ANNEX 4 – PERTINENT PROVISIONS OF THE GENERAL INSTRUCTIONS FOR THE MEDICAL EXAMINATION OF ARMED FORCES CONSCRIPTS
GENERAL INSTRUCTIONS FOR THE HEALTH EVALUATION OF CONSCRIPTS IN THE ARMED FORCES
(Approved by Decree No. 60822 of June 7, 1967 and amendments)
(Text of Decree No. 703 of 1992)
13. Technical instructions for the health evaluation of conscripts, volunteers, and applicants for enrollment in Reserve Training Outfits.
13.1 –General Norms for Health Evaluation by Health Evaluation Panels (JIS)
13.1.1 – The methodology for carrying out the health evaluation of conscripts shall depend on the selection’s objective.
13.1.2 – The health evaluation for the screening selection, both general and supplementary, shall be carried out by the JIS’s pursuant to the following guidelines:
(a) Evaluation for the screening selection: it is done at the same location as enlistment. Its purpose is to release those that are clearly unfit (“Unfit C”), as shown by a summary psychological and physical examination.
It may be done by a civilian medical doctor attached to a federal agency or by a specially contracted medical doctor.
(b) Evaluation for the general and supplementary selection. It is done in the second semester of the year preceding induction or enrollment (Chap. I, (3.2) (3.2). It shall consist in as thorough as possible a physical and psychological examination; complementary tests may be requested for diagnostic clarification;
(c) Evaluation for the general and supplementary selection. It consists in the medical review carried out by the Military Organization’ health service (Chap. I, (3.2) and (3.2) during the period prior to induction or enrollment. It shall include the complementary exams possible, taking into consideration the regional priority and those that are indispensable, pursuant to item 13.4.16 of this Chapter.
This medical review cannot change the JIS decision; it can only opine against induction or enrollment. If a definitive incapacity is detected (“Unfit C”), the evaluation subject shall be directed for further health examination by the Navy’s Regular Health Panels (JRS), the Army’s Garrison Health Evaluation Panels (JISG), or the Air Force’s Health Regular Panels (JRS), according to the pertinent Force, with a view to changing JIS’s decision.
(d) The JISs shall make the effort to arrive at clearly defined diagnostics. Exceptionally, in case of definitive incapacity owing to ill-defined symptoms, lesions, syndromes, and signs, the JISs shall also explain their opinion, indicating the location, the side, and other information deemed necessary to justify said opinion.
13.2 – To pass a judgment on the conscripts’ aptitude or incapacity, the JISs shall observe the prescriptions contained in the following annexes to this IGISC:
I – Health Evaluation of Conscripts or Volunteers for the Reserve Officers Training Outfits;
II – List of Diseases, Lesions, and Morbid Conditions Leading to the Definitive Exemption from Military Service in the Armed Forces of Conscripts and Volunteers Assigned to Reserve Officers Training Outfits;
III – Minimum Indexes of Conscripts’ Aptitude for Military Service services in the Armed Forces; and
IV –Height, Weight, and Thorax Measurements Table.
13.3 – Conscripts and Volunteers should be examined particularly in respect of:
(a) Family antecedents: tuberculosis, cancer, alcoholism, and mental disorders;
(b) Personal antecedents: birth conditions, school life, childhood illnesses, venereal diseases, convulsions, traumatisms, and surgeries.
13.4 – Exams shall follow the following order:
(a) Checking against the “Height, Weight, and Thorax Measurements Table” (Annex IV);
(b) Maximum and minimum thorax measurements shall be taken with a metric tape placed horizontally around the thorax at the height of the nipples during inspiration and expiration, respectively;
(c) Average thorax measurement equals the sum of the maximum and minimum measurements divided by two; and
(d) Great span is the distance between the tips of the middle finger, measured with the arms opened wide.
