USPHS - disqualified and very disappointed

[zeusfaber]

Hi all, 

I just wanted to vent/write this out and maybe get some feedback. I have been working at the BOP since 9/2014, and almost immediately I began the process of trying to get into the USPHS. I had gone through a couple of bad private sector jobs, and finally I felt like I found my calling with the BOP and with the prospect of USPHS service. My whole department is PHS: Both my bosses, the physician, dentist, pharmacist, nurses, and they have all been very supportive in helping me convert - writing letters of rec, etc. In August of 2015, I had finished the interview and was seemingly awaiting my date for OBC when I was disqualified medically.

 

In 2014, I had gone for therapy for about 4 sessions over 3.5 months, when I was feeling bad about being unemployed and also dealing with a breakup. I hadn't taken any meds, wasn't hospitalized or anything - I had just needed to talk to someone and regain a positive mindset. Well, that decision to be proactive about my mental health was apparently the worst decision I ever made. My therapist diagnosed me with Major Depressive Disorder, and when the USPHS medical board got this information, I was disqualified. I was permitted an appeal for the decision, which included more letters of rec from my SP (the clinical director), my boss, the warden of my facility, and another personal statement. I tried to get the therapist to change his diagnosis to Adjustment Disorder (he said no, that I met the criteria for MDD and that was that). He did write me a letter saying the condition was resolved, there is no follow up indicated, etc. The answer from USPHS after I appealed: Still no. 

 

In the aftermath, I realize I just shouldn't have disclosed my having gone to therapy to the PHS. It was such a non-issue that now has slammed the door on the career opportunities that I would have had through the PHS. I love my job at the BOP but it doesn't pay enough, doesn't have career growth opportunities and I can see myself outgrowing it soon. I feel very lost right now. I am disappointed that the PHS - an organization of health care workers - can't see the nuance between someone who went to therapy briefly and someone who is truly mentally ill and not fit to serve. Also, it is known that the BOP needs PAs and has a hard time recruiting qualified providers. I've lost a lot of respect for the PHS, to be honest. My colleagues are all equally shocked and disappointed, since I'm very highly regarded in my department and they all went above and beyond to support my application and my appeal (while also agreeing that I shouldn't have disclosed the therapy). I feel like I poured so much effort into my PHS application - possibly more than my PA school application - and also had excitedly told family and friends about PHS when I passed the interview portion and was supposedly awaiting an OBC date. 

 

I just feel lost now, I feel like the rug has been pulled out from under me, and I'm not sure what my next career steps are - since I had big plans with the PHS and was hoping to go out on deployments, eventually work at the CDC or FDA, etc. Perhaps I shouldn't have made these plans, but it's hard not to think ahead when you spend over a year applying for something like this. 

 

Anyway, I guess I'll be working at the VA or something in the future, and that will be my life path. Sorry if this post sounds overly dramatic - this has been one of the biggest, most frustrating professional disappointments I've experienced and I just needed to vent. If anyone has any info about how to still try to get into the PHS, I'm all ears - doesn't sound like they have any wiggle room on the disqualification though. 

[MT2PA]

It's unfortunate that you were disqualified, but MDD is nothing to scoff at.  It may not have required medication or apparent follow up, but it is a part of you.  Don't regret seeking help if it was the right thing to do for you.

[rev ronin]

It's unfortunate that you were disqualified, but MDD is nothing to scoff at.  It may not have required medication or apparent follow up, but it is a part of you.  Don't regret seeking help if it was the right thing to do for you.

Assuming the OP had MDD in the first place.  It's overdiagnosed vs. simple depression because Medicare pays more for it.

[MT2PA]

Assuming the OP had MDD in the first place.  It's overdiagnosed vs. simple depression because Medicare pays more for it.

 

A valid point.  We don't know for sure and neither does USPHS.

[rev ronin]

A valid point.  We don't know for sure and neither does USPHS.

The OP could possibly sue the originally diagnosing clinician for malpractice, as the guidelines for MDD do not appear to be met:

 

http://evolutioncounseling.com/major-depressive-disorder-dsm-5-criteria/

 

Ask for your entire medical records from that provider, and then go over whether the criteria for MDD were actually documented in the encounter.  If not, you may have recourse...

