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Commentary On Medical Group Processes And Opinions From An Enlisted Airman

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Guest
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[quote]To minimize confusion in this post, I will combine the terms transsexual(ism) and transgender(ism) to just "trans" and "trans-ism." These terms are still relatively new and have not yet been fully defined, especially due to their many similarities.

Various interest groups and political leaders have begun to investigate the policies of denying trans personnel from joining the US Military, the administrative separation of trans personnel upon discovery, and denying coverage for trans procedures or care.
[url="http://www.defense.gov/news/newsarticle.aspx?id=122225"]http://www.defense.gov/news/newsarticle.aspx?id=122225[/url]
[quote]
Hagel was also asked whether department policy regarding trans individuals serving in the military should be revisited now that gays and lesbians are allowed to serve openly. He called the issue complicated because of its' medical component.
“These issues require medical attention. In austere locations where we put our men and women in many cases [those military posts] don’t always offer that kind of opportunity,” he explained.
“I do think it should continually be reviewed … because the bottom line [is] every qualified American who wants to serve our country should have an opportunity, if they fit the qualifications and can do it. This is an area we’ve not defined enough,” Hagel said. [/quote] This is a politically sensitive topic in a progressively tolerant society. Additionally, as recent policy changes allowing Lesbian, Gay, and Bisexual individuals to continue to serve, it seems the DoD is still discriminating or punishing the last letter of the ever so popular acronym, "LGBT."

Why is the military allowed to deny entry or discharge personnel for these conditions? Titles 10 and 14 of the US Code and the Civil Rights Act of 1964 only protect against discrimination based on race, color, religion, sex and national origin. Age and medical conditions are not protected. Note that the Americans with Disabilities Act and Title 42 of the US Code generally do not apply to uniformed military service members, but they usually extend to most civilian personnel in the DoD. This also means that unless the Supreme Court rules at some later date, the legislature could reinstate some version of DADT, or repeal the repeal of DADT and allow the DoD do selectively enforce it in it's own way. Of course this is definitely not going to happen anytime soon, but the point is that it could legally happen.

One of the key points is that the Air Force and DoD do not consider trans-ism "unfitting" but rather "unsuiting." In short something "unfitting" is a medical disability or disease that prevents military service due to a physical condition (AFI 48-123), while something "unsuiting" is a behavior or disorder that somehow precludes service due to the nature of the condition and the requirements of military service (AFI 36-3208). Some conditions blur this line, and others have specific exemptions, such as PTSD. These categories are considered beyond the member's control and the member will not be "punished" but may require application of "Force Management Programs."

An example of this subtle difference might be highlighted in a presumptive ADHD diagnosis. Let's imagine an Airman sees her PCM with a complaint of difficulty concentrating. After some discussion, the doctor might order some laboratory tests.
[list]
[*]If the labs are normal, the doctor may refer the patient to Mental Health and/or the Behavioral Health Optimization Program (BHOP). Despite a year or more of counseling and various medication trials, the member has had minimal improvement. She has continued difficulty performing her duties and little desire to remain in the Air Force. Her Mental Health providers and Commander would likely pursue an Administrative Discharge for an "unsuiting" condition. This would be a UNIT COMMANDER ADMINISTRATIVE action with MEO/EEOC and AF/JA oversight.
[*]If the labs identify an abnormally low TSH levels and other results, the doctor refers the member to an Endocrinologist. The specialist diagnoses her with some variant of hyperthyroidism. After a year of various medication trials and possible procedures, the hyperthyroidism is only minimally controlled and still requires regular evaluation by the Endocrinologist, regardless of whether her ADD-like symptoms have improved or not. Her doctor compiles the medical information from her medical record and begins the Initial Review In Lieu of Medical Evaluation Board (I-RILO MEB) process for an "unfitting" condition. This would be a MEDICAL action with PERSONNEL (AFPC) oversight.

