The Military Medical PULHES Grading System

To determine if a recruit is eligible for service, the military requires a series of medical fitness checks. These medical checks are graded using what is called the PULHES Factor, which is an acronym that stands for the following:

• P — Physical capacity/stamina
• U — Upper body
• L — Lower body
• H — Hearing
• E — Eyes
• S — Stability/psychiatric

All jobs have specific standards, and upon entering the military the recruit will also be given a numerical grade of one, two, three, and four for each element of the PULHES acronym system.

Physical Profile Serial System

The physical profile serial system is created around the various military duties and provides a numerical standard that a medical doctor recommends during the routine recruit physical. These physicals are based primarily upon all of the body system functions. Great care is given to executing a medical functional grade as these grades are an analysis of the individual’s medical, physical, and mental status.

Here's a more detailed breakdown of the Army's PULHES system:

• Physical capacity or stamina. The P in PULHES is an overall inspection of the body and its living systems (heart, lungs, digestion, reproductive, central nervous system, and hormonal). Common diseases of any of these systems stemming from nutritional deficiencies, blood diseases, allergies, breasts, soft or hard tissues as well fall under the physical capacity or stamina element.
• Upper extremities. The U in PULHES is focused on the upper body checking for any weakness, lacking full range of motion, and general deficiencies with movement.
• Lower extremities. The L in PULHES concerns the lower body from the lower back and hips connections (bones, muscle, soft tissue) to the feet and toes checking for any weakness, lacking a full range of motion, and general deficiencies with movement. 
• Hearing and ears. The H is PULHES is focused on hearing and any diseases of the ear. 
• Eyes. The E in PULHES concerns the recruits ability to see to a certain standard and able to see red/green color differences as well as diseases and defects of the eye.
• Stability / Psychiatric. The S in PULHES concerns personality, emotional stability, and psychiatric diseases. 

How PULHES Are Graded

As for the numerical designations, the PULHES grades generally mean a military medical evaluation of numbers one through four:

1. The military considers an individual having a numerical designation of “one” under all factors to possess a high level of medical fitness. A number one in all categories means that people fully ​qualify and will require no medical waivers. 
2. A physical profile designation of “two” under any or all factors indicates that an individual possesses some medical condition or physical defect that may require some activity limitations. There are many jobs still available in the military for people who do not perfectly physically/medically qualify for arduous duty.
3. A profile containing one or more numerical designations of “three” signifies that the individual has one or more medical conditions or physical defects that may require significant limitations. For those applying for military service, this designation is usually a disqualification. For individuals already in the service, like amputees or seizure patients, they may still be able to stay in the military, but limited in what duties they can perform.
4. A profile serial containing one or more numerical designations of “four” indicates that the individual has one or more medical conditions or physical defects of such severity that the performance of military duty must be drastically limited. This value of four is a disqualifier for both entering the military, and for continued military service, if already in the military.

How the Grading System Works

For example, if a military job requires a serial profile of "123123," that means in order to qualify for that job, a person would have to be medically rated the following:

• P — One in the area of physical capacity or stamina
• U — Two in the area of upper extremities
• L — Three in the area of lower extremities
• H — One in the area of hearing and ears
• E — Two in the area of eyes and visual acuity
• S — Three in the area of stability/psychiatry