war on the rocks

Department of Disqualified: Fixing the Broken Military Medical Accessions Process

November 20, 2018

If discontent is the first necessity of progress, then the military medical accessions process — by which recruits are medically evaluated for military service — is ready for improvement. With 59 percent of Americans medically ineligible to join and tens of thousands of applicants medically rejected every year, there is plenty of discontent. I would know. I was one such disgruntled applicant.

I started applying to Army Officer Candidate School in October 2015 as a senior at the Massachusetts Institute of Technology. After seven months of navigating the medical accessions process, I was medically rejected from the Army on account of congenital scoliosis and a medical history of spinal fusion surgeries. Neither my career as a Division III Varsity soccer player nor a letter from my surgeon — a retired Army doctor and chief of orthopedic surgery — noting that I had “no limitations whatsoever” had any impact on my medical evaluation. After switching my application to the Navy the following spring, I was medically rejected again. Finally, after one last medical rejection from the Army National Guard in the summer of 2016, I gave up on my dream of serving my country in uniform.

As anyone who has served will tell you, the “needs of the military” come before any individual servicemember and, by extension, applicant. With this I completely agree. But what, exactly, are the needs of the military? We often hear about the military’s “brain drain,” from a well-documented dearth of military officers from top universities to the need for applicants with STEM skills, a shortage that former Secretary of Defense Ash Carter sought to address as part of  a comprehensive initiative known as the “Force of the Future.” In the complex security environment defined by rapid technological change described in the 2018 National Defense Strategy, it is likely that the impact of shortages will only be exacerbated.

Given these needs, the military should be going out of its way for applicants from top universities or with STEM skills. And while there are some promising initiatives, including an Army effort to directly commission and provide recruitment bonuses to cyber warriors, the overly restrictive medical accessions process is preventing countless similar applicants from joining military service. My personal experience is, unfortunately, not atypical. I have met a number of applicants with similar stories. A classmate at MIT, studying computer science, was medically rejected after having completed his first year of Reserve Officer Training Corps, forcing him to pay back his first year’s tuition scholarship in full. Why? Because of a minor tree nut allergy. I have a coworker who has multiple degrees from Stanford, on top of being a Rose Bowl Champion football player, who was rejected from military service on account of mild sleep apnea that is easily remedied with a mouth guard.

Thousands of highly qualified applicants are rejected each year for medical conditions that may not impact their ability to serve. Incredibly, despite its self-described needs, the military does not know how many such applicants are rejected each year, nor does it fairly evaluate most of the applicants it does reject. I propose an assisted accessions process for applicants with STEM skills and other highly qualified applicants to address the shortcomings of the waiver process and meet the changing needs of the armed forces.

A Troubling Pattern

If you think the examples discussed above are simply a few bad cases, consider this: In 2012, according to the Department of Defense’s Accession Medical Standards Analysis & Research Activity (AMSARA) Annual Report, 38,000 of 200,000 active duty applicants (or 19 percent) across all military services were medically disqualified from service. If disqualified, it is possible to apply for a waiver, but it is generally the recruiter’s decision. Yet recruiters are neither medical professionals nor are they empowered to evaluate an applicant holistically, weighing their talents and background against their medical condition. Such a holistic evaluation is the intent of the waiver process, but three-quarters of disqualified applicants never apply for one or, more commonly, they are never allowed to apply. In 2012, less than half of disqualified applicants (18,000 out of 38,000) applied for a waiver.  Similar trends exist between 2010 and 2015 (the last year for which AMSARA data is available) and across the Reserve and National Guard components. In my case, I was medically rejected pre-physical and not allowed to apply for a waiver during my rejections from the Army, the Navy, and the Army National Guard.

According to AMSARA, the top conditions for active duty medical disqualification from 2010-2014 were weight/body build (17 percent), psychiatric (12 percent), refraction (11 percent), and skin/allergies (9 percent). These conditions largely hold across years and components. Many conditions included in these categories may inhibit an applicant’s ability to serve effectively. However, many do not. Although overweight applicants would most likely not be able to meet military physical standards, according to AMSARA one-third of “weight/body build” disqualifications include cases of underweight applicants who may not have such issues. Ongoing psychiatric conditions should be taken seriously, but even symptoms or outpatient treatment of depression within three years of applying for military service is disqualifying, according to the Department of Defense’s Medical Standards for Appointment, Enlistment, or Induction regulations. Vision that cannot be corrected to 20/40 as well as allergic reactions to fish, insects, and nuts can be disqualifying as well.

