An RPCV looks at the Peace Corps Screening and Medical Clearance Process

Peace Corps' Screening and Medical Clearance

The purpose of Peace Corps' screening and medical clearance process is to ensure safe accommodation for applicants and minimize undue risk exposure for volunteers to allow PCVS to complete their service without compromising their entry health status. To further these goals, PCOL has obtained a copy of the Peace Corps Screening Guidelines Manual through the Freedom of Information Act (FOIA) and has posted it in the "Peace Corps Library." Applicants and Medical Professionals (especially those who have already served as volunteers) are urged to review the guidelines and leave their comments and suggestions. Then read the story of one RPCV's journey through medical screening and his suggestions for changes to the process.

An RPCV looks at the Peace Corps Screening and Medical Clearance Process







RPCV Chuck Ludlam (chuck.ludlamATgmail.com) writes: "As an older – 60 years old – applicant for the Peace Corps in 2005, I found that the medical selection process for the Peace Corps can be maddening. This was the case even though I was applying to serve again, after a 37 year gap (Nepal, 68-70). I found that the Peace Corps provides a minimum of useful information about the possible twists and turns that can occur and what alternatives the applicant can pursue at each point in the process. My impression is that the paramount value for the Peace Corps seems to be secrecy, to reduce the power of the applicant and maximize the power of the Peace Corps selection personnel."



An RPCV looks at the Peace Corps Screening and Medical Clearance Process



As an older – 60 years old – applicant for the Peace Corps in 2005, I found that the medical selection process for the Peace Corps can be maddening. This was the case even though I was applying to serve again, after a 37 year gap (Nepal, 68-70). I found that the Peace Corps provides a minimum of useful information about the possible twists and turns that can occur and what alternatives the applicant can pursue at each point in the process. My impression is that the paramount value for the Peace Corps seems to be secrecy, to reduce the power of the applicant and maximize the power of the Peace Corps selection personnel.



As a result of our experiences with this process, I filed a Freedom of Information Act request and obtained a copy of the medical selection/screening guidelines the Peace Corps uses in evaluating the medical qualifications of applicants. I learned of the existence of the guidelines by accident during as my application was being reviewed and immediately asked to see them. After a month of evasion, I secured a copy of the guidelines relevant to my own medical issues (cardiology). I was shocked to find the guidelines to be woefully out of date, embarrassingly out of date, and I then feared that they would prejudice my application. I forcefully argued that the guidelines were out of date, and supplied extensive clinical trail and other documentation to prove that point. The Peace Corps refused to reconsider the guidelines and would not permit me to base an appeal on the obsolescence of the guidelines. In the end, I was accepted to serve again in the Peace Corps and am now serving as a Peace Corps Volunteer, together with my wife, who is also a 60s RPCV. But I found the medical screening process to be a bitter experience.



Having obtained part of the medical selection/screening guidelines, I filed a Freedom of Information Act request to see all of them, with the purpose of posting them on Peace Corps On Line. When the Peace Corps agreed that the FOIA request was appropriate and to supply me with these copies of the guidelines, I first proposed that the Peace Corps itself post them on its website instead of my posting them here. The Peace Corps refused the offer, which I find to be in keeping with its preference for secrecy. I also invited it to supply background information about the guidelines, the role they play in the medical clearance process, and to define other relevant concepts (discussed below), including the concept of a medical "deferment" and medical "accommodation." Again, it refused.



So, I will attempt here to explain all of this, but it would have been preferable for the Peace Corps itself to have done so in my stead and to do so on its website where all applicants and their doctors can see the guidelines. Posting them on Peace Corps OnLine will help, but this is not the best way to ensure that all applicants are aware of the guidelines and other relevant information about the twists and turns that can occur during the medical clearance process.



Advice to Applicants to the Peace Corps



My advice is simple: if you have any medical issues that may affect your application, automatically and immediately ask to see the relevant portions of the guidelines. Cite the success of my FOIA request as the basis for your request. Ask to see the up to date version. The version posted here might become obsolete over time. Then review the guidelines VERY carefully to discern the way the Peace Corps thinks about your medical condition. Have your doctor look at them as well. You will likely see a list of factors that cut in favor or against clearance and information on possible "accommodations" that might be imposed (see more on this below). If the guidelines are obsolete, or do not address directly the condition at issue, then perhaps the applicant and his/her doctor can extrapolate from the information in the guidelines.



