1. SMB Overview — What Is It?
The Special Medical Board (SMB) is a multi-specialist medical examination conducted at Armed Forces Medical Services (AFMS) hospitals. CDS candidates are referred to the SMB after receiving an SSB recommendation — it is the definitive medical assessment that determines fitness for commissioned service.
The SMB is not a single doctor's check-up. It is a structured board process in which a team of specialists examines each candidate, reviews all investigation results, and arrives at a collective fitness decision.
| Parameter | Details |
|---|---|
| Form used | AFMSF-2 (or AFMSF-2A) |
| Duration | Typically 1–2 days (AFA Flying: up to 2.5 days) |
| Specialists involved | General Medicine, Surgery, Ophthalmology, ENT, Dental; Gynaecology (female candidates only) |
| Sequence | Investigations (Day 1) → Specialist examinations (Day 2) → Board decision |
| Possible outcomes | Fit / Temporarily Unfit / Permanently Unfit |
| Appeal route | Appeal Medical Board (AMB) → Review Medical Board (RMB) at DGMS discretion |
2. Mandatory Blood Tests
A complete blood investigation panel is performed on Day 1. Most tests require a fasting sample drawn in the morning. You are given 75 g of glucose after the fasting draw; a second post-load blood sample is taken 2 hours later.
| Test Name | What It Checks | Armed Forces Relevance |
|---|---|---|
| Haemoglobin (Hb) | Oxygen-carrying capacity of blood | Anaemia impairs performance at altitude and during sustained exertion |
| Total Leucocyte Count (TLC) with Differential (DLC) | White cell types — neutrophils, lymphocytes, eosinophils, monocytes | Eosinophilia (≥ 500/cu mm) or monocytosis → unfit; suggests occult allergy, parasitic infection, or malignancy |
| Platelet Count | Clotting function and bleeding tendency | Thrombocytopenia → unfit for combat roles where trauma risk is high |
| ESR (Erythrocyte Sedimentation Rate) | Non-specific inflammatory marker | Elevated ESR raises suspicion of occult infection, autoimmune disease, or malignancy — triggers further investigation |
| Hb Electrophoresis | Detects haemoglobin variants by electrical separation | Sickle cell trait/disease, Beta Thalassaemia Major/Minor/Trait, Alpha Thalassaemia — all permanently unfit |
| Fasting Blood Glucose | Fasting plasma glucose level | Diabetes Mellitus → permanent rejection; impaired fasting glucose → full OGTT |
| 2-Hour Post 75 g Glucose (OGTT) | Post-load plasma glucose at 2 hours | Impaired glucose tolerance or DM → rejection; rules out latent diabetes in borderline candidates |
| HbA1c (if indicated) | 3-month average blood glucose | Ordered when family history of DM is declared or fasting/OGTT values are borderline |
| Lipid Profile | Total cholesterol, LDL, HDL, triglycerides | Dyslipidaemia → cardiovascular risk assessment; significant derangement → cardiologist evaluation |
| Liver Function Tests (LFT) | AST, ALT, ALP, total bilirubin, albumin, total protein | Hepatitis, chronic liver disease, or liver cirrhosis → unfit |
| Renal Function Tests (RFT) | Serum creatinine, blood urea nitrogen, eGFR | Chronic kidney disease → unfit; single or structural kidney anomalies → carefully assessed |
3. Urine Investigation
| Test | What It Checks |
|---|---|
| Urine Routine Examination (RE) | Protein, glucose, blood (haematuria), ketones, bilirubin, urobilinogen, pH, specific gravity |
| Urine Microscopy (ME) | Red blood cells (RBCs), white blood cells (WBCs), casts (granular, RBC), crystals, epithelial cells |
Why Each Finding Matters
- Proteinuria: Suggests kidney disease — triggers RFT correlation and nephrology referral if persistent
- Glycosuria: Blood glucose overflow into urine — automatically triggers full OGTT review
- Haematuria (RBCs in urine): Renal calculi, tumour, glomerulonephritis, or IgA nephropathy — all require investigation
- WBC casts: Pyelonephritis or other ascending urinary infection — current infection → temporarily unfit
- RBC casts: Glomerular disease — significant pathology requiring nephrology review
4. Radiology (X-Rays)
| X-Ray View | All CDS Entries | AFA Flying Only |
|---|---|---|
| Chest PA view | ✅ Mandatory | ✅ Mandatory |
| Lumbosacral Spine AP & Lateral | ✅ Mandatory | ✅ Mandatory |
| Cervical Spine AP & Lateral | ❌ Not routine | ✅ Mandatory |
| Dorsal (Thoracic) Spine AP & Lateral | ❌ Not routine | ✅ Mandatory |
What Each X-Ray Screens For
Chest PA View
The chest X-ray is the most important routine investigation at the SMB. It screens for pulmonary tuberculosis (active or healed), cardiomegaly, pleural effusion or thickening, lung masses, hilar lymphadenopathy, mediastinal widening, and rib anomalies. Any of these findings can result in temporary or permanent rejection depending on the finding.
