How hypertension affects fitness for military service

During martial law, fitness for military service often comes down to the conclusion of the Military Medical Commission (VLK), and hypertension is one of the most common reasons for doubts and unrealistic expectations. Many people focus only on “blood pressure numbers” or one-off measurements, but for the commission the decisive factors are different: a confirmed diagnosis, the stage and grade of arterial hypertension, the presence of target-organ damage (heart, kidneys, brain, vessels, retina), and how the condition affects the ability to tolerate physical exertion.

This article explains what is considered hypertensive disease, how its stages differ, the logic the VLK uses to determine fitness, and which documents and examinations are most often required to confirm your health status. We also provide practical tips on how to prepare for the examination, avoid common mistakes, and properly document medical facts that actually influence the commission’s conclusion.

What is hypertensive disease

Key definitions and the essence of arterial hypertension

Hypertensive disease (arterial hypertension) is a condition in which blood pressure is persistently or regularly elevated and requires medical monitoring and treatment. For the VLK, what matters is not a single high reading, but a confirmed condition with an established stage, the grade of blood pressure elevation, and an assessment of damage to so-called target organs.

In the Schedule of Diseases (an annex to the Ministry of Defense Order No. 402), hypertensive disease is classified among disorders associated with elevated blood pressure (ICD-10 codes I10–I15).

Impact of hypertension on the body and functional capacity

The key issue with hypertension is not just the numbers, but the risk of target-organ damage: the heart (hypertrophy, heart failure), brain (cerebrovascular events), kidneys (impaired function), blood vessels, and the retina. It is the presence or absence of such changes that determines the “weight” of the diagnosis for the VLK.

It also matters to the VLK whether blood pressure is controlled with therapy. The notes on applying the relevant provisions of the Schedule of Diseases state that the stage of hypertensive disease is established taking into account blood pressure levels and objective signs of target-organ damage, and that the expert diagnosis must specify the stage and the nature of the damage.

Stages of hypertensive disease and their significance

Important: in medical practice, “stage” (target-organ damage) and “grade” (blood pressure level) are used in parallel. For the VLK under Article 39, both are relevant, but the stage and complications are often decisive.

Stage I — what it means

Stage I usually means elevated blood pressure is present, but there are no confirmed irreversible structural changes in target organs (based on ECG/echocardiography, fundus examination, renal function tests, etc.). In other words, it is uncomplicated hypertension that requires treatment and follow-up, but does not by itself prove severe functional impairment.

Stage II — more serious manifestations

Stage II is when elevated blood pressure is accompanied by objective signs of target-organ damage (e.g., left ventricular hypertrophy, retinal vascular changes, early renal involvement, etc.). That is why evidentiary support is crucial for the VLK: entries in the outpatient record, cardiology conclusions, and results of instrumental and laboratory testing.

Stage III — target-organ complications

Stage III is the most severe stage, with pronounced complications and/or significant structural target-organ lesions. For the VLK, it is essential whether these lesions are considered irreversible (this affects the fitness category under Article 39).

How the VLK assesses fitness for military service

Provisions of Article 39 — general rules for health assessment

Article 39 of the Schedule of Diseases in MoD Order No. 402 sets out the approach to hypertensive disease and secondary hypertension. It defines three key pathways:

• subparagraph “a” — Stage III hypertensive disease with irreversible structural target-organ lesions → unfit for military service;
• subparagraph “b” — Stage III hypertensive disease without irreversible target-organ lesions, as well as Stage II hypertensive disease → fit for service in specified support units/formations;
• subparagraph “c” — Stage I hypertensive disease → fit.

What is considered in determining fitness — blood pressure and organ damage

With hypertension, the decisive factors are not only the readings, but the persistence of elevated blood pressure and the presence of target-organ damage. These two blocks of indicators most often determine whether the conclusion will be “fit,” “fit for service in support units,” or “unfit.”

In practice, the VLK evaluates:

1. blood pressure levels and their persistence (whether this is documented beyond a single visit);
2. the grade of arterial hypertension (the Regulation provides a blood-pressure-based classification: grades 1, 2, 3);
3. documented target-organ damage (heart, kidneys, eyes, brain, vessels);
4. response to treatment (whether blood pressure is controllable or resistant).

How the commission’s conclusion is formed

A VLK conclusion is not the subjective opinion of one doctor, but a decision made under the criteria of the Schedule of Diseases, based on examination and documented medical data. The commission correlates your documents and test results with the fitness criteria and records the category in its conclusion.

The VLK conclusion is a legally significant decision based on:

• a medical examination;
• analysis of the medical documents provided;
• test results (if additionally prescribed);
• application of the Schedule of Diseases and its notes (annexes to Order No. 402).

A separate nuance in recent years: the “limited fit” status as a standalone category was abolished, and the system shifted to formulations such as “fit,” “unfit,” and “fit for service in support units …,” etc.

If you disagree with the conclusion or have reason to believe your documents were not considered, you may seek legal assistance and appeal the VLK decision.

Fitness for service at different stages of hypertension

Below is the logic specifically under Article 39 of the Schedule of Diseases. It does not “predict” the exact conclusion in every case, but it sets the boundaries for fitness categories.

Fitness with Stage I

For Stage I hypertensive disease, the Schedule of Diseases directly provides: “Fit.”

In practice, this means the fact of Stage I without complications usually does not justify an “unfit” conclusion. If a person has significant deterioration, the key factor is not the label “hypertension,” but documented functional impairment and/or comorbid diagnoses relevant under other articles of the Schedule.