When the Peace Corps responded to my FOIA request, I am not sure it supplied me with all of the guidelines. Do not assume that all of the guidelines are published here. If you see no guidelines relevant to your condition, then you should ask if there exist any medical clearance guidelines for that condition. If the Peace Corps hesitates to supply the relevant guidelines, immediately file a FOIA request for them.



Role of the Guidelines



The precise role the guidelines play is not well defined. The Peace Corps will say that the guidelines are not binding and that they have ample discretion to accept applicants who do not fall precisely within the terms of the guidelines. I suspect that like any bureaucracy handling a large number of cases, the Peace Corps staff relies heavily on the guidelines to simplify its decision making process and feels little latitude to deviate from them. This is particularly true as the staff tend to be very young and there is tremendous turnover (with the five year rule). This makes it likely that the guidelines tend to be definitive, not suggestive.



Peace Corps Medical Selection Process Vagaries



Going beyond the guidelines, I can say that I was constantly surprised, mostly negatively, by the selection and medical clearance process. The overriding philosophy of the Peace Corps seems to be to keep everything secret, surprise the applicant repeatedly, and test whether they can handle this stress and really want to be a Volunteer. I assume this is not literally the case, but this is how it seemed to me.



We first applied in early summer to try to catch the matches for couples in August. We found out about the August (and October) couples placements from our recruiter. But if this is the routine time frame for matching couples, all couples should be notified that these are the crucial periods -- and notified online. Something the Peace Corps will probably resist.



In fact the Peace Corps website should have a special section on the special application issues for couples highlighting these dates and other issues specific to couples. Secrecy on this point only serves to alienate couples. Perhaps the Peace Corps doesn’t want couples enough to address the special issues that apply to them.



We didn't find a match in August. So, we waited for the October offerings. As we sorted through the October options, we asked to be sent the electronic description of the program options and we were told they are only given orally. We see no reason whatever why the formal descriptions can't be made available to the applicants. We do not expect that they'll reveal the country by name, but we see no reason why the formal program description can't be emailed or mailed to the applicants as they review the options. Secrecy only alienates the applicants. Despite the secrecy, we bid for a program and got matched.



After we were matched, we first heard about my being medically "deferred." There was no information online about what this meant. It took us a week of inquiries to find out what it meant.



We came to understand that a "deferment" means that the Peace Corps will not process your application further until a medical issue is resolved. The length of the deferment can vary and the terms under which one secures a lifting of the deferment varies.



Any cursory review of my application would have revealed that this deferment was going to be imposed. And in my case, the duration of the deferment is fixed in the guidelines, not variable. So, it would have been easy to alert us to this situation when we'd applied, not many months later. We were attempting to organize our lives around a projected departure date, which was obviously affected by the deferment. Our recruiter should have had this information and given us this heads up before we applied.



This is one of many examples of the fact that there is zero coordination between the recruitment, placement and the medical staff. In our case, this had a whipsaw impact on our sense of the likely timing of the process.



In addition, any cursory review of my application would reveal that a medical accommodation would automatically be applied to me that would limit the country in which placements would be available. (A "medical accommodation" means that the Peace Corps will accept the applicant only for certain countries where specialized medical facilities exist.) Yet, in October, four months after we'd applied, the Peace Corps "matched" us with a program that did not satisfy the accommodation. Again, there was zero coordination between the placement's staff and the medical staff, whipsawing us. Again, this is information that recruiters should be given. In fact, we didn't find out about the medical accommodation until ten months after we'd applied, at the end of the medical clearance process.



When we were hit with the deferment, we initially were told we couldn't start the regular medical process until the deferment was lifted. This proved not to be true. We were permitted to pursue both simultaneously. Nothing about the interplay between deferments and the medical clearance process is explained online.



During the medical clearance process, we were told that some of the data we'd submitted might not comply with the "medical clearance guidelines," so, naturally, we asked to see the guidelines. It took us 6-8 weeks for us to get a copy of them (after we threatened a FOIA request). The guidelines should be presented online. Again, secrecy seems to be the paramount Peace Corps value.