Lumbosacral Spine (AP & Lateral)
The lumbar spine X-ray is mandatory for all CDS entries because candidates will carry loads, march over long distances, and operate in environments with significant spinal loading. Findings screened include:
- Spondylolysis / Spondylolisthesis — stress fracture of the pars interarticularis; forward slip → unfit
- Spina bifida occulta — most cases fit; overt spina bifida → unfit
- Block vertebrae — congenital fusion altering spinal mechanics
- Disc disease — loss of disc space, end-plate changes (Modic) at young age
- Sacralisation of L5 / Lumbarisation of S1 — transitional vertebra; significant asymmetric type → assessed carefully
- Scoliosis — curves > 10° (Cobb angle) → further assessment; > 30° → unfit
Cervical & Dorsal Spine (AFA Flying Only)
AFA Flying candidates face ejection-seat forces of up to +15 Gz along the spinal axis. Cervical and dorsal spine X-rays screen for atlanto-axial anomaly, block vertebra (risk of catastrophic injury during ejection), Scheuermann's disease (juvenile kyphosis with vertebral wedging), disc disease at any level, and congenital vertebral anomalies that could be catastrophically injured during an ejection sequence.
5. Ultrasound (USG)
Abdominal and pelvic ultrasound is a mandatory investigation at the CDS SMB. It is performed by a radiologist and covers multiple organ systems in a single session.
| USG Area | What Is Looked For | Who |
|---|---|---|
| Liver, gallbladder, spleen, pancreas | Hepatomegaly, fatty liver (Grade II/III → noted), gallstones, choledocholithiasis, splenomegaly | All candidates |
| Kidneys & urinary tract | Renal calculi, simple renal cysts (> 1.5 cm → unfit), complex cysts, hydronephrosis, horseshoe kidney, ectopic kidney, structural anomalies | All candidates |
| Bladder | Bladder wall thickening, diverticulum, calculi, residual urine volume | All candidates |
| Prostate | Size, calcifications, structural anomalies | Male candidates |
| Uterus & ovaries | Fibroids (size, number, location), ovarian cysts (simple vs complex), endometriosis, congenital Müllerian anomalies (bicornuate uterus, septate uterus) | Female candidates — mandatory |
6. Cardiac — ECG
A 12-lead ECG is mandatory at all CDS SMBs. It is typically performed on Day 1 after the candidate has rested for at least 10 minutes.
What the ECG Assesses
- Heart rate (normal sinus rhythm: 60–100 bpm)
- PR interval (AV conduction time)
- QRS duration and morphology
- Corrected QT interval (QTc) — prolonged QTc → risk of fatal arrhythmia
- ST segment changes (depression/elevation) → ischaemic pattern
- T-wave changes (inversion, flattening, hyperacute) → ischaemia or strain
- Conduction abnormalities: RBBB, LBBB, WPW (delta wave, short PR), Brugada pattern
- LVH voltage criteria (Sokolow-Lyon or Cornell)
- Arrhythmias: VPCs, PACs, AF/flutter, heart blocks
What Happens If the ECG Is Abnormal
| ECG Finding | Outcome at SMB |
|---|---|
| Normal sinus rhythm, no ST/T changes | Cleared — no further cardiac evaluation |
| Incomplete RBBB, juvenile T-wave pattern | Referred — echocardiogram to exclude structural disease; usually cleared |
| Complete RBBB | Referred — cardiologist evaluation + echo mandatory; may be cleared if no structural disease |
| WPW syndrome (delta wave + short PR) | Unfit for AFA Flying; evaluated for other entries on case-by-case basis |
| ST depression / T-wave inversion | Referred — stress test (ETT/TMT) + echo at AMB |
| Prolonged QTc (> 450 ms) | Unfit — risk of torsades de pointes / sudden cardiac death |
| Heart rate > 100 bpm (resting tachycardia) | Re-assessed — if physiological cause not confirmed → unfit |
| Heart rate < 60 bpm (resting bradycardia) | Evaluated — athlete bradycardia acceptable if confirmed by cardiologist; pathological → unfit |
7. Ophthalmology Tests
Ophthalmology is one of the most detailed assessments at the SMB. The examination is conducted by a specialist ophthalmologist and covers both functional and structural aspects of vision.