Restricted fitness with Stage II

The term “limited fit” is still used colloquially, but the official VLK wording is what matters. For Stage II hypertensive disease, Article 39 provides fitness for service in designated units/support formations, TCCs, training centers, medical units, logistics, communications, security, etc.

In other words, this is not an automatic “exemption,” but a restriction on the type and/or place of service when the condition is incompatible with certain loads but allows service in support roles.

Importantly, do not confuse “limited fit” with “temporarily unfit.” A brief explanation of the difference is here: Limited suitability and temporary unsuitability: what is the difference and what does it mean?.

Unfitness with Stage III and complications

For Stage III hypertensive disease, the decision depends on whether irreversible structural target-organ damage is present:

• if present → unfit for military service (subparagraph “a” of Article 39);
• if not present → possible fitness for service in support units/formations (subparagraph “b” of Article 39).

That is why, in severe cases, the quality of evidence becomes decisive: hospital discharge summaries, echocardiography findings, documented complications, and specialist opinions.

How to substantiate the diagnosis for the VLK

Required medical documents

For the VLK, it is not what you say about your blood pressure, but what is documented. The more systematically discharge summaries, test results, and physicians’ conclusions are gathered, the less room there is for doubt about the diagnosis and stage.

It is usually useful to prepare:

• discharge summaries/epicrises (if hospitalized);
• the outpatient record or extracts from it with documented elevated blood pressure;
• ECG and echocardiography results (as indicated);
• tests reflecting kidney function (as prescribed);
• an ophthalmologic fundus exam, as evidence confirming or refuting target-organ damage.

Why this matters: the notes to Article 39 explicitly state that the stage is established considering blood pressure level and objective signs of target-organ damage.

Examinations and blood pressure monitoring (e.g., ABPM)

The most common issue at the VLK is “no proof of persistent elevated blood pressure.” That is why tests showing blood pressure over time matter—particularly Ambulatory Blood Pressure Monitoring (ABPM). In everyday speech it is sometimes called a “blood pressure Holter” (not to be confused with ECG Holter monitoring).

ABPM can show 24-hour averages, the night profile, and peak surges, thereby strengthening the evidentiary basis for the diagnosis.

The role of the cardiologist’s conclusion

A cardiologist’s conclusion is valuable not by itself, but because it:

• formulates the diagnosis correctly (stage + grade + risk/complications);
• references specific examinations (echo, ABPM, labs);
• describes whether target-organ damage is present and what it is.

This directly matches the VLK requirement to formulate an expert diagnosis indicating the stage and organ damage.

Practical recommendations for conscripts/reservists

How to prepare for the VLK

Preparing for the VLK is, in essence, preparing your evidence: what exactly is diagnosed, what stage is documented, which tests confirm it, and how long the condition has persisted. A structured approach helps avoid situations where the commission “does not see” the disease because key documents are missing. Below is a short checklist.

1. Assemble documents into a logical package: concise discharge summaries + key tests + specialist conclusions.
2. Make sure the documents are specific: stage/grade, target-organ damage (or its absence), test dates, signatures/stamps (where applicable).
3. Avoid self-diagnosis: the VLK assesses documented conditions under the Schedule of Diseases.

If you need legal support regarding VLK/TCC issues or a document review before the commission, see “Military Law”.

Proper medical follow-up

If your blood pressure is elevated, the best strategy is not to “game” readings for the VLK, but to follow a standard treatment pathway: regular follow-up, therapy, and monitoring. First, it reduces health risks. Second, a consistent medical history is what makes your position clear to the commission.

Common mistakes in assessing fitness

• Relying on one-off blood pressure measurements without proof of persistence or a confirmed diagnosis.
• Lack of evidence of target-organ damage when asserting Stage II–III.
• Confusing “grade” and “stage” (and vice versa), even though the criteria differ.
• Relying on the outdated “limited fit” status: after changes, different official formulations apply, and many people with the old status underwent re-examination.

Frequently asked questions

Does Stage I hypertension affect fitness for military service?

Under Article 39 of the Schedule of Diseases, Stage I hypertensive disease falls under the “Fit” category. However, comorbid conditions (cardiac disorders or other diagnoses under different articles) may affect a specific case.

Which stages of hypertensive disease can lead to unfitness?

Under Article 39, Stage III with irreversible structural target-organ damage leads to unfitness.

How to confirm hypertensive disease before the VLK?

The most persuasive combination is a documented medical history plus tests that confirm:

• persistent elevated blood pressure (ABPM often helps);
• stage (through assessment of target-organ damage);
• grade (based on blood pressure levels).

Can you be mobilized with Stage II hypertension?

Under Article 39, Stage II does not automatically mean “unfit”: it typically results in fitness for service in designated support units/formations.

Which hypertension complications are considered by the medical commission?

The VLK focuses on target-organ damage and its irreversibility—heart, kidneys, brain, vessels, and the fundus—based on objective findings documented in medical records.

Conclusion

Hypertensive disease affects fitness for military service not by the “name of the diagnosis,” but by stage, blood pressure grade, and the presence of target-organ damage. Under the current logic of Article 39 of the Schedule of Diseases: Stage I — fit; Stage II — fit for service in support units/formations; Stage III — either fit for support roles or unfit if irreversible lesions are present.

If you are preparing for the VLK, the best step is to assemble an evidence-based medical file (tests, specialist conclusions, confirmation of stage and complications) and stick to documented facts—these are what the VLK compares with the criteria of MoD Order No. 402.

If you need an individual review of documents before the VLK or support in a disputed situation, contact the lawyers of “Pravovyi Lider”—the first consultation is free.