Then it turned out that the medical clearance guidelines were completely obsolete. My doctor laughed at them. So we had little confidence in what the outcome would be for us given the obsolete guidelines.



Fortunately, despite the obsolete guidelines, I got medically cleared. Then we first found out about the "medical accommodation." Again we were given no information on what an "accommodation" meant. We only knew that the country to which we'd been matched in October was not available – never had been available. Again, all of this could have been revealed to us the previous July when we applied.



Once we got to our country we found that the accommodation restricts not only what country in which we can serve, but where in the country we can serve. We have been given a site that is 2-3 hours from specialized medical attention (for cardiology). Again, secrecy is the Peace Corps' highest value.



Someone should file a FOIA request to determine all of the conditions for which accommodations might be imposed.



In fact, there seems to be a good deal of secrecy between the medical clearance staff and the country staff. It's easy for the DC staff to say that an accommodation has been imposed, but in the country they have to determine if an actual site is, in fact, available. In our case, there was, but the country medical staff had to scramble to set it up, a process made more difficult by the fact that we're a couple and they needed a site that was appropriate for both of us (we're in separate programs).



As the Peace Corps was seeking to match us to a country that satisfied the medical accommodation and fit our skill sets, we asked if the Peace Corps could give us a list of the countries where the medical accommodation could be satisfied. Again, it refused, secrecy being the paramount value. There is no reason why this information can't be made publicly available and a FOIA request would surely reveal this information.



Despite the accommodation, we were offered a new match and accepted it. Switching to another match was an extremely aggravating process, all of which was intensely secretive. We are delighted with our service, but we were highly uncertain of the outcome as the whip sawing was taking place.



The matching of us in October and the rematching of us in April (to a country that satisfied the medical accommodation) was a classic whipsaw. The October matching was never going to stick, so why put us through that process? Why not have the medical staff spend 5 minutes to see if there is some obvious block on where we can serve so we are only matched once?



After all this, we were hit with a legal "hold." We gather this happens to everyone. But we had no idea why there was any hold or that it meant nothing. It turned out there was no reason for a hold. Never had been. Another negative surprise.



We assume that there are certain medical conditions that will inevitably disqualify an applicant from serving. We have seen such a list, but again we had to ask for it. It's not posted on the Peace Corps website, which is basically useless on all of these issues. Some one should file a FOIA request to secure this information.



Encouraging Applicants by Older Persons



Other issues have come to our attention. For one, if the Peace Corps wants to encourage older applicants, it should be willing to give us full reimbursement for the special tests we are required to take to satisfy the Peace Corps. Also, because older applicants have their own doctors, the Peace Corps should be willing to give us full reimbursement for these costs -- instead of paying according to a very stingy formula. RPCVs are given zero preference in this process, which seems wrong to me.



The Peace Corps has taken a lackadaisical attitude toward lifting a financial barrier to Federal retirees serving, These retirees are entitled to buy Federal employee health insurance for life, but they must maintain "continuity," keep buying the insurance. During Peace Corps service, retirees have no need for this insurance. It took me fully two years of constant pressure – I was a Congressional staffer – to secure Peace Corps assistance in securing for me (and all other Volunteers) the right to suspend our retiree health insurance while we serve. The Peace Corps attitude towards lifting this barrier could not have been more lackadaisical. The new right went into effect December 31, 2005.



I have pressed the Peace Corps to contact the fifty governors and their associations to grant this same right to state and local government employees, many of whom have guaranteed medical coverage similar to Federal retirees. I doubt if the Peace Corps will bother to do so.



The Peace Corps also fails to give information to applicants on which of their unreimbursed medical expenses might be tax deductible. Older Volunteers tend to itemize their deductions and these expenses might be deductible as charitable donations to the Peace Corps (not as medical expenses for which there is a high floor).



It is also crucial to older volunteers that they be given an early decision by the Peace Corps. These older Volunteers tend to have many financial affairs to settle before they can depart for service. The Peace Corps seems to make no attempt to give older applicants an early decision, another demonstration that it’s not really interested in older applicants.