[/list] AFI 36-3208, para. 5.11.9. states that to pursue administrative discharge, "[...] A recommendation for discharge under these provisions must be supported by a report of evaluation by a psychiatrist or PhD-level clinical psychologist who confirms the diagnosis of a disorder listed below, as contained in the current edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). [...]" The specific definition is in para. 5.11.9.5. as "Transsexualism or Gender Identity Disorder of Adolescence or Adulthood, Nontranssexual Type (GIDAANT)."
The most recent edition of the DSM has changed the class of disorders from “Sexual and Gender Identity Disorders” to the more accommodating term of "Gender Dysphoria." This move was to emphasize that [url="http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf"]"Gender identity disorder [...] is neither a sexual dysfunction nor a paraphilia."[/url] Despite this change, the American Psychiatry Associations' compromising and opinion, the DoD retains ultimate ownership of personnel actions.

But why does the DoD consider trans-ism "unsuiting?" There will likely be numerous and varied answers to this question in the coming months, but here's my belief in the reality. In general, these conditions just aren't conducive to military service and are costly to the Military Health System. These conditions, whether they are presumably resolved prior to entry or not, and whether they will or have undergone surgical procedures or not, will almost certainly require extensive medical support. The specialty services most likely to be heavily utilized might include psychiatry/psychology/behavioral health, endocrinology, and urology/gynecology. The US Military doesn't exist to provide health care no matter how significant or costly a condition may be (though it doesn't always feel that way), but rather to provide independently-medically capable servicemembers to execute the various missions of the DoD. Such frequent evaluation and medical support precludes deployment or assignment to numerous locations, such as Korea, Turkey, or Africa. In summation, the logistics just don't add up.
Certainly there will be many people who would decry trans-ism as some corruption or aberrance, or others who could claim it would demoralize the unit. Whether these reasons have any merit or applicability is secondary. In the 21st century, it appears that religion and culture will be taking a back seat to finances.[/quote][/background][/size][/font][/color]
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Guest

What do you want from the Medical Group? You probably only want two things: good healthcare when you need it, and to be left the hell alone when you don't. Both of these things can only exist with good communication, something the Air Force generally lacks in great quantities. There will be many times when you really need to talk to somebody about the results of a test, the documentation from an off-base visit, or the status of a special duty application. There will also be times that the MDG wants to talk to you, so they annoyingly call you 5 times a day. Or they'll call once and leave a message, but their line is constantly busy or they never answer the phone.

You could attempt to physically go to the MDG, but the likelihood of being seen by the right person on the same day is pretty low unless you already made an appointment through the appointment line. IF your clinic has sick-call, that can only solve the few immediate medical problems, and not the many other medical requirements or your greater needs. Chances are that you will be re-directed to the appointment line.

Unfortunately, the Air Force doesn't employ several hundred Doctors to answer every phone call, so the caller has the great pleasure of instead talking to one of the dozen middle-men in the MDG, the gate-keepers that (slowly) route and direct phone calls, after enduring lengthy hold times. Does anybody enjoy calling the appointment line? How educated or skilled are the appointment line folks? Some are fabulous--many are not. You might just have a simple administrative request that doesn't need an actual face-to-face appointment, but you get to wait on hold for several minutes and are then told the wrong information. Alternatively, have you ever had the marvelous experience of actually being seen by your Doc in a room, and having several questions or concerns, just to be told that you'll need multiple appointments? Or that you never needed an appointment in the beginning and you waited a week for no reason? Wasn't that a great use of everybody's time?

Wait a minute--we live in the information age. What about e-mail? The Air Force gave us all an official e-mail address. Can't we just do appointment scheduling and medical counseling that way? Sadly not, as there are NUMEROUS problems with AF e-mail. Do you know the name of your Doc? What if your Doc is on-leave, TDY, or PCS'd? What if their inbox is full and can't receive more messages? Does your Doc even regularly check their e-mail? Do you regular check your e-mail? How many e-mails are unread and deleted? We only have so many doc's--is this something your Nurse or tech should manage rather than the Doc? What if you have a major conversation about a significant condition--can we just delete that e-mail in a month? Who will ensure that documentation gets into your medical record?

