The army and mitral valve prolapse (MVP): are they allowed to serve with such a pathology?

Tsuprekov Artem Head of the human rights department of the Assistance Service for Conscripts in St. Petersburg

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Is it necessary to serve in the army with a diagnosis of mitral valve prolapse? There is no clear answer to this question. Different stages of this disease give different eligibility categories. In this article I will tell you in what cases people are drafted into the army with prolapse and what nuances the lawyers of the Conscript Assistance Service advise you to pay attention to in order to receive a military ID.

Prolapse is an abnormal location of an organ, its prolapse or protrusion through natural openings. All four valves are affected by cardiac abnormalities: tricuspid, aortic, pulmonary and mitral. Pathologies of the first three valves are rarely detected - more often cardiologists encounter the fourth case. Therefore, in this article I will tell you in more detail how compatible mitral valve prolapse and military service are.

What is grade 1 mitral valve prolapse?

MVP is a heart defect or disease associated with dysfunction of the valve located between the ventricle and the left atrium. During normal functioning of the heart, when the atrium contracts, the valve is open, blood flows into the aorta. With connective tissue pathologies, the heart muscle changes and the structure of the mitral valve is disrupted. This leads to bowing of the valves into the left atrium. When the ventricle contracts, blood flows back into the atrium, disrupting the normal functioning of the organ.

The severity and complexity of the pathology is judged by the amount of reverse blood flow. With a slight return, the disease proceeds without clinical manifestations and does not cause deterioration in well-being. The condition does not require special treatment, but requires some restrictions in lifestyle. In cases where the amount of reverse blood flow is large, surgical intervention is required to correct the defect.

With MVP of the first or mild degree, a person feels well, no special treatment is required, and symptoms do not appear. The defect is discovered by chance during auscultation or echocardiography. No drug therapy is required.

In general, symptoms of mitral valve prolapse include:

• pain in the heart area;
• vegetative manifestations;
• increased heart rate, interruptions in heart function;
• causeless slight increase in temperature;
• fainting, presyncope;
• dizziness;
• hyperventilation syndrome;
• increased fatigue;
• feeling of incomplete inspiration;
• dyspnea.

In 40% of patients, there are no symptoms, the clinical picture is blurred, and the disease does not manifest itself in any way.

Features of the disease

Prolapse is a phenomenon with an uncharacteristic location of an organ or its protrusion through natural openings. The lesion can affect all 4 heart valves: aortic, tricuspid, pulmonary, mitral. Most cases occur in the last valve.

Under normal conditions, the left atrium ejects blood by compressing this area, at which point the valve flaps open and blood is transported through them into the left ventricle. After which the valves close, and the blood moves further due to the contraction of the ventricles.

Mitral valve prolapse (MVP) alters normal functioning. With this diagnosis, during compression of the ventricles, blood partially returns to the atrium due to the fact that deflection (prolapse) prevents the valves from completely closing.

A backflow of blood occurs (med. - regurgitation), which can provoke mitral insufficiency. The severity of regurgitation depends on the amount of reverse blood flow.

The first stages are asymptomatic, and people do not even suspect the presence of the disease. It is identified by cardiologists, who do not consider the primary stages to be life-threatening or dangerous for military service. The exact causes of the pathology have not been identified, but doctors focus on genetic predisposition.

Some recruits experience tricuspid regurgitation (of the tricuspid valve). A similar process of blood outflow occurs, but on the right side. It is considered more harmless compared to the first case, but in the “Schedule of Diseases” they are described equally and are in the same group that determines the fitness category.

What is mitral valve insufficiency

Mitral regurgitation is an acquired heart defect with dysfunction of the mitral valve. As a result of the pathology, each time the ventricle contracts, blood flows back into the atrium. Isolated disease is rare. Often mitral insufficiency is combined with stenosis and aortic heart disease. The clinical picture for acute and chronic forms is different. During the calm period, the disease does not manifest itself in any way. Pathology is diagnosed by listening to a heart murmur. Confirmed by cardiogram. Changes in the valve leaflets and a decrease in the size of the opening are determined by echocardiography.

Mild mitral valve insufficiency does not manifest itself clinically and does not require special treatment, but changes in lifestyle are required. In severe forms of the pathology, surgical intervention and valve replacement are required.

When assessing heart failure, functional class (FC) is taken into account.

