Why did the military doctor do .... if it's not allowed for the Service Academies???

Over the years I have noticed a not so rare trend: A young person is treated in the military medical system and then when it comes time to receive DODMERB clearance they are disqualified for some treatment they received from a military physician. When this happens one of the first responses from applicants/parents is "why didn't the doctor know better" or "why didn't the doctor warn me" or "why were they allowed to do that when it's not allowed for the Academies."

Having now worked in the military medical system for several years and coming up on two years as a military physician I hope to answer/put to rest some of the reasons. For children who come in to see the physician one of the last things that we would even imagine to think of is "where is this patient going to go to college?" A more pressing issue is ruling out "bad stuff" and then coming to a reasonable diagnosis and treatment plan. Our goal as a physician is to provide the best/most reasonable treatment for a particular diagnosis and to return that patient to a state of well being. Various factors can play into what treatment plan we choose; however, if we don't know what those factors are we can't do anything about it. I have never had a patient who is of high school age come to me and say "doc, I want to go to an Academy so keep that in mind."

Now for the majority of military physicians even if you said that it probably wouldn't register that they need to consider disqualifying treatments. The great majority of military physicians have zero experience dealing with the service academies and their only experience with DODMERB is getting their own medical clearance when applying to medical school. The military physician is not a subject matter expert when it comes to DODMERB physicals and disqualifying diagnoses/treatments. Remember, we don't even do the physicals, they are contracted out. With that in mind we have very little interaction with any step in the Academy selection and therefore would not think of how a particular treatment would effect someone's DODMERB clearance.

The other factor in play is that many treatments can begin before someone even considers the Academies as a college choice. This can be true for those diagnosed as ADHD or some other problems.

Overall, please don't blame the military physician. Their ultimate responsibility is to treat the patient as best they can. If you are considering a Service Academy please consider informing your physician so they can become familiar with the regulations regarding your particular diagnosis and come up with a treatment plan that will work within your situation.

I am NOT a physician, but have been in this business for a long time. kp2001 is 1,000,000% correct!!! And the same goes for civilian physicians and retired or former military physicians working in a civilian setting.

I have a 6th grader that says he wants to goto USNA when he goes to college. My oldest is applying to USNA now. My youngest is on Vyvance for ADHD now. How can I find out what the rules are as far as what is acceptable and what is not, time frames, etc? I think I read somewhere they need to be off adhd meds by the time they are 14 to be eligible for the SA's. Is this true? Is there a list of guidelines that I can share with my doctor so going forward he looks for alternatives? On another note my dermatologist was trying to put my oldest on the new version of Accutane called Isotretinion. I discovered on my own that that is a DQ so I asked him to treat the acne another way. He thought I was nuts when I told him that was a DQ. I understand that doctors are doing their best to treat their patients. I just would like to know what is allowed on certain things and what is not. Anyone know where I can find this info?

MullenLE said:

I am NOT a physician, but have been in this business for a long time. kp2001 is 1,000,000% correct!!! And the same goes for civilian physicians and retired or former military physicians working in a civilian setting.

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I have a 6th grader that says he wants to goto USNA when he goes to college. My oldest is applying to USNA now. My youngest is on Vyvance for ADHD now. How can I find out what the rules are as far as what is acceptable and what is not, time frames, etc? I think I read somewhere they need to be off adhd meds by the time they are 14 to be eligible for the SA's. Is this true? Is there a list of guidelines that I can share with my doctor so going forward he looks for alternatives? On another note my dermatologist was trying to put my oldest on the new version of Accutane called Isotretinion. I discovered on my own that that is a DQ so I asked him to treat the acne another way. He thought I was nuts when I told him that was a DQ. I understand that doctors are doing their best to treat their patients. I just would like to know what is allowed on certain things and what is not. Anyone know where I can find this info?

psessions said:

MullenLE said:

I am NOT a physician, but have been in this business for a long time. kp2001 is 1,000,000% correct!!! And the same goes for civilian physicians and retired or former military physicians working in a civilian setting.

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I have a 6th grader that says he wants to goto USNA when he goes to college. My oldest is applying to USNA now. My youngest is on Vyvance for ADHD now. How can I find out what the rules are as far as what is acceptable and what is not, time frames, etc? I think I read somewhere they need to be off adhd meds by the time they are 14 to be eligible for the SA's. Is this true? Is there a list of guidelines that I can share with my doctor so going forward he looks for alternatives? On another note my dermatologist was trying to put my oldest on the new version of Accutane called Isotretinion. I discovered on my own that that is a DQ so I asked him to treat the acne another way. He thought I was nuts when I told him that was a DQ. I understand that doctors are doing their best to treat their patients. I just would like to know what is allowed on certain things and what is not. Anyone know where I can find this info?

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DOD Instruction 6130.03. You should be able to get to it here. However, each service has regulations that can 'tighten' the criteria based on needs of the specific service or position. Pilots for example have more rigid criteria.

