

1.7.2. All cases of thyroid swelling having abnormal iodine uptake and abnormal thyroid hormone levels will be rejected. Cases of simple goiter with minimal thyroid swelling, who are clinically euthyroid and have normal iodine uptake and normal thyroid functions may be accepted.

1.7.3. Candidates detected to have diabetes mellitus will be rejected. A candidate with a family history of diabetes mellitus will be subjected to blood sugar and Glycosylated Hb evaluation, which will be recorded.

CHAPTER 8

DERMATOLOGICAL SYSTEM

1.8.1. Relevant history and examination. Careful interrogation followed by examination of the candidates skin is necessary to obtain a clear picture of the nature and severity of any dermatological condition claimed or found. Borderline skin conditions should be referred to a dermatologist. Candidates who give history of sexual exposure, or have evidence of healed penile sore in the form of a scar should be declared permanently unfit, even in absence of an overt STD, as these candidates are likely ‘repeaters’ with similar indulgent promiscuous behavior.

1.8.2. Assessment of diseases of the Skin. Acute non-exanthematous and noncommunicable diseases, which ordinarily run a temporary course, need not be a cause of rejection. Diseases of a trivial nature, and those, which do not interfere with general health or cause incapacity, do not entail rejection.

1.8.3. Certain skin conditions are apt to become active and incapacitating under tropical conditions. An individual is unsuitable for service if he has a definite history or signs of chronic or recurrent skin diseases. Some such conditions are described below:-

(a) Palmoplantar Hyperhydrosis. Some amount of Palmoplantar Hyperhydrosis is physiological, considering the situation that recruits face during medical examination. However, conditions with significant Palmoplantar Hyperhydrosis should be considered unfit.

(b) Acne Vulgaris. Mild (Grade 1) Acne consisting of few comedones or papules, localized only to the face may be acceptable. However moderate to severe degree of acne (nodulocystic type with or without keloidal scarring) or involving the back should be considered unfit.

(c) Palmoplantar Keratoderma. Any degree of palmoplantar keratoderma manifesting with hyperkeratotic and fissured skin over the palms, soles and heels should be considered unfit. 

(d) Ichthyosis Vulgaris. Ichthyosis involving the upper and lower limbs, with evident dry, scaly, fissured skin should be considered unfit.  Mild Xerosis (dry skin) could be considered fit. 

(e) Keloids. Candidates having any keloid should be considered unfit.

(f) Onychomycosis. Clinically evident onychomycosis of finger and toenails should be declared unfit, especially if associated with nail dystrophy. Mild degree of distal discolouration involving single nail without any dystrophy may be acceptable.

(g) Giant Congenital Melanocytic Naevus. Giant congenital melanocytic naevi, greater than 10 cm should be considered unfit, as there is a malignant potential in such large sized naevi.

(h) Callosities, corns and warts. Small sized callosities, corns and warts may be considered acceptable after treatment. However candidates with multiple common warts or diffuse palmoplantar mosaic warts, large callosities on pressure areas of palms and soles and multiple corns should be rejected.

(j) Psoriasis. Psoriasis is a chronic skin condition known to relapse and/or recur and hence should be considered unfit.

(k) Leukoderma. Candidates suffering from minor degree of Leukoderma affecting the covered parts may be accepted. Vitiligo limited only to glans and prepuce maybe considered fit. But those having extensive degree of skin involvement and especially, when the exposed parts are affected, even to a minor degree, should not be accepted.

1.8.4. A history of chronic or recurrent attacks of skin infections will be cause for rejection. A simple attack of boils or sycosis from which there has been complete recovery may be considered for acceptance.

1.8.5. Individuals who have chronic or frequently recurring attacks of a skin disease of a serious or incapacitating nature e.g. eczema are to be assessed as permanently unfit and rejected.

1.8.6. Any sign of Leprosy will be a cause for rejection.

1.8.7. Naevi. Naevus depigmentosus, Beckers Naevus may be considered it.  Intradermal Naevus, Vascular Naevi may be considered unfit.

1.8.8. Ptyriasis Versicolor. Mild P Versicolor may be considered fit. Extensive Ptyriasis Versicolor may be considered unfit.