13.4.2 – Ear examination:
(a) The external ear and the mastoid shall be examined by inspection and palpation. The external auditory meatus and the tympanic membrane shall be examined by reflected light or through the otoscope. Cerumen, if it occurs, should be removed before the examination;
(b) The anomalies of the auditory meatus and the tympanic membrane should be checked for infections, tumors, and acquired or congenital deformities of the external ear;
(c) Hearing acuity shall be determined by the whispering voice test: the subject being tested shall be stationed at 5 (five) meters from the examiner, with the ear to be tested turned to the examiner, and covering the other ear with the hand. The examiner shall pronounce a few words or numbers in a whispering voice. The result shall be expressed by 0 to 5, depending on the distance in meters, at which the words are recognized;
(d) Exceptionally, if indicated and if technically possible, audiometry shall be used;
(e) The results of the whispering voice test or the audiometry shall be checked against the indexes shown in Annexes I, II, or III, as the case may be.
13.4.3 – Eye examination:
(a) The eye examination shall consist in the verification, through inspection of alterations, such as ocular asymmetry (position, size, color, rima palpebrarum) potosis palpebrarum, pterygium, strabismus, signs of infection, ulceration, tumors, cysts, opacities, degeneration, traumatism or burn sequelae, congenital defects, nystagmus, entropion, ectropion, tearing alterations, pupil reflexes, etc., as well as checking of the intra-ocular pressure by palpation;
(b) For the sake of language uniformity and to facilitate judgment, the Snellen or Decimal scales shall be used for evaluating visual acuity from afar and the Jaeguer scale for evaluating visual acuity from near;
(c) Color vision shall be determined through the use of pseudo-isochromatic plates. Results shall be checked against the indexes shown in Annexes I, II, and III.
13.4.4 – Nose, larynx, and pharynx examination:
Checking for congenital deformities, tumors, sequelae from traumatism or chemical agents, infections, functional breathing, phonation, and deglutition deficiencies, fistulae, tonsillae hypertrophy, etc.
13.4.5 – Teeth and mouth examination:
Note shall be taken mainly of congenital deformities, functional mastication deficiencies, oral hygiene, cavities, infections, malocclusion, tumors, restorations, unsatisfactory prosthesis, etc.
13.4.6 – Head and neck examination:
Checking for anomalies, malformations, loss of substance, fistulae, atrophies, abnormal movements, cysts, tumors, scars, lymph node hypertrophy, goiter, etc.
13.4.7 – Respiratory apparatus examination:
(a) The thorax shall be examined by the semiological methods possible;
(b) Intradermal reaction for BK (PPD) is obligatory in the complementary selection; radiological exams (abreugraphy or teleradiography) are admitted in doubtful cases. Only insignificant radiological alterations free of functional repercussions, definitely without evolving morbid potential shall be tolerated;
(c) Checking for thoracic anomalies, traumatism sequellae, congenital or acquired defects. Checking also for the occurrence of dyspnea and other signs of respiratory insufficiency, infections, bronchial asthma, etc.
13.4.8 – Examination of the circulatory apparatus:
(a) Shall consist of cardiac auscultation, recording the number of pulsations, simple effort test if necessary, and obligatory checking of the arterial pressure in all phases of the medical screening;
(b) Investigation, in particular, of the occurrence of congenital or acquired cardiopathies. Heart murmurs should be carefully evaluated;
(c) Importance shall also be given to rhythm disturbances, alterations in the cardiac area, symptomatic arterial hypotension, arterial hypertension, and peripheral vascular diseases;
(d) For the examination of the circulatory apparatus, clinical history is very important;
(e) In regions where the Chagas disease is endemic, specific serologic test shall be done, pursuant to 13.3.16.
13.4.9 – Examination of the digestion apparatus:
(a) Checking for wall anomalies (hernias, fistulae, tumors, scars) through inspection and palpation. Megaviscera, prolapse, hemorrhoids, anal fissures, etc. should be investigated;
(b) Clinical history is important in this phase, particularly in respect of surgeries, infections, functional disturbances, hospitalizations, etc.