[ventana]

need to request your records from the therapist

see what was documented

 

A big thing is that I always have had the 6m rule for Dx - 

greater then 6m of depression in order to Dx - not sure if this is by the book or not?

 

If you are set on USPHS and you were less then 6m and did not have MDD

 

Hire a Psychiatrist to do a chart review and come to a formal opinion...  and why according to the DSM - 

 

people are correct - the Dx is a coding and payment issue - unlikely (and the therapist might not realize the sig of teh Dx)  Explain to them, then investigate your alternatives - ie consult someone

 

 

 

I had a similar issue for 3 PT visit for an acute low back strain that disability insurance exempted by back for ever after seeing.  It took a few years, but I got it lifted...

[zeusfaber]

It's unfortunate that you were disqualified, but MDD is nothing to scoff at.  It may not have required medication or apparent follow up, but it is a part of you.  Don't regret seeking help if it was the right thing to do for you.

 

 

I don't think it was the right thing to do for me. I was trying to be proactive about my negative mindset, but had I known that I would be "labeled" with MDD and in the future be denied career opportunities, I would have just worked through it on my own. I wasn't in any danger of harming myself or needing medication. It "cleared up" as soon as I started working again. Seeking mental health care has hurt me more at this point by getting in the way of my USPHS application more than it helped me at the time. In fact, I would strongly discourage others from seeking mental health services unless they have sustained symptoms, SI/HI, or psychotic symptoms. Or at least, I would advise them to go outside their medical home and pay cash.

 

I disagree that MDD is "a part of me." I don't think that 4 visits to a therapist over 3 months because I was fired from my job and recently dumped should alter the course of my career to this degree nor should it define who I am. What did help me was starting a new job where I fit in well and felt valued. 

 

I did try to argue about whether or not the criteria for MDD were met - according to the therapist, they were - because of answers to questions I was asked, such as "do you feel sad most days" and "are you sleeping more or less than normal" (I was sleeping more bc I didn't have a job to go to...). My friend who is a psychologist disagrees that the criteria were met and would have called it Adjustment Disorder since it was less than 6 months and resolved once the stressor was taken away (unemployment). This friend even wrote a super great letter as part of my appeal expressing his disagreement and indignation regarding the disqualification on these grounds. However the therapist was sticking to his diagnosis per the DSM, knowing the implication of keeping this dx on my record, and that was that.

 

MDD or not, I fail to see how this temporary issue which is now completely resolved makes me unfit to serve in the PHS. My boss was in rehab (!!!) when she got into the PHS with a 3 year "probation", my acquaintance has seen a therapist for years but "forgot" to put it on her application, my other colleague has diabetes and is overweight x years but somehow has managed to stay in PHS. One of the PHS nurses has ADHD (he went off meds to be able to stay in PHS) and severe tremors (he does not function as a nurse anymore). So compared to these things I don't know how my situation is so much worse that I'm not fit to serve. I think it's the injustice of this that has me more upset than anything.

[rev ronin]

So, expert witnesses agree misdiagnosis, therapist has been given opportunity to correct the false diagnosis, knowing that the false diagnosis was communicated to a third party and harmed you, and refused to do so.

 

Time to pony up a few hundred bucks and have a lawyer write a demand letter on your behalf. 

 

If no response, complain to the state licensing body.  Then sue for both malpractice and libel.

 

You might not win, but it should be an interesting ride.  Your lawyer should be able to tell you how much the suit would cost, but I'm guessing well into five figures.

[loliz]

I'm curious... how did they know about this piece of your medical history? What question did they ask that required you to disclose this?

[zeusfaber]

I'm curious... how did they know about this piece of your medical history? What question did they ask that required you to disclose this?

 

 

 

It was my fault for disclosing it - I shouldn't have. They have a comprehensive health history form as well as a form that a provider has to do - and it's the standard "military physical". I'm too honest and answered yes to the question "Have you ever sought counseling?" The doc who filled out my physical form, where he has to comment on my health history, noted that I sought brief counseling, it resolved, the end. They then came back with requests for details, where I had to disclose the diagnosis, which was MDD. 