1.8.9. Tinea Cruris and Tinea Corporis. Maybe considered fit on recovery.

1.8.10. Scrotal Eczema. Maybe considered fit on recovery.

1.8.11 Canities (premature graying stain) maybe considered fit if mild in nature and no systemic association is seen.

1.8.12. Intertrigo. Maybe considered fit on recovery.

1.8.13. Sexually Transmitted Diseases : Genital Ulcers. These should be considered unfit.

1.8.14. Scabies. Maybe considered fit only on recovery. Genital scabies maybe made unfit.
 

CHAPTER 9

MUSCULOSKELETAL SYSTEM AND PHYSICAL CAPACITY

Physical Endurance

1.9.1. The assessment of the candidate’s physique is to be based upon careful observation of such general parameters as apparent muscular development, age, height, weight and the correlation of this i.e. potential ability to acquire physical stamina with training. The candidate’s physical capacity is affected by general physical development or by any constitutional or pathological condition.

Spinal Conditions

1.9.2. Relevant history. Past medical history of disease or injury of the spine or sacroiliac joints, either with or without objective signs, which has prevented the candidate from successfully following a physically active life, is a cause for rejection for commissioning. History of spinal fracture/ prolapsed intervertebral disc and surgical treatment for these conditions will entail rejection.

1.9.3. Examination. Mild kyphosis or lordosis where deformity is barely noticeable and not associated with pain or restriction of movement may be accepted. When scoliosis is noticeable or any pathological condition of the spine is suspected, X-ray examination of the appropriate part of the spine needs to be carried out.

1.9.4. X-Ray Spine. For flying duties, X-ray (AP and lateral views) of cervical, thoracic and lumbosacral spines is to be carried out. For ground duties, X-ray examination of spine may be carried out, if deemed necessary.

1.9.5. Assessment. The following conditions detected radiologically will disqualify a candidate for Air Force service: -

(a) Granulomatous disease of spine.

(b) Arthritis / Spondylosis.

(i) Rheumatoid arthritis and allied disorders.

(ii) Ankylosing Spondylitis.

(iii) Osteoarthrosis, spondylosis and degenerative joint disease.

(iv) Non-articular rheumatism (e.g. lesions of the rotator cuff, tennis elbow, recurrent lumbago etc.)

(v) Misc disorders including SLE, ,Polymyositis, and Vasculitis.

(vi) Spondylolisthesis / spondylolysis

(vii) Compression fracture of Vertebra

(viii) Scheuerman’s Disease (Adolescent Kyphosis)

(ix) Loss of cervical lordosis when associated with clinically restricted movements of cervical spine.

(x) Unilateral / Bilateral Cervical ribs with demonstrable neurological or circulatory deficit.

(xi) Any other abnormality is so considered by the specialist. 

1.9.6. Fitness for Flying Duties. The deformities/disease contained in para 1.9.5 above will be cause of rejection for all branches in IAF. In addition for candidates for flying branches the under mentioned rules will also apply: -

(a) Spinal anomalies acceptable for flying duties: -

(i) Bilateral complete sacralisation of LV5 and bilateral complete lumbarisation of SV1.

(ii) Spine bifida in sacrum and in LV5, if completely sacralised.

(iii) Complete block (fused) vertebrae in cervical and /or dorsal spine at a single level.

Note: However, an annotation will be made of these anomalies in AFMSF-2.

(b) Spinal conditions not acceptable for flying duties.

(i) Scoliosis more than 15 degree as measured by Cobb’s method.

(ii) Degenerative disc disease.

(iii) Presence of Schmorl’s nodes at more than one level.

(iv) Atlanto - occipital and atlanto-axial anomalies.

(v) Hemi vertebra and/or incomplete block (fused) vertebra at any level in cervical, dorsal or lumbar spine and complete block (fused) vertebra at more than one level in cervical or dorsal spine.

(vi) Unilateral sacralisation or lumbarisation (complete or incomplete) at all levels and bilateral incomplete sacralisation or lumbarisation.

Conditions affecting the assessment of Upper Limbs

1.9.7. Amputations. Candidate with an amputation of an upper limb will not be accepted for entry. Amputation of terminal phalanx of little finger on both sides is, however, acceptable

1.9.8. Fingers and Hands. Deformities of the upper limbs or their parts will be cause for rejection. Syndactyly, polydactyly will be assessed as unfit except when polydactyly is excised.