13.4.10 – Examination of the genitourinary tract:
(a) Checking for anomalies, defects, and malformations of the external genitalia, such as, anorchidism, hypospadias, phimosis, etc;
Checking for tumors, infections, fistulae, sexually transmissible disease, cryptorchidism, varicocele, and other disturbances that are demonstrable by urinalysis, if applicable, or through anamnesis.
(b) Genitourinary diseases should be thoroughly investigated, owing to their high frequency in this age bracket.
13.4.11 – Examination of the skin and subcutaneous cellular tissue:
(a) It shall be done with the naked patient standing in front of the examiner, and showing him the front, back, and sides of the body, successively;
(b) Checking particularly for infections, ulcerations, tumors, scars that may hinder the wearing of military uniform and equipment, lesions consistent with Hansen’s disease (pain sensitivity to a pin prick test), vascular moles, edemas, mycoses, eczemas, tattoos, etc.
13.4.12 – Examination of the bones, muscles, and ligaments:
(a) The normality of these systems is fundamental for good performance of military activities. Accordingly, examination in this stage must be absolutely strict;
(b) Full mobility of joints must be checked;
(c) Checking for traumatic, degenerative, or inflammatory lesions, deformities, old fractures, luxations, amputations, edemas, handicaps, gait alterations, etc;
(d) The following exams are obligatory, owing to the frequent pathological findings in practice:
184.108.40.206 – Feet examination:
(a) Checking for deformities or any alterations in the normal structure of the feet, such as missing toes, hyperdactilism, syndactilism, anomalies of the pelmatic arch, etc;
(b) Initially, false flatfoot of adults who habitually go barefoot should not be considered as pathologic, as the flat aspect is caused by the development of the soft parts. What is important is to determine whether the feet preserve their aesthetics and if the muscles, ligaments, and tendons are dynamically preserved, indicating the candidate’s aptitude.
220.127.116.11 – Examination of the axis of the lower limbs:
Varus deviation that does not compromise a martial attitude is not incapacitating.
18.104.22.168 – Examination of the knees:
Checking of ligament lesions, the occurrence of painful points at meniscus movement, blockage, and hydrarthrosis.
22.214.171.124 – Examination of the lower limbs’ length:
When there is a difference in the length of the lower limbs, the shoulder on the side of the shorter limb is lower than the other, and pelvis basculation and scoliosis occur.
126.96.36.199. – Examination o f the upper limbs:
(a) Checking for deformities or any other structural alterations in the hands; the subject must flex and extend his fingers, holding an object first with the thumb and index finger and then with the entire hand;
(b) Checking also for recidivistic shoulder luxation, winged scapula, elbow deformities, and alterations in the mobility of the shoulders, elbows, and wrists.
188.8.131.52 – Examination of the vertebral column:
(a) Checking for scoliosis, kyphoscoliosis, kyphosis, hyperlordosis, and other deformities, such as hemivertebra, spondylolysis, spondylolisthesis, etc;
(b) It should be recalled that postural and physiological scolioses or light curvature, attributable to greater use of an upper member, are not incapacitating.
3.4.13 – Neurological examination:
(a) Checking for abnormal gait, associated movements, lateral deviations, occurrence of involuntary movements, etc., as the examinee walks a certain distance on a straight line, first with open, then with closed eyes;
(b) Checking for restlessness, arms deviations, tremors, involuntary movements, etc, as the examinee stands upright, with feet together and arms extended forward;
(c) Checking for hypoplasia, hypertrophies, muscle asthenia, etc, pupil diameter and reflexes, strabismus, nystagmus, ptosis palpebrarum, and eye, tongue, and facial movements;
(d) Checking for sensitivity (digital pinching, pointed instrument, etc.), on various points: forehead, face, wrist, knee, ankle, etc., as well as all osteotendinous reflexes.
13.4.14 – Psychiatric examination:
(a) During the anamnesis and the physical examination, experts should gather information on which to base their evaluation of the examinee’s mental and psychic condition, such as speed of comprehension, memory, reasoning, affectivity, will, behavior, etc.;
(b) Checking for tachycardia, cardiac erethism, palmar sudoresis, excessive paleness or redness, and other signs of heightened emotivity;
(c) It should be noted that speech impediment is incapacitating, if it is incompatible with military functions;
(d) Checking of the examinee’s social background: family set-up, original background, school performance and adaptation and symptoms suggesting the use of drugs liable to cause physical or psychic dependence, whose occurrence should be entered into the Selection Form.