IANAD but Accutane/Isotretinion are not disqualifying unless the diagnosis (severe acne that interferes with wearing protective equipment for example) for this treatment is disqualifying or the treatment is within a certain amount of time prior to examination.

"""IF""" anyone still has a question on this thread, follow the instructions on the "FAST" DoDMERB thread

psessions said:

I have a 6th grader that says he wants to goto USNA when he goes to college. My oldest is applying to USNA now. My youngest is on Vyvance for ADHD now. How can I find out what the rules are as far as what is acceptable and what is not, time frames, etc? I think I read somewhere they need to be off adhd meds by the time they are 14 to be eligible for the SA's. Is this true? Is there a list of guidelines that I can share with my doctor so going forward he looks for alternatives? On another note my dermatologist was trying to put my oldest on the new version of Accutane called Isotretinion. I discovered on my own that that is a DQ so I asked him to treat the acne another way. He thought I was nuts when I told him that was a DQ. I understand that doctors are doing their best to treat their patients. I just would like to know what is allowed on certain things and what is not. Anyone know where I can find this info?

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My oldest took ADHD meds for several years. He was told he had to be off all meds and NO sped accommodations for a 2 full years (which he did do). He dropped Sped when he entered HS. He did get a waiver for ADHD for a few places, but each academy and program is different. Honestly, those meds for a couple of years made all the difference in his education and he wouldn't have had the grades of knowledge of content without meds.

Fun Texas Family - For your information ....This thread was from Feb 2020.

Actually the initial post was from 2008, ten years before the sixth grader's post went up. Double zombie!

Fun Texas Family said:

My oldest took ADHD meds for several years. He was told he had to be off all meds and NO sped accommodations for a 2 full years (which he did do). He dropped Sped when he entered HS. He did get a waiver for ADHD for a few places, but each academy and program is different. Honestly, those meds for a couple of years made all the difference in his education and he wouldn't have had the grades of knowledge of content without meds.

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Where did he end up getting a waiver too? My son has been off meds for 2 plus years and no accomodations. He has received conditional appointment to USGA(he is also a athlete - coach called him with appointment news before xmas) and now we are waiting for med process - he was asked to send in AMIs which all support no meds for 2/3 plus years. Its his dream to attend and he is very worried about this process AND he always hated the meds

I happened to go my DD's last annual well-visit and I know the physician that my wife chose as our family doctor has a tendency to give a specialist referral for just about every complaint you might mention. I'm glad I went to the visit. My DD has a habit of staying up late on her phone then complains of not sleeping well and being tired, unfocused at school. She plays on 3 travel teams, is on her class NHS council and works 3 days a week...so when she mentioned poor sleep, and sometimes being distracted or tired at school, he discussed a consult for sleep study to R/O Narcolepsy and a Pysch consult for ADD. I was like....wooah camel! I did let him know that I don't have the opinion that she has either of those conditions with a high degree of confidence and that she is considering the path of a military officer. I am also a retired Army Reserve medical officer and am familiar with the regulations. I actually have received e-mails for the last two years asking me if I'm interested in a retiree-recall for 1 yr of AD to do these DoDMERB's virtually from the comfort of my home....after 2 weeks in GA then 5 weeks of training at Great Lakes. Maybe I'll regret saying no from a karma standpoint if/when my own DD has difficulty or delays with the medical piece.

USMC8993 said:

I happened to go my DD's last annual well-visit and I know the physician that my wife chose as our family doctor has a tendency to give a specialist referral for just about every complaint you might mention. I'm glad I went to the visit. My DD has a habit of staying up late on her phone then complains of not sleeping well and being tired, unfocused at school. She plays on 3 travel teams, is on her class NHS council and works 3 days a week...so when she mentioned poor sleep, and sometimes being distracted or tired at school, he discussed a consult for sleep study to R/O Narcolepsy and a Pysch consult for ADD. I was like....wooah camel! I did let him know that I don't have the opinion that she has either of those conditions with a high degree of confidence and that she is considering the path of a military officer. I am also a retired Army Reserve medical officer and am familiar with the regulations. I actually have received e-mails for the last two years asking me if I'm interested in a retiree-recall for 1 yr of AD to do these DoDMERB's virtually from the comfort of my home....after 2 weeks in GA then 5 weeks of training at Great Lakes. Maybe I'll regret saying no from a karma standpoint if/when my own DD has difficulty or delays with the medical piece.

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Glad you were there to throw yourself in front of that future DQ train.

Capt MJ said:

Glad you were there to throw yourself in front of that future DQ train.

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My main point is that the doctor's office can be a dangerous place for applicants. Family doctors nowadays have a very low threshold for specialist consults or putting things in charts that could cause speculative problems. Obviously, if my DD had a legit problem that needed treatment that would trump any concerns about scholarships or academy appointments.