1.9.9. Wrist. Painless limitation movement of wrist will be graded according to the degree of stiffness. Loss of dorsiflexion is more serious than loss of palmer flexion.

1.9.10. Elbow. Slight limitation of movement does not bar acceptance provided functional capacity is adequate. Ankylosis will entail rejection. Carrying angle of more than 15 degree for male and more 18 degree for female candidates will be a cause for rejection.

1.9.11. Shoulder Girdle. History of recurrent dislocation of shoulder will entail rejection.

1.9.12. Clavicle. Malunion / non-union of an old fracture clavicle will entail rejection.

Conditions affecting the assessment of Lower Limbs

1.9.13. Hallux Valgus. Mild cases (less than 20 degrees), asymptomatic, without any associated corn / callosities / bunion, are acceptable. Other cases will entail rejection. Shortening of first metatarsal is also considered unfit.

1.9.14. Hallux rigidus. Hallux rigidus is not acceptable.

1.9.15. Hammer Toes (single or multiple). Isolated single flexible mild hammertoe with no history of disabling symptoms may be accepted. Fixed (rigid) deformity or hammertoe associated with corns, callosities, mallet toes or hyperextension at metatarsophalangeal joint (claw toe deformity) is causes for rejection.

1.9.16. Loss of Digits. Loss of any digit of the toes or fingers entails rejection.

1.9.17. Extra Digits. Extra digits will entail rejection if there is bony continuity with adjacent digits. Cases of syndactly or loss of toes/fingers will be rejected.

1.9.18. Flat feet. Feet may look apparent flat. If the arches of the feet reappear on standing on toes, if the candidate can skip and run well on the toes and if the feet are supple, mobile and painless, the candidate is acceptable. Restriction of the movements of the foot will also be a cause for rejection. Rigidity of the foot, whatever may be the shape of the foot, is a cause for rejection.

1.9.19. Pes Cavus and Talipes (Club Foot). Mild degree of idiopathic pes cavus is acceptable. Moderate and severe pes cavus and pes cavus due to organic disease will entail rejection. All cases of Talipes (Club Foot) will be rejected.

1.9.20. The Ankle Joints. Any significant limitation of movement following previous injuries will not be accepted. However, cases with no history of recurrent trouble and having plantar and dorsiflexion movement of at least 20 degree may be assessed fit for ground duties. Fitness for aircrew duties will be based on functional evaluation.

1.9.21. The Knee Joint. History or clinical signs suggestive of Internal Derangement of Knee will need careful consideration. Fitness in such cases will be based on functional evaluation and possibility/progression/recurrance of the treated pathology.

1.9.22. Genu Valgum (Knock Knee). If the distance between the internal malleoli is less than 5 cm, without any other deformity, the candidate is considered fit. If the distance between the two internal malleoli is more than 5 cm, he should be declared unfit.

1.9.23. Genu Varum (Bow Legs). If the distance between the femoral condyles is within 10 cm the candidate should be considered fit.

1.9.24. Genu Recurvatum. If the hyperextension of the knee is within 10 degrees and is unaccompanied by any other deformity, the candidate should be accepted as fit.

1.9.25. Hip Joint. True lesions of the hip joint will entail rejection.

CHAPTER 10

 CENTRAL NERVOUS SYSTEM

Relevant Personal History

1.10.1. Mental Illness. A candidate giving a history of mental illness/psychological afflictions requires detailed investigation and psychiatric referral. Such cases should normally be rejected. Most often the history is not volunteered. The examiner should try to elicit a history by direct questioning, which may or may not be fruitful. Every examiner should form a general impression of the candidate’s personality as a whole and may enquire into an individual’s stability and habitual reactions to difficult and stressful situations.

1.10.2. Insomnia, Nightmare, Sleepwalking or bed-wetting. History of insomnia, nightmares or frequent sleepwalking, when recurrent or persistent, will be a cause for rejection.