Peace Corps Staff: Trapped in the System



We've found all the Peace Corps staff we've dealt with to be very friendly. They always attempted to explain the situation, what terms mean, what we had to do next, and the new rules of the -- to us -- constantly changing game. They've responded promptly to our inquiries.



At every step, however, we had to ask and sometimes ask repeatedly for the information we needed. None of the information seemed to be online. We constantly had the impression that the Peace Corps wants the applicants to know as little as possible so the agency is free to run its process without any interference, meddling, or input. That might not be the intent, but that's what it looked like to us. The staff apparently are instructed to handle the process this way even though they all seemed to understand how aggravating this was to the applicants. Because the staff tend to be very young and operating under the five year rule, there seems to be no one senior enough to change the system.



Summary of Experience







So, it's been a very unpleasant process, with many negative surprises. It looks like the Peace Corps is bound up in paper and rules. It's easy to see that applicants who are less committed than we are would give up and let their applications die. The lack of coordination between the placements and medical staff, the lack of early notice about the deferment and accommodation, and the reluctance to reveal the medical clearance guidelines make no sense. All in all it was a process well calculated to discourage applicants, aggravate them, and whipsaw them. It is certainly a process that is well designed to discourage older applicants, who are more likely to have medical clearance issues.



We're delighted to be serving again as Volunteers. We are highly motivated to serve. We couldn't be more delighted with our site, with the service opportunities here and with the other Volunteers.



We strongly urge older individuals to serve, including RPCVs, but we do warn you that the application process can be quite outrageous and discouraging. It's a shame that the Peace Corps has so little interest in older applicants. It seems to be a missed opportunity, particularly for recruiting RPCVs to serve again.



Addendum







Peace Corps Volunteers "are free to petition the US Government and its officials in the same manner as if they resided in the United States." Peace Corps Handbook. The essay above is a petition, recommending reforms in US Government policies and is, therefore, protected speech. This essay makes no mention of the country in which we are currently serving or the programs there, says nothing about our village or our host country, is not published "in-country," and cannot have any "adverse consequences for the Volunteer or the program in the host country…" Peace Corps Handbook. On November 5, 2005, I formally offered not to submit the guidelines for publication on Peace Corps OnLine if the Peace Corps would take the initiative to do so on its own website. It officially declined my offer. In this offer, I clearly stated that if the Peace Corps did not make them public, I would have them posted in Peace Corps OnLine. In this same offer, I invited the Peace Corps to write its own explanation of the guidelines on its website. It declined this offer as well. In this request, I clearly stated that if the Peace Corps did not write its own explanation of the guidelines, I would draft my own cover memo (presented here) regarding the guidelines, again to be published on Peace Corps On Line. In addition, on our about April 18, 2006, this draft essay was transmitted to the Peace Corps by House of Representatives staff, with my permission, and it was asked to submit its comments. It has yet to do so. I have also forwarded the cover memo to Peace Corps Washington for comments and have received none. This process shows how responsible we've been and how much care we've taken to give the Peace Corps every opportunity to participate in or offer its comments on these documents. In short, the publication of these guidelines and this essay comply fully with all applicable Peace Corps rules for Volunteers.



Chuck Ludlam (Cherkh Sow)

Voluntaire, Corps de la Paix Americain

chuck.ludlam AT gmail DOT com









Complete List of Peace Corps Screening and Medical Clearance Guidelines

Applicants and Medical Professionals (especially those who have already served as volunteers) are urged to leave their comments on the following guidelines and restrictions with any suggestions for changes so that they can be incorporated into future guidelines.

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Story Source:

This story has been posted in the following forums:

PCOL34154

By Anonymous (200.93.8-176.dyn.dsl.cantv.net - 200.93.8.176) on Saturday, September 30, 2006 - 8:24 pm: Edit Post

Thank you so much for posting these detailed guidelines.

By Harvey Paige (75.52.168.74) on Thursday, November 09, 2006 - 8:20 pm: Edit Post

I am not able to access the guidelines. A blank pdf screen results when I click on any of the links. Have the links been disabled?



At the moment I am also a frustrated older (65) applicant, who might have done things differently had I read this before starting the application process.

