Interdepartmental variability of expert decisions in military medical examination: a comparative analysis of fitness categories among conscription-age citizens

BACKGROUND: Ensuring the national security of the Russia requires maintaining a high level of readiness of security forces, which is directly associated with the quality of medical selection of personnel. Military medical examination is a key tool for assessing the health status of conscription-age citizens; however, despite unified regulatory frameworks, variability in expert decisions persists across federal executive authorities and regions.AIM: Comparative analysis of interdepartmental variability of expert decisions in military medical examination based on the assessment of the distribution of fitness categories for military service among conscription-age citizens.METHODS: A retrospective medical-statistical analysis of the results of military medical examination of conscription-age citizens in the systems of the MIA, the EMERCOM, and the Rosgvardiya for 2020–2025 was conducted. The study included data from four regions of the Russia: Moscow, SPb, Arkhangelsk, and Krasnodar Krai. Average annual rates of fitness categories A, G, and the combined categories D+V were assessed. Statistical analysis was performed using IBM SPSS Statistics. Data visualization was carried out using boxplot diagrams.RESULTS: A stable interdepartmental variability in the distribution of fitness categories was identified. The highest values of category A were observed in the National Guard system, the lowest in the MIA system, with intermediate values in EMERCOM. The opposite pattern was observed for categories G and D+V. The most pronounced interdepartmental differences were found in SPb, whereas in the Arkhangelsk differences were not statistically significant. Category G demonstrated high sensitivity to expert assessment strategies, reflecting variability in decision-making in borderline clinical and functional conditions.CONCLUSION: The interagency differences reflect both population characteristics and organizational/methodological factors, including differing interpretations of clinical conditions. The results support further standardization of expert assessments, implementation of unified clinical and diagnostic algorithms, and improved interagency coordination to enhance the objectivity of military fitness evaluation and national security.