1.10.3 Severe or ‘throbbing’ Headache and Migraine. Common types of recurrent headaches are those due to former head injury or migraine. Other forms of occasional headache must be considered in relation to their probable cause. A candidate with migraine, which was severe enough to make him consult his doctor, should normally be a cause for rejection. Even a single attack of migraine with visual disturbance or ‘Migrainous epilepsy’ is a bar to acceptance.

1.10.4. Fits and convulsions. History of epilepsy in a candidate is a cause for rejection. Convulsions/fits after the age of five are also a cause for rejection. Convulsions in infancy may not be of ominous nature provided it appears that the convulsions were febrile convulsions and were not associated with any overt neurological deficit. Causes of epilepsy include genetic factors, traumatic brain injury, stroke, infection, demyelinating and degenerative disorders, birth defects, substance abuse and withdrawal seizures. Enquiry should not be limited only to the occurrence of major attacks. Complex Partial seizures may masquerade as “faints” and therefore the frequency and the conditions under which “faints” took place must be elicited. Such attacks indicate unsuitability for flying, whatever their apparent nature. An isolated fainting attack calls for enquiry into all the attendant factors to distinguish between syncope and seizures. For e.g. fainting in school is of common occurrence and may have little significance. Other complex partial seizures may manifest as vegetative movements as lip smacking, chewing, staring, dazed appearance and periods of unresponsiveness. In any event, a prolonged period of freedom from recurrence must have elapsed before fitness for flying duties can be considered and if the electroencephalogram does not show any specific abnormality.

1.10.5. Heat stroke. History of repeated attacks of heat stroke, hyperpyrexia or heat exhaustion bars employment for air force duties, as it is an evidence of a faulty heat regulating mechanism. A single severe attack of heat effects, provided the history of exposure was severe, and no permanent sequelae were evident is, by itself, not a reason for rejecting the candidate.

1.10.6. Head Injury or Concussion. A history of severe head injury is a cause for rejection. The degree of severity may be gauged from the history of duration of Post Traumatic Amnesia (PTA). Mild brain injury is associated with 0-1 hour PTA, moderate with 1 – 24 hours PTA, severe with 1-7 days PTA and very severe with > 7 days of PTA. Other sequalae of head injury are post concussion syndrome which has subjective symptoms of headache, giddiness, insomnia, restlessness, irritability, poor concentration and attention deficits; focal neurological deficit, posttraumatic epilepsy and posttraumatic neuropsychological impairment which includes deficits in attention concentration, information processing speeds, mental flexibility and frontal lobe executive functions and psychosocial functioning. Neuropsychological testing including pyschometry can assess these aspects. It is important to realize that sequelae may persist for considerable period and may even be permanent. Fracture of the skull need not be a cause for rejection unless there is a history of associated intracranial damage or of depressed fracture or loss of bone. When there is a history of severe injury or an associated convulsive attack, an electroencephalogram should be carried out which must be normal. Presence of burr holes will be cause for rejection for flying duties, but not for ground duties. Each case is to be judged on individual merits. Opinion of neurosurgeon and psychiatrist must be obtained before acceptance.

Family History

1.10.7. History of Psychological Disorders. When a history of nervous break down, mental disease, of suicide of a near relative is obtained, a careful investigation of the personal past history from a psychological point of view is to be obtained. While such a history per se is not a bar to air force duties any evidence of even the slightest psychological instability, in the personal history or present condition, should entail rejection.

1.10.8. Epilepsy. If a family history of epilepsy is admitted an attempt should be made to determine its type. When the condition has occurred in a near (first degree) relative, the candidate may be accepted, if he has no history of associated disturbance of consciousness, neurological deficit or higher mental functions and his electroencephalogram is completely normal.

1.10.9. Emotional Stability. The assessment of emotional stability the must include family and personal history, any indication of emotional liability under stress as evidenced by the occurrence of undue emotionalism as a child or of any previous nervous illness or breakdown. The presence of stammering, tic, nail biting, excessive hyperhydrosis or restlessness during examination could be indicative of emotional instability.

1.10.10. Psychosis. All candidates who are suffering from psychosis are to be rejected. Drug dependence in any form will also be a cause for rejection.

