I've thought long and hard about how to write this, and if I was even going to write it at all. I mostly am doing this to help someone who may be able to use this information, because a few months ago I was desperately looking for it. Throughout this whole PCS process, I've found myself saying over and over again, "I wish I would have known that". You don't know what you don't know. When we decided that these orders where something we wanted, I thought that was that. As a disclaimer, I do not intend to speak poorly about my husband's employer (the AF) but simply present facts, my experiences, and occasionally my frustrations. I will not publish this until we know if we have or do not have clearance, as I write most of it, it still remains a mystery. I'm trying to do this so it remains as level headed as possible and unbiased.--- (Update if you read my last post, we found out we received clearance, most of this was written before we knew!)
Like I said before, when we first got the orders to move to Japan, I thought that meant we were for sure going. I mean it's ordered of my husband to go. I started researching things I needed to be doing in order to prepare for the move and things I needed to be doing on my part. I joined a spouses Facebook page that was related to the base we are going to, and started following the forums there. I quickly learned that our pets would require a lot of work before they would be permitted to go, and took care of that as quickly as possible. I mostly kept all networks open and was always listening for something I could do because I had never done this before and didn't really know what to expect. Until it was too late, I found out what medical clearance was, and even when I wanted to know more, the resources I found were very limited. Read the packets that the Exceptional Family Member Program (EFMP) gives you, several times if you have to so you can be as educated as possible in regards to all of this.
So What is Medical Clearance and why do I need it? I am still learning this as I go. I'm sure more seasoned spouses out there could probably give a much more in depth version of this, but so far this is what I've learned. The gaining base wants to make sure they have what they need in order to care for your health needs. Do not make the mistake of thinking, like I did, " It's a hospital, of course they have what I need." They may not, and they may not be able to care for the most simple of things. It took 3 doctors to review my paperwork to determine if I was cleared, just because the base you are presently at says you are healthy and you are cleared by your family doctor does not mean you are cleared. I thought I was. She said I was healthy, to my face at least. After we saw her I thought that was that, and I was medically cleared, but that was only one tiny step. My paperwork that my family doctor fills out is then sent to another doctor on base, who we had to make a fancy appointment for, he reviews everything and then sends it to the gaining base. THE DOCTORS AT YOUR CURRENT BASE HAVE NO SAY IN WHETHER YOU ARE MEDICALLY CLEARED OR NOT. They merely present the facts about your health and write them on paper and fax that paper to the gaining base. It is the GAINING BASE that determines whether or not you are medically cleared. If you are denied medical clearance, you have one opportunity to appeal the denial. I wish I would have known that. You don't know what you don't know.
How this has affected our lives- During my pregnancy my ultra sound tech found a cyst on my ovary. I was reassured by my doctors that it wouldn't hurt my baby and that after I delivered, it could go away, but if it didn't or if it flipped the ovary it could require surgery. I was reassured time and time again that it was very unlikely that it would not require surgery. After I had my baby, my doctors never mentioned it again, when I brought it up, they seemed like my concern was an annoyance. I insisted that we investigate it further. I had no idea this would result in being denied medical clearance. My doctors determined that it was a large cyst (9 centimeters) but at the time didn't think it required surgery, and determined that they would watch it, if it gave me pain, it could potentially require surgery, but it really was fine where it was and we were hoping it would get smaller.
When it came time to do my medical clearance paperwork, I didn't realize how important that paperwork was. I did it in the lobby of our doctors office, I did not know the intense network of people it would go through and I did not think it would affect our future so much. This paperwork, is probably the MOST important paperwork you will do as a spouse during an overseas PCS. Also, once we were denied clearance, I found myself saying, " I never should have told that doctor about my cyst!" Because she seriously did not know, the doctors at our clinic are pretty bad about communication and charting. Come to find out, that the gaining base would find out and I could have been in some trouble for not providing that information. Do not lie on your paperwork! If you have a problem, state it. My family doctor made some phone calls to the baby doctor that found the cyst, and I'm confident that the way she wrote it, did not help our case " Patient has 9 centimeter cyst on ovary, which may require immediate surgery."- Geeze, thanks for the reassuring details that I am healthy! At the time, I didn't think anything of her wording. THE WAY YOUR CASE IS WRITTEN MATTERS! I've learned that the more positive details your doctor can provide is the way to go. After all this learning experience, I think to myself , Goodness! Of course we were denied clearance! Just because your doctor went to school for 8 years, and is in the military, do not assume they know what they are doing with this paperwork. I've done this paperwork twice now, and had to hold both of our doctor's hands and help them along the way both times. I'm pretty sure we were the first overseas medical clearance both of our doctors have done, and in all fairness it can be a tad confusing.