| Test | What It Measures | Notes |
|---|---|---|
| Snellen chart (unaided) | Uncorrected visual acuity (UCVA) — both eyes separately | Compared against entry standard for each academy |
| Snellen chart (corrected) | Best corrected visual acuity (BCVA) with glasses/trial lenses | BCVA must reach 6/6 in each eye; failure → unfit |
| Subjective refraction | Manifest refractive error — myopia, hypermetropia, astigmatism (dioptres) | Candidate-directed; glasses/lenses optimised until best vision achieved |
| Retinoscopy | Objective refractive error — performed with cycloplegia if needed | Cannot be manipulated by the candidate; the definitive measure used by the board |
| Ishihara plates | Colour perception — CP Pass / CP-II / fail categories | IMA/OTA requires CP-II minimum; AFA requires CP-I |
| Nagel Anomaloscope | Precise colour perception grading — CP-I normal colour vision confirmation | AFA Flying / AMB only; Ishihara pass does not guarantee CP-I on anomaloscope |
| Slit-lamp examination | Anterior segment — cornea, lens, anterior chamber depth, iris | Detects post-LASIK corneal flap, keratoconus, cataract, iritis |
| Fundus examination | Optic disc (cup-to-disc ratio), retina, macula, periphery, vessels | Lattice degeneration, high myopia fundus changes, optic disc drusen — all assessed |
| Tonometry (if indicated) | Intraocular pressure — glaucoma screen | Performed when suspicious optic disc or high myopia is noted at slit-lamp |
| Synoptophore (if indicated) | Binocular vision grade — simultaneous macular perception, fusion, stereopsis | INA (Navy) requires Grade III binocular vision; ordered when squint or binocular concern noted |
| Orthoptic assessment (if squint noted) | Manifest squint angle and type | Manifest (tropic) squint → unfit; latent squint (phoria) → assessed by degree |
8. ENT Tests
The ENT assessment covers hearing, nasal airway, the oral cavity, throat, larynx, and speech. It is conducted by an ENT specialist at the SMB.
| Test | Method | Standard Required |
|---|---|---|
| Whisper test | Candidate stands 610 cm (20 feet) from examiner with back turned; examiner whispers forced consonants | Must clearly hear forced whisper in both ears separately |
| Pure Tone Audiometry (PTA) | Headphone-delivered pure tones at standardised frequencies (250 Hz – 8000 Hz) and decibel levels | Hearing loss < 20 dB at all frequencies 250–8000 Hz in both ears |
| Otoscopy | Otoscope visualisation of external auditory canal and tympanic membrane | No wax impaction, no tympanic membrane perforation, no discharge, normal landmarks |
| Nasal examination | Anterior rhinoscopy with speculum; rigid nasal endoscopy if indicated | No significant DNS (deviated nasal septum), no polyps, no turbinate hypertrophy obstructing airway |
| Throat & oral examination | Direct examination; indirect laryngoscopy (mirror) if indicated | Tonsils, palate, uvula, posterior pharynx — no acute pathology; no peritonsillar scarring obstructing oropharynx |
| Voice & speech assessment | Clinical — conversational speech and sustained phonation | No stammer, no stutter, no dysphonia (hoarseness), no nasal quality suggesting palatal palsy |
9. Dental Assessment
Dental fitness is assessed by a dental surgeon at the SMB. The key metric is the dental point count — a scoring system that counts functional tooth units.