1.10.11. Psychoneurosis. Mentally unstable and neurotic individuals are unfit for commissioning. Juvenile and adult delinquency, history of nervous breakdown or chronic ill health are causes for rejection. Particular attention should be paid to such factors as unhappy childhood, poor family background, truancy, juvenile and adult delinquency, poor employment and social maladjustment records, history of nervous break down or chronic ill-health, particularly if these have interfered with employment in the past.

1.10.12. Organic Nervous Conditions. Any evident neurological deficit should call for rejection.

1.10.13. Tremors. Tremors are rhythmic oscillatory movements of reciprocally innervated muscle groups. Two categories are recognized: normal or physiologic and abnormal or pathologic. Fine tremor is present in all contracting muscle groups, it persists throughout the waking state, the movement is fine between 8 to 13 Hz. Pathologic tremor is coarse, between 4 to 7 Hz and usually affects the distal part of limbs. Gross tremors are generally due to enhanced physiological causes where, at the same frequency, the amplitude of the tremor is grossly enhanced and is elicited by outstretching the arms and fingers which are spread apart. This occurs in cases of excessive fright, anger, anxiety, intense physical exertion, metabolic disturbances including hyperthyroidism, alcohol withdrawal and toxic effects of lithium, smoking (nicotine) and excessive tea, coffee. Other causes of coarse tremor are parkinsonism, cerebellar (intention) tremor, essential (familial) tremor, tremors of neuropathy and postural or action tremors.

1.10.14. Stammering. Candidates with stammering will not be accepted for air force duties. Careful assessment by ENT Specialist, Speech therapist, psychologist/ psychiatrist may be required.

1.10.15. Basal E.E.G. Only those candidates for aircrew duties will be subjected to EEG examination as specified in para 2.9.13. Those with following EEG abnormalities in resting EEG or EEG under provocative techniques will be rejected for aircrew duties: -

(a) Background Activity. Focal, excessive and high amplitude beta activity /hemispherical asymmetry of more than 2.3 Hz/generalized and focal runs of slow waves approaching background activity in amplitude.

(b) Hyperventilation. Paroxysmal spikes and slow waves/spikes/focal spike pattern

(c) Photo Stimulation. Bilaterally synchronous or focal paroxysmal spikes and slow waves persisting in post-photic stimulation period/suppression or driving response over one hemisphere.

1.10.16. Non specific EEG abnormality will be acceptable provided opinion of Neuropsychiatrist / Neurophysician is obtained. The findings of EEG will be entered in AFMSF-2.

CHAPTER 11

 EAR, NOSE AND THROAT

1.11.1. Nose and paranasal sinuses.

(a) Obstruction to free breathing as a result of a marked septal deviation is a cause for rejection. Post correction surgery with residual mild deviation with adequate airway will be acceptable.

(b) Any septal perforation will entail rejection.

(c) Atrophic rhinitis entails rejection.

(d) Cases of allergic rhinitis will entail rejection for flying duties.

(e) Any infection of para-nasal sinuses will be a cause for temporary rejection. Such cases may be accepted following successful treatment.

(f) Multiple polyposis is a cause for rejection.

1.11.2. Oral Cavity and Throat.

(a) Candidates where tonsillectomy is indicated will be temporarily rejected. Such candidates may be accepted after successful surgery.

(b) The presence of a cleft palate is a cause for rejection.

(c) Any disabling condition of the pharynx or larynx including persistent hoarseness of voice will entail rejection.

1.11.3. Eustachian Tube Dysfunction. Obstruction or insufficiency of eustachian tube function will be a cause for rejection. Altitude chamber ear clearance test will be carried out before acceptance for aircrew duties.

1.11.4. Tinnitus. The presence of tinnitus necessitates investigation of its duration, localization, severity and possible causation. Persistent tinnitus is a cause for rejection, as it is liable to become worse through exposure to noise and may be a precursor to Otosclerosis and Meniere’s disease.

1.11.5. Susceptibility to Motion Sickness. Specific enquiry should be made for any susceptibility to motion sickness. An endorsement to this effect should be made in AFMSF-2. Such cases will be fully evaluated and, if found susceptible to motion sickness, they will be rejected for flying duties.

1.11.6. A candidate with a history of dizziness is unsuitable for employment on flying duties.

1.11.7. Hearing loss.

(a) Free field hearing loss is a cause for rejection.

