A pilot program initiated in April that gives Army doctors at military in-processing facilities broad authority to grant waivers for 147 low-risk medical conditions has gone so well that the service may make it permanent, said the one-star general heading the Army’s Medical Process and Augmentation Team. Additionally, she told Army Times that the service has also offered a second chance to hundreds of would-be recruits who were previously denied waivers.
Brig. Gen. Katherine Simonson, who is also a registered nurse and deputy commanding general for the medical arm of U.S. Army Recruiting Command, spoke candidly at a late June meeting of the Defense Advisory Committee on Women in the Services about how the military’s new electronic health record, MHS Genesis, had extended the recruit processing timeline and increased the workload for staff without meaningfully increasing the number of medical disqualifications. The health record, which essentially documents every medical encounter in a recruit’s lifetime, merely gave staff less leeway to exercise their own judgment over conditions that technically required waivers but were known to be low-risk. The added step of retrieving additional medical documents to support a waiver — one that could add another 100 days to entry-level processing — increased a recruit’s likelihood to “walk away,” Simonson said.
Following a Pentagon-wide pilot program that eased barriers to entry for 38 medical conditions, the Army rolled out its own pilot with the 147 conditions that data showed received waiver approval more than 95% of the time. For these, providers received guidelines and leeway to help them exercise their own judgment in passing a recruit through. In addition to things like mild or past asthma, the pilot included a number of female-specific conditions, such as abnormal pap smears without cancer indicators, past gestational diabetes, and well-managed endometriosis and polycystic ovarian syndrome.
Results from the first month of the pilot program were dramatic. The waiver approval rate for recruits with technically disqualifying medical information rose from 39% to 47%, she said, and the proportion of “return without action” applicants — those required to secure more medical documentation or consults to get approved — dropped from 40% to 32%. The new waiver guidelines, she indicated, have also brought more consistency to waiver decisions.
“In our analysis, if we looked at an asthma patient with a similar packet, we may have one provider who felt very comfortable making a decision for a one-time albuterol prescription they rarely used, and another provider who felt that that patient needed a consult or more information, medical records, etc.,” Simonson said.
With the help of a staffing plus-up that included more than doubling the U.S. Army Recruiting Command waiver team to 20 medical providers and growing the medical behavioral health team to nine providers, Simonson said the Army has brought its backlog down to 3,600 applicants awaiting waiver decisions, with 300 to 500 new waiver requests daily and up to 5,000 per month. With the new providers on board, she said, Army officials hoped to get the waiver decision timeline down to two weeks.
In an interview with Army Times following the briefing, Simonson said the “best part” for her had been the Army’s decision to call up prospective recruits who’d applied as far back as November and been denied medical waivers. Of those, she said, 271 accepted the invitation to return to military entrance processing stations to resume the entry pipeline.
“But other than that, we really haven’t changed our denial rate, which shows us we’ve looked at very low-risk conditions — we didn’t change much of the risk,” she said.
Still, the Army is proceeding with caution when it comes to making the pilot permanent or adding new conditions. Simonson said the pilot included tracking the recruits granted waivers as they move through the training pipeline and complete their first tour of service to evaluate any change in medical drop rates or medical issues in service.
The Pentagon has yet to report early results of its own waiver program, which was set to remain in effect through June. Officials told Military Times last April that following the pilot’s conclusion, they would evaluate the data and determine whether to extend it.