Even if your unit and MDG successfully use e-mail for medical communication, the Air Force considers their e-mail system non-compliant with the HIPAA standards for communication (45 CFR, §164.530©), and they're probably right. Anybody ever send or receive an e-mail that had sensitive information (like social security numbers, date of birth, etc.) but wasn't encrypted? Was it because the sender or receiver didn't have their security/encryption setting set-up or did the sender just forget to click that button? Ever sent or received an e-mail intended for another person, but they had a similar name? If you noticed the error, does message re-call work every time? The potential for HIPAA violations is immense. Lastly, what about your spouse and children? Do they have a .mil e-mail? Dependents are a huge chunk of the MDG's care, and we haven't considered them. How do we know your wife's e-mail address is chocolategumdrop@rainbowflowers.org? What about your 6 year old son? Does he have an e-mail address? Don't you want to see that communication? How is his documentation separated from yours if you use the same address?

So what the hell can we do to improve the time-sink and poor communication within the MDG? The Air Force now has MiCare, which is similar to e-mail, but it also maintains a permanent record of your communication for documentation, and has an internal routing system that ensures your request goes to the right person, including administrative offices. You can also send and receive large files without filling up your e-mail's data size cap. Lastly, you don't need CAC access, so you and your family can send and read messages from your home computer.

Every MDG has a slightly different process for registering, but the easiest way is probably to go to your clinic or Patient Administration office in-person. Your MDG MIGHT have an electronic process for people can't leave work during regular duty hours, but don't count on it. If everybody registered in this program, care quality would increase, time wasted in the MDG would decrease, and communication would improve. Please see your clinic and get registered.

You can read more information about MiCare here: http://www.afms.af.mil/micare

If you already registered, you can sign-in at: https://app.relayhealth.com/security/login/default.aspx

Don't try to register at this site. You usually need to register in-person.

Guest

Current BMT Standards

I remember looking at the different physical standards from the 40's of the Army Air Corps, then the transition to post-Vietnam and finally to the 21st Century. I thought of how very difficult Basic Training must have been for the first generation of Airmen, and how it continued to ease as we converted to a more highly information based and socially aware military.

My flight wasn't kicked or punched if we give the instructor attitude. My flight usually got at least 5 hours of sleep every night, and 3 meals every day. Nobody died or broke a bone. I can clearly remember pondering the day of training every night just before I slept, thinking "This isn't so bad. I can do it. Hell, thousands of trainees have successfully graduated these standards, and these are the easiest standards in the history of the Air Force." I grew physically and matured mentally, and many others progressed to more demanding schools than I, others to less demanding, and nearly all made it through the courses.

Then, I started talking to the most recent, freshest pipeliners. These Airmen who generally say how minimally difficult their time at Lackland was, and that some wish it were a bit more rigorous. Trainees are allowed more personal freedom than ever before, and there has been marked power shift away from the Instructors in the last 5 years. I know how much of a REMF I am. These newest batches make me worry for the Air Force.

Welcome to the generation of pseudo-entitlement and customer service. Warrior Airmen are taking a back-seat in our fiscally constrained, information age, socially progressive military. These are good things, but change always has unanticipated effects, and there are two halves of this coin.

So here's my advice for anyone worried about the horrors and trials of Air Force Basic Military Training: It looks like a freaking cake-walk to me.

Guest

Everyone that gets a hearing test always asks the same thing--"What do all these numbers mean?" There are plenty of educational aids, but many get too detailed or they don't empower the reader with enough real information.

This is the best pamphlet and graphic I have ever seen that concisely answers this question. This is also one of the best training videos I have ever seen regarding hazardous noise/noise-induced hearing loss. Great for a less boring training day.

There's plenty of other stuff on the internet, but I like these.

Guest

Below is a list of publicly available regulations that are worth knowing exist. You do not need to read or ever actually download any of these, but again, you might need to someday, or your boss/wingman/troop might need to be pointed in the right direction.

This only covers medically relevant regulation within the 4X series, and a few more from 10, 11, and 36. Obviously, there is more, but these are the major ones.