USMC8993 said:

My main point is that the doctor's office can be a dangerous place for applicants. Family doctors nowadays have a very low threshold for specialist consults or putting things in charts that could cause speculative problems. Obviously, if my DD had a legit problem that needed treatment that would trump any concerns about scholarships or academy appointments.

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Agreed.
One family kid was listed as severe anxiety because they said yes to having panic attacks.

We asked why the yes. Because they forgot a test was scheduled one school day and "panicked".

justme said:

Agreed.
One family kid was listed as severe anxiety because they said yes to having panic attacks.

We asked why the yes. Because they forgot a test was scheduled one school day and "panicked".

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Classic.

My son sometimes is smarter than me. During a physical with his doctor - I told him to get an inhaler for me. The doctor said he would prescribe it … my son told the doctor no, he wasn’t going to be dishonest.

Turned out to be a good move. How do you explain to DoDMERB that you don’t have asthma- the inhaler was for your idiot father?

USMC8993 said:

I happened to go my DD's last annual well-visit and I know the physician that my wife chose as our family doctor has a tendency to give a specialist referral for just about every complaint you might mention. I'm glad I went to the visit. My DD has a habit of staying up late on her phone then complains of not sleeping well and being tired, unfocused at school. She plays on 3 travel teams, is on her class NHS council and works 3 days a week...so when she mentioned poor sleep, and sometimes being distracted or tired at school, he discussed a consult for sleep study to R/O Narcolepsy and a Pysch consult for ADD. I was like....wooah camel! I did let him know that I don't have the opinion that she has either of those conditions with a high degree of confidence and that she is considering the path of a military officer. I am also a retired Army Reserve medical officer and am familiar with the regulations. I actually have received e-mails for the last two years asking me if I'm interested in a retiree-recall for 1 yr of AD to do these DoDMERB's virtually from the comfort of my home....after 2 weeks in GA then 5 weeks of training at Great Lakes. Maybe I'll regret saying no from a karma standpoint if/when my own DD has difficulty or delays with the medical piece.

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Beyond the military path, this is so important for a plethora of other things!! Including ‘pre-existing conditions with insurance, health questionnaires for life insurance, etc, etc.

One of the best pieces of advice I ever got, was from our pediatrician. With our first born. Think ‘clueless parents’ here. He said ‘don’t label. Once you have you cannot uncheck that box’.

I have passed that along to my own kids, and all the parents I met through my daycare years. Anyone that will listen. It’s sometimes shocking how quickly DR’s want to proceed to diagnose. And how society wants to be labeled.

We were fortunate to have a conservative pediatrician. And it’s interesting how differing styles were, even within the same practice offices.

I am very thankful for Dr Pete.

justdoit19 said:

Beyond the military path, this is so important for a plethora of other things!! Including ‘pre-existing conditions with insurance, health questionnaires for life insurance, etc, etc.

One of the best pieces of advice I ever got, was from our pediatrician. With our first born. Think ‘clueless parents’ here. He said ‘don’t label. Once you have you cannot uncheck that box’.

I have passed that along to my own kids, and all the parents I met through my daycare years. Anyone that will listen. It’s sometimes shocking how quickly DR’s want to proceed to diagnose. And how society wants to be labeled.

We were fortunate to have a conservative pediatrician. And it’s interesting how differing styles were, even within the same practice offices.

I am very thankful for Dr Pete.

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I am also thankful for a great pediatrician when ds#2 was 6. He was so different than my first-born that I suspected he might have ADD/ADHD and asked the dr. about it. She pointed out that he was a 6yo boy and his behavior was completely normal for a 6yo boy. She gave me some good parenting advice based on her own experiences getting through medical school and that was that. I am so grateful that she saw through my lack of knowledge and general parenting fear and had DS's best interest at heart.

I think the advice not to label is so good!

Sometimes it is not the doctor’s fault but the patient’s. If the doctor asks you if you get short of breath and you answer yes (because you get “short of breath” whenever you run fast), and then the doctor makes a diagnosis that you have a possible breathing problem and lists it as a diagnosis in your chart and orders a big workup, then that is your fault for not answering the question correctly.
If the doctor asks you if you have panic attacks and you answer yes because one time you panicked when you forgot about the test that day, and the doctor diagnoses you with an anxiety issue, then that is your fault!

Wahoo Fan said:

Sometimes it is not the doctor’s fault but the patient’s. If the doctor asks you if you get short of breath and you answer yes (because you get “short of breath” whenever you run fast), and then the doctor makes a diagnosis that you have a possible breathing problem and lists it as a diagnosis in your chart and orders a big workup, then that is your fault for not answering the question correctly.
If the doctor asks you if you have panic attacks and you answer yes because one time you panicked when you forgot about the test that day, and the doctor diagnoses you with an anxiety issue, then that is your fault!

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I don't disagree but young folks don't have enough life experience to know what the 'right' answer is.