Carlos Morales was a few drinks in late one evening when he first contacted his local Coast Guard recruiting office, but when he woke up the next day, he did not regret his late-night submission.
He had been eyeing service for a decade, he tells The War Horse. He thought about joining the Marines at 19, then decided to attend the prestigious Boston University. After graduation, he started a successful personal training business. Life got in the way, but he could not shake the small signs the world placed in his path.
“Despite having carved out a great life for myself, I have always felt a pull to serve,” Morales says.
As a kid with a post-9/11 childhood, war had appeared daily in his periphery—in the news, through the people he saw in uniform, or on bumper stickers or yard signs showing support for the troops. But as an adult, he began to understand he could be part of the group that served.
After a few years, health science degree in hand, he decided to join the military.
Morales didn’t hide the autism diagnosis he had received as an adult. While teachers, parents, and therapists often catch symptoms—not looking people in the eyes, not smiling or responding to social cues, repetitive motions like hand flapping, or aversion to certain textures—in people with autism by the time they’re three years old, Morales did not receive his diagnosis until he was 25. Because his symptoms were mild—mild enough that he earned his way into BU and then completed his degree—he figured getting a health waiver to enter the Coast Guard would be fairly easy.
“I am autistic, not incapable,” Morales says. He is one of about five million Americans diagnosed with autism spectrum disorder.
He told his recruiter immediately. He then spent months navigating the service’s application process, carving out time between training sessions, spending more than 50 hours collecting paperwork that stretched back to elementary school, and filling out countless forms.
“It felt like the worst scavenger hunt in which I’ve ever participated,” Morales says.
After four months of bureaucracy, the Coast Guard told him he didn’t qualify for service.
Then they stopped returning his emails and phone calls.
Morales’s recruiter did not respond to a request for comment.
Autism is one of hundreds of conditions—from asthma to attention-deficit/hyperactivity disorder to a history of anxiety—the Defense Department says disqualifies people from serving in the military.
The average American doesn’t meet the basic qualifications to serve, and the pool of eligible Americans has dropped from 29% in 2013 to 23% in 2023. About 4% of eligible applicants would be ruled out for psychological and developmental diagnoses, such as autism, depression, or attention-deficit/hyperactivity disorder, according to the Defense Department, which works out to thousands of potential recruits a year.
As the military faces a recruiting crisis, with the Army, Navy, and Air Force expected to miss their goals this year, the military medical waiver process may no longer be serving the services. Qualified candidates may not bother to apply because the process is so opaque—enough so that Congress has enacted legislation to ensure medical waivers do not “inappropriately” disqualify candidates. And how each service processes medical waivers varies, frustrating recruiters and recruits alike. This affects a generation of potential recruits—including young adults diagnosed with ADHD or people with a diagnosis on the autism spectrum who may be more inclined to choose careers in cybersecurity or coding—who often have the focus on detail and ability to see patterns the military needs to protect the United States. However, the Defense Department has launched a pilot program to try to streamline the issue, and it looks as if recent changes may have affected the number of potential recruits being turned away.
The War Horse found several examples of young people who tried to join the military with varying levels of success: In one case, a Navy ROTC candidate was diagnosed with autism when he was four, and then was denied entry into the Navy because he didn’t have—because he didn’t need it—an individualized education program in high school. Another young person, an athlete whose family thought he’d be a “shoo-in,” tried to join the Air Force, but because he had ADHD, his recruiter didn’t bother with the waiver process. And a recruiter reports that while her recruits with asthma didn’t stand a chance in her chain of command, recruiters in other states had no problems pushing paperwork through.
For Morales, the waiver process simply feels discriminatory. He never had a chance.
“I fully get that, because I’m autistic, there should be an investigation as to whether or not my autism is actually an issue,” Morales says. “But I don’t feel like I’ve even been given the opportunity.”