(b) Audiometric loss should not be greater than 20 db, in frequencies between 250 and 4000 Hz. In evaluating the audiogram, the baseline zero of the audiometer and the environmental noise conditions under which the audiogram has been obtained should be taken into consideration. On the recommendation of an ENT Specialist, an isolated unilateral hearing loss up to 30 db may be condoned provided ENT examination is otherwise normal.

1.11.8. Ears. A radical / modified radical mastoidectomy, or a fenestration operation entails rejection even if completely epithelialised and good hearing is preserved. Cases of cortical mastoidectomy in the past with the tympanic membrane intact and presenting no evidence of disease may be accepted.

1.11.9. External Ear. Cases of chronic otitis externa accompanied by exostoses or unduly narrow meatii should be rejected. Exaggerated tortuosity of the canal, obliterating the anterior view of the Tympanic Membrane will be a cause for rejection.

1.11.10. Middle Ear. Tympanoplasty type I is acceptable twelve weeks after surgery, provided ear clearance test in altitude chamber is normal. The following middle ear conditions will entail rejection:-

(a) Attic, central or marginal perforation.

(b) Tympanic membrane scar with marked retraction.

(c) Tympanoplasty type II onward but not type I

(d) Calcareous plaques (tympanosclerosis) if occupying more than 1/3 of pars tensa.

(e) Middle ear infections.

(f) Granulation or polyp.

(g) Stapedectomy/ Stapedolysis operation.

1.11.11. Miscellaneous Ear conditions. The following ear conditions will entails rejection:-

(a) Otosclerosis even if successfully operated.

(b) Meniere’s disease.

(c) Vestibular Dysfunction including nystagmus of vestibular origin.

(d) Bell’s palsy.

CHAPTER 12

 OPHTHALMIC SYSTEM

1.12.1. Visual defects and medical ophthalmic conditions are amongst the major causes of rejection for flying duties. Therefore, a thorough and accurate eye examination is of great importance in selecting flying personnel.

1.12.2. Personal and Family History and External Examination.

(a) Squint and the need for spectacles for other reasons are frequently hereditary and a family history may give valuable information on the degree of deterioration to be anticipated. Candidates, who are wearing spectacles or found to have defective vision, should be properly assessed.

(b) Ptosis interfering with vision or visual field is a cause for rejection till surgical correction remains successful for a period of six months. Candidates with uncontrollable blepharitis, particularly with loss of eyelashes, are generally unsuitable and should be rejected. Severe cases of blepharitis and chronic conjunctivitis should be assessed as temporarily unfit until the response to treatment can be assessed.

(c) Naso-lachrymal occlusion producing epiphora or a mucocele entails rejection, unless surgery produces relief lasting for a minimum of six months.

(d) Uveitis (iritis, cyclitis, and choroiditis) is frequently recurrent, and candidates giving a history of or exhibiting this condition should be carefully assessed. When there is evidence of permanent lesions such candidates should be rejected.

(e) Cornea - corneal scars, opacities will be cause for rejection unless it does not interfere with vision. Such cases should be carefully assessed before acceptance, as many conditions are recurrent.

(f) Cases with Lenticular opacities should be assessed carefully. As a guideline any opacity causing visual deterioration, or is in the visual axis or is present in an area of 7 mm around the pupil, which may cause glare phenomena, should not be considered fit. The propensity of the opacities not to increase in number or size should also be a consideration when deciding fitness.

(g) Visual disturbances associated with headaches of a migrainous type are not a strictly ocular problem, and should be assessed in accordance with para 3.10.3 and 3.10.4. Presence of diplopia or detection of nystagmus requires proper examination, as they can be due to physiological reasons.

(h) Night blindness are largely congenital but certain diseases of the eye exhibit night blindness as an early symptom and hence, proper investigations are necessary before final assessment. As tests for night blindness are not routinely performed, a certificate to the effect that the individual does not suffer from night blindness will be obtained in every case. Certificate should be as per Appendix “A” to this chapter.

(j) Restriction of movements of the eyeball in any direction and undue depression/ prominence of the eyeball requires proper assessment.

1.12.3. Visual Acuity/Colour Vision. The visual acuity and colour vision requirements are detailed in Appendix B to this chapter. Those who do not meet these requirements are to be rejected.