• I – heart disease does not require changes in physical activity. Normal exercise does not cause shortness of breath, rapid heartbeat, or weakness.
• II – symptoms appear during normal physical activity, but disappear at rest.
• III – shortness of breath, disturbance of heartbeat rhythms is observed with little physical activity.
• IV – symptoms are disturbing at rest.

People with mitral valve prolapse are drafted into the army if the disease is accompanied by FC I heart failure.

Features of passing a military medical examination

Each conscript becomes the object of close attention from members of the military medical commission, but young men who have been diagnosed with MVP deserve special attention. There are situations when this disease is detected during the process of passing a conscription medical examination, and this is not at all a matter of the competence of “civilian” doctors, it’s just that the organs of adolescents, including the heart, tend to change, and not always for the better.

If, while listening to the heart for murmurs, doctors suspect something is wrong, the patient is referred for an ultrasound. This diagnostic method allows not only to identify the disease, but also its degree. Doctors who are members of the military medical commission are always guided by a special document - the “Schedule of Diseases”, namely Article 42.

To determine the fitness category, specialists evaluate cardiac rhythm and conduction disorders, and also determine the functional class of heart failure, of which there are only four:

• The easiest. Existing heart disease does not affect your lifestyle in any way. That is, during normal exercise the patient does not experience weakness or shortness of breath.
• With moderate physical activity, symptoms appear, but at rest they disappear.
• Even slight physical activity provokes shortness of breath, rapid heartbeat and other symptoms.
• A person is bothered by shortness of breath, even if he is at rest.

What is mitral valve stenosis

Narrowing of the left atrioventicular orifice. Acquired heart defect. The pathology is characterized by narrowing of the atrioventricular orifice. Leads to disruption of blood flow from the atrium to the ventricle. Mitral valve stenosis can be isolated or combined with other heart pathologies, damage to other valves, or mitral valve insufficiency.

Experts cite previous rheumatism (80% of cases) and infectious diseases (20%) as the causes of stenosis. As a result of the pathology, the flow of arterial blood is disrupted and it is released back into the atrium. With stenosis, the valve leaflets thicken, the blood does not have time to be pumped out, and the pressure in the atrium increases. Shortness of breath appears during physical activity. The progression of the disease causes difficulty breathing at rest, dizziness, weakness, pale skin, etc.

What is taken into account during the examination

Members of the IHC, when assigning a fitness category, are guided by three main criteria:

• severity of deviations in heart rhythm;
• the presence of a condition that differs from the norms of blood conductivity;
• diagnosed heart failure.

The last factor is quite significant. Experts focus on the gradation of functional classes:

• FC I – the conscript’s condition does not require restrictions on physical activity, since signs of deviations are not present at its usual level;
• FC II - increased heart rate, weakness and shortness of breath occur during standard exercise, but are no longer present at rest;
• FC III – symptoms are provoked by even a weak level of physical activity;
• FC IV – signs of the disease are present even at rest.

Mitral valve prolapse and the army 2020

Heart valves regulate blood flow and prevent backflow. When the valve is open, blood enters the ventricle, after which it closes, and from the ventricle the blood moves further into the aorta. If there are pathologies, the valves sag, the valve does not perform its functions, and blood flows back into the atrium. Depending on how much of it comes back, several stages of the disease are distinguished.

1. The deflection of the sashes is minimal - up to 6 mm. The outflow is insignificant. The functionality of the organ is not impaired. Symptoms do not appear; the pathology is determined by chance during an examination of the heart. No drug therapy is required.
2. The deflection of the sashes is up to 9 mm. Characteristic symptoms appear, the clinical picture is pronounced. General health is unsatisfactory; special treatment and specialist supervision are required.
3. Deflection more than 9 mm. Severe degree of disease. Characterized by a significant outflow of blood. The clinical picture is clearly expressed. There is no relief without surgery.

Depending on the degree of deflection of the valve leaflets, the severity of the symptoms, a conscript diagnosed with “mitral valve prolapse” is assigned category B, C, D. This disease is included in the list of diseases according to which they are not allowed to serve in the army, but will they be taken into the army or sent? in reserve, depends on the clinical picture.

