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Airmen with medical waivers get reviewed

If you haven’t deployed because you wrenched your back or had a baby, the Air Force is watching you — closely.

The scrutiny is the response to findings by the Air Force Audit Agency that the service failed to track its medical waivers from late 2001, when deployments ramped up after the 9/11 terrorist attacks, through 2006. Only this year has there been a strict accounting policy in place Air Force-wide.

Now, all airmen who have medical waivers face a monthly review by their base commanders and doctors — and a possible change in their deployment status, according to Lt. Col. Brian Pinkston, a flight surgeon and chief of operational medicine for the Air Force Medical Support Agency.

“If someone has a broken arm that should have healed in six weeks and it’s now six months, they pull the records and say, ‘Does this make sense?’Ÿ” Pinkston said.

Because of the new scrutiny, the number of airmen with permanent nondeployable conditions is a fraction of what it was eight years ago.

In 2001, 1.57 percent of the service’s 307,635 airmen, or 4,830, had permanent conditions that kept them from deploying, according to the Surgeon General’s Office. By 2006, that figure crept up to 2.16 percent, or about 6,800 of the 314,800-member active-duty force. Today, about 0.26 percent of the 293,400 active-duty airmen, or roughly 760, cannot be deployed for health reasons.

Many of the airmen with permanent conditions have left the service or have been reclassified as deployable if they can be sent to an overseas base that has a hospital or clinic. This year, about 9,680 airmen, or 3.4 percent, are in the new category of having a condition that requires medical care but doesn’t prevent them from deploying.

Another 3.89 percent of airmen — almost 11,415 — have waivers for temporary conditions, requiring them to be eligible for deployment within a year of the diagnosis. The number of temporary waivers had hovered around 2 percent until the crackdown.

About a quarter of all waivers are issued for muscle and skeletal conditions, such as back problems, arthritis, broken bones and torn ligaments, according to the Surgeon General’s Office. Pregnancy was the second most common cause, at 14.4 percent.

Playing possum?

Before the new policy, which was implemented base by base throughout 2007 and 2008, the Air Force did not regularly review the medical waivers it issued; an airman could go for more than a year without his deployment status being updated.

After the 9/11 attacks, the frequency and number of deployments skyrocketed — and so did the tales of imaginary illnesses and conditions. Concerned there were fakers in his ranks, then-Chief of Staff Gen. T. Michael Moseley ordered the Air Force Audit Agency to review how the service approved medical deployment waivers and what it did to get airmen back in the deployment pool.

The audit agency didn’t find widespread abuse of the waiver system but did find examples of poor oversight and record keeping.

For example, a nurse administrator considered nondeployable for medical reasons had gone at least 18 months without an appraisal, and the condition of a junior officer in a career field being downsized had not been reviewed for more than two years.

The audit agency also found that personnel databases didn’t have correct information on airmen’s medical status. An example cited: 763 pregnant airmen were listed as nondeployable in medical readiness records but considered to be “worldwide deployable” in the Military Personnel Data System.

After laying out its findings, the audit agency recommended an overhaul of waiver policy.

“There was a call for greater scrutiny, and we finally had the technical ability to do that,” Pinkston said.

Within a year, the Air Force retooled its rules and began implementing them.

A new Air Force instruction laid out detailed procedures for determining who qualified for a waiver for “duty limiting conditions” and mandated reviews as frequent as once a month. Also introduced was an electronic record-keeping system that allows squadron commanders as well as medical personnel to review airmen’s medical waivers.

A lengthy process

Getting a waiver still starts with a visit to a base clinic or hospital and a doctor’s diagnosis, said Pinkston, the operational medicine chief.

Sleep apnea, difficulty breathing while asleep, is an example of a condition that restricts where an airman can deploy but does not require him to stay home, he said.

The sandy conditions of desert bases make it difficult to maintain the breathing equipment used by sleep apnea patients, Pinkston said, but the sufferers could deploy elsewhere if a base could provide adequate treatment.

“The recommendation is put into the databases and reviewed by a flight surgeon who understands the airman’s duties,” Pinkston said. “They review it and say, ‘Does this make sense from a medical standpoint? Does this make sense from a duty standpoint as well?’Ÿ”

After the medical review, the recommendation is sent to the airman’s squadron commander for a decision. If the commander objects, the waiver request gets a second medical review before being turned over to the wing commander for a decision.

Because of federal privacy law, an airman’s medical records that are not related to his ability to deploy are not shared with squadron and wing bosses.

“Commanders can’t know everything, but they can know things that change duty status,” Pinkston said.

Once an airman’s waiver is approved, the airman’s doctors and squadron commander are expected to make sure the airman is getting the medical care needed to recover, Pinkston said.

As a check, the airman’s status is reviewed monthly by the base’s Deployment Availability Working Group.

The electronic system also automatically flags the records of airmen with recurring problems prompting deployment waivers.

An airman who does not become deployable after one year will have his case considered by a medical evaluation board, a review that could lead to the airman leaving the service, Pinkston said.

While the percentage of airmen with duty-limiting conditions has increased since 2001, Pinkston attributed the rise to improved reporting and the Air Force’s willingness to keep in uniform airmen with skills that are in high demand, even if their deployment options are limited.

“It’s not an epidemic of disease,” he said. “It’s an epidemic of accountability.”

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