At this point we were on a bit of a time crunch and I didn't realize it, after this paperwork was done, we had to schedule a meeting with the head doctor who is in charge of signing off on the paperwork. He conveniently only sees people on Wednesdays after a certain time. Cool.
At this meeting, this doctor did not seem remotely worried about my cyst, he said it would be unlikely it would cause any issues. It didn't mean that my heart didn't sink at this meeting and I lost a little bit of hope. Another thing I thought a long time about writing, but because I have heard so many people are denied medical clearance in relation to this I thought I would share. When I was pregnant with Ely, I was going through a rough time emotionally. My parents divorce was affecting me, and things that normally didn't bother me did on a whole new level. I was really struggling with depression, and I didn't want it to affect my baby so I started seeing a therapist. At this fancy Wednesday meeting, this doctor highly encouraged me to have my therapist re-do her part of the paperwork. She, like my other doctor wrote about one sentence stating that I saw her a few times, and that was about it. My doctor told me that Japan is very selective about mental health, and that if I saw her when I was pregnant and that it was mostly pregnancy related, that would be very favorable to my case. He encouraged me to have her write as many positive details about my mental health as possible. That was the truth, and I really have no intention of seeing a therapist again. I struggled when writing this, because I don't want a spouse to read this and think that in order to successfully get overseas orders, that they shouldn't ever see a therapist. If you need help, please seek it!
After this meeting I learned that if you have seen a therapist in the past 5 years, that is taken very seriously and it must be documented in your clearance. Even if you are fine now but saw a therapist or had a mental health ailment 5 years ago, that is taken into consideration. Many cases like this that are denied are appealed and accepted however! If you receive orders to Japan and have a mental health history, do not lose hope and do not think you would be denied like I did!
It took about 5 days to have my therapist re-do the paperwork, when your spouse's Report No Later Than Date is approaching a few days here and there can be really stressful. Once it was submitted they told us that Japan had 14 duty days to respond. Duty days, so that did not include the weekends or any holiday that might have fallen during that period. Our EFMP worker told us she would request that it would be expedited because we were coming close to Sean's report no later than date. They got back to us in about a week, and that week of waiting was one of the most anxious weeks of my life. I'm pretty sure I cried every single night. Poor Sean. I was convinced that we would be denied clearance because I saw a therapist. Every night I would sob " I wish I never saw a therapist! I really didn't need it!" Sean was so awesome and reassuring and even said a million times, " Ely is healthy, I would rather have you seen the therapist, and have you and her be healthy, than have the orders to Japan. I would gladly loose the orders for that." He has been really awesome about balancing out how stressed I have been & hiding any concerns he had.
In my last post I mentioned being prompted to schedule an appointment with my doctor about a consult for surgery, I figured that it might be a good idea to explore options once we went so in case I needed surgery in the future I would be able to go to a doctor in Japan and explain what I needed done.
At this point, I still thought it was the therapy that was going to cause the denial, and that once we received clearance, they really couldn't say anything about me getting surgery. I called and scheduled a consult to talk about surgery that morning. I figured I could get surgery shortly after my last day of work, and because Sean was pushing his RNLT date back, we would be well on our way and fine.
The same day I called to make the appointment for the consult, we received the phone call afterward stating that we were denied clearance because of the cyst. I was a little relieved it was because of the cyst and not the therapy, and yet very heartbroken. We could appeal this, and I already had the consult for surgery scheduled, but it didn't mean that I wasn't incredibly sad. After the phone call I held my daughter and cried, I'm pretty sure for the duration of the day. I jumped into high gear and didn't want just a consult, but to get the surgery scheduled ASAP! I was disappointed I couldn't pick the day, I had two days to pick from out of the whole month, one at the beginning and one at the end. I of course picked the earlier one, but it meant that I had to cut nearly several days off of my last week of work from a job I loved. It also meant I had about 2 weeks, to get my life in order before surgery.