‘We Don’t Want to Put Someone in Who Is Going to Break’
The military establishes rules on everything from minimum and maximum height to color blindness to ensure service members can meet the basic standards needed to function in extreme environments, as well as to keep people with health issues safe during training or deployments. After working with a recruiter, each potential recruit then goes through Military Entrance Processing Stations—or MEPS—to see if they meet the military’s standards.
“We are trying to, where appropriate, eliminate barriers to service where it makes sense, both not just for the department, but for the individual as well,” says Linden St. Clair, deputy director of the Defense Department’s accession policy directorate. “We don’t want to put somebody in who is going to break.”
If a person doesn’t meet the standards, MEPS officials flag the potential recruit and forward the flag to the branch the person hoped to join—the Coast Guard, in Morales’s case.
“The decision to pursue and then approve a medical waiver to allow them to enlist resides with each service,” says Marshall Smith, a U.S. Military Entrance Processing Command spokesperson.
But the process seems to vary by state, recruiter, condition, and service, sources tell The War Horse. Some recruits say they were allowed to apply for a medical waiver, while others with the same conditions were not. The Defense Department says it uses a highly individualized “whole person” medical review process, but because it makes those decisions behind closed doors, it leaves everyone else blind: Can they appeal, and, if so, how do they get the information necessary to make an appeal? Is everyone treated the same way? Could they get a different answer if they apply in a different state?
It’s enough of a problem that Congress members addressed it in the 2021 National Defense Authorization Act report from the House Armed Services Committee: “The committee is concerned as to whether there is actual uniformity in the determination of waivers across the military services and if data on waivers is reviewed on a reoccurring basis as well.”
The committee asked the military for a report showing how many potential recruits had been turned away due to mental health conditions “like anxiety and depressive disorders that are no longer undergoing treatment and are considered stable,” and for attention-deficit/hyperactivity disorder medication use, as well as how having the waiver process handled at a lower level of the chain of command has impacted recruiting.
The percentage of approved waivers for mental health conditions decreased from 59% in 2015 to 54% in 2019, the Defense Department reported back in November 2021. And the number of people disqualified overall decreased significantly.
A mental health condition disqualified about 50,000 people from joining the military from fiscal year 2015 to fiscal year 2019, with 39% of applicants requesting a waiver after they were found medically unfit, the report shows. About 55% of waivers were granted, with the services granting waivers to more enlisted recruits—57%—than officers, at 48%.
From 2016 to 2020, the Walter Reed Army Institute of Research found that more than 31,000 potential recruits with a learning disability, psychiatric diagnosis, or behavioral health diagnosis were disqualified from service. Of those, 49% applied for a waiver and roughly 35% of all waiver applicants were processed into the military.
Those overall numbers may have decreased because, in the past, potential recruits with ADHD could not qualify to join if they had been prescribed medication past their 14th birthdays. In 2018, that changed to a prescription within the prior two years.
As the branches continue to miss their recruiting goals, those extra recruits become more important.
The Army missed its 2022 recruiting goal by 25%, a recruitment shortfall of 15,000, with the Army, Navy, and Air Force all projected to miss their goals in 2023. Many Americans can’t meet the fitness or weight requirements. Not only are the majority of Americans not eligible to serve, but they may not care to. About 9% of Americans say they are interested in military service, according to a Defense Department study.
“Sometimes we have witnesses come from the committee, oftentimes uniformed witnesses, who cite that data almost as if it’s a point of pride about how few young Americans are even eligible to serve,” said Sen. Tom Cotton, a Republican from Arkansas, during a March 22 Senate Armed Services Committee hearing that addressed the military’s recruiting challenges. “We should find ways to help young men and women be eligible for our services, not try to find ways to keep them out. Do you agree?”
“I do, Senator,” Gabriel Camarillo, undersecretary of the Army, told the committee. “Senator, we have a robust waiver process.”
‘Such Medical Condition Doesn’t Qualify for a Waiver’
Morales doesn’t qualify for military service because of a “history of autism disorders,” according to the Defense Department.