| Assessment | Minimum Standard |
|---|---|
| Dental point count | Minimum 14 points — each functional opposing pair scores points; missing or non-functional teeth deducted |
| Periodontal health | No significant pyorrhoea (periodontitis); not more than 2 teeth with grade II or higher mobility |
| Malocclusion | No severe malocclusion (Class III prognathism, severe Class II) that impairs mastication |
| Mouth opening (inter-incisal distance) | Minimum 30 mm — essential for field dental care and intubation if needed |
| Fixed orthodontic braces | Unfit — must be removed before SMB; allow 6–8 weeks after removal for assessment |
| Fixed lingual retainers | Acceptable — passive wire retainers behind teeth are permitted |
| Dental implants | More than 2 implants → unfit |
10. Physical Examination Systems
Following the investigations, each specialist examines the candidate systematically. The physical examination is structured by organ system and performed in sequence.
| System | What Is Assessed |
|---|---|
| General | Build, nutrition, height, weight, body composition; skin (vitiligo extent, keloid, psoriasis, tinea); lymph node groups; hernia check (all orifices); genitalia (male — scrotal contents) |
| Cardiovascular | Radial pulse rate and rhythm; blood pressure in both arms; heart auscultation (murmurs, added sounds); peripheral pulses (dorsalis pedis, popliteal, femoral) |
| Respiratory | Chest expansion (minimum 5 cm for IMA); percussion note; auscultation — breath sounds, adventitia (wheeze, crackles, rub) |
| Abdomen | Liver size and tenderness; spleen size; any masses; hernia orifices (inguinal, femoral); anorectal examination for haemorrhoids, fissures, fistulae (Grade III haemorrhoids → unfit) |
| Musculoskeletal (MSK) | Spine — scoliosis (Cobb angle), lumbar range of motion, kyphosis; limbs — genu valgum/varum (knock knees / bow legs), pes planus (flat feet — flexible vs rigid), hallux valgus; joint stability, range of motion |
| Neurological | Gait pattern; coordination (heel-toe walk, Romberg); deep tendon reflexes; plantar response; cranial nerve examination if clinically indicated |
| Genito-urinary (male) | Testis — cryptorchidism (undescended testis → unfit), hydrocele, varicocele (Grade III → unfit); phimosis (tight non-retractile prepuce → temporarily unfit until corrected) |
| Skin | Tattoo location and size (only inner forearm and dorsum of hand permitted); vitiligo extent (face/genitalia → assessed carefully); psoriasis; keloid scars; hyperhidrosis |
11. AFA Flying — Additional Tests
Candidates aspiring to the Air Force Academy (AFA) Flying branch undergo a significantly more stringent medical assessment beyond the standard SMB battery. The additional tests reflect the unique physiological demands of flying — G-forces, hypoxia at altitude, ejection-seat loads, and the requirement for perfect colour vision.
| # | Additional Test / Assessment | Purpose |
|---|---|---|
| 1 | EEG (Electroencephalogram) | Screens for epileptiform activity or any seizure predisposition — mandatory or indicated by history; any seizure history → permanent unfit for flying |
| 2 | Cervical Spine X-ray AP & Lateral | Ejection seat safety screen — atlanto-axial anomaly, block vertebra, disc disease at C-spine level → high-force ejection risk |
| 3 | Dorsal Spine X-ray AP & Lateral | Scheuermann's disease (vertebral wedging >5° in three adjacent vertebrae), disc space narrowing, thoracic kyphosis — ejection injury risk |
| 4 | Colour Perception by Nagel Anomaloscope | CP-I confirmation — Ishihara pass is necessary but not sufficient; anomaloscope differentiates true normal (CP-I) from anomalous trichromats who can pass Ishihara; flying requires CP-I |
| 5 | Detailed Anthropometry | Sitting height, standing height, leg length, thigh length — must fall within cockpit accommodation limits of the aircraft type; outside limits → unfit for flying even if otherwise medically fit |
| 6 | Aviation Medicine Review (cardiac) | Any ECG abnormality is referred to AFMS aviation medicine specialist; standards are stricter than ground-duty entries — even incomplete RBBB requires echo clearance |
| 7 | Night Vision Screen (if indicated) | Ordered when candidate history suggests night blindness or retinal pigmentary changes noted at fundus examination; formal dark-adaptation testing at AMB if positive screen |
12. Female Candidates — Additional Tests
Female candidates at the CDS SMB (for OTA Women) undergo all standard investigations plus a dedicated gynaecological assessment. The examination is conducted exclusively by a Lady Medical Officer or a Lady Gynaecologist.