The links are good. We just opened several of the files now. The problem is that some of the files are quite large (One is over 20MB.) and they may take a long time to load. (It may take 15 - 30 seconds for them to load if you are on a DSL line. Much longer if you are on dial-up.)



Try going to directory where the files are located at:



http://peacecorpslibrary.org/medical/



and opening them from inside Adobe Acrobat. Be sure and give them plenty of time to open.



Best Regards,





Admin1

By Anonymous (dyn-170-238-231.myactv.net - 24.170.238.231) on Monday, January 01, 2007 - 11:15 pm: Edit Post

Where's the cardiology section of the manual? I guess I'm assuming there is one.

By Anonymous (cpe-24-195-151-212.nycap.res.rr.com - 24.195.151.212) on Wednesday, August 08, 2007 - 9:05 pm: Edit Post

Under section 2, the lipids chart refers you to the "Hyperlipidemia Guideline" for an explanation of actions. Any idea where I can find that? Thanks

Thank you for the documents. I wish I would have read this before I began my medical screening process.

I feel like the Peace Corps application/medical screening process is set up to weed out the weak of heart. I was medically deferred for 2 years (my doctor was just as shocked as I was), I appealed the deferral and the Screening Board ruled in my favor, but it was still a frustrating and draining experience--that was largely unnecessary.

Has anyone had any experience with an appeal based on allergies? My nut allergy is considered "severe" because if I eat a very large quantity I could go into shock. Yet I am by no means like a lot of the young children today who swell up if another child in the same room eats a nut. I can touch nuts, be around them, and even eat a bite or two and be fine (I usually detect the taste right away, get a slightly itchy throat, drink some water, and I'm fine). I'm just wondering if there's any good way to show them that though my allergy is technically severe, in reality and practice I've never had a severe reaction and have never gone to the ER or any doctor for a reaction.



Has anyone else tried submitting a doctor (or two doctor's letters) in support of your case?



Thanks for any help/suggestions you can provide!

By Anonymous (urmc-nat18.urmc.rochester.edu - 128.151.71.18) on Monday, January 14, 2008 - 1:06 pm: Edit Post

Very helpful! Thanks so much for posting!

By Anonymous (c-71-234-68-115.hsd1.ct.comcast.net - 71.234.68.115) on Saturday, February 02, 2008 - 9:55 am: Edit Post

I am in the process of getting cleared and have also come across a medical deferrment. Thank you so much for posting this. It is very helpful and encouraging knowing that I am not alone in this process!

By Anonymous (ns1.peacecorps.gov - 65.205.231.250) on Friday, February 08, 2008 - 2:15 pm: Edit Post

I'm looking over these guidelines and see that many do not mesh with what I've been told in speaking with PC medical staff as I go through the process. Perhaps they've been updated? I'd advise calling them directly at 800.424.8580, ext 1500 if you have questions about the process and how to get through it smoothly.

By Anonymous (c-69-181-147-219.hsd1.ca.comcast.net - 69.181.147.219) on Wednesday, February 27, 2008 - 11:59 pm: Edit Post

THANK YOU so much. The sheer number of sections surprised me! Certainly glad you posted.

By Anonymous (68-188-27-108.dhcp.stls.mo.charter.com - 68.188.27.108) on Tuesday, April 15, 2008 - 7:04 pm: Edit Post

I have experienced an extremely long and frustrating medical clearance process. The past few months my mind has changed from OK we will get cleared to we will never get cleared. I sympathize with a previous comment about 'weeding out the weak at heart.' It has eased my mind to read through the medical screeners' decision making process notes. I thank you for your persistence in posting this extremely useful information.

By PC Hopeful (128.8.8.69) on Friday, December 12, 2008 - 12:26 am: Edit Post

This is FANTASTIC! Thank you so much. I've been dealing with the Kafkaesque medical clearance process, which like you said seems to be built largely on silence and secrecy, and to actually have the guidelines at my disposal when submitting an appeal is more than I could have ever hoped for.

Just chiming in, a little late here . . . I went back in after 40 years as well, to help with the tsunami in Thailand, with Crisis Corps, just a 6-month assignment. Not only was the process maddening--not just to me, but to the other volunteers, much younger than I--but when some of the top PC medical staff came out from Washington on a sort of field trip to see how we were doing, they first asked for our opinions, then told us we were completely wrong and had no idea what we were talking about. That is how out of touch they were!

