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“You have to pay attention to detail and you have to give it your maximum effort”
Daniel Fletcher: Welcome to “The Only Easy Day Was Yesterday,” the official Navy SEAL podcast.
DF: Mental and physical health is essential to a successful trip through Navy Boot Camp, even more so for NSW candidates. I’m Daniel Fletcher. As we continue our boot camp series from Great Lakes, Illinois, we sit down with medical liaison for crew training command, Chief Hospital Corpsman Jeff Ramirez. We answer some common questions about recruit medical history, mental health, medications, and preventative care. Listen up.
DF: Thanks for sitting down with us for one, and if you could just briefly talk about what you do here that would be a great start.
JR: I deal with all medical related issues, in terms of recruit appointments, any injuries that we have here going to network hospitals, to the federal healthcare center, outsourced down to Chicago. Any questionable areas that the doctors have that they need to liaison with the RDCs here in terms of missed appointments or recruits not eating enough, or even if they feel like they’re getting too much exercise, because there’s instances where we start breaking some recruits down that are couch potatoes, and then they get over here, and they learn right away that it’s a little different here.
DF: What types of tests or any type of screening do you administer, or is that not part of your position?
JR: So, that’s not part of my position here. So, I deal with the docs, and it’s going to range from mental health to your physical therapy, your preventative meds and then general, sick hall, but it’s every illness or injury or anything medical related between RTC and the providers.
DF: Okay. Are there any ailments or injuries that you see specifically for the 800 guys that are coming through the pipeline here?
JR: 800 guys... I would say the biggest injuries that I see would be shin splints, stress fractures and not getting enough nutrients. Rhabdo, Rhabdomyolysis. We’ll see that. They didn’t train for the pipeline before they got here. So, when they’re doing the DIVEMO PT, their body is breaking it down. (DF: Pretty severe.) Their muscles are breaking it down pretty severe, yes.
DF: I guess that is kind of a form of a failed test so to speak, if someone’s put in a position physically where their body is not holding up. Are there any other specific medical tests that are given periodically or on a routine basis that you see NSW candidates having issues with?
JR: Special physicals. They’ll go to special physicals. They’ll answer the questionnaires there, go through their overall history to see if there’s anything that raises any red flags. In terms of anything periodic, that doesn’t happen unless they, they choose to go to sick hall. You know, if they’re having some issues that RDCs say they see, any 800, any recruit really walking around with limps or looking distressed or sick, we’re going to send them to sick hall regardless. You’ll get your labs drawn over there, or if you’ve got to go to bone density scan or X-rays. A lot of 800s, you know, they really want to be here most of them, so it’s kind of hard to get them to go to medical sometimes. So it’s, you know, its our responsibility, and I get a lot of phone calls about that, “Hey, I have a recruit that’s kind of been limping around. He says he’s okay, but, however, my spidey senses are telling me he probably needs to get seen.” Then we’ll go ahead and send him in there and usually find out something else.
DF: If there’s somebody who gets to this point in the process and then a medical screening turns up not good enough or a fail, whatever you want to call it. Are there chances for a candidate to kind of retake a test? Can you tell me a little bit about that landscape of that kind of situation?
JR: So, if we’re going to use vision as an example. So if you came in. the MEPS doctor says your vision’s a certain score, and you come here, and it’s not, or you’re colorblind, they’re going to reissue the actual test again. So, you’re going to do one at MEPS, you’re going to do one here. If you fail that, you’re going to do it again. And if all the scores end up as the same here, then they’re going either request a waiver, if you’re eligible. The special phys docs, they’re going to determine whose waiverable per the BUMED instruction. So they’ll go in there and make sure it is a waiverable condition, whether it’s vision, hearing. If it is waiverable, we’ll keep them in the pipeline here, and then the waivers usually come back by the time they get out of here. If it’s not since they’re most of them are contracted, then they can opt to either pick a different rate or pretty much get separated in their contract. So, your basic recruits, they’re coming in they’re not contracted like the 800s. If they don’t meet specific requirements for a certain job, then they’ll get put in another job. But for the 800s, if they don’t want to fulfill their contract because they can’t, due to something medically related, then they can either opt to go or stay with another rate.
DF: Our primary audience is, I guess I could say the laymen or the layperson or civilian. So I’ll do a little bit of interpreting for them. So, someone who comes into the Special Warfare pipeline is kind of quasi hired by the Navy, and they can then choose to choose a different direction to take their career. Is that, is that accurate?
JR: Yes. That’s exactly what I’m saying and if they got their heart set on being a SEAL, and you don’t meet the medical qualifications to fulfill that contract, then yes, you can drop on request and get separated from the Navy all together.
DF: Or decide to to make a different decision. How often do you see that misalignment of MEPS decision versus something onsite here?
JR: There is those that do fall through the cracks. There’s always human error. It’s not as much as we think. Most of our, our drops are usually “drop on request” really, after. In terms of medical, it’s not as much as we, we actually think.
DF: Okay, well, that’s good to hear. What types of tests can a recruit fail to have them say, “You’re not going to be able to be in the Navy at all”?