| Test / Assessment | Notes |
|---|---|
| Gynaecological examination | Conducted by Lady Medical Officer or Lady Gynaecologist only; male medical officers are not present |
| Menstrual, obstetric & gynaecological history | Detailed history taken — cycle regularity, dysmenorrhoea, obstetric history; declare all gynaecological conditions and past treatments |
| Speculum / PV examination | Not performed in unmarried candidates; conducted only in married candidates with informed consent |
| USG abdomen + pelvis | Mandatory for all female candidates — screens uterus (size, fibroids, congenital anomalies) and ovaries (cysts, polycystic ovaries) |
| Breast examination | Lumps, galactorrhoea (discharge without pregnancy), polythelia (accessory nipples) — clinical assessment; imaging if mass found |
13. How to Prepare
The SMB cannot be "gamed" — it screens for genuine fitness. However, there is a significant difference between being medically fit and being prepared for the SMB. Many candidates fail not because of a true medical condition but because of avoidable and correctable issues that they did not attend to in advance.
- Get dental work done — fill all cavities, treat gum disease with scaling and root planing, count your own dental points with a dentist
- Visit an ENT specialist — get ear wax professionally cleaned, assess nasal septum if you have a history of nasal obstruction or trauma
- Get a current refraction done at an ophthalmologist — know your dioptres; if LASIK-eligible, plan and complete it now
- Get a complete health check: fasting glucose, lipid profile, blood pressure — identify any borderline results now when you have time to act
- Bring your weight within the DGMS height-weight chart range — gradual, structured loss/gain is sustainable; crash approaches before the SMB can affect blood test results
- Arrange all surgical and medical records for any past operations, hospitalisations, or chronic conditions
- If you have fixed orthodontic braces, consult your orthodontist now — removal must be planned well in advance
- Fast from midnight — blood glucose and lipid profile both require a minimum 8-hour fast; you may drink water freely
- Get 6–8 hours of sleep — sleep deprivation causes a resting tachycardia that can trigger ECG re-assessment
- Avoid alcohol for at least 24 hours before the SMB — alcohol elevates liver enzymes (ALT, AST) and can affect blood pressure
- Gather and organise all documents: AFMSF-2 (fully filled and signed), medical records, past blood reports, LASIK certificates, surgical discharge summaries
- Prepare photocopies of all documents — originals and copies both must be available
- Arrive 15 minutes before the reporting time — late arrival creates stress-induced tachycardia
- Sit quietly for 10 minutes before ECG recording — do not rush directly from the car or bus to the ECG room
- Bring original documents and photocopies of everything; do not leave any record at home
- Wear loose, easily removable clothing — you will undress for physical examination multiple times across specialities
- Remove all jewellery and metal belt buckles before the radiology session — they create X-ray artefacts that necessitate repeat films
- Do not take caffeine or stimulants on the morning of the SMB — they cause resting tachycardia and blood pressure elevation
- Declare all medications honestly on your AFMSF-2 — concealment is grounds for permanent disqualification if discovered at any point in your career
14. Frequently Asked Questions
How many days does the CDS SMB take?
The SMB typically takes 1–2 days. Day 1 usually involves all investigations — blood tests (including fasting and 2-hour post-load glucose), urine examination, X-rays, ultrasound, and ECG. Day 2 involves specialist examinations — ophthalmology, ENT, dental, general medicine, and surgery. Some centres with adequate staffing complete everything in a single long day. AFA Flying candidates may require an additional half-day for the extra tests including EEG, cervical and dorsal spine X-rays, detailed anthropometry, and the Nagel Anomaloscope colour vision test.
Can I eat before the CDS medical board?
No — you must fast from midnight before the day your blood tests are collected. Fasting blood glucose and the lipid profile both require a minimum 8-hour fast. You may drink plain water freely. After the fasting blood is drawn, you will be given 75 grams of oral glucose to drink. You must then wait 2 hours (without eating or drinking anything other than water) before the second blood draw — this is the post-load glucose test for the OGTT. You should eat a light meal after the post-load blood draw, which is typically done in the mid-morning.