My argument is not that the military should give up strict medical and physical standards entirely. Given the unique mission and demands that the military puts on servicemembers, these standards are necessary for many roles. But out of the 30,000+ applicants across all services and components who are medically disqualified each year without an appeal for a waiver, there are many who would provide tremendous value to the military despite their medical conditions — applicants who are “worth the risk.” These applicants should not be waived for certain physically demanding military occupations (Army and Marine Corps infantry, Air Force pilot) or career tracks (special operations), but have much to offer in other career fields (engineering, logistics, intelligence, cyber) where their medical histories will not have an impact on their job performance. Unfortunately, medical standards are not eased for these less physically demanding positions.

The rigidity of the military’s standards is particularly self-defeating when it comes to the disqualification of top-tier applicants and applicants with STEM skills. How many disqualified applicants might fall into these categories? The Department of Defense cannot even begin to answer this question. And that, too, is part of the problem. In the section “The Procrustean Bed: The Military Personnel System,” the Force of the Future report describes how the military services were unable to identify or even define top talent when asked by the Office of the Secretary of Defense. The report proposes that the military services start to capture, record, and employ the unique background and skills of their forces, especially Reserve and National Guard troops, who may have special expertise from their civilian jobs. Given the Defense Department’s limited internal talent management capacity, it seems unlikely that the department will attempt to understand the talent of accepted applicants, let alone rejected ones, in the foreseeable future. Thus, thousands of applicants each year will continue to be medically rejected without applying for a waiver. And the Defense Department will continue not to know what it is missing.

The Way Forward

With discontent accounted for, what of progress? There is certainly no shortage of ideas. Some, like Jacquelyn Schneider, advocate a complete reevaluation of the military accessions process and standards. Others counter that this could damage military readiness and have implications for military culture. However, there is a middle-ground approach that will give highly qualified and in-demand applicants a chance to serve without compromising readiness.

I propose creating an “assisted accessions process” for shepherding these applicants through the bureaucratic and often dysfunctional accessions process. Eligible applicants could be evaluated by a number of factors, including undergraduate university, grade point average, military aptitude test score, and/or physical fitness test score. If the military requires more recruits with a certain background — computer science, for example — applicants with skills in these fields could be flagged for the assisted accessions process. The system would give select applicants access to senior military leaders and medical professionals, who would evaluate the applicant holistically, weighing the talent they bring to the military against the risk that their medical history presents.

Theoretically, this is what the medical waiver appeals process is supposed to do. However, as my case illustrates, many steps and people stand between an applicant and a waiver appeal. The system proposed here would empower senior leaders to make more informed decisions earlier in the process, before highly qualified applicants are turned away or disqualified. Senior leaders are busy, but if managed correctly, such a system would not take much of their time — they would likely only be evaluating a few hundred applicants per year, and each would only take a handful of hours of each leader’s time (review of file, interview, shepherding). Considering the potential return on investment to the military, it would be time well spent. Moreover, much of this process could be automated: For instance, if an applicant gets a certain score on their Armed Forces Qualifying Test or Physical Fitness Test and gets medically rejected, they could automatically get entered into the waiver process.

I am confident that such a system would work because I benefited from such assistance, albeit informally. After my three medical rejections, I restarted my application to the military through the Air National Guard. Although I was, once again, initially medically rejected prior to a physical, this time I had backup. A friend who was a senior officer in the Air National Guard was, along with the State Air Surgeon, able to get me temporarily waived to take a physical at the Military Entrance Processing Station. Notably, this physical was the first time that I was officially screened in-person by a medical professional in any of my four accessions attempts. At the Military Entrance Processing Station, the physician, an independent medical reviewer, was forced to officially disqualify me based on regulations but recommended me for a waiver. My file then went to the office of the Air National Guard Surgeon General where, with strong advocacy from the State Air Surgeon, I received a waiver and was medically cleared for military service. Three years later, I now have the opportunity to serve my country as an engineering officer in the Air National Guard.