Degrees of the disease

1. The deflection of the valve flaps is minimal and does not exceed 6 mm. The first degree of the disease does not cause any inconvenience, and the patient feels quite well. This defect can be easily identified during a medical examination, which involves an echocardiogram. In such a clinical case, the patient does not even require drug treatment, not to mention surgical intervention.
2. The deflection of the valve flaps is 9 mm or slightly less. Here the clinical picture of the disease is more pronounced, and the patient may experience various discomforts: from shortness of breath when moving to fainting. Periodically, pain occurs, which is eliminated through medications.
3. The deflection of the valve flaps exceeds 9 mm. This is the most severe form of the disease, requiring surgical intervention. The patient's circulatory system is not functioning properly, and if surgery is not performed in a timely manner, this will lead to serious deformation of the heart, which will not allow it to function.

Can you join the army with grade 1 mitral valve prolapse?

A mild stage of the disease does not exempt you from service. The conscript's health condition is stable and normal. The pathology does not cause discomfort, deterioration of well-being, and does not require special treatment. There is no clinical picture, no complaints. First-degree mitral valve prolapse does not require restrictions on physical activity if physical activity does not worsen your health. No special diet or medications are required. Regular monitoring by a cardiologist is necessary. A conscript with this diagnosis is not exempt from military service. He is assigned category “B” and sent to serve with minor restrictions.

They are not drafted into the army with grade 2 or 3 prolapse in the presence of severe disturbances in heart rhythm, conduction, or heart failure.

Controversial cases

If the treatment has not had a positive effect and a diagnosis has been established in which the army is inadmissible, it is worth preparing all the documents (medical record, cardiogram results, x-rays, conclusion of the treating cardiologist, discharge from the hospital, if any) and submit them to the IHC.

The young man must write an application to the military registration and enlistment office, describing in detail the situation and the reasons why he needs a deferment or release. If there has been surgical intervention, they are not eligible to join the army.

Everyone knows about the strictness of the military commission. Therefore, re-examination may be required to confirm the diagnosis. But even with poor health, the guy risks ending up in the army. If this happens, you must send a request (application) to higher authorities; file a claim in court, supporting it with original medical reports, certificates and other documents.

Thus, mitral valve prolapse does not pose a threat to military service if we are talking about grade 1 and no discomfort. At grade 2, the level of regurgitation is taken into account, and grade 3 is considered unacceptable for joining the Armed Forces of the Russian Federation.

How to avoid the army with mitral valve prolapse

The commission of the military registration and enlistment office takes into account not only the diagnosis itself, but also the symptoms that it provokes. If there are no complaints, the conscript is sent to the army. To get through a first-degree MVP, you need to work hard. It is required to visit a specialist with complaints of heart pain, dizziness, shortness of breath, and other symptoms e=at least once every 3 months. All appeals must be recorded so that they can later be presented to the military registration and enlistment committee. However, one must also take into account the fact that specialists also rely on the results of the examination - cardiogram and other methods. If first-degree MVP with heart failure is detected at the initial stage, it will not be possible to get rid of it from the army.

Liberation from the army

As the level of mitral regurgitation increases, the risk of complications is very high. The development of mitral insufficiency is likely.

It is possible that arrhythmia or infective endocarditis will occur. Therefore, conscripts with persistent heart rhythm disturbances, decreased conductivity with the presence of FC II deficiency have every reason to qualify for exemption from service.

Art. tells us this. 42, according to the rules of which the young man receives category “B”.

The disease in the 3rd stage has more pronounced symptoms. Due to the increased deflection, the outflow increases, and then regurgitation provokes a disorder of the circulatory system, worsens the heart rhythm and increases heart failure.

In this case, the conscript is released from the army.

Reviews

Dear readers, was this article helpful? What do you think about mitral valve prolapse and military service? Leave feedback in the comments! Your opinion is important to us!

Maksim

“I learned about the diagnosis while undergoing commission into the army. There were no complaints before this. I was sent to serve with category B. I have been living for 4 years after the army. Everything is fine, nothing bothers me."

Anton

“MVP is often associated with other heart pathologies, so the diagnosis itself does not exempt you from the army, but if there are other pathologies, it will exempt you in total. They will be recognized as having limited fitness and will be assigned category B.”

How can we help?

