New rules, old problems: the UNBA discussed the work of the ETAIDF and MMC

The reform of medical-social assessment and military medical commissions has changed procedures but has not resolved practical issues. People face situations where documents are not issued, decisions are based on technicalities, assessments are delayed, and they struggle to demonstrate their actual health status in specific life situations.

These issues were explored during the roundtable «Challenges facing the ETAIDF and Military Medical Commissions», organized by the UNBA Committee on the protection of the rights of persons with disabilities in collaboration with civil society organizations.

Participants discussed the reform of the Medical and Social Expert Commission (MSEC), the practice of appealing decisions by the Medical and Labor Commission (MLC) and expert teams assessing a person’s daily functioning (ETAIDF), as well as the challenges faced by conscripts, military personnel, and civilians with disabilities.

Reform in question

The meeting was opened by the chairman of the UNBA Committee Oleksandr Voznyuk, who explained that its goal was to discuss new trends in reforming the Medical and Social Examination Commission (MSEC) and the system for assessing individuals’ functioning, as well as the mistakes that arise during the implementation of this reform. He outlined the main topics of discussion: whether the reform has taken place, whether the decisions of expert teams have improved, whether patients and doctors are satisfied, whether time spent has decreased, and whether any shortcomings remain.

O. Voznyuk also mentioned his participation in work with the Ministry of Health, various departments, and researchers on Law No. 4170-IX of December 19, 2024, regarding the reform of medical and social expertise and the introduction of assessments of a person’s daily functioning, as well as on Cabinet Resolution No. 1338 of November 15, 2024, «Certain issues regarding the introduction of the assessment of an individual’s daily functioning».

Separately, the advocate drew attention to the reform of the Medical and Social Expert Commission (MSEC). In his assessment, this area is one of the most complex, and the most difficult changes are being advanced in cooperation with the Ministry of Defense.

A certificate that does not exist

Member of the Committee Ivanna Kostrakevych focused on appeals against decisions of the Medical and Social Examination Commission (MSEC) at the TCC and the Specialized Medical Commission (SMC) during conscription and regarding military personnel. She noted that the commission issues resolutions in the form of a medical certificate or a statement of illness, and the appeal period is one month.

One of the practical problems the advocate highlighted is that, during conscription, conscripts are not issued with the Medical Examination Commission’s certificates, even though the documents are generated electronically. Because of this, advocates are forced to request them from the TCC, and the person effectively does not have a document in hand that they can use to appeal. In her opinion, MMC certificates should be available in electronic form in «Reserve+», since the loss of paper documents subsequently complicates the retrieval of medical records and materials.

Separately, I. Kostrakevych drew attention to the handling of medical data. She noted that starting in 2025, medical documents from municipal and state institutions will be generated in the Unified Health Care System (UHCS) and MMC members will be able to view information about the conscript’s health status during examinations. At the same time, she said, in practice, not all members of the Medical Examination Commission take this data into account or properly assess existing conditions and the severity of their symptoms.

As examples, she cited situations where medical records contained information about illnesses but were not properly reflected in the Medical Examination Commission’s conclusion, as well as a case in which an individual was deemed fit for military service following psychiatric treatment despite the existence of medical records in the UHS.

Not the diagnosis, but the functions

The ETAIDF’s decision lies at the intersection of medicine and law, and the quality of the initial decision often determines whether a legal dispute will arise later. This argument was put forward by member of the Committee Oleg Romanishyn, who emphasized that an administrative appeal is the mechanism through which the substance of the medical assessment is actually reviewed, whereas the court does not reassess the individual’s functional status and primarily reviews the procedure. Therefore, according to him, it is not only the initial decision itself that matters, but also the content of the complaint filed by the patient or their representative.

Among the problems, O. Romanishyn noted that the ETAIDF decision is effectively a form-based document with minimal reasoning. Because of this, the patient does not understand the reasons for the refusal to establish a disability group or the causal link; the advocate does not see what exactly to challenge; and the doctor who issued the referral does not see where his conclusion was not taken into account or how the diagnosis was correlated with the disability group.

Denis Sukhotin of the Transcarpathian Regional Association of Persons with Disabilities noted that the issue of medical commissions has become more prominent not only because of the number of cases but also due to the military’s active efforts to appeal decisions regarding their health status. At the same time, people with congenital disabilities or disabilities not related to military service often have less psychological resilience and fewer resources to navigate challenges in the healthcare system.

The implementation of the ETAIDF, according to the speaker, has complicated the procedures, particularly due to the system’s slowness and the technical unpreparedness of some doctors for digitalization. As an example, D. Sukhotin cited the case of a woman with a congenital visual impairment who needed to renew her old MSEC certificate and obtain a new medical opinion, but the process had been ongoing since March, and she had still not received a referral to the ETAIDF. According to him, the problem began because the doctor did not know how to record the case in the electronic system.

Among other examples, he cited a case where a person, due to a deterioration in their health, needed a wheelchair instead of crutches, but the process took 12 months. There was also a case of an internally displaced person abroad who submitted German medical documents with an official translation to Ukrainian doctors, but the doctors did not know how to process them.

D. Sukhotin emphasized that for people with disabilities, what matters is not a formal list of regulations, but a clear, practical path: from the start of the procedure to the final outcome.

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Summarizing the discussion, O. Voznyuk noted that practical cases are being collected to change the rules and simplify procedures for all parties. According to him, the ETAIDF system remains imperfect, and some doctors perceive it as an additional technical burden. At the same time, the war has accelerated the development of medical law, so new rules in this area must be formulated with an eye toward the real-life situations faced by patients, doctors, and advocates.