Can You Join the Military if You Have Diabetes?

It’s patriotic and noble to join the armed forces to fight for your freedom and country. Not only that, it can offer a fully-paid trip to college, early retirement, good insurance, a 0% down VA home loan, and a whole host of other perks.

 

If you graduate from a military school, not only do you get a free ride, but you also get to go in as an officer after you graduate, with competitive pay and excellent benefits.

If you are active duty, you get insurance through Tricare, which is pretty good insurance. More people have picked themselves up out of poverty by joining the military then by any other means, so it can be a sweet deal for some.

What about Pre-diabetes, Type 1, Type 1.5, or Type 2 Diabetes and the military?

But what if you have Pre-diabetes, Type 1, Type 1.5, or Type 2 diabetes? Will you be allowed to join the ranks of the military, and serve your country, or will you be told that you are unfit to serve? Will you be permanently disqualified for military service (PDQ’d)?

This is a question that many people living with pre-diabetes and diabetes of all types have asked, especially since both have reached epidemic proportions in the United States. It would seem discriminatory for someone with pre-diabetes or diabetes to be told that they cannot serve in the military. It would also seem wrong to discharge a person in the military because they were diagnosed with pre-diabetes or diabetes during their time of service.

In researching this topic, this does seem to be happening on a regular basis, especially when you are trying to see a recruiter and get in, or when you are diagnosed while in active duty and do not fight the system to try to stay in. Let’s look at whether or not you will be told no if you apply for military service, or if there is a way around it.

Let’s also look at what could happen if you are diagnosed with diabetes when you are already in the military. It would be helpful to understand why you may be discharged, or what you may do to appeal a decision if you don’t agree.

The reality of combat

Let’s say you are in Afghanistan, on a tour of duty with the Marines, and you are in the hot desert. MRE’s (meals ready to eat) mainly consisting of carbohydrates are all that is available to eat. At times, you must go long periods without eating. It’s hot, and there is no refrigeration available.

You are having trouble keeping your insulin from being exposed to extreme temperatures. You are on active duty and constantly on the move, getting little sleep. Stress is high, and you hear gunshots as your unit prepares to move in on a terrorist cell.

The reality of combat with diabetes

Now let’s imagine that you are a person living with Type 1 diabetes or a person living with Type 2 diabetes on insulin, and you are in the midst of this combat zone in Afghanistan. Your unit has had to move out quickly, and you have left your insulin pen behind in a rush.

You got your morning dose along with a carb-loaded MRE, but as you expended more energy throughout the day, your blood sugar started to drop at about the time your troop moved in on the terrorist cell. You have no quick carbohydrates left, and you have a low blood sugar reaction right at the time when the gunfire starts.

Your unit is scrambling for supplies. Should your unit stop and tend to you in the middle of combat, or do you pose a risk not only to yourself, but to those fellow soldiers who fight with you? If they stop to take care of you, will they be ambushed by the enemy? Will your combat buddies lose their life because they stopped to take care of your diabetes? Or will you be left behind, and imprisoned by the terrorists?

Military stance on diabetes and active duty

This is the hard stance of the military related to Type 1, Type 1.5 and Type 2 diabetes, and generally all branches of the military feel this way about a person with diabetes serving in combat. The general consensus is that you will not be able to make it through tough periods of combat, and that you will be a burden to others that are serving with you.

All branches of the military will not allow a Type 1, Type 1.5, or Type 2 diabetic to enlist. You can submit waivers, but you may still get a no. There are stories of automatic PDQ’s (Permanently Disqualified for Military Service) given out to those with pre-diabetes before a medical evaluation has been done, but it is unclear whether or not these persons were disqualified due to being overweight or obese, or some other factor such as a mental illness. If someone already in the military is diagnosed with Type 1 diabetes, they will be discharged unless that person can prove that they are fit for active duty.

There have been some rare cases where this has been done, and a Type 1, Type 1.5 or Type 2 military person has been allowed to remain in active duty, depending upon his or her military occupation. For example, someone with diabetes serving on a submarine, or piloting an aircraft would not be allowed to stay in active duty. There have been cases where someone has been reassigned to another occupation.

There are a few inspirational stories about these persevering individuals further along in this blog. Some military personnel have developed Type 1 diabetes from exposure to chemicals while serving overseas. These folks can be discharged as well, as unfortunate as that may be.

Tricks you can try and hoops you can jump through

The key here seems to be whether or not you use insulin, but then it gets a little tricky. It is possible to slip through some loopholes here. If you are a Type 1 or a Type 2 diabetic that is taking insulin, you may be allowed to serve in a branch of the military, including, especially if you are already in. With Type 1, Type 1.5, and Type 2 diabetes that is well controlled and an A1C below 7, you may be able to stay in, even if you require insulin.

There will be some hoops to jump through, but your foot is already in the door, so to speak. You will need to submit waivers to your physicians and officers. You will go through medical testing (MEP’s) to see if you are fit. You may be placed in a non-combat related position, such as the mess hall or an office, or allowed to remain in your current occupation if it is on the list of jobs that is permissible for a person with diabetes to hold. This list is called the Military Occupational Specialty list, or MOS.

