CONFIDENTIAL

AFMSF – 15 (Ver 2006)

MOB -7697903109
MEDICAL BOARD PROCEEDINGS
CATEGORISATION / RECATEGORISATION /SICK LEAVE
PART I
PLACE OF BOARD: INHS KALYANI, VISAKHAPATNAM AUTH: AO 09/2011/DGMS(ARMY)
1. Service No IC-62129W 2. Rank : LT COL 3. Name :SAJITH MD 4. Unit/Ship : 13 A BN NCC,
D No:4-70-3, Bharadwaj,Lawsons
Bay Colony, Visakhapatnam-
530017
5. Service : ARMY 6. Arms/Corps/ 7. Date of Birth : 8. Age : 50 YEARS
Branch/Trade : 08 MAR 1972 Sex : Male
ENGRS HT :171 CM, WT:73 KG BMI-24.96
9. Address on leave if 10. Date of Commission 11. Record Office with 12. Ceased Duty on :
applicable :---NA- 08 JUN 2002 Address: IHQ -NA-
MOD(Army), NEW
DELHI

13. Past Medical History : 14. Medical category prior to Present

Medical Board :
(I) PRIMARY HYPERTENSION
ICD NO: I 10.0 COMPOSITE LMC
(II) GOUTY ARTHRITIS
ICD NO : M10.0 S1H1A1P3(T-24)E1
(III) DYSLIPIDEMIA
WEF 26 OCT 22 Signature of the individual
ICD NO : E-78.0
Date: Apr 2023
(IV) SEIZURE DISORDER
ICD NO: G 40.4
PART II

15. Details of Present and Previous Disabilities:

SI No Disabilities (principal/others) Date /place of origin Previous Medical Category Next Medical
with date categorization
Due

(I) SEIZURE DISORDER ICD AUG 2022 P3(T-24)

NO : G40.4 VISAKHAPATNAM WEF 26 OCT 22

(II) PRIMARY HYPERTENSION AUG 2022 P3(T-24)

ICD NO: I 10.0 VISAKHAPATNAM WEF 26 OCT 22 12 APR 2023

(III) GOUTY ARTHRITIS ICD NO: FEB 22 P2(T-24)

M 10.0 VISAKHAPATNAM WEF 26 OCT 22
(IV) DYSLIPIDEMIA ICD
NO: E-78.0

16. Specialist Opinion : Attach the clinical summary sheet containing a brief history and present condition, after page 2
without any folds. No part of the sheet should protrude out of the form
SPECIALIST OPINION ATTACHED
17. Is the disability attributable to service ? (Y/N) : If so please explain ?
FOR DIS (I),(II),(III),(IV) As per initial Medical Board.

18. If not directly attributable to service, was it aggravated by service (Y/N) If so, please explain
FOR DIS (I),(II),(III),(IV) As per initial Medical Board.

Notes : 1. Injury report (for injury cases)/14 days Charter of duties (for IHD cases)/any othet relevant document required ,
is to be attached and endorsement made in column 17/18.
2. Columns 17-18 should be completed only if they are not completed in initial/earlier board.
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19. Medical category now recommended with duration 20. Date and Place of next recategorization Board :

Disability Profile : P3(PMT) for DIS(I)

P2(PMT) for DIS(II),(III),(IV) APR 2025 FOR DIS (I),(II),(III),(IV)
AT NEAREST MILITARY HOSPITAL
Medical Classification: SHAPE 3Z

20. Percentage of disability (only for permanent LMC)

- Previous Disablement % : NA
- present Disablement % : TO BE DECIDED LATER
- Reasons for Variation if any NA

21. Any specific restriction regarding employment : As per Appx ‘F” to AO 09/2011/DGMS (ARMY)

22. Instructions given to the individual by the President of the board: YOU ARE PLACED IN LOW MEDICAL
CATEGORY P3(PMT) FOR DIS (I) WEF APR 2023 AND P2(PMT) FOR DIS(II), (III), (IV) WEF APR 2023.
INTERVENING PERIOD FROM 12 APR 2023 TO APR 2023. TO BE COUNTED AS PREVIOUS LOW MEDICAL
CATEGORY SUBJECT TO APPROVAL BY HIGHER MEDICAL AUTHORITY.

ADVICE : - AS PER SPECIALIST ADVICE

Date : Signature of the Individual

Place : VISKAHPATNAM

Date : Member member Signature of President

APPROVING AUTHORITY
(Where Applicable)

Place : VISAKHAPATNAM Signature

Date : Rank & Designation

PERUSING AUTHORITY
(Where Applicable)

Place : VISAKHAPATNAM Signature

Date :

Rank & Designation

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 APPENDIX “F”
(Ref to IHQ of MoD(Army) Letter
No.76086/Policy/DGMS-5A dated
18 Jan 22)
COPE CODING OF LOW MEDICAL CLASSIFICATION OFFICERS

1. Pers No : IC- 62129W 2. Rank : LT COL

3. Name : SAJITH MD 4. Unit : 13(A) BN NCC

5. Medical Classification : SHAPE 3X,Disability profile : P3(PMT) FOR DIS(I), P2(PMT) FOR DIS (II),(III),(IV)

6. Diagnosis :
(I) SEIZURE DISORDER ICD NO : G40.4
(II) PRIMARY HYPERTENSION ICD NO : 1 10.0
(III) GOUTY ARTHRITIS ICD NO : M10.0
(IV) DYSLIPIDEMIA ICD NO : E -78.0

COPE Code Employability Restrictions Remarks and

Justification
C 2a Unifit for specific climate on terrain Disability may be
(b) & (c) (a) HAA (9000-15000 feet) and for hilly terrains. aggravate with uneven
(b) Extremes of cold climate, places with subzero terrain and exposure to
temperature for more than 03 month in year. cold.
(c) Unfit for ECC/CI Ops area.
O 2(a) To be under periodic surveillance by basic specialist at Monthly review by AMA
nearest MH/civil hospital where such facilities is available. 03 Monthly follow up in
MOPD
P 2(a) Unfit for extreme exertion and competitive sports, fit for To prevent further
sedentary duty only for desk job due to Generalized Epilepsy. aggravation of disability.
E 2(k) Medical Advice : To prevent further
(a) Avoid handling firearms/ammunitions/driving/ aggravation of
swimming. disability/accident.
(b) Excuse night duty.
(c) Not to be employed with firearms.
(d) To work under supervision.
Place :

Date : Apr 2023 Signature of the Officer

Date Member 2 Member 1 Signature of President

APPROVING AUTHORITY
(Where Applicable)

Place : VISAKHAPATNAM Signature, Rank & Designation

Date :

PERUSING AUTHORITY
(Where Applicable)

Place : VISAKHAPATNAM Signature, Rank & Designation

Date :