As we approach Memorial Day and recognize those serving our country, we thought it would be worthwhile to look at the ease with which people with diabetes are able to serve in the military, and how that’s changed through the years.

Sadly, the picture isn’t as optimistic as we would have hoped.

While access to military service for PWDs has gotten a little better over time, not much has changed and it remains mostly hit-or-miss when it comes to someone being able to serve despite their condition.

The American Diabetes Association’s legal advocacy director, Katie Hathaway, says it’s pretty much “a mixed bag” and military service is off limits for most PWDs. It comes down to an individual being able to educate a military medical panel that he or she can still serve despite their diagnosis, often battling the same misconceptions and perceptions that plague those of us on the civilian side. Our battle is their battle, and the war spills into all ranks and military branches, apparently.

Of course, we have to talk types here. Really, we’re only talking about those PWDs already diagnosed with type 1 or dependent on insulin at the time they wish to enter the military. The possibility of service pretty much becomes a non sequitur when you’re living with a pre-existing condition.

Growing up, I was told specifically as long as I could remember that serving in the military wasn’t possible thanks to my type 1 diabetes. So that killed any thought of following in the footsteps of my maternal grandfather who served in World World II. I wouldn’t describe it as a “dream” of mine to serve, but if I’d had the chance I might have explored it as a possible path. Sadly, I have friends who did have that dream but had it stolen thanks to diabetes. So sad to think that so little has changed to this day!

“It’s hard to see a kid’s dreams dashed by a diagnosis of diabetes, and the military is one of the few jobs still off-limits to those with diabetes,” she says, noting that commercial airline pilot is the other, and the ADA is working actively to try to change that.

The federal anti-discrimination laws that apply to private and government employers don’t apply to the military, Hathaway said. No new laws have been passed in recent years to change this in any way. So basically, the military can discriminate as it sees fit — even if you’re a PWD who is qualified for the job (aargh!!)

Basically, we have athletes who’ve competed in the Olympics, are professional athletes worldwide, have endured safaris and mission trips and climbed the highest mountains in the world… but serving in the military isn’t allowed, because someone in the upper ranks believes that a PWD is a flat-out higher risk than any other soldier who might trip or have a heart attack? Maybe this is my naive civilian perspective speaking, but I think that’s wrong.

At least some PWDs still have the chance to serve, though: those whose diagnosis hit after they were already in.

One of the role models in the world of PWDs has been Master Sergeant (MSG) Mark Thompson, a senior career counselor based in Washington who was diagnosed with diabetes in November 2000 after collapsing one morning while stationed in Germany — following weeks of weight loss, exhaustion and thirst. First told he was type 2 as a likely result of his age at the time, Thompson said he was able to get promoted late that year, but eight days later he learned that he actually had LADA (latent autoimmune diabetes in adults).

Not wanting to scrap his promising Army career that was 4.5 years strong at that point, Thompson gathered information from the ADA’s website about managing his condition and used that knowledge to persuade a military medical board to let him stay in. With his win, Thompson was deployed to Iraq in 2004 and has since returned and served as a national spokesman and role model for PWDs in the military.

A Stars and Stripes article published in 2004 told his story, and he says that after the article ran, a bevvy of soldiers with family members with diabetes approached him, and he was bombarded with emails from other PWDs in the military — some of whom were keeping their diabetes a secret.

You could say that Thompson broke through the “don’t ask, don’t tell” principle for people with diabetes in the military, and he insists that there have been some significant changes in recent years.

Perhaps most importantly, in 2007 the military published a checklist about when PWDs can be deployed, which can be found in Army Regulation document 40-501 (Standards of Medical Fitness). In the middle of this 150-page document, the military now lays out specific criteria for those with “diabetes mellitus” who do and do not meet medical standards for service; if a PWD maintains what the military considers to be good control, they can be considered for duty. That changed the game, so that at least PWDs weren’t automatically thrown out of the military and have a chance to contribute.

Waivers are available for those diagnosed while serving and want to remain enlisted, Hathaway says. But these waivers can be difficult to obtain and depend mostly on the individual person’s case and medical review board, so getting the support of one’s chain of command and supervisors is crucial.

“It really boils down to the specific situation. It varies so widely across the military branches. We don’t know where the disconnect is, but it pretty much comes down to your being able to convince that medical panel,” Thompson says.

The ADA states that its organization has made in-roads on individual cases, such as Thompson’s, and it’s trying to educate PWDs about military rules and processes such as physical evaluation boards and the need for really solid medical support. Finding others who may have been in that position and faced service questions can be a valuable resource, they say.

Thompson says a key is education, and that is often the biggest hurdle in someone being able to stay in the military. Many people don’t understand diabetes or have preconceptions based on what they’ve seen in the media or how a family member’s poor health might translate to all PWDs. Ah, so misconceptions and prejudice about diabetes spill into the military just like anywhere else!

While reasonable minds can disagree on whether PWDs should be able to serve in certain capacities, it’s pretty clear that our community has a long way to go in getting more equal treatment when it comes to serving our country.

So, that’s the current picture for those PWDs who are serving or might want to serve in the military. But what about those who have already served? Does our country step up to help them with their diabetes care into retirement? That’s a whole other issue, and one our correspondent Wil Dubois will be exploring on Memorial Day Monday. So stay tuned!!