What is Hb electrophoresis and why is it done?
Haemoglobin electrophoresis is a laboratory technique that separates haemoglobin molecules by their electrical charge to identify different variants. It reliably detects sickle cell trait, sickle cell disease, Beta Thalassaemia Major, Intermedia, Minor (Trait), and Alpha Thalassaemia — all of which are permanently disqualifying for armed forces service. Many carriers of thalassaemia trait are completely healthy and do not know they carry the gene, because they have no symptoms. This test is one of the most reliable screens in the entire SMB panel and cannot be influenced by any form of preparation or supplementation — it reports your genetic haemoglobin type.
My hearing is fine but I have a perforated eardrum from childhood. What happens?
A perforated tympanic membrane (eardrum) is cause for rejection at the SMB. However, a perforation that has fully healed with a completely intact, normal-appearing tympanic membrane is acceptable — the otoscope will reveal a normal drum. If the perforation was surgically repaired by Tympanoplasty or Myringoplasty, it was repaired because of Chronic Otitis Media (CSOM) — and that history of CSOM makes the candidate permanently unfit, even if the surgical outcome was excellent and the membrane looks intact. Bring your complete ENT records, including surgical notes, to the SMB. The medical officer will want to see the history.
I will be menstruating on the SMB day. Will this affect my medical?
Inform the Lady Medical Officer when you report. The urinalysis may show haematuria (blood in urine) from menstrual contamination if a routine mid-stream sample is used — the LMO will use a clean-catch technique or a catheter sample to avoid this artefact. Pelvic ultrasound can still be performed during menstruation in most cases, though the endometrial lining and uterine cavity are best visualised in the follicular phase (days 5–12 of the cycle). The gynaecological history and clinical examination can proceed normally. In rare cases of very heavy menstrual bleeding, the gynaecological portion of the examination may be deferred to the next day.
Will the ECG detect my LASIK?
No — LASIK is a corneal refractive procedure with no cardiac relevance whatsoever. It will not appear on an ECG. The ECG exclusively measures the electrical activity of the heart. Your LASIK history is instead detected by the ophthalmologist through slit-lamp examination of the cornea (which may show the flap interface under high magnification) and potentially corneal topography, which shows the characteristic oblate post-LASIK corneal shape. You must proactively declare your LASIK on the AFMSF-2 form and bring all documentation including the surgical certificate, pre-operative refraction records, post-operative topography, and current pachymetry measurement.
What is the USG (ultrasound) looking for in my abdomen?
The abdominal ultrasound systematically screens multiple organs: liver — size, echogenicity (fatty liver Grade II/III is noted), surface nodularity (cirrhosis); gallbladder — gallstones, wall thickening, polyps; kidneys — stones, simple cysts (a simple cyst larger than 1.5 cm makes a candidate unfit), complex cysts, structural anomalies (horseshoe kidney, ectopic kidney), hydronephrosis; bladder — wall abnormalities, calculi, diverticulum, post-void residual; spleen — size and echogenicity. In female candidates, the pelvic USG additionally screens the uterus and ovaries for fibroids, ovarian cysts (simple vs complex), endometriosis, and congenital Müllerian anomalies.
I take medication for hypothyroidism. Will this affect my CDS SMB?
Yes, this requires mandatory declaration. Any active use of prescription medication must be disclosed on the AFMSF-2 form and verbally to the examining medical officer. Hypothyroidism requiring levothyroxine is assessed on a case-by-case basis — stable, well-controlled hypothyroidism on a low dose (typically ≤ 50 mcg daily) with consistently normal TSH levels, and no symptoms of hypothyroidism or cardiovascular involvement, may be accepted at the discretion of the medical board. There is no fixed rule that all hypothyroid candidates are unfit — the assessment is individualised. However, concealing any medication use is a serious offence under the armed forces medical enrolment rules; candidates found to have concealed a medical condition or ongoing medication use may be permanently disqualified from all future entries, even if the condition itself would have been acceptable.
Related Medical Standard Pages
This page is for informational guidance only. Medical standards and their application are at the discretion of the Armed Forces Medical Services. Always consult official notifications and your recruiting authority for the definitive standard applicable to your entry.