1.12.4. Myopia. If there is a strong family history of Myopia, particularly if it is established that the visual defect is recent, if physical growth is still expected, or if the fundus appearance is suggestive of progressive myopia, even if the visual acuity is within the limit prescribed, the candidate should be declared unfit.

1.12.5. Ophthalmic Surgeries. Radial Keratotomy, Photo Refractive Keratotomy / Laser in Situ Keratomileusis (PRK/LASIK) surgeries for correction of refractive errors are not permitted for any air force duties. Corneal Topography may be done in suspected cases. Candidates having undergone cataract surgery with or without IOL implants will also be declared unfit.

Ocular Muscle Balance

1.12.6. Individuals with manifest squint are not acceptable for commissioning.

1.12.7. The assessment of latent squint or heterophoria in the case of aircrew will be mainly based on the assessment of the fusion capacity. A strong fusion sense ensures the maintenance of binocular vision in the face of stress and fatigue. Hence, it is the main criterion for acceptability.

(a) Convergence

(i) Objective Convergence. Average is from 6.5 to 8 cm. It is poor at 10 cm and above.

(ii) Subjective Convergence (SC). This indicates the end point of binocular vision under the stress of convergence. If the subjective convergence is more than 10 cm beyond the limit of objective convergence, the fusion capacity is poor. This is specially so when the objective convergence is 10 cm and above.

(b) Accommodation. In the case of myopes accommodation should be assessed with correcting glasses in position. The acceptable values for accommodation in various age groups are given in Table 1.

Table 1. Accommodation Values - Age wise.

Age in years              17-20  21-25     26-30    31-35   36-40       41-45

Accommodation        10-11  11-12  12.5-13.5 14-16   16-18.5   18.5-27

in cm.

1.12.8. Ocular muscle balance is dynamic and varies with concentration, anxiety, fatigue, hypoxia, drugs and alcohol. The above tests should be considered together for the final assessment. For example, cases just beyond the maximum limits of the Maddox Rod test, but who show a good binocular response, a good objective convergence with little difference from subjective convergence, and full and rapid recovery on the cover tests may be accepted. On the other hand, cases well within Maddox Rod test limits, but who show little or no fusion capacity, incomplete or no recovery on the cover tests, and poor subjective convergence should be rejected. Standards for assessment of Ocular Muscle Balance are detailed in Appendix C to this chapter.

1.12.9. Any clinical findings in the media (Cornea, Lens, Vitreous) or fundus, which is of pathological nature and likely to progress will be a cause for rejection. This examination will be done by slit lamp and ophthalmoscopy under mydriasis.

Appendix A

(Refers to para 1.12.2(h)

CERTIFICATE REGARDING NIGHT BLINDNESS

Name with initials_______________________________________

Batch No. ____________________ Chest No ______________]

I hereby certify that to the best of my knowledge, there has not been any case of

night blindness in our family, and I do not suffer from it.

Date. ……………………………….                               (Signature of the candidate)

Countersigned by

(Name of Medical Officer)

Appendix B

(Refers to Para 1.12.3)

VISUAL STANDARDS

OFFICERS, CADETS AND AIRMEN AIRCREW AT INITIAL ENTRY

Note 1. Ocular muscle balance for personnel covered in Sl. Nos. 1 and 2 should conform to Appendix C to this Chapter.

Note 2. Visual standards of Air Wing Cadets at NDA and Flt Cdts of F (P) at AFA should conform to A1G1 F (P) standard (S1. No. 1 of Appendix B)

Note 3. The Sph correction factors mentioned above will be inclusive of the specified astigmatic correction factor.
 

Appendix C

(Refers to para 1.12.8)

STANDARD OF OCULAR MUSCLE BALANCE FOR FLYING DUTIES

CHAPTER 13

HAEMOPOIETIC SYSTEM

1.13.1. All candidates will be examined for clinical evidence of pallor (anaemia), malnutrition, icterus, peripheral lymphadenopathy, purpura, petechae/ecchymoses and hepatosplenomegaly.