By Anonymous (98.115.96.130) on Monday, June 28, 2010 - 9:08 pm: Edit Post

Thank you so much for the docs. Unfortunately, this just makes me terribly nervous. I was treated for depression for six months until January of 2010, and I am recovered now, but it says stable condition needed for two years. These documents are from 2004...does anyone know if there are updated ones?

By Kati Wilkins (76.104.182.146) on Thursday, September 02, 2010 - 7:36 pm: Edit Post

Wow, thanks for posting this! I'm about to go in for the interview next week, but this helps me think further down the road to what I'll need to have looked at. Looks like I'll need to get in contact with my dermatologist back in DC to have him do some paperwork (I have displastic nevous (sp?) disorder - basically it just means I've got a gazillion moles) which will give me a medical restriction. Yay! (<sarcasm) Hopefully a lot of countries have dermatologists... cause it looks like I'll need to see one every 6 months. But at least some of the other things I was worried about look like I should be fine (IBS and seeing a therapist after my parent's divorce). I will be more than happy to use the doc.'s on this site as ammo if they deny me, too! You ROCK and you've probably saved a few potential PCV's a lot of heartache!

By PCVPhilippines (24.180.87.61) on Thursday, February 24, 2011 - 12:55 am: Edit Post

Thank you so much. These helped me in my application process. I was initially deferred during my application because I have shoulder subluxation. PC told me that I had to be stable for 2 years prior to serving or have had surgery and be stable after that for 6 months. Well, my doctors laughed at the idea of me having surgery, and the definition of subluxation is instability. It moves a little more than it should and is only a minor inconvenience. Only had it checked out because I was playing sports in high school. I got two letters of doctors support saying I should be able to serve, previous employeers (I had physical jobs)letters saying I never missed a day of work, and sent them to my senator, Carl Levin, who then contacted Peace Corps for me. Shortly after I was accepted.



Now, I have been serving for 14 months, and was diagnosed with systemic Lupus. However, I am very fortunate to have a very mild form of Lupus, and the only reason I know I have it is my blood work. I have a low platelet count. My doctors have prescribed me plaquenil (not a steroid, and has similar side effects to medicine the likes of aspirin), and see no reason why I shouldn't be able to return. I do not feel sick or fatigued at all, and the possibility of my platelet levels dropping to a critically low level is incredibly unlikely while on medication. However, Peace Corps has medically separated me. Their reasons being because i'm on new medication, the low platelet count could be life threatening, and because I have active Lupus - my doctors disagree with all three. Moreover, I was initially told that I could return in 6 months if I had a stable platelet count, no new medication, and no new symptoms. Then I talked to another person who told me that I couldn't return as long as I was on plaquenil, which is a lifetime medication. I still don't know which it is. I'm in the process of appealing the separation right now. Any suggestions are more than welcome.

By Priya Devineni (128.158.1.168) on Monday, April 21, 2014 - 10:53 am: Edit Post

This is great information to have during the Peace Corps application process. I have food allergies and am wondering what will happen during my medical pre-clearance stage (I am in this stage now and have heard nothing after 4 weeks of submitting my paperwork from my doctor.). My reactions aren't severe, however my lips has swolen a tad before, but I've never not been able to breathe or anything like that. My reactions can be controlled with Benadryl, Prednisone if I want to get rid of it fast, and Zyrtec. But, I'm still wondering if the PC medical office will see this is as criteria for not granting me my medical clearance? I hope not!!

By Drake Starling (138.220.176.47) on Friday, January 06, 2017 - 11:24 am: Edit Post

I am currently in the process of submitting my medical portion of my application. I have mild Ulcerative colitis. After reading the section 14 pdf you shared (thanks for that!) does anyone think that that will prevent me from being accepted? I have been in remission for 2 yeaars, but the medical guidelines on Ulcerative Colitis seem to be a bit off. For example, it says that roughly 1% of patients achieve remission. That is entirely untrue. Many patients achieve remission through medication. I am becoming more concerned that this will be the deciding factor of my rejection. Am I off base?