Often conscripts do not know their illnesses, where to go and where to be examined in order to confirm diagnoses and have the right to a deferment or exemption from the army. We employ specialists with extensive positive experience and this is confirmed by reviews from our clients. We guarantee qualified assistance, advice and support from specialists until you receive a military ID or a refund of 50% of the cost of services in the event of a different decision by the draft commission.

You study, work, you have many plans for life. Are you worried about your career or further studies? Are you a law-abiding citizen, but do you think that military service could worsen your health? Contact us and, if you have the right not to serve, we will help you prove it!

Criteria for suitability for service of a young man with MVP

At first glance, it may seem that mitral valve prolapse and the army are incompatible things. Indeed, this is essentially a heart defect. How can a young man with such a disease be recruited into the army? However, not everything is so simple.

Based solely on the presence of mitral valve prolapse in a person, it is impossible to determine whether he should be admitted to emergency service or not.

Expert opinion

Antonov Viktor Sergeevich

Practicing lawyer with 8 years of experience. Specialization: military law. Recognized legal expert.

I often hear the question: do they enlist in the army with grade 1 mitral valve prolapse? According to the legislation of the Russian Federation, there are the following criteria for the suitability of people with MVP for service:

• mitral valve prolapse of the 1st degree with regurgitation of the 1st degree;
• the conscript has no signs of chronic heart failure or serious heart rhythm disturbances;
• no cases of sudden cardiac death associated with prolapse in close relatives.

Such conscripts are assigned category “A” - fit for military service. They can even serve under a contract.

If there is a MVP with regurgitation of the second degree, the conscript is assigned category “B” - fit with minor restrictions. The young man is sent to a type of military service in which service does not involve performing heavy physical activity - defense of missile combat systems, radio engineering units, etc.

If a person has MVP with grade II regurgitation and functional class I heart failure (this is when symptoms of CHF appear only during very intense and prolonged physical work), he is assigned category “G” - temporarily unfit for military service. The conscript is given a deferment and a referral for cardiac treatment, after which (6-12 months) he again undergoes a military medical commission.

In the case of prolapse with II degree of regurgitation, signs of severe CHF (II-IV functional class), dangerous heart rhythm disturbances, category “B” is established - limited fit for military service. This means that the young man is not subject to conscription in peacetime.

What documents to collect and what examinations to do?

1. Passport.
2. Medical insurance policy.
3. SNILS.
4. Registration certificate.
5. Outpatient card from the clinic with doctors' notes on the presence of mitral valve prolapse.
6. Research protocols (electrocardiography, echocardiography) with conclusions confirming the presence of MVP, severe arrhythmias or heart failure.

It is very important to take with you documents, certificates and medical records confirming the presence of mitral valve prolapse.

Procedure for passing the commission

The military medical commission includes 2 stages:

1. Medical examination.
2. Final commission.

This is important to know: How to deregister based on age at the military registration and enlistment office

During the medical examination, the conscript undergoes a minimum laboratory and instrumental examination directly at the military registration and enlistment office:

• general blood analysis;
• general urine analysis;
• fluorography;
• electrocardiography;
• blood test for HIV, hepatitis B and C.

He is also examined by the following medical specialists:

• ophthalmologist (ophthalmologist);
• otorhinolaryngologist (ENT);
• psychiatrist;
• dentist;
• surgeon;
• neurologist;
• dermatovenerologist;
• therapist.

The therapist is the last in the line of doctors on the commission. He collects all records received from other specialists,, if necessary, prescribes an additional examination, and, focusing on the conscript’s health condition, preliminarily determines his suitability for military service.

If a young man knows that he has mitral valve prolapse, it is the therapist who needs to report this, provide supporting medical records from a cardiologist or therapist in his outpatient record, as well as an echocardiography (ultrasound of the heart) report.

When examining a conscript, the therapist listens to the heart with a stethoscope to detect auscultatory signs of prolapse (systolic click and noise), checks the rhythm of the pulse, and examines the legs for edema; asks whether there have been episodes of loss of consciousness, whether there are cases of death of close relatives associated with MVP, studies the cardiogram to identify heart rhythm disturbances.

Next, the therapist issues a referral for echocardiography, Holter (24-hour) ECG monitoring, if the last study was more than 6 months ago. It is preferable to perform stress echocardiography, i.e. ECG during physical activity. This will clearly determine the severity of the disease. The following cardiac ultrasound indicators are of interest:

• degree of prolapse (sagging) of the valves;
• degree of blood regurgitation;
• Left ventricular ejection fraction is an indicator characterizing the ability of the heart muscle to pump blood.