AFI 10-203 | DUTY LIMITING CONDITIONS | 25 Jun 2010

AFI 10-250 | INDIVIDUAL MEDICAL READINESS | 9 Mar 2007

AFI 11-403 |AEROSPACE PHYSIOLIGICAL TRAINING | 30 Nov 2012

AFI 32-1053 | INTEGRATED PEST MANAGEMENT PROGRAM | 23 Jun 2009

AFI 36-2626 | AIRMAN RETRAINING PROGRAM | 1 Jul 1999

AFI 36-2905 | FITNESS PROGRAM | 1 Jul 2010

AFI 36-2910 | LINE OF DUTY (MISCONDUCT) DETERMINATION | 4 Oct 2002

AFI 36-3003 | MILITARY LEAVE PROGRAM | 26 Oct 2009

AFI 36-3212 | PHYSICAL EVALUATION FOR RETENTION, RETIREMENT, AND SEPARATION | 2 Feb 2006

AFPD 40-6 | EDUCATIONAL AND DEVELOPMENTAL INTERVENTION SERVICES | 30 Jun 2006

AFI 40-101 | HEALTH PROMOTION | 17 Dec 2009

AFI 40-102 | TOBACCO USE IN THE AIR FORCE | 26 Mar 2012

AFI 40-104 | NUTRITION HEALTH PROMOTION | 4 Oct 2011

AFI 40-301 | FAMILY ADVOCACY | 30 Nov 2009

AFI 40-404 | BIOGRAPHICAL EVALUATION AND SCREENING OF TROOPS (BEST) PROGRAM | 01 Nov 1997

AFI 40-701 | MEDICAL SUPPORT TO FAMILY MEMBER RELOCATION AND EXCEPTIONAL FAMILY MEMBER PROGRAM (EFMP) | 15 Feb 2012

AFI 41-101 | OBTAINING ALTERNATIVE MEDICAL AND DENTAL CARE | 01 Apr 1996

AFI 41-110 | MEDICAL HEALTH CARE PROFESSIONS SCHOLARSHIP PROGRAMS | 23 Aug 2004

AFI 41-126 | DEPARTMENT OF DEFENSE/VETERANS AFFAIRS HEALTHCARE RESOURCE SHARING PROGRAM | 11 May 2011

AFI 41-210 | TRICARE OPERATIONS AND PATIENT ADMINISTRATION FUNCTIONS | 06 June 2012

AFI 44-102 | MEDICAL CARE MANAGEMENT | 20 Jan 2012

AFI 44-107 | THE AIR FORCE CIVILIAN DRUG DEMAND REDUCTION PROGRAM | 07 Apr 2010

AFI 44-109 | MENTAL HEALTH, CONFIDENTIALITY, AND MILITARY LAW | 01 Mar 2000

AFI 44-110 | THE CANCER PROGRAM | 01 Oct 1996

AFI 44-120 | MILITARY DRUG DEMAND REDUCTION PROGRAM | 03 Jan 2011

AFI 44-121 | ALCOHOL AND DRUG ABUSE PREVENTION AND TREATMENT (ADAPT) PROGRAM | 11 Apr 2011

AFI 44-170 | PREVENTIVE HEALTH ASSESSMENT | 22 Feb 2012

AFMAN 44-144 | NUTRITIONAL MEDICINE | 29 Jun 2011

AFMAN 44-163_IP | FIRST AID MANUAL | 23 Dec 2002  FM 4-25.11

AFI47-101 | MANAGING AIR FORCE DENTAL SERVICES | 01 Jun 2009

AFI 48-101 | AEROSPACE MEDICAL OPERATIONS | 19 Aug 2005

AFI 48-102 | MEDICAL ENTOMOLOGY PROGRAM | 01 Jul 2004

AFI 48-105 | SURVEILLANCE, PREVENTION, AND CONTROL OF DISEASES AND CONDITIONS OF PUBLIC HEALTH OR MILITARY SIGNIFICANCE | 1 Mar 2005