But, as is common within military bureaucracy, there is the official instruction and there is the workaround.
“When an individual is disqualified medically at MEPS, that does not mean that a journey is over,” St. Clair says. “It just means it goes back to the services for them to make an informed decision on the level of risk they’re willing to take.”
Without information about the services’ reasoning, or about the appeals process, potential recruits like Morales often have no recourse. But Morales reached out to his U.S. representative, Jake Auchincloss, a Democrat from Massachusetts, for answers. While the Coast Guard didn’t provide an explanation to Morales, they did respond to Congress, saying Morales’ recruiter learned of his diagnosis on Jan. 31, 2023.
“On February 2, 2023, the same recruiter contacted Mr. Morales to inform him he was medically disqualified for military service due to this medical condition,” Coast Guard officials wrote. “Currently, such medical condition doesn’t (sic) qualify for a medical waiver consideration.”
Unlike Morales, who was an adult when he was diagnosed with autism, Tory Ridgeway was diagnosed when he was four. Over the years, he has received special education services and therapy to help him cope with aspects of his autism.
But, also unlike Morales, Ridgeway comes from a military family that understood there’s often a workaround.
“I would just hang out with my dad while he was working in his hangar,” says Ridgeway, a former Navy ROTC candidate and the son of a retired Navy senior chief petty officer. “It makes an impression on you at that young age when half the people you see every day are in uniform.”
Ridgeway knew early that he wanted to serve in the Navy, like his father, as an aerospace engineer. Ridgway also earned his way to Eagle Scout, as well as a full Navy ROTC scholarship for Embry-Riddle Aeronautical University.
Because Tory came from a military family and used the military medical system, he knew he might be a candidate for a medical waiver. So, Ridgeway shared his diagnosis on his application forms as he was advised to do by his military recruiters, and he wrote about how autism affects him in his application letter.
“Tory was evaluated by [the Navy’s] doctor, who said his condition is controlled,” says Tory Rideway’s mother, Vanessa Ridgeway.
He received a June 3, 2021, letter from the Navy’s Bureau of Medicine—after he’d been told he received the ROTC scholarship—that said he was “not physically qualified” to serve, and he was not eligible for a medical waiver because of “a history of anxiety disorder, academic skills disorders, pervasive developmental disorders, color vision deficiency, and distant visual acuity not correctable to 20/20 in each eye.”
The Ridgeway family disagreed with the Navy’s assessment. Based on knowledge gained through military experience, they made some calls. They notified ROTC officials of Tory Ridgeway’s intention to appeal the decision June 16, 2021. He filed an appeal on June 17, 2021, and then contacted his congressman, Steny Hoyer, a Democrat from Maryland, on June 18, 2021, and asked the Navy to provide justification for their disqualification. He also reached out to local media outlets to tell his story and put pressure on the Navy to act.
Soon after, Ridgeway got a new letter saying the Navy needed more information to process his waiver: new eye exams, medical history since he was four, and all of his special education records for the seven schools he had attended as a military kid.
In July, the Navy sent a letter to Hoyer that said Ridgeway was medically disqualified because he couldn’t show he did not need an individualized education program or accommodation when he graduated from high school. Instead, he received services through an IEP only until eighth grade, when he no longer needed it.
Tory chose not to further pursue a waiver. Instead, he continued his studies at Embry-Riddle and accepted an internship with the Federal Aviation Administration.
“Tory received three phenomenal internship offers,” his mom says. “Unlike the Navy, these employers believe in the importance of inclusion and saw Tory’s autism as a unique gift and an incredible asset.”
‘The Secret Is That Many Navy SEALs Have ADHD’
But students like Ridgeway—students with the diligence to earn an Eagle Scout badge and the capacity to gain acceptance to Embry-Riddle—appear to be exactly the kinds of students the military may need as it continues a war often of technology, rather than brawn.
