From Peace Corps Wiki
We are all seemingly and constantly plagued with questions about Peace Corps Medical, whether its before applying, during the medical review, or about benefits before or after service. This page is where you can quickly find links to pages that may help you out with questions you have regarding Peace Corps Medical. This page is a work in progress.
One should note that it is quite difficult to find providers who take Choice Care when you come back to the US. There is a lots of talk about how PC will cover conditions sustained in country. It can be difficult to find doctors stateside who will accept the coverage.
WIKI MEDICAL LINKS
Medical Clearance System -- briefly describes the medical system of the Peace Corps and supplies the link for Program Evaluation Report: Peace Corps' Medical Evaluation System
Medical and Legal Clearance -- reviews the purpose of medical and legal
Medical Benefits -- brief information about the medical benefits volunteers are supplied during service, and on completion of service
MEDICAL CLEARANCE INFORMATION
Medical Restrictions -- a constant work in progress, goal is to describe what a restriction is, help you understand how that effects you, and ultimately compile a (always changing) list of programs v. restrictions
Medical and Dental Forms -- PDFs of the medical and dental forms you are sent in your medical kit for your doctors to fill out
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.
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.