AFI 48-116 | FOOD SAFETY PROGRAM | 22 Mar 2004

AFI 48-117 | PUBLIC FACILITY SANITATION | 06 May 1994

AFI 48-120 | DEPLOYMENT RESILIENCY ASSESSMENTS | 29 Dec 2010

AFI 48-123 | MEDICAL EXAMINATIONS AND STANDARDS | 24 Sep 2009

AFI 48-135 | HUMAN IMMUNODEFICIENCY VIRUS PROGRAM | 12 May 2004

AFI 48-145 | OCCUPATIONAL AND ENVIRONMENTAL HEALTH PROGRAM | 05 Mar 2008

AFI 48-149 | FLIGHT AND OPERATIONAL MEDICINE PROGRAM (FOMP) | 29 Aug 2012

AFJI 48-104 | QUARANTINE REGULATIONS OF THE ARMED FORCES | 24 Jan 1992

AFJI 48-110 | IMMUNIZATIONS AND CHEMOPROPHYLAXIS | 29 Sep 2006

AFJI 48-131 | VETERINARY HEALTH SERVICES | 29 Aug 2006

AFMAN 48-125 | PERSONNEL IONIZING RADIATION DOSIMETRY | 07 Aug 2006

AFMAN 48-154 | OCCUPATIONAL AND ENVIRONMENTAL HEALTH SITE ASSESSMENT | 28 Mar 2007

AFMAN 48-155 | OCCUPATIONAL AND ENVIROMMENTAL HEALTH EXPOSURE CONTROLS | 01 Oct 2008

AFOSHSTD 48-137 | RESPIRATORY PROTECTION PROGRAM | 10 Feb 2005

AFOSHSTD 48-139 | LASER RADIATION PROTECTION PROGRAM | 10 Dec 1999

AFOSHSTD 48-20 | OCCUPATIONAL NOISE AND HEARING CONSERVATION PROGRAM | 30 Jun 2006

AFOSHSTD 48-9 | RADIO FREQUENCY RADIATION (RFR) SAFETY PROGRAM | 01 Aug 1997

AFPAM 48-151 | THERMAL INJURY | 18 Nov 2002

Guest

This entry is for personnel already in the Air Force, not applicants.

Frequently, you may feel that nobody in the MDG is doing what they should be doing for you.

You submitted a clearance request X days ago and got no response or you need a copy of your records but nobody is giving you a good answer on the delay or you need to complete a specialty clinic consult but it's still unapproved/unpaid.

You have a few options, but I recommend we start at the bottom. The good ol' PDG has some great wisdom to give here: "The key principle is to resolve problems and seek answers at the lowest possible level. With loyalty up and down the chain, a highly efficient and effective system is in place for getting things done."

Even though you've maybe spoken to the same office five times already, give them one last chance before you elevate the problem with someone else. You will get very little accomplished by yelling. Unless you wear E-7+ or O-5+ rank, only your boss gets to yell at us. Your cute little rank is no different than the rest of the swarming masses when you start to shout.

Next, I recommend you try to talk to their NCOIC/OIC, again, at the lowest level. Explain things patiently, slowly, and calmly. Now comes a very difficult step--wait for the next duty day. 24 hours (or 72 hours for the weekend) shouldn't break your back. If it does, you should've elevated this to your command some time ago before you reached this emergency situation.

Now, if you still don't get any resolution, ask for the Patient Advocate. This position is not in any regulation and is considered a best practice for most of the MDG's around the world. Know this person is usually pretty good at conflict resolution and generally on your side. Talk to them, and just try to play nice this last time.

Finally, if that hasn't gotten you anywhere, take the problem through your chain. Hopefully, you've been updating your supervisor/NCOIC about all the developments. By now, you'll probably just notify your supervisor/NCOIC that you're going to your OIC and the Sq/Super. Superintendents are generally really awesome at knowing the right people and getting stuff done. At this stage, the Super can triage and troubleshoot, then automatically involve the First Sergeant, Sq/CC, Gp/CC, etc., on either side of the MSG/OG/MDG/MXG as necessary. You might get some help from your OIC in coordinating time off duty to arrange everything, but usually you'll need to jump to the Superintendent (or higher) for real support.

If you think you're problem isn't hot enough for your OIC/Super to get a handle on it, then maybe you need to work within the MDG a little more first. You know your leadership better than I do, however for most people, this is the route I'd pursue.