 

Multiple colleagues (PHS and non) have said that I should not have disclosed it. The doc who did my physical in retrospect said I shouldn't have disclosed it although at the time he didn't comment either way, as he also did not think it would be an issue. He is PHS and used to do military physicals when he was in another branch of service, so he would know.

 

I also had used my work insurance to pay for it, and had previously disclosed the counseling on my background check, so I figured lying about it and then getting caught would be worse (perjury, etc). I was then informed that the PHS simply don't have the manpower to cross check and they would never have known. So to summarize, I disclosed it bc I was scared of lying about it and then getting caught since I felt it was "traceable" but  it seems like I shouldn't have disclosed it and it would have been fine.

[loliz]

Wow. I honestly feel for you. This got blown way out of proportion. 

[HCM4416]

Anything more ever happen with this?

[virtuous woman]

Any updates? 

[Mantenso]

I don't feel the need to start my own thread on this, but I find myself in a similar situation and am furious. Despite having worked hard over the last year and half to improve all measures of health, and succeeding in lowering my LDL nearly 100 mg/dl (without the benefit of a statin I might add), I was disqualified from USPHS service on the basis of a previous lipid panel that showed my LDL to be 4 mg/dl over the limit of 200. Never mind that I have been so successful in lowering my cholesterol that my physician has advised me to stop taking my cholesterol lowering medication. Never mind that I provided four subsequent lipid panels that show I now meet the standards. Never mind that I am currently well under the threshold for acceptable lipid levels. I am considered unfit to serve. No appeals or waivers possible, thank you and don't let the door hit you on the way out.

Before embarking on the commissioning process I combed through the 50-odd page medical accession standards to make sure I met everything and wouldn't be wasting my time in applying. The unnecessarily narrow way in which the DODMERB reviewers are applying the standards are not only cruel but in my mind detrimental to the recruitment of medical professionals who wish to serve their country. 

 

[bovineplane]

It isnt the provider applying a standard. The standards come from federal regulations. I have seen many Soldiers come in on waivers and generally they dont make it. Previous ACL repairs, micro disc surgery, scoliosis, etc. The rigors that come with some of these jobs are not written to a specific military job, they apply to everyone the same. 

As far as lipid, I would guess the motivation is cardiac risk. Hard to say since the regs are written echelons above us. It does prevent some good people from joining but it also protects the majority from injury with service. 

 

[moleashish]

Some of the standards and requirements on surface level doesn't make sense, might seem cruel as you, @Mantenso, put it but it is not detrimental to recruitment for medical professions wanting to join. They get enough applications that meet all their requirements that they can be picky. Does it suck? Yes it does for people who want to serve but aren't qualified. 

I am sorry you had to go through the process and better yourself to prove you are fit but not given a chance. That does seem unfair but hey, on the bright side you have improved a lot, health wise, and that's all some of us can ask for. 

[cgsarmedic]

On 3/26/2016 at 4:02 PM, zeusfaber said:

I did try to argue about whether or not the criteria for MDD were met - according to the therapist, they were - because of answers to questions I was asked, such as "do you feel sad most days" and "are you sleeping more or less than normal" (I was sleeping more bc I didn't have a job to go to...). My friend who is a psychologist disagrees that the criteria were met and would have called it Adjustment Disorder since it was less than 6 months and resolved once the stressor was taken away (unemployment).

To the OP, I highly suggest that you do not get MDD changed to adjustment disorder.  Although this sounds better from your perspective, it is one of the most commonly used psychiatric diagnoses to remove people from the military.  Fight the diagnosis if you don't think you had it, but be careful replacing it with another one that may be looked at more poorly.

 

[bovineplane]

On 9/30/2019 at 1:46 PM, cgsarmedic said:

To the OP, I highly suggest that you do not get MDD changed to adjustment disorder.  Although this sounds better from your perspective, it is one of the most commonly used psychiatric diagnoses to remove people from the military.  Fight the diagnosis if you don't think you had it, but be careful replacing it with another one that may be looked at more poorly.

 

Adjustment disorder is quite common in the military. However, it is much more common because we are not worried about reimbursement rates and paid visits. Civilians like to get paid and often get right to a higher diagnosis. It isnt right but it happens. As for the military, you can stay in the Army with adjustment disorder. It is common to separate Soldiers for it but it is also common to be retained and a much easier diagnosis to join the military with than MDD.