My story happens to have a happy ending because the stars aligned for me. I happened to be connected to senior military leaders who were not only able to assist me, but had an incentive to do so. (In the National Guard, recruits apply directly to their state of choice, as opposed to Active Duty recruits who process through a local recruiting station and then go off to the “big” Army or Air Force. Thus, National Guard units have an incentive to pursue waivers for applicants that they want in their unit.) Without those senior leaders, I would not have received a medical waiver. Many more like me could be allowed into military service if we gave them similar access and attention.

Skeptics of the assisted accessions process may object for a number of reasons including scalability, deployability, and affordability. First, they may argue that senior leaders do not have the time to assist applicants. However, the assisted accessions process would most likely only apply to a small number of highly motivated candidates per year. Additionally, as discussed, this system would not require an exceptional amount of time per applicant and some of the process could be automated. Second, some may suggest that my proposal runs contrary to Secretary of Defense James Mattis’ “deploy-or-get-out” rule for the military. But, I am not advocating changing military medical or physical standards. Rather, my proposed assisted accessions process aims to give specific applicants (those who fit the self-described needs of the military) the opportunity to apply for a medical waiver. If these applicants are rejected by the waiver authorities, so be it, as long as they are evaluated holistically and the military is making a conscious assessment that the applicants’ medical conditions will prohibit them from successfully completing military service. Third, skeptics might raise the concern of second-order financial impacts, such as potential future medical expenses in service and in retirement. However, the costs of tens or even hundreds of potential assisted applicants will be relatively small compared to the 100,000–150,000 military accessions per year. And if the military truly needs top talent and STEM skills to compete with U.S. adversaries, the cost of inaction will be orders of magnitude higher than the cost of action.

Some readers might agree with the ends advocated here, but disagree with the means. These critics might posit that there are simpler ways to increase STEM talent or highly qualified service members in the armed forces — such as increasing the size of the MIT Reserve Officer Training Corps program, as an example — that are less burdensome than creating an entirely new process inside a large, bureaucratic organizations like the military services. However, expanding existing programs, like ROTC, will not solve the problem. Cadets will still need to receive a medical clearance before signing a contract. Thus, I would still be rejected as would my aforementioned MIT classmate. Additionally, focusing on existing ROTC-type programs would necessarily be reactionary. It would take five years for recruits to apply and be accepted to a university, complete their undergraduate education, and then commission as officers. Although STEM skills are likely going to be important for military operations for the foreseeable future, such a system would not be able to accommodate urgent needs for other skill sets. If the United States becomes involved in another major counter-insurgency, for instance, the armed forces may need more sociologists and psychologists. The assisted accessions process would be more agile and responsive to such needs, since it focuses on assisting current applicants, instead of recruiting and educating new applicants.

Still, I recognize that my proposal is a band-aid solution. Structural changes need to be made to the military recruitment and accessions process if the military wants to win the “war for talent” — specifically, the armed forces must reevaluate the incentives and qualifications of recruiters, the Military Entry Processing Station screening process, and the medical standards themselves. And recruitment and accessions are just one piece of the military talent management system that needs to be reimagined, including assignments, promotion, retention, and retirement. Thus, the assisted accessions process would be little more than a drop in the ocean — but it would be an important start.

Conclusion

Most people may not realize that some of this country’s greatest military and political leaders had to overcome significant medical barriers to enter military service. In his early twenties, John F. Kennedy was rejected from enlistment twice due to back issues. Only through connections from his father, the former ambassador to the United Kingdom, was Kennedy able to join the Navy. As an applicant to the United States Military Academy, Douglas MacArthur was rejected twice due to scoliosis. After moving to Wisconsin to work with a medical specialist for two years of intense physical therapy, he was able to reduce his spinal curvature sufficiently to gain entrance to West Point. Without their own champions and medical exceptions, these two great Americans, and surely many others, would not have been able to serve their country in uniform.

Today’s highly qualified applicants, who are already asking what they can do for their country, deserve to know that there is something their country is willing to do for them. Such is the discontent that we can prevent, and the progress we need.

 

Joe Schuman is a recent graduate of the Massachusetts Institute of Technology and an Air National Guard applicant. He works in Washington, DC in the defense innovation community. He can be contacted at joeschuman1234@gmail.com.

Image: Staff Sgt. Duane Duimstra