13.4.15 – Examination of the endocrinous system:
(a) Ectoscopy and anamnesis are important; checking for nutritional deficiencies, alterations in physical development, as signs of the most frequent pathologies liable to affect this system;
(b) Particularly important are manifestations of hidden or evident disendocrinism.
13.4.16 – Complementary exams:
133.16.1 - Requesting of complementary exams shall depend on: the phase and type of selection, clinical indication, and local availability.
184.108.40.206 – At inspections for screening, general, and supplementary selection, such exams are optional.
220.127.116.11 – At inspection for complementary selection, the following exams are mandatory:
(a) Intradermal reaction to test sensitivity to BK (PPD), done at a Military Health Organization or Public Health clinic;
(b) The same complementary exams required for active list personnel and for the inspection of conscripts assigned to special troops or for the performance of particular activities, according to the regulations of each Force (for example, parachutist, diver, air or jungle activities, etc.).
(c) The complementary exams that, owing to clinical or epidemiological indications, are mandatory for arriving at an opinion, such as routine urinalysis (suspicion of nephropathy); parasitological stool and/or specific serologic test (in zones where schitosomiasis and/or Chagas disease are endemic), etc.
18.104.22.168 – Observation: at a complementary selection, whenever possible, whether with own resources or under agreements of mutual interest with hemotherapy services, complete hematological screening should be done: hemoanalysis, serologic tests for Lues, Chagas disease, viral hepatitis, HIV/AIDS, etc.
14.1 – Diagnosed diseases, affections, syndromes, lesions, morbid disturbances, or physical defects should be entered with greater clarity and written in full, preceded by the corresponding numbers of the international disease classification in force.
14.1.1 - If no disease or physical defect is detected or if detected but deemed to be insignificant for the evaluation, instead of the diagnostic, the expression Absence of Anomalies at the Clinical Examination should be entered.
14.1.2 – If a physical defect or disease compatible with the Military Service is detected, it should be mentioned in the diagnostic, with the addition of the expression Compatible with Military Service.
14.3 – In case of detection of a disease that causes definitive incapacity for the Military Service, the incapacitating disease should be on the “List of diseases, lesions, and morbid conditions justifying the Definitive Exemption of Conscripts and Volunteers for Military Service in the Armed Forces, including those assigned to the Reserve Officer Training Outfits” (Annex I). The disease’s corresponding classification number shall be entered by the medical examiner into the Diagnostic column of Book of Health Inspection Records, followed by the diagnostic written in full, as for example: 030.0 – Virchow’s morphea).
14.1.4 – On the copies of the health examination records or equivalent documents, the classification number but not the diagnostic written in full shall be entered, except for copies meant to form part of proceedings or for judiciary or disciplinary purposes, in which case the full diagnostic should be entered, without the classification number. In the latter case, the document shall be marked as Confidential. The diagnostics written in full on copies of the records shall not be published in the Daily or in the Internal Bulletin or other publicity documents.
15. – Opinions
15.1 – Panel opinions or findings shall be expressed as follows:
(a) Fit A – if the examinees meet regulation requirements, being in vigorous physical condition. Hey may present small lesions, physical defects or diseases, provided these are compatible with the Military Service;
(b) Unfit B-1 – if examinees are temporarily incapacitated by diseases, lesions, or physical defects from which they can recover in a short period of time. For the purposes of the Military Service, this period may be of up to 1(one) year;
(c) Unfit B-2 – if the examinees are temporarily incapacitated by diseases, lesions, or physical defects from which they can recover after a long period and/or which advise against their induction or enrollment. For the purposes of the Military Service, this period may exceed 1 (one) year;
(d) Unfit C – if examinees are found to be definitively incapacitated (irrecoverable) by diseases, lesions, or physical defects deemed incurable or incompatible with the Military Service.