After this, the conscript with all the records, research results, and a therapist’s diagnosis to determine suitability for service is sent to the final commission, consisting of the chairman and his deputies. Officials carefully study all medical certificates and conclusions and conduct a conversation with the conscript.

At the end of the meeting, the young man is given a degree of suitability for military service.

The following sources of information were used to prepare the material.

Is a citizen with 1st degree secondary compulsory military equipment subject to conscription?

If a young man is diagnosed with grade 1 MVP, then this cannot serve as a reason for granting a deferment or complete exemption from the army. Most likely, the young man will be assigned fitness category B, which means serving not in elite, but in more “mundane” units.

Of course, information about this disease will be brought to the attention of doctors, who are sure to be present in any garrison.

Excessive psychological and physical stress is prohibited for such patients, but gymnastics and light sports are recommended. Yes, doctors do not see any contraindications for military service, but it is worth taking into account that such a patient must be under the supervision of a cardiologist and undergo regular examinations, since the disease can sometimes progress.

It happens that a guy has first-degree MVP, but short-term exertion causes shortness of breath. Then in the medical record it is written about, which is the basis for assigning the young man “non-conscription” category B.

But such cases are rare.

Medical examination at the military registration and enlistment office

The physical and emotional stress of military service can lead to significant deterioration in health. Young people must provide a package of medical documents confirming the presence of the disease or verbally voice complaints about their health. Obtain a deferment from conscription from the military registration and enlistment office for additional examination. The diagnosis is confirmed by clinical data and echocardiography results.

What is included in the package of documents: - an outpatient card with data on a visit to a cardiologist; — echocardiogram (displacement of the mitral valve leaflets, thickening ≥ 5 mm); — an extract from the medical history with a confirmed diagnosis.

The conscript has the right to challenge the conclusion of the medical commission at the military registration and enlistment office (Federal Law “On Military Duty and Military Service”, paragraph 7, Article 28). If you disagree with the assigned category, you should file a complaint with a higher organization (city or regional military registration and enlistment office) and file a claim in court. It is important to collect all the necessary documents and complete them correctly. A lawyer can represent the interests of the plaintiff in court. You can sign up for a free consultation with specialized lawyers in Perm by calling

Pass or fail

The established diagnosis indicates the following:

• The first stage of the secondary battery is compatible with the army.

  Minor deviations are not grounds for exemption from service or granting a deferment - unless there are additional pathologies. The conscript is assigned fitness category “A” or “B”. He has the right to undergo training along with healthy fighters, but excessive loads are contraindicated for him. Be sure to undergo regular examination by a cardiologist;

• The prognosis for the second stage is influenced by the degree of blood reflux, which affects well-being.

  Depending on this, the young man will be assigned category “B” or “G”. That is, they will assign it to reserve or provide a deferment for a certain time;

• in severe prolapse, the service is contraindicated

  – group “D” is assigned. If the recommendations are violated, emergency surgery will be required.

Also, failure to follow the rules can lead to seizures.

How is prolapse diagnosed at the military commissariat?

Problems with the heart puzzle specialists at the military registration and enlistment office, so they approach the examination with seriousness. Mitral valve prolapse is a disease that has serious consequences. Whether such patients are admitted to service or not is decided by the medical commission.

Every young man undergoes a medical examination before being drafted into the army. The list of specialists must include a cardiologist - failures or deviations will be detected. If the doctor becomes suspicious, the conscript is prescribed additional measures.

Doctors' reports must be preserved and shown to members of the commission. Regardless of the results of the examination, the military registration and enlistment office carries out its own procedures that will confirm the diagnosis or cancel it. The set of measures includes - ECG, ultrasound of the heart, chest fluorography, listening with a phonendoscope, visual examination to study symptoms.

If at the end of the procedures the diagnosis is confirmed and the young man is diagnosed with stage 1 prolapse, he will go into the army. Military loads will not harm your health.

The document filled out by doctors at the military registration and enlistment office contains a fitness column that does not contain a line about the condition of the heart valves. But there is a column for characterizing the valves.

If a conscript has stage 1 regurgitation, this deviation is not a reason for deferment and does not characterize the guy as unsuitable. However, there are exceptions.