Guest

The PCM sees 20+ patients in clinic EACH DAY; the Nurse has 30+ requests/consults EACH DAY. The technician is part secretary and good ones help their PCM's stay informed and prioritized. Sadly, this rarely happens.

The PCM is horrendously overworked and "good" care for their empanellment size requires 70+ hour work week in clinic (seeing patients and doing admin work) and then go home and read or research cases there too. Most are just overworked and punch out after around 50 hrs/wk. Many patients get a level of care that fills the box. Just about every time you see your PCM, they are thinking about the clock and the few minutes they can spend with you, and try to do whatever is the minimum necessary for you to walk out of the door. This doesn't mean they don't care, but that they don't have the time to perform real, full-length discussions except for the extreme cases (diabetes, MEB's, etc.). Additionally, they have plenty of appointments with patients that only want to fill the box on their checklist so they can leave (PHA, Post-Deployment Re-Assessment, Occ. Health Exam, etc.) or the patient already knows what they want and the PCM is just facilitating that (Sudafed for my cold, STD test, referral to specialist). Essentially, all these patients want is to get the box checked.

Also, PCM's often focus on being good Dr.'s (or PA's/NP's, etc.) and let the administrative tasks fall on the tech, who does it wrong because it's above their level/training.

The Nurse is overworked, but as most of them are civilians, they can't work more than 40 hrs a week, and the burden transitions to the other team members. The AD nurses burn out quickly and are upset because they are stuck to their telephone, rarely actually seeing patients (kinda not why they went to school for several years). They talk to whiny, needy patients that soak up appointments, then have to work out what to do with AD personnel with a real mission need but there is no appointment availability.

Good technicians become NCOIC's and are taken away from general care to write EPR's and babysit screw-up Airmen instead of doing their job (that's leadership!). Bad technicians who stick around sometimes become NCO's through time-in-service overcoming the WAPS cut-offs and stay in patient care and continue to give bad service, but now they have rank, so it seems authoritative and official!

This post is not to bash the PCM teams, but to let the patients know the stress and how these teams are required to operate. Many PCM teams give fantastic support, but many variables lead to less than stellar support for some patients—and this is why.

My next post is how you can get better administrative support for your clearances, and hopefully make the process easier for the patient, the PCM team, and the MPF.

Guest

This post is meant to do two things:

Empower the applicant to know what the fuck they actually need

Get the paperwork done

The Air Force is an enormous organization that is buried in red tape, and the Medical Group is among the worst. Obviously other career fields are in the same boat, however Medical is unifying in that everybody has to contact somebody in the Medical Group for some reason at least once a year.

To reliably get anything done, you need to be the one to initiate it. Only one person is truly responsible for your career: you. Be proactive about whatever the thing is you're supposed to do and know what you need.

Figure out when your TDY/RNLTD/Separation/Retirement/Vol By/Retraining window is. An estimate is better than nothing, and that alone will sometimes get the ball rolling. A deadline at least will put a date in your brain so you don't start the process 30 days later than you should have. Also know the MDG will rarely clear anybody for anything more than 180 days in the future.

So you want to talk to the right office to get everything started, but who to call? You need to have a decent idea of what the fuck you're talking about before calling the general appointment line. The knowledge-foundation of people who man the appointment phones is a wild crapshoot. Some have been working in the MDG a LONG time (i.e. longer than you've been alive) and care about your delicate, unique snowflake life. Some graduated tech school within 3 months and barely know how to tie their boots. Others just want a paycheck so they can go do whatever they do when not at work and have no desires for decent patient service. So before you pick up the phone, hit 0 and ask the base operator for the most generic possible number to the labyrinthine MDG, read whatever your poorly photo-copied instructions are, and hopefully the dunce putting it together had enough smarts to list a current POC and maybe cite a governing regulation. If so, give that regulation a quick glance; E-Pubs isn’t too tough to find, is it? I truly despise people who call because they were told to call, but did not perform the basic requisite of normal human interaction: know what the fuck you're talking about.

