Table of Contents
SMB Overview — What Is It?
The Special Medical Board (SMB) is a multi-specialist examination conducted at an Armed Forces Medical Services (AFMS) hospital. NDA candidates attend the SMB after receiving an SSB recommendation — it is the final medical hurdle before enrolment as a cadet.
- Form: AFMSF-2 (or AFMSF-2A for female candidates)
- Duration: 1–2 days depending on the centre and wing
- Specialists involved: General Medicine, Surgery, Ophthalmology, ENT, Dental, and Gynaecology (for female candidates)
- Sequence: Investigations (blood, imaging) → Specialist examinations → Board decision
- Possible outcomes: Fit / Temporarily Unfit / Permanently Unfit
- Appeal pathway: Appeal Medical Board (AMB) within ~42 days; Review Medical Board (RMB) at DGAFMS discretion
Source: NDA Notification Appendix IV, paras 4–6 (page 30).
Bring your AFMSF-2 form (fully completed and signed), all past medical records, surgical records, and specialist reports. Come fasting from midnight — blood glucose and lipid tests require it.
Mandatory Blood Tests
The following blood tests are drawn on Day 1, typically in the early morning (fasting). Two samples are collected: one immediately (fasting) and one 2 hours after drinking 75g oral glucose solution (for the OGTT).
| Test | What It Checks | Armed Forces Relevance |
|---|---|---|
| Haemoglobin (Hb) | Oxygen-carrying capacity of red blood cells | Anaemia impairs performance at high altitude and under physical exertion |
| Total Leucocyte Count (TLC) + Differential (DLC) | WBC types — neutrophils, eosinophils, monocytes, lymphocytes | Eosinophilia ≥ 500/cu mm or monocytosis → unfit |
| Platelet Count | Clotting function | Thrombocytopenia → unfit for service |
| ESR | Non-specific inflammation marker (erythrocyte sedimentation rate) | Elevated ESR raises suspicion of occult infection or inflammatory disease |
| Hb Electrophoresis | Haemoglobin variants (Hb A, S, C, F, E, beta-thalassaemia) | Sickle cell disease/trait, Beta Thalassaemia (all types including Trait) → unfit |
| Fasting Blood Glucose (FBG) | Fasting blood sugar level | Diabetes Mellitus (FBG ≥ 126 mg/dL) → rejection |
| 2-hour Post 75g Glucose (OGTT) | Post-load blood sugar (oral glucose tolerance test) | Impaired glucose tolerance (≥ 140 mg/dL) or DM (≥ 200 mg/dL) → rejection |
| Lipid Profile | Total cholesterol, LDL, HDL, triglycerides | Cardiovascular risk screening; requires 12-hour fast |
| Liver Function Tests (LFT) | AST, ALT, ALP, bilirubin, albumin, total protein | Hepatitis, chronic liver disease → unfit |
| Renal Function Tests (RFT) | Creatinine, blood urea nitrogen, eGFR | Chronic kidney disease → unfit |
Hb Electrophoresis detects thalassaemia trait even in completely healthy candidates. There is no preparation that affects this result — it cannot be faked. Many carriers of thalassaemia trait are completely asymptomatic and unaware. If you have a family history, get tested at a private lab well before your SMB so you are not blindsided.
Urine Investigation
A mid-stream urine sample is collected on the morning of investigations. Both routine examination (dipstick) and microscopy are performed.
| Test | What It Checks |
|---|---|
| Urine Routine Examination (R/E) | Protein, glucose, blood (haemoglobin), ketones, bilirubin, urobilinogen, pH, specific gravity |
| Urine Microscopy (M/E) | RBCs, WBCs, epithelial cells, casts (granular, hyaline, WBC, RBC), crystals, bacteria |
Clinical significance at SMB:
- Proteinuria → kidney disease; confirmed proteinuria triggers further renal evaluation
- Glycosuria → diabetes mellitus or renal glycosuria; will trigger glucose tolerance testing
- Haematuria (blood in urine) → renal calculi, infection, glomerulonephritis
- WBC casts → renal parenchymal infection or pyelonephritis
- RBC casts → glomerulonephritis
First morning mid-stream urine is preferred — it is more concentrated and reduces false negatives. Avoid heavy protein meals and intense exercise the evening before, as both can cause transient proteinuria or haematuria that mimics pathology.