JR: Hearing’s on a bigger scale right now than vision is.
DF: Why is that?
JR: Any kind of permanent hearing loss, the deeper decibels. It’s an automatic disqualifier, and some of them aren’t even waiverable.
DF: So, you’re saying that it’s starting to become a bigger issue than it used to be? Or it’s more noticeable or...
JR: Probably more, more noticeable. I would say that the ear buds and the working out. I’d be a hypocrite if I didn’t say, “I do it myself.” I would imagine that has something to do with it. So if you listen something loud, right away you’ll have that, that that minimum hearing loss, the temporary, lower frequencies, but the higher frequencies, that would be you consistently listened to your earphones really loud when you’re in the gym 24/7, or in your cars nowadays.
DF: No good. I’m guessing that there’s sometimes injuries that happen during basic training that can kind of put someone in that same situation. Is that something that people should be concerned with, or is that pretty rare in terms of shin splints that are so severe, or whatever it may be that they’re not able to continue? Do they have a chance to maybe, have a few weeks to kind of heal up?
JR: So, we have the recruit convalescence unit that’s actually here in Ship 4. The reason for that is if you get shin splints or stress fractures, you actually get a rehab time. So, when you go to the hospital, you see one of our docs, and they say, “Hey, you got shin splints. You’re going to be Light Limited duty for 21 days.” So, that’s 21 days of rehab. So during that 21 days they’re going to go to Ship 4 and their job is to get better. They’ll be put in a hold status until they are fit for full duty. Once they’re fit for full duty, they’ll incorporate with another 800 division to keep the training going.
DF: Does that happen often enough that you think that’s a successful way to deal with that?
JR: I don’t think it happens as much for the 800s. For the regular recruit divisions yes, for the 800s, no.
DF: And that’s the same process for both of them in terms of the time that they’re given and stuff like that?
JR: Yes. If you look at the recruit convalescence unit, you’ll have for every 30, 40 recruits, you might have one 800 in there. Usually when the 800s get injured, it’s because that individual didn’t prep. So, he came over here and did a little bit more running than he or she was doing at the time.
DF: Right, right, right. From your perspective, what type of advice would you give to someone coming into the pipeline to avoid types of medical issues that we’re speaking of?
JR: The biggest thing is prep. So, don’t do the bare minimum before you actually get here. Going over to DIVEMO PT, they’re going to give you a workout you know. So if you weren’t prepped before you got over here, it’s going to show, and it’s going to show quick. DIVEMO’s really where they start falling out, its not regular PT. It’s not the PT that all the other recruits get here because you’re contracted. You’re going to do something more strenuous. So, definitely prep is huge.
DF: Is there part of the process that you think people should be maybe more aware?
JR: You have to prep. Prep’s the biggest thing. If you’re taking a lot of protein powders and all this stuff you can get from GNC or bodybuilding.com, whatever you’re taking, just remember you’re not going to have it here you know, the stuff that gets you over a good workout, because sometimes you’re pushing your body so much that you need that extra protein, or you need a little bit extra, (DF: or whether it’s Pre-workout or whatever) pre-workout, you’re not going to have it here. That’s going to cut straight out of your your whole diet. Now you need to know how to eat correctly, and we do our classes here to teach you how to eat. However, it’s a lot better if you have the history of doing it and you know your greens, you know your fruits, you know what you’re doing. Because you can’t just take that simple protein powder and call it a day. It’s not going to happen here.
DF: Right. If there’s anything that you see on a common basis that you think that people should be more aware of, it would be great for you to kind of cover some of that as well.
JR: One big thing is the psych issue. And when I say that, it would be more geared towards the mental health part of it. Mental health is a big part here, and it’s a great, great tool for crew training command. Some of the 800 guys that we have, we’ll get them, and they’re watching videos and everything since they were young, they’re real motivated, can’t wait to do it. Which is outstanding. However, they come to boot camp, and they figure out, “Maybe this is not what I wanted to do.” So, it’s a general hype that they get themselves going through for however long that they get themselves hyped up for, but they get here, and they kind of shut down a little bit, and once they shut down, it’s kind of hard to pick them back up. So then they end up going to mental health and talking to them. Sometimes they can say things that may disqualify them. Does it happen? Yes. And it’s not, you know, on a huge scale; however, it does happen. Almost like they pretty much psych themselves out. The first couple DIVEMO days, they kind of psych themselves out, and they go, “Okay, maybe this is not what I want to do,” cause it’s strenuous. It hurts. At the end of the day, this is what you wanted, and you’re getting trained by the best people we have over there, but sometimes they can... psych themselves out and they put themselves in a bad position.
DF: I think you brought up a good point. So much of the focus on the prep and even further along in the BUD/S process, and then throughout, there’s a huge emphasis on physical preparedness, physical capabilities, but the mental aspects seem to be coming to the forefront a lot more than it used to be in the past, and even awareness of mental health issues. Speak to that a little bit, are there underlying issues that people should be aware of if they want to come through basic training, or maybe in the past, they had issues with depression or anxiety. What’s the Navy’s kind of opinion on that in NSW and the Big Navy, and how does that kind of fit into your job?
