Guidelines for civilan providers preparing evaluations for military use:
- Opening. Use your letterhead and address the letter To Whom It May Concern, or To the Commanding Officer of ____. Mark your letter Confidential. (Remember, however, this will not stop the military from using your evaluation as evidence against the patient.)
- Military Experience. If you have had military experience, please cite it.
- History. If you have been treating the patient for some time, say so: your letter will be given more weight.
- Test Results. Military personnel favor numbers and pictures. Whenever possible, clinical impressions should be corroborated with objective findings.
- Diagnosis. Try to be as complete and detailed as possible.
- Prescriptions. Emphasize any prescriptions which may be difficult to fill under military conditions, such as special clothing, special diet, or limits on activity. Ex. "Patient should not use weapons or heavy machinery" or "Patient should avoid loud or stressful situations and get extra sleep when needed," or "Patient should discontinue any activity that causes pain." Include any limitations that result from medications prescribed.
- Prognoses and Conclusion. Consider providing two prognoses: one if the prescription is followed, and the other if it is not. For example, If the patient scrupulously adheres to a bland diet she may experience few gastrointestinal difficulties. But if the restricted diet cannot be adhered to, acute and painful episodes will continue, probably requiring surgical intervention.
Stress Military Needs Not Patient Welfare
The military wants to know whether the patient can perform their duties without causing trouble, embarrassment, or expense. His or her welfare is distinctly less important. Emphasize the impact of your patient’s condition on job performance. If, however, the patient’s problem may result in death, suicide, or serious disability, stress this fact.
Military authorities do not like civilians to tell them what to do. They often believe that civilians don’t understand military needs. Therefore, it is unwise to offer an opinion of the patient’s ability to adjust to military service.
It is also unwise to directly express criticisms of the military. Instead, offer your opinion of the patient’s ability to adjust to specific factors which may be present in military service. If the patient requires a special adjustment you suspect the military could not provide, state the requirement. The exception to this rule is if you have previous military medical experience. In this case, cite your experience.
Less clear examples of medical evaluations are:
- This person should be discharged.
- This person will not be able to adjust to military life.
Excellent examples of evaluations include:
- This person should not be required to live or work in close quarters.
- This person should only be required to walk moderate distances.
Avoid Documenting Incriminating Evidence