“My son is 24 and he has a learning disability, dysgraphia”—a neurological disorder that causes his writing to be distorted—“ADHD, and executive-function issues,” says Cindy Cipoletti, executive director of the Learning Disabilities Association of America. But when he wanted to join the Air Force, she thought he was a shoo-in. “Jake is very physically fit, athletic—so to look at him and talk to him, it’s like, ‘OK, this is what the military is looking for.’”
But when Jake Cipoletti told his recruiter he has ADHD, his military journey ended abruptly.
“The Air Force recruiter basically shot him down and was like, ‘Look, you’re probably gonna have no chance of getting in,’” Cindy Cipoletti says. “And that was crushing, soul-crushing, for Jake.”
Air Force officials say they’ve changed the way they handle waivers to ensure the process is quick and equitable.
“The [Air Force’s] Accession Waiver Division was created two years ago in part to make sure that we’re making consistent decisions that are aligned with our operational need that are rapid and repeatable from applicable applicant to applicant,” Col. Micah Schmidt, chief of the Air Force’s Medical Standards Program, tells The War Horse. “Approval rates for some conditions, like asthma or ADHD, have actually gone up considerably since we established a centralized office and they can communicate to everybody, ‘These are the factors associated with this condition that are an unacceptable risk.’”
The Air Force intends for the “whole person” approach to minimize the possibility of discrimination, Schmidt says.
“We determine these [risk assessments] on an individual level,” he says. “What diagnosis does this individual have? What additional medical information gives us an inclination to—is this going to get worse or better over time? What if it’s episodic? How likely is this to reoccur?”
But some individuals do not get that far into the review process.
Jake Cipoletti didn’t seek a waiver because he didn’t know that was an option, his mother says.
“I think there’s an assumption that a learning disability or ADHD makes you somehow lesser or not capable,” she says. “A lot of things that go along with learning disabilities and ADHD actually make you better at a lot of this, not only in the civilian workforce but would also carry over to the military.”
Studies have found that people with autism can excel in some fields because they often have superior attention to detail, are better at recognizing patterns, and can focus on one thing for long periods, according to the Western Australian Data Science Innovation Hub. For that reason, the Australian Defence Force employs people with autism to work in AI, analyzing data sets and looking for patterns, while the Israeli Defence Forces look to people with autism to find analysts to look at surveillance satellite data, according to the Harvard Business Review.
And a 2023 report from Rand Corporation, a nonpartisan think tank, by Cortney Weinbaum and her team, found that people with neurodivergent traits often have skills that could help in national security fields—but they are frequently treated as if their disability precludes them.
“Fundamental strengths that are common among the neurodivergent population can translate into job strengths, particularly in certain career fields of interest to national security,” Weinbaum’s team wrote. “Autistic traits are also associated with an increased presence in careers related to computing, information technology (IT), engineering, and physics; more-advanced digital skills; up to 40 percent faster problem-solving; and better systematizing skills.”
A 2021 RAND study found that “waivered recruits and recruits with a documented history of marijuana, ADHD, or depression/anxiety are likely to perform as well as or better than similar recruits on many dimensions.” The Defense Department has tracked this data to update the medical waiver processes, but these updates may be too slow to address the recruiting shortfall.
And while there can be challenges at work, such as sensory overload or misunderstanding social mores, the benefits may outweigh the risks. Rather than preventing them from serving, individuals who have neurodivergent traits that allow them to hyperfocus on a given task often thrive under the structure and formality of the military.
Although he primarily works with military children, Jeffrey Katz says he believes many active-duty members serve undiagnosed, a finding the Rand study reported. Katz is a child, adolescent, and adult psychologist and leading expert in the field of ADHD, learning disabilities, and behavioral problems based in Virginia Beach, Virginia.
“The secret is that many, many [Navy] Seals have ADHD,” Katz says.