JR: I work with mental health really, really closely here, and the reason being is because it is a different kind of day and age. We do have kids getting prescribed meds from an early age. However, that’s not all disqualifying factors. Yes, there are certain diagnosis where it’s going to be a disqualifying factor, and that’s just kind of what it is. If you are bipolar type II or something like that, it’s going to be a disqualifying factor. However, if you struggle a little bit through school or even your first year of college, and you’ve shown progression, and you have those notes by a doc saying that you’re good to go, you’ve been on meds for a little bit, or something bad happened in the family, these are all things that they are waiverable. You’ve just got to show the actual documentation. So, in terms of someone prepping to come here, it’s good to know that if you’re going to get your civilian medical records, and it’s going to say that you’re put on a certain medication, don’t just stop. Don’t just stop and say, “Okay, well, I’m going to stop taking this because I plan to go to boot camp in a year.” So, if you stop when your doctor tells you to stop, and then you show the progression for the one or two years, preferably two, you know, the doc can sign off on that and say, “Hey, this person fell into a kind of a slump, did what he had to do, she had to do, and recovered fully. We’re good.” Where we have the issue is when someone goes to a hard part in their life, gets prescribed some medications and then decides this is what they want to do. They want to go to boot camp and then just stops it. So, when you get someone’s civilian medical records, it shows that you were getting treated, and then there’s a blank. So there’s really nothing to go off of, and now you got to get reevaluated here (DF: It’s a liability issue) its huge. So, there’s nothing wrong with mental health. It’s a part of all of us whether we like it or not; however, it’s the way we go about it.
DF: Well, I think that’s a good thing to point out. I think a lot of people might say, “You know, whatever existing condition whether it’s physical, mental or whatever disqualifies me,” and I think reading between the lines is talk to your doctor, and you guys want to see as long of a spread between, whether it’s a prescription or a diagnosis and having some evidence to say, like, “Hey, this is where I am now.” I think that would be helpful for a lot of people to hear because a lot of people just might say, “Well, I can’t do that now.”
JR: Absolutely. And I mean overall in mental health, there’s a lot of different areas, a lot of different diagnoses, and it doesn’t speak for every single one of them, but there’s a big chunk out there that you can still be in the Navy, nothing wrong with it. They just need to see the full treatment plan. They can’t just cut it off in the middle cause you never went through treatment.
DF: There seems to be maybe some confusion in the aspect of medical records and how that’s integrated into the Navy from civilian integrating the sailor life. What’s that process look like, or, you know, does the Navy scoop up everyone’s medical records when you come in?
JR: Any diagnosis, anything that legally you have to put on your medical history form, and that’s a medical history form that’s legally used by the whole Department of Defense. You do have to provide that documentation if you put a diagnosis on there. So, if you put a diagnosis on there, you have to provide that actual information because the docs want to know what the treatment plan was for and how it’s going to affect you. In terms of receiving all the civilian medical records, we’ll get what you put in there. Do we get them all? Probably not. With that being said, we probably don’t get it because they’ve still got human error, or you’ve got humans lying as well.
DF: Right. Do you see that as an issue normally, or I guess not normally, but...?
JR: I think it is an issue. Otherwise, we wouldn’t have recruits separating every day because they’ll go to mental health, or they’ll get seen because a past injury is going to act up. Past injury acts up here, and we find out that it’s something that was pre-existing. (DF: You can’t lie about that) So, now, if they want to stay in, we’re going to request those civilian medical records so we can see if you can actually stay in. But in terms of the Navy just reaching out to civilian hospitals and getting medical records, that’s not even legal.
DF: Well, obviously, it seems like being honest on your, on your forms is probably not only legal but the better thing to do for your own success.
JR: Yes, absolutely. So, like I said, any medical history form you get in the Navy, you have to list, legally. That’s why they’re asking you. We’ve got to know what’s wrong with you, and if you don’t provide that, that actual information, I mean you can get in trouble for that. But in terms of if you don’t provide it, and even if we think something, it’s not like we can reach out to where you got seen as a kid and say, “Hey, I need those records.” It definitely doesn’t work like that.
DF: Are there any kind of medical issues that can develop here that can disqualify someone completely from the Navy?
JR: Reoccurring stress fractures or reoccurring shin splints. You’re contracted to be here, however, if you can’t get past DIVEMO because you just keep on breaking, unfortunately. That’s not your fault. However, that’s something that would definitely you want to make it much farther than that because you’re pretty fragile, and after this pipeline you’re going into something even more, more aggressive.
DF: Right, right. More rigorous. Appreciate you taking the time to sit down and talk with us. I know this might not be the most glamorous topic, but it’s just as important as every other part of this pipeline. You know, crawl, walk, run. Medical is a big part of that. Thank you for your service, and thank you for the time today.
DF: Find out more at SEALSWCC.com, and join us again for the next NSW Podcast.