Remember that Type 2 is progressive, and with subsequent beta cell destruction through the years, you may begin to require more insulin and it may become harder to keep your A1C below 7. At the point your diabetes becomes uncontrolled and your A1C is over 7, you could be discharged regardless.

The same would be true of a person with Type 1 diabetes. It depends on how determined you are to stay in active duty, and to keep your diabetes managed at all times. This can be a challenge in the military.

Pre-diabetes and active duty

If you have pre-diabetes, they should let you stay in the military if it gets picked up while you’re in service. They may not let you enlist. You will want to prevent yourself from being diagnosed with Type 2 diabetes by following your diet and activity regimen.

At the point you are diagnosed with Type 2, they will look at your situation more closely, and may discharge you depending on your level of control. At which point, you will have to go and jump through their hoops, and submit waivers to try to convince command that you capable of self-managing your diabetes.

Can you enlist in the military with pre-diabetes or diabetes?

It’s hard to enlist in the military with Pre-diabetes, Type 1, Type 1.5 or Type 2 diabetes if you are not already in. Again, the severity of your disease is going to be looked at, and you will have to show that you are self-managing your diabetes. Your A1C will need to be in a range where you are not at risk for complications (under 7), and you will need to keep your post-prandial blood sugars under 180.

There are many stories related to people who tried to enlist, but were unable to serve. There are stories related to folks with diabetes of all types, including Type 1.5 (Latent Autoimmune Diabetes in Adult). There seems to be a large volume of PDQ’s given out without any medical evaluation being done with just the mention of diabetes on the application. Military recruiters may say no, but then you will have the opportunity to state your case and get approval through waivers. Be prepared for recruiters to say no anyway, and have another plan in case.

What if you are already in the military and get diagnosed with diabetes?

If you’re in the military, get diagnosed, and they are talking discharge with you and you have just a few more years before you can retire, then you may be able to stay in based on the status of your position. You will need to submit the waivers to command. They will look at whether or not it is on the MOS list of jobs that is possible for a diabetic to hold in the military.

There are certain jobs that a person with diabetes may not be safe doing. Those jobs include jobs on the front line, or anything to do with piloting a military plane or serving on a submarine, among others. In particular cases where the military is giving a person with diabetes a hard time, it can be helpful to call your Congressman, as command will usually listen to Congressional inquiries.

From branch to branch, whether it is the Army, Navy, Air Force, or Marines, National Guard or Reserves, if you are already in, they are looking at each person on a case-by-case basis. Above all else, they are looking at how safe the person will be in combat, and if they will pose a risk to others in their unit.

You could push through the system in order to remain in a position with the military if you have Type 1, Type 1.5 or Type 2 diabetes. First, you would need to research the regulations of your particular branch of the military, guard or reserves, and find out what you need to do in order to submit a waiver. Most branches are going to require that you have a tight control on your diabetes, A1C less than 7, and letters from your commanders and physicians stating that you are fit to serve, and remain deployable if you are requesting deployment.

Take the example of one National Guardsman who wanted to go to Afghanistan with his unit. He submitted one waiver, which was approved. However, they changed the rules and revoked his waiver. This time, he submitted another waiver. He got approved, and was able to deploy to Afghanistan with his unit. Here is a summary of his story:

• Sergeant Mark Thompson’s story

US Army Sergeant First Class Mark Thompson tells his inspirational story of making it through the waiver process with an insulin pump. He is evidence that as long as you can prove to the military that you are in control of your disease and not the other way around, that you can make it through the grueling process and get approved. It is going to take dedication and perseverance, but it can be done. Mark got help from the American Diabetes Association and went before a medical review board.

He got his A1C down to a 6. Mark did have some set-backs while deployed with his unit to Iraq for 18 months. His insulin pump was crushed and he had to start taking up to 16 injections per day with regular, not insulin, needles in order to stay in range with his blood sugars. He had to wait a month for a new pump to be delivered, and he had an episode of low blood sugars that his unit buddies had to help him out of.

He went through sleep deprivation and the stress of long night watches that raised his blood sugars¹. The following is a link to the YouTube video of Mark Thompson’s inspirational story: https://www.youtube.com/watch?v=eZfCXlXo8R0. Mark gives hope to people diagnosed with diabetes while in the military who wish to remain in active duty with our nation’s military forces.

 

 

 

 

• Captain Nick Lozar’s Story

The Marines has Captain Nick Lozar, diagnosed with Type 1 diabetes and placed on an insulin pump after 10 years of service. He didn’t want to be discharged, so he set to work. He went through the waiver process. His first hurtle was the medical board. It’s a slow a process and it took a full 11 months before he was returned to active duty. His advice for those active military personnel that are diagnosed with Type 1 diabetes and wish to remain in active service is to find as many doctors and superiors that you can to sign off that you are fit for active duty.

His particular active duty occupation as a logistician made it possible for him to stay in active duty. He makes a point. If you want to join the military I hope you can follow your dreams and do so!

TheDiabetesCouncil Article | Reviewed by Dr. Sergii Vasyliuk MD on June 10, 2020