1.13.2. In the event of laboratory confirmation of anaemia (<13g/dl in males and <11.5g/dl in females), further evaluation to ascertain type of anaemia and aetiology has to be carried out. This should include a complete haemogram (to include the PCV MCV, MCH, MCHC, TRBC, TWBC, DLC, Platelet count, reticulocyte count & ESR) and a peripheral blood smear. All the other tests to establish the aetiology will be carried out, as required. Ultrasonography of abdomen for gallstones, upper GI Endoscopy/ proctoscopy and hemoglobin electrophoresis etc may be done, as indicated, and the fitness of the candidate, decided on the merit of each case.

1.13.3. Candidates with mild microcytic hypochromic (Iron deficiency anaemia) or dimorphic anaemia (Hb < 10.5 g/dl in females and < 11.5g/dl in males), in the first instance, may be made temporarily unfit for a period of 04 to 06 weeks followed by review thereafter. These candidates can be accepted, if the complete haemogram and PCV, peripheral smear results are within the normal range.  Candidates with macrocytic / megaloblastic anaemia will be assessed unfit.

1.13.4. All candidates with evidence of hereditary haemolytic anaemias (due to red cell membrane defect or due to red cell enzyme deficiencies) and haemoglobinopathies (Sickle cell disease, Beta Thalassaemia: Major, Intermedia, Minor, Trait and Alpha Thalassaemia etc) are to be considered unfit for service.

1.13.5. In the presence of history of haemorrhage into the skin like ecchymosis / petechiae, epistaxis, bleeding from gums and alimentary tract, persistent bleeding after minor trauma or lacerations / tooth extraction or menorrhagia in females and any family history of haemophilia or other bleeding disorders a full evaluation will be carried out. These cases will not be acceptable for entry to service. All candidates with clinical evidence of purpura or evidence of thrombocytopenia are to be considered unfit for service. Cases of Purpura Simplex (simple easy bruising), a benign disorder seen in otherwise healthy women, may be accepted.

1.13.6. Candidates with history of haemophilia, von Willebrand’s disease, on evaluation, are to be declared unfit for service at entry level.

1.13.7. Human Immuno Deficiency Virus (HIV). Seropositive HIV status will entail rejection.

CHAPTER 14

ASSESSMENT OF WOMEN CANDIDATES

1.14.1 History. Detailed menstrual and obstetric history, in addition to general medical history, must be taken and recorded as outlined in para 2.13.2. If a history of menstrual, obstetric or pelvic abnormality is given; an opinion of gynaecologist is to be obtained

Examination

1.14.2. General Medical and Surgical Standards

(a) Any lump in the breast will be a cause for rejection. Cases of Fibroadenoma breast after successful surgical removal may be considered fit with the opinion of a surgical specialist.

 (b) Galactorrhoea will be cause for temporary unfitness. Fitness after investigation/treatment may be considered based on merits of the case and opinion of the concerned specialist.

 1.14.3. Gynaecological Disorders

 (a) Any abnormality of external genitalia will be considered on merits of each case. Significant Hirsutism especially with male pattern of hair growth will be a cause for rejection. Doubtful cases if any will be decided based on the opinion of the specialists.

 (b) A detailed pelvic sonography will be conducted. If any abnormality is detected, the candidate will be examined by the concerned specialist. Following conditions will not be a cause for rejection:-

 (i) Small fibroid uterus (3 cm or less in diameter) without symptoms.

 (ii) Small ovarian cyst (3 cm or less in diameter) as such cysts are invariably functional.

 (iii) Congenital elongation of cervix (which comes up to introitus).

 (iv) Congenital uterine anomalies such as bicornuate uterus, uterus didelphys and arcuate uterus.

 (c) Acute or chronic pelvic infection and Endometriosis will be causes for rejection.

(d) Severe menorrhagia will entail rejection, since it is likely to interfere with work ability. Amenorrhoea without pregnancy will be investigated and fitness will be considered on merits after examination and investigation by gynaecologist.

(e) Complete prolapse of uterus will be a cause for rejection. Minor degree, after surgical correction, may be considered for fitness on merits.

(f) Any other gynaecological condition not covered above will be considered on merits of each case by gynecologist.

(g) Pregnancy will be a cause for rejection during commissioning for all branches other than medical and dental, where temporary unfitness will be given till 24 weeks after delivery.