If you have zero guidance, spend at least 5 minutes worth of your best google-fu to find a starting point. If you still failed, ask your NCOIC, UCC/CSS, UDM, or First Sergeant who to call. These people exist only to help you--use them!

Public Health and Flight Medicine is another great starting point on your journey. My advice: don't call the appointment line until somebody tells you that you definitely need an appointment.

Additionally, know that your PCM (Primary Care Manager) team is usually the wrong place to start. They are near the finish line, not the beginning (see my previous blog post).

So the right person is doing what (you believe) you need. But did you ever get what you needed? Where's my signed form? Is this the right documentation?

Your regulation and standards from the person who gave you the application package is likely working with paperwork somebody put together 5 years ago and never bothered to read the references. I get requests every day for an outdated or straight-up now illegal/wrong standard (re: SPECAT). The technician often needs to research whatever the standard is, and that standard from the MPF might not jive with AFPC/AFMS or some other well-known publication that never got updated but people keep using.

So follow-up with the office that is processing your request. I'd recommend calling or e-mailing somebody about once a week just for a status update. More frequently than weekly will likely just piss them off, but weekly always keeps you somewhere in the back of their brain and aware of your request. You should generally not go in-person to the clinic. It creates a hassle as someone has to escort you to the office, and the right person may not even be in office.

Some future posts will have more information on who does what in the MDG, the PT exemptions process, and how to elevate concerns in the MDG.

Guest

Among the most widely used and unquestioningly great excuses you could ever give for delays or tardiness in the modern Air Force (or likely any time since the Air Force existed) is "Medical is screwing up." Anytime your boss could doubt you, you can effortlessly say, "TSgt Awesome Pants was on leave so I had to work with A1C Snuffy who had no idea what the fuck he was doing and we ended up calling some other office and they're supposed to call me back later. It's such a dumb process anyway; I don't know why they couldn’t just clear me while I was there." See? Bulletproof.

However, there are two sides to every story.

Very frequently, a clearance or other request hits a snag (patient has a disqualifying condition and needs a waiver or somebody else’s case took priority or something else). Then a complaint of the bottlenecking effect of the Medical Group leads NCOIC's and Commanders to ask sharp, direct questions about a program. The answer that isn’t spoken is the member/applicant should’ve notified the MDG of the application/deadline as soon as they found out (AKA reading and following the god-damn instructions they're given in a timely manner). This would allow enough time to work around these bumps. Unfortunately, that doesn’t happen and the problem is compounded by inexperienced or alternative program managers making bad decisions quickly OR failing to make any decision and letting work pile-up for when the other guy comes back. This isn't the case every time, but it happens fairly regularly.

The other common reason for your delay is that you’re broken. You shouldn’t be cleared for whatever it is you want to do and can anticipate a disqualifying recommendation in the very near future. Of course the only solution for that is to stop being broken—good luck with that.

The most important part that many people fail to see is how often patients and med techs ruin a wonderful program by cutting corners for the sake of the Mission (or because they're buddies). It creates a rippling effect through the entire Air Force of:<p id="blog_message" style="margin-bottom: 10px">

  • Slightly broken people doing jobs they shouldn’t be cleared to do and taking time away from duty to manage their condition;
  • Delays in finding replacements for those that are DQ’d; and
  • Delays in processing the healthy people because the broken ones take up all the techs’ time (the 80/20 rule has never been more true than in the MDG).

Guest

These are examples of real patients I've had: the Patient--

  • Gets a special-duty OCONUS assignment with a unique medical requirement. Patient didn't get the correct paperwork from some other office in the MDG several months ago, but knowingly (re: lazily) sat on that knowledge and did nothing until <14 days from their RNLTD, then called my office freaking out.
  • Asks for a medical clearance <48 hours from the Vol By closeout when the position ad has been posted for >60 days.
  • "Needs" a Flight Clearance accomplished for a NASA application. Package submittal closeout is <14 days away.
  • Says they are tip-top when requesting the clearance. Then five minutes into a record review, I find very serious conditions, leading to an MEB/Code 37 and Med Hold because the patient didn't return Nurse phone calls and passive-aggressively held-up medical processing (the spineless MDG then forgets about the patient until my review).

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