Radiology (X-Rays)
Radiological investigations are conducted at the hospital radiology department, typically on Day 1 alongside blood tests. Remove all metal jewellery, belt buckles, and underwire before entering the X-ray room.
| X-Ray View | All NDA Wings | Air Force Only |
|---|---|---|
| Chest PA (Postero-Anterior) view | ✅ Mandatory | ✅ Mandatory |
| Lumbosacral Spine AP & Lateral | ✅ Mandatory | ✅ Mandatory |
| Cervical Spine AP & Lateral | ❌ Not required | ✅ Mandatory |
| Dorsal (Thoracic) Spine AP & Lateral | ❌ Not required | ✅ Mandatory |
What each X-ray screens for:
- Chest PA: Tuberculosis (active or healed), cardiomegaly, pleural thickening or effusion, lung masses, pneumothorax, mediastinal enlargement
- Lumbosacral spine: Spondylolysis, spondylolisthesis, spina bifida occulta, block vertebrae, disc space narrowing, Bertolotti syndrome, sacralisation/lumbarisation
- Cervical + Dorsal spine (Air Force): Atlanto-axial anomaly (AAA), Scheuermann's disease, block vertebra, wedging, disc disease — ejection-seat injury risk assessment
If you have a history of back pain, get a spinal X-ray done before your SMB so you know your baseline — surprises on the day slow down the board and increase anxiety. Address any finding with a spine specialist well in advance.
Ultrasound (USG)
An abdominal and pelvic ultrasound is performed by a radiologist, typically on Day 1. You will need to arrive with a full bladder for the pelvic component — drink 2–3 glasses of water 30 minutes before.
| Area Scanned | What Is Screened |
|---|---|
| Liver, gallbladder, pancreas | Liver disease (cirrhosis, hepatomegaly), gallstones (cholelithiasis), hepatic cysts, pancreatic pathology |
| Kidneys & urinary tract | Renal calculi, renal cysts (> 1.5 cm → unfit), structural anomalies (horseshoe kidney, duplex collecting system), hydronephrosis, pelvic kidney |
| Pelvis (male) | Bladder capacity and wall, post-void residual, prostate (if age-appropriate) |
| Pelvis (female) | Uterus (size, position, fibroids), ovaries (cysts, PCOS morphology), adnexal masses — mandatory for all female candidates |
USG frequently reveals unsuspected renal cysts or gallstones that were completely asymptomatic. If you know you have either, get treated or formally evaluated before the SMB — a written specialist opinion stating "not clinically significant" or confirming treatment gives the board confidence.
Cardiac — ECG
A standard 12-lead electrocardiogram (ECG) is mandatory at all NDA SMBs regardless of wing. It is typically recorded on Day 1 as part of the investigation battery.
What the ECG screens for: Sinus rhythm, PR interval, QRS duration, QTc interval, ischaemic changes, conduction abnormalities (RBBB, LBBB, Wolff-Parkinson-White/WPW), left ventricular hypertrophy (LVH) voltage criteria, atrial enlargement, ventricular ectopics.
Abnormal ECG pathway:
- Temporary rejection → echo (echocardiogram) + stress test (ETT/TMT) at the AMB
- Benign findings (incomplete RBBB, juvenile T-wave inversion in V1–V3) → cleared after echo + cardiologist opinion in most cases
- WPW syndrome → unfit for Air Force flying branch; evaluated case-by-case for other wings
- BP > 140/90 mmHg → 24-hour Ambulatory Blood Pressure Monitoring (ABPM) to differentiate white-coat hypertension from persistent hypertension
Arrive rested and sit quietly for at least 10 minutes before the ECG is recorded. Exercise-induced tachycardia from rushing to the examination venue can produce a falsely elevated heart rate, ST changes, and artefacts that complicate interpretation. Do not panic if you are asked to repeat the ECG — it is common.
Ophthalmology Tests
Ophthalmological assessment is one of the most critical parts of the SMB, particularly for Air Force candidates. The examination is conducted by an AFMS ophthalmologist. Bring your current spectacles or contact lens prescription.
