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On April 6, 2018, the Draft Decision of the RA Government “On Approving the Procedures for Health Check-ups of Citizens, Medical Expertise and Examination as well as Referral for Examination, the Bodies Conducting Medical Examination and the Procedure Governing their Activity, the Forms for Examination Conclusions, the Lists of Medical Examinations and Medical Institutions and the Procedure for Remuneration for Services Performed and on Declaring Several Decisions of the RA Government Void” and the Draft Decision of the RA Government “On Establishing the List of Diseases Determining the Degree of Citizens’ or Servicemen’s Fitness for Military Service as well as the Conditions of Military Service Contraindicated to Citizens’ or Servicemen’s State of Health” were put for public discussion on the joint website for the official publication of the draft legislative acts of the RA Ministry of Justice until April 21.

However, those draft decisions were adopted on April 12, prior to the deadline, and, according to the RA Ministry of Defense, the urgency of their submission by the RA MoD to the RA Government Staff and their subsequent adoption at the RA Government session of 12.04.2018 were conditioned by the need to properly organize and implement the works of the 2018 summer call-up.

The existing issues in the list (the list was approved under Decision 404-N of the RA Government) of diseases determining the degree of citizens’ or servicemen’s fitness for military service are the center of HCA Vanadzor’s attention. Therefore, we conducted a professional analysis on the basis of the international legislative regulations in order to submit that analysis by April 21. Yet, it was impossible to do so due to the decision being adopted before the deadline. Nevertheless, the suggestions developed as a result of the professional analysis were submitted to relevant bodies following the adoption of the decision.

Later, in its correspondence dated July 2, 2018, the RA Ministry of Defense informed that the analysis of HCA Vanadzor in connection with the list of diseases established by the decision was taken into account, and the process connected with it will be carried out until the 2018 winter call-up.

The following issues were identified as a result of the professional analysis of HCA Vanadzor:

1. In the case of the majority of the diseases, the definitions do not correspond to the 10th Revision of the International Classification of Diseases (ICD-10), which was approved in the Republic of Armenia in 2005;
2. In the case of some diseases, especially surgical diseases, the procedure for refusal of treatment has been established. Yet, the further procedure for examination in the case of refusal of treatment has not been established;
3. In some case, negative, humiliating terms, terms of sympathy (e.g. suffering) and other terms, which should be ruled out;
4. In the case of intellectual disability, when determining fitness, the extent of the gravity of impairment of behavior is assessed; however, the factors and indicators to be taken into consideration when assessing the extent of the gravity have not been clearly established;
5. In the case of many diseases, namely “organic psychiatric disorders” and “acute and transient psychotic disorders” (including paranoid reaction, psychogenic paranoid psychosis, reactive psychosis, oneirophrenia, delusional outbreaks, etc.), the indicated expressions “prolonged”, “short-term” and other expressions establishing timeframes, the expressions envisaged for treating diseases, namely “with a prolonged course”, “requiring long treatment”, “with a short course”, are not clearly established. It is difficult to assess the time period through those expressions. It is beyond understanding how many days, weeks or months these expressions refer to. That is, the terms denoting time have not been clearly established;
6. In the case of some diseases, namely “vascular diseases of the brain and the spinal cord”, there are no objective indicators of defining the disease or derangement;
7. In the article on “the diseases and developmental defects of the organs in the abdominal cavity”, changes have been made in determining fitness. According to the article, the amount of indirect bilirubin reached 30 μmol/l from 25 μmol/l; however, the need for this change is not understandable. Apart from this, Gilbert’s syndrome is no longer included in the list;
8. In the case of some diseases, namely “diseases and developmental defects of the organs in the abdominal cavity”, “systemic connective tissue diseases, including joints and muscle diseases, infectious tendon diseases, infectious and allergic diseases and dystrophic diseases”, “chronic inborn defects of bones, cartilages, tendons and joints, injuries, their consequences and chronic diseases” and other diseases, the degrees of functional impairments have not been established;
9. The need to reduce the weight threshold is not grounded and clarified. The relevant changes, for instance, “physical norm”, “the skeletal system corresponds to the biological one” and other terms, are not clarified;
10. In the case of the disease “condition experienced after acute infectious and parasitic diseases and intoxications”, the term “without functional impairments” is not clearly established. Besides, in this case, it is necessary to view the person who has HBS-antigen as the source of spreading the infection. The concept “a healthy carrier” is not used anymore due to the chronic HBV infection, since, even in the case of absence of clinical symptoms, the risk of hepatocellular carcinoma increases. Besides, reactivation of HBV replication can be viewed as accidental or iatrogenic or as a result of chemotherapy courses or immunosuppression.

Source: https://www.medscape.com/viewarticle/702587. The clinical standards are not established either;

1. In the case of chronic infectious diseases, it is necessary to clarify the list of diseases in accordance with ICD-10. For instance, dysbacteriosis is indicated in the list as a separate disease even though it is viewed as a deviation in the intestinal microflora. As a result, the information remains incomplete following the diagnosis. Besides, it is necessary to clarify the term “other diseases”, regulating and defining the determination of fitness after treatment;
2. It is necessary to clarify and regulate the procedure for individual determination of fitness, taking into consideration the fact that chronic carriers of bacteria are the main sources of the abdominal typhus infection. The fecal-oral rout of infection is typical of abdominal typhus and paratyphus. The transmission occurs through water, food and everyday contact;
3. In the case of “endocrine system diseases and metabolic diseases”, with respect to the goiter, the hormone level should be determined. To clarify the concepts “considerably increased”, “different visceral changes”, “raise in the average level”, clearly define the measurements of diseases of other endocrine glands, to clarify the term “degree of functional disorder”
4. In the case of “blood system diseases (anemia, agranulocytosis, hemoblastoses, haemosarcoma, lymphogranulomatosis, hemorrhagic diatheses and so forth)”, it is necessary to clarify the term “dependent on the clinical course”. In the case of lymphadenopathies, it is necessary to define the further steps in the case of rejecting and not rejecting the aforementioned diseases;
5. In the case of “toe defects”, changes have been made which are not understandable and should be substantiated;
6. It is necessary to define time-limits conditioned by planned surgery instructions;
7. In the case of “a persistent disorder of the barofunction of the nose and paranasal sinuses”, the scale of the results of measuring pressure is not defined;
8. In the case of “speech defects and sound formation disorders”, it is necessary to make consultation with a speech therapist a compulsory part of the examination;
9. In the case of “tooth, periodontal and oral mucosa diseases”, before, it was defined that the diagnosis of parodontitis is established through a detailed X-ray examination of the entire dentoalveolar system and through the identification of accompanying diseases; however, this requirement has now been removed, which is not understandable;
10. In the case of the article of “severe ulcerative blepharites that frequently become acute as well as chronic conjunctivitis with hypertrophy of foliate papillae and infiltration of the submucosa of a tissue”, the characteristics “treatable” and “untreatable” are general and do not fully describe the disease. Apart from that, there is a lack of measures of treatment effectiveness.
11. When carrying out an examination under Point D of the Article on “chronic skin diseases that are difficult to treat or are not treated”, it is necessary to clearly define the measurement options of the measures that are taken into account.

Thus, Decision N 404 of the RA Government “On Establishing the List of Diseases Determining the Degree of Citizens’ or Servicemen’s Fitness for Military Service as well as the Conditions of Military Service Contraindicated to Citizens’ or Servicemen’s State of Health” needs to be reviewed.