‘It Should Not Be This Variable’
Because the different military branches don’t have the same waiver policies, the process can look different from person to person and branch to branch. And that makes sense: A Marine’s tasks differ significantly from an airman’s. And all of them have to be able to deploy in the event of a war.
“Having medical standards—don’t twist my words—but just by their very nature are discriminatory,” St. Clair says. “The services, along with [the Office of the Secretary of Defense], are making these determinations as to what is acceptable on the front end. And that’s always been informed by deployability and by attrition.”
Recruiters know this, and they sometimes work together to help a person enlist.
“It’s different by each service,” says Lt. Col. Kim Helgemoe, assistant director, Reserve and Medical Manpower for the Department of Defense. “So just like the [branch] waiver authorities are willing to waive certain standards, the recruiters, they pretty much know what the waiver authorities will and won’t do.”
The Army saw a 35% rate for learning, psychiatric, and behavioral disorder waiver applications for people who had been medically disqualified, while the Navy saw a 60% rate, according to the Walter Reed Institute of Research. And the Army saw a 46% approval rate for those waivers, while the Marine Corps had a 71% rate.
But recruiters say the waiver process can differ even from state to state.
“I would route a candidate through that required a waiver and it wouldn’t get approved,” says Marine Corps Staff Sgt. Abigail Seitz of her time serving as a recruiter. “And so I would call my friend in another state and say, ‘Hey, if you routed this package, would it get approved?’ And they said, ‘Shit, yeah, of course. I did three of those last week.’ It should not be this variable. So it’s incredibly frustrating when somebody is either allowed entry or disqualified based on the opinion of one person over another.”
Can a Pilot Program Correct Branch Variability?
Common learning disorders, such as attention-deficit/hyperactivity disorder, can also be found on the Defense Department’s 41-page list of disqualifying conditions. As the prevalence of ADHD diagnoses has risen over the past two decades, so have the requests for medical waivers for ADHD.
But ADHD may not be an automatic disqualifier for long. It is one of the 38 conditions the military has included in a pilot program that seeks to remove some conditions from automatically disqualifying potential recruits.
The military launched the pilot in June 2022 as part of the Military Health Service’s new electronic health records system, Genesis, which centralizes all military medical records. This system made it easier for officials to review detailed medical histories of those with medical waivers and track their performance and attrition over time, St. Clair says—which allowed the Defense Department to identify conditions that have had historically high waiver rates.
“The Air Force would approve waivers for certain standards that the Marine Corps would not, so that had to be taken into consideration,” says Helgemoe, explaining how officials selected the 38 conditions for the pilot program. “Not all of them were approved at the same rate, and they didn’t make the list. The second thing that needed to be considered is deployability.”
A recruit’s diagnosis will show on their record, but won’t flag them for disqualification or slow down their recruiting process.
The pilot was scheduled to run through June 2023, when the “DOD will go back and conduct their analysis to determine the feasibility of extending the program,” St. Clair says. “And if we feel it’s successful, then we’ll look at reevaluating the medical accession standards.”
Smith confirmed that the pilot continues to operate.
Though the pilot program stands to expedite the medical recruiting process for many, it won’t for Morales or others with autism. Morales is deciding whether he should submit his application to another recruiting office or branch of service with higher waiver approval rates, after learning that he has little chance of joining the Coast Guard.
“I’ll always have my autistic moments; that’s part of my disability,” Morales says. “I can still learn from them, though. I can still grow from my experiences. In part, because I have less of a filter than ‘normal’ people, I can admit when I’m wrong without making excuses.”
He doesn’t regret applying.
“I did this—all of this—because I want to serve my country.”
This War Horse investigation was reported by Jennifer Barnhill, edited by Kelly Kennedy, fact-checked by Jess Rohan, and copy-edited by Mitchell Hansen-Dewar. Headlines are by Abbie Bennett. A Military Veterans in Journalism grant funded Barnhill’s research.
© Copyright 2023 The War Horse. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.