| Test | What It Measures |
|---|---|
| Snellen chart (unaided) | Uncorrected visual acuity (UCVA) — vision without glasses at 6 m |
| Snellen chart (corrected) | Best corrected visual acuity (BCVA) with trial lenses or spectacles |
| Subjective refraction | Manifest refractive error — myopia, hypermetropia, astigmatism reported by candidate |
| Retinoscopy | Objective refraction — independent of candidate cooperation; cannot be manipulated |
| Ishihara plates | Colour perception grading: CP Pass (normal) / CP-II (partial defect) / Fail |
| Nagel Anomaloscope (Air Force / AMB) | CP-I — full normal colour vision (Rayleigh equation matching); required for Air Force flying |
| Slit-lamp examination | Anterior segment: cornea clarity, anterior chamber depth, lens (cataract, subluxation) |
| Fundus examination | Posterior segment: retina, optic disc, macula, posterior vitreous, lattice degeneration |
| Synoptophore (if indicated) | Binocular vision grade and angle of squint — primarily for Naval entry |
| Orthoptic assessment | Manifest and latent squint (cover test, cover-uncover test) |
Wing-wise vision standards (summary):
- NDA Army: Uncorrected 6/36, correctable to 6/6 each eye; myopia ≤ −2.5 D; hypermetropia ≤ +2.5 D; CP-II acceptable; LASIK NOT permitted
- NDA Navy: Uncorrected 6/12, correctable to 6/6; myopia ≤ −1.0 D; hypermetropia ≤ +2.0 D; CP Pass; LASIK permitted with conditions
- NDA Air Force Flying: NIL myopia (any measurable myopia disqualifies); hypermetropia ≤ +1.5 D; CP-I (Nagel Anomaloscope); LASIK permitted with strict conditions including minimum 12 months post-op
ENT Tests
The ENT examination is conducted by an AFMS specialist. Hearing is assessed both clinically and instrumentally. Ensure your ears are clean before the SMB — wax impaction is the most preventable cause of ENT-related delays.
| Test | Standard / Notes |
|---|---|
| Whisper test (clinical hearing) | 610 cm (6 metres) bilateral, with back to examiner; must hear clearly in both ears |
| Pure Tone Audiometry (PTA) | Hearing loss < 20 dB at all frequencies 250–8000 Hz in both ears |
| Otoscopy | No excessive wax (cerumen), no tympanic membrane perforation, no active discharge; TM must be intact with normal landmarks |
| Nasal examination | No significant deviated nasal septum (DNS), no nasal polyps, no obstructive turbinate hypertrophy; adequate nasal airway |
| Throat / oral pharynx examination | Tonsils (grade), posterior pharynx, soft palate, uvula, adenoid status (indirect) |
| Voice & speech | No stammer, no significant stutter, no dysphonia, normal voice production under stress |
Get ear wax professionally cleaned by an ENT surgeon 2–3 weeks before the SMB — not the day before, as freshly irrigated ears can be mildly inflamed. Wax alone causes temporary, fully reversible PTA failure, and is entirely preventable.
Dental Assessment
The dental assessment is conducted by an AFMS dental officer. Dental fitness is graded on a points system derived from functional tooth apposition.
| Standard | Requirement |
|---|---|
| Minimum dental points | 14 dental points required (functional points in occlusion) |
| Anterior teeth (per jaw) | Any 4 of the 6 anterior teeth (incisors and canines) must be present and functional |
| Posterior teeth (per jaw) | Any 6 of the 10 posterior teeth (premolars and molars) must be present and functional |
| Periodontal health | ≤ 2 loose teeth; no severe pyorrhoea (periodontitis with bone loss and pus) |
| Malocclusion | No severe malocclusion that interferes with function or causes cosmetic disfigurement |
| Mouth opening | ≥ 30 mm inter-incisal distance (trismus → unfit) |
| Orthodontic appliances | Fixed braces → unfit (must be removed before SMB); lingual retainers are acceptable |
| Dental implants | Maximum 2 implants; > 2 implants → unfit |
Get a full dental evaluation 3–4 months before your expected SMB date. Fill all cavities, treat active gum disease, and remove fixed orthodontic braces. Do not leave dental work to the last minute — some procedures require healing time before the board.
Physical Examination Systems
The physical examination is conducted by a Physician (General Medicine) and a Surgeon. It is a full-body system-by-system examination. A standard recording form (AFMSF-2) is completed for every candidate.
