By Annette M. Boyle
FORT KNOX, KY — As the services draw down forces, standards for medical waivers for recruits apparently are tightening, especially when it comes to mental health issues.
The Army approved 377 fewer medical waivers for recruits in 2012 than 2011, down 5.7%, according to Kathleen Welker, U.S. Army Recruiting Command spokesperson. About 8% of new soldiers have medical waivers.
“The 8% represents a slight increase over the past couple of years, like tenths of a percent, but the percentage is also related to our end-strength goals. FY12’s mission was lower than FY11’s, so the percentage seemed to go up,” Welker told U.S. Medicine.
In 2007, about one-third of recruits entered the Army with some kind of waiver. In recent years, the number of some types of waivers has dropped dramatically. Last year, only 10% of new soldiers entered with waivers of any type. No waivers were approved for previous substance abuse issues or misconduct convictions in 2011.
Army personnel numbered about 570,000 at the height of the Iraq war, but DoD plans to cut that back to 490,000 by 2017.
Mental Health Waivers
Only about one-third of requests for waivers in the psychiatric or behavioral health category are approved, Welker said.
Army medical standards state that recruits who have previously had a single instance of short-term (i.e., less than six months) depression may receive waivers, but that usually does not occur. The other military services follow the same medical qualification requirements.
According to Reilly, in the mental-health category, “certain things are automatic disqualifiers, such as mood disorders like depression or bipolar disorder, suicide attempts, self-mutilation or drug/alcohol dependence. Each case is evaluated on its own merits.”
In a recent update, meanwhile, the Army National Guard has clarified its tough position on certain mental-health issues for recruiters. The Guard said in a memorandum that it has suspended all waivers for “mood disorders to include depression and bipolar disorder, drug or alcohol abuse/dependence” and previous suicidal attempts or gestures. The new guidelines are non-negotiable, with the directive stating that “during the period of the suspension, requests for exceptions will not be considered.”
The statement, issued in September, follows the loss of 12 Army National Guard soldiers to suicide in August. In 2010, 301 active duty, reserve and guard members committed suicide. The number of guard and reserve suicides doubled from 80 in 2009 to 145 in 2010. The number dropped to 118 in 2011, with 114 confirmed or potential suicides among guard and reservists through November 2012.
Behavioral health waivers also include those for attention deficit hyperactivity disorder and dyslexia or other learning disorders. Generally, an Army recruit must demonstrate passing academic or work performance without the use of medications or other accommodations for the previous 12 months. Waivers for conditions such as “ADHD depend on how long the applicant has been off medication and what they are doing and how they are functioning without medications,” said Col. Kevin Reilly, MD, command surgeon, U.S. Army Recruiting Command. “It’s about the whole person.”
Despite the sharp increase in diagnoses of ADHD among American children and adolescents, Reilly said he doesn’t think there has been a rise in waivers for learning or attention issues.
According to the Centers for Disease Control and Prevention, nearly 10% of parents across the U.S. report that their children have received a diagnosis of ADHD. The prevalence of the condition varies significantly by state, with less than 6% of children in Nevada receiving a diagnosis, but more than one in seven children in Alabama, Louisiana and North Carolina considered to have ADHD.
As the diagnosed rates are highest in many states that typically provide a large percentage of the country’s soldiers, this disqualification could create a future recruitment challenge.
More waivers are granted for physical health issues such as orthopedic and eye conditions than mental health issues, however.
“Approximately 35% of individuals desiring to enter the armed forces today have some physical condition that is disqualifying,” said DoD spokeswoman Eileen Lainez. Some of those who are technically disqualified do receive waivers, however.
Welker noted that the most common medical waivers were for orthopedic and eye conditions, followed by those for psychiatric/behavioral health. Among the biggest orthopedic considerations for waivers are anterior or posterior cruciate ligament repairs and arthroscopic surgery repairs of dislocated shoulders, “especially where ‘devices’ such as screws or plates are left behind,” Reilly said.
Waivers may be considered in these cases, if the recruit has been cleared for unrestricted physical activity and has had no symptoms for six months to a year. Other common orthopedic conditions that receive waivers include a past history of Osgood-Schlatter’s disease, with no residual symptoms, and flat feet with no pain or involvement of the Achilles tendon.
As orthopedic issues, particularly related to back and joint pain, are the most common reasons for medical discharge within a year of enlistment, these waivers are carefully reviewed.
Waivers for eye conditions are typically for vision correctable by glasses. The major concerns for eye waivers are astigmatism, near and far vision corrections, and LASIK surgery, Reilly said.
Lainez suggested that recruits determined to support the work of the armed forces have other options other than enlistment.
“The Department of Defense team consists of both military and civilian members. Individuals who are physically disqualified for military duty can and do become civilian members of the team. The work they perform for the department and our country is valuable and rewarding but without the rigors of military duty,” she pointed out.
In 2007, the Army introduced a special waiver for physically fit recruits who exceeded weight standards. The program gave the new soldiers a year to lighten up. In 2010, former Secretary of Defense Robert Gates noted that three-quarters of potential recruits were ineligible to join, usually because they were obese or overweight.
While recruiting commands did not comment specifically on changes to the program, the Army dismissed 1,625 soldiers for not meeting physical standards in the first 10 months of this year, about 15 times the number let go in 2007, according to media reports based on DoD documents.
The most common age for diagnosis of schizophrenia is late teens to early 30s.
A new report gave the VA high marks for the quality of mental health care provided to veterans of the conflicts in Iraq and Afghanistan, according to the National Academies of Sciences, Engineering and Medicine.