15.2 – Observation: the findings of temporary or definitive physical incapacity refer solely to the requirements for the rendering of Military Service and have no implication as to the subjects’ aptitude or incapacity for the exercise of civilian activities.
16. – Observations:
16.1 – Into the Observations column of the Book of Health Inspection Records the following information shall be entered: 1st or 2nd inspection, 1st or 2nd period, the purpose of the inspection (induction or enrollment), and the exceptional inspection done by a single medical doctor, as the case may be (“2nd period” corresponds to “Supplementary Selection”).
ANNEX 5 – Relevant provisions of the Military Penal Code
MILITARY PENAL CODE
Decree-law No. 1002 of October 21, 1969 as amended)
Art. 22 – For the purposes of enforcement of this Code, any person that, in times of peace or in war time, inducted into the Armed Forces to serve in them at a post or rank, or subject to military discipline, shall be considered a military.
Art. 50 – A minor under the age of 18 years shall not be legally liable, unless he has attained the age of 16 years, demonstrates sufficient psychic development to understand the illicit nature of the fact and to act accordingly. In such a case, the applicable penalty shall be reduced by one third down to a half.
Art.51 – Although they may not have yet attained the age of 18 years, those who fit the following categories are deemed to have attained it, namely:
(a) The military;
(b) Those called, who report for induction, or who, having been temporarily dispensed, fail to report themselves at the expiration of their leave; and
(c) The students at schools or other educational institutions under military management and discipline, who have attained the age of 17 years.
Art. 187 – If a military absents himself for more than eight days, without permission, from the unit in which he serves, or from the location where he should stay:
Penalty – Detention for six months to two years; if an officer, the penalty shall be aggravated.
Art. 188 – The same penalty shall apply to a military that:
I – Fails to report at the designated location within eight days from the expiration of his transit or vacation period;
II – Fails to report himself to the competent authority within eight days from the date of expiration or cancellation of his leave or nonduty status, or of a state of siege or war declaration;
III – Fails to report himself within eight days from having served his sentence;
IV – Obtains his exclusion from active service or nonduty status by effecting or simulating incapacity.
Art. 189 – In the case of crimes under Arts. 187 and 188, I, II, and III:
Especially mitigating circumstance
I –If the agent voluntarily reports himself within eight days after the crime has been committed, the penalty shall be reduced by half; it shall be reduced by one third, if he reports himself after more than eight days, but within sixty days.
Especially aggravating circumstance
II – If desertion occurs in a unit stationed on the border with a foreign country, the penalty is aggravated by one third.
Art. 190 – When a military fails to report himself at the time of a ship’s or an aircraft’s departure, or of a unit’s or force’s deployment.
Penalty – Detention for up to three months if, after the departure or deployment, he reports himself within twenty-four hours to the military authority of the place or, in its absence, to the police authority, so that his reporting will be communicated to the competent military command.
Paragraph 1 – If he reports himself within a period of more than twenty-four hours but not in excess of five days:
Penalty – Detention for two to eight months.
Paragraph 2 – If within a period of five days but not in excess of eight days:
Penalty – Detention for three months to on year.
Paragraph 3 – If over eight days:
Penalty – The penalty shall be increased by one third, in the case of a sergeant, second lieutenant, or warrant officer, and by one half, in the case of an officer.
Art. 191. In the case of plotting desertion from the military:
I – If desertion is not consummated:
Penalty – Detention for three months to one year.
II – If desertion is consummated:
Penalty – Confinement for two to four years.
Desertion by evasion or flight
Art. 192. When a military evades from under an escort, or from the detention premises or prison, or flees after committing a crime so as to avoid arrest, and remains a fugitive for more than eight days:
Penalty – Detention for six months to two years.
Abetting a deserter
Art. 193. Harboring a deserter or hiring him or providing him with or facilitating transportation for him or a means of hiding, having grounds to know that he has committed one of the crimes referred to under this Chapter:
Penalty – Detention for four months to one year.