| System | What Is Assessed |
|---|---|
| General | Build, nutrition, pallor, cyanosis, clubbing, oedema, jaundice, lymphadenopathy; anthropometry (height, weight, BMI, chest expansion); hernias; genitalia |
| Cardiovascular | Radial pulse (rate, rhythm, volume, character), BP both arms, heart auscultation (murmurs, extra sounds), peripheral pulse palpation (femoral, popliteal, dorsalis pedis) |
| Respiratory | Tracheal position, chest shape, respiratory rate; percussion (dullness, hyperresonance); auscultation (breath sounds, added sounds); chest expansion measurement |
| Abdomen | Inspection, percussion, palpation; liver size, spleen size; hernia orifices (inguinal, femoral, umbilical); anorectal examination (haemorrhoids, fistula, prolapse) |
| Musculoskeletal (MSK) | Spine — scoliosis (Adams test), range of movement, tenderness; lower limbs — knock knees, flat feet, valgus/varus deformity, leg length discrepancy; joints — range of motion; upper limbs — full elbow extension, grip strength |
| Neurological | Gait (normal, ataxic, antalgic), coordination (finger-nose, heel-knee-shin), deep tendon reflexes, plantar response, cranial nerves screening |
| Genito-urinary (male) | Testicular examination (cryptorchidism, atrophy, hydrocele, varicocele), epididymis, spermatic cord; phimosis; external genitalia normality |
| Skin | Tattoos (location, size, content documented on AFMSF-2); vitiligo (extent and location — face/dorsal hands → unfit); keloid scars (extensive → unfit); hyperhidrosis (severe palmoplantar → unfit); psoriasis, ichthyosis, chronic skin conditions |
NDA Air Force — Additional Tests
NDA Air Force Flying Branch candidates undergo an extended battery beyond the standard SMB. These additional investigations are driven by the unique physiological demands of military aviation — including ejection-seat safety, G-tolerance, hypoxia, and flicker vertigo.
| # | Additional Test / Requirement | Why It Is Done |
|---|---|---|
| 1 | EEG (Electroencephalogram) | Indicated for: family history of epilepsy, past head injury, past neurological or psychological history, syncope episodes. Seizure disorder → permanently unfit for flying |
| 2 | Cervical Spine X-ray AP & Lateral | Ejection-seat safety — atlanto-axial anomaly, cervical block vertebra → unfit |
| 3 | Dorsal (Thoracic) Spine X-ray AP & Lateral | Ejection-seat safety — Scheuermann's kyphosis, wedge fractures → unfit |
| 4 | Nagel Anomaloscope (CP-I) | Full normal colour vision mandatory for pilot/observer; Ishihara alone insufficient for Air Force flying branch |
| 5 | Detailed Anthropometry | Sitting height 81.5–96 cm; leg length 99–120 cm; thigh circumference ≤ 64 cm — cockpit geometry and ejection-seat clearance |
| 6 | Aviation Medicine Review | Any ECG abnormality, BP borderline, or relevant systemic finding triggers Aviation Medicine specialist review before board decision |
Requirements drawn from NDA Notification Annexure C (Air Force additional requirements), IAP 4303 5th Edition, and AFMS flying medical standards. Standards listed are the screening standards at SMB — further evaluation at the Institute of Aviation Medicine (IAM), Bangalore, may follow for borderline cases.
Female Candidates — Additional Tests
All female NDA candidates undergo an additional gynaecological evaluation as a mandatory component of the SMB. This examination is conducted exclusively by a Lady Medical Officer (LMO) or Lady Gynaecologist in a private examination room.
| Test / Examination | Notes |
|---|---|
| Gynaecological examination | Conducted exclusively by Lady Medical Officer — mandatory, no exceptions |
| Detailed gynaecological history | Menstrual history (menarche, cycle regularity, dysmenorrhoea), obstetric history, past gynaecological surgeries, current medications |
| Speculum / per-vaginum (PV) examination | NOT performed in unmarried candidates; only for married candidates with indication |
| USG abdomen + pelvis | Mandatory for all female candidates — uterus, ovaries, adnexa; done as part of the standard USG session |
| Breast examination | Clinical breast exam — lumps, axillary lymph nodes, galactorrhoea, polythelia (accessory nipples) |
Declare all gynaecological conditions on the AFMSF-2 form — including menstrual history, past surgeries, PCOS diagnosis, endometriosis, or any known conditions. Non-disclosure of a known condition found on USG is treated as misrepresentation and is a more serious finding than the condition itself.
How to Prepare
The SMB rewards candidates who know their own body. Most failures at the medical board are preventable with adequate lead time. Here is a practical preparation timeline.
- Dental: fill cavities, treat gum disease, remove fixed braces
- ENT: treat significant DNS; remove large tonsils if causing problems
- Check current refraction — confirm myopia/hypermetropia is within limits
- Get Hb electrophoresis done privately if family history
- Confirm weight is within DGMS height-weight chart
- Collect all medical, surgical and specialist records
- Fast from midnight (water is allowed)
- Get 6–8 hours of sleep
- No alcohol for 24 hours prior
- No intense exercise (affects ESR, urine, heart rate)
- Organise all original documents and photocopies
- Set clothes out — loose, easy to remove for examination
- Arrive 15 minutes before reporting time
- Sit and rest 10 minutes before ECG recording
- Bring originals AND photocopies of every document
- Wear loose clothing for easy examination access
- Remove metal jewellery and belt buckles before X-ray
- Drink 2–3 glasses of water 30 min before USG for pelvic scan