My surgeon told me because the size of my cyst to expect a 6 WEEK recovery, and that as my doctor she couldn't turn in the appeal until after 6 weeks post operation. That was not the news I wanted to hear. She also said that she would try to do it laparoscopically, but it would most likely be an incision similar to a C-section and to prepare for that when planning care for my little one. She told me I probably wouldn't be able to pick up my daughter for 2 weeks and would have to be cautious holding her. I did not want to hear that either. She told me to expect at least 3-5 days in the hospital. I did not want to sleep in a building where my daughter wasn't! I was so not ok with getting this surgery, but was more willing to do it because I knew it was what God wanted me to do. My surgeon also told me that it was actually a really smart thing for me to be doing, because the cyst had so much scar tissue around it, that if I would have waited, it probably would eventually result in the removal of my ovary and tube. What? She prepared me for that as well and said she would do her best to not remove ovary tissue but because it was so large it was a big possibility. Where was this information even a few weeks ago when all these other doctors said it wasn't such a big deal????
The day of my surgery, I woke up to a sweet nurse telling me everything went well. The poor thing, she told me that they drained the cyst and didn't remove it. I was still heavily sedated and I kind of chewed her out because I wanted it removed. She told me that I was lucky and that because they were able to drain it, that they were able to do the surgery laparoscopically. This was good news. This also meant I could go home from the hospital that day. I could be around my little girl! I only had to pump and dump one day, and my pain was manageable enough that I didn't need the heavy narcotics so I didn't have to use freezer milk as much as I thought. I felt so fortunate with this alone. After 3 days, I could walk around the house. After about a week I could pick up my little girl out of her crib. At my 2 week appointment, my surgeon explained that once they got in that they were able to drain the cyst, and that was the best option. She also randomly said "Your cleared!". I had to ask her at least three times what that meant. She originally told me it would be 6 weeks of recovery, not 2. She explained that if I had gotten the bigger incision that my recovery would have been 6 weeks, but because it was laparoscopic, that two would be sufficient. She said, "I will note on your chart you are medically cleared." She obviously had never done medical clearance paperwork before. She was in for a fun roller coaster ride with me. She kindly started the paperwork, did it once incorrectly, I had to make an appointment to explain to her how to properly do it. Again what you write and how you write it matters, I hated to be breathing down her neck but this appeal was our last shot!
Phrases like "Needs no further updates" and words like "stable" and "benign" or very very important when your doctor is filling out paperwork. I had to stress this to her, the first time she wrote it out, she wrote "Patient is cleared"- this is not the way to go about writing medical clearance paperwork, because technically she isn't the one doing the clearing, Japan is. I'm not sure why it took so much to get her to understand this, I love this doctor as she delivered our daughter and don't want to make her sound like uneducated, I think it was a matter of getting her to REALLY care about me. This whole process has taught me that you just have to be relentless and annoying sometimes. That is so not within the bounds of my personality. If you are going through this, make your doctor wind down, the ones out at our clinic are always in a hurry! If their handwriting is sloppy, make them do it again! Stress the importance of this and educate them about it, you might be the first person they are doing this paperwork for.
So after this was completed I was able to turn it into EFMP. I have a love hate relationship with EFMP. The two women that work there have been so helpful and I'm confident that if they didn't educate me on how to get my doctors to phrase their wording that we probably wouldn't have clearance right now, but we have had a few issues with them. Do not assume that they will remember who you are or your case, which is completely understandable because they see a ton of people every week. Every time we went in, I had to say who I was and explain what was going on. They told us once we had our appeal in that it probably shouldn't take as long as it did last time, but with a word of caution that Japan has an infinite amount of days to get back to us on an appeal. That was great news, and Japan did get to us quickly ( I think 4 days), it was our EFMP that sat on the paperwork and didn't get it sent off. 3 weeks from the day we turned in our paperwork we heard back from Japan. It's ok to be relentless and annoying, because we were trying to be passive and polite, and it wasn't until we called and bothered them to see if they had heard anything that they got it together and sent it.
The day we received clearance, Sean woke me up in bed and gave me a breakfast burrito from our favorite food truck and said "Happy Medical Clearance Day!" April 16th will forever be a day in which we eat breakfast burritos and celebrate that good news. I am beyond grateful. Before this, I had all these things that I wanted for Japan and would be unhappy if we didn't get our way. Before I needed a house with a yard, I needed shopping close by, I needed a car with air conditioning, and I needed my same ordinary groceries that I am use to. Now, I will be grateful for whatever we get, I will live in a tower, and drive a junker car, and eat crazy strange foods even if it is every single meal. I will just be grateful and happy we are there.
So this isn't the case everywhere, at our current base this is how things go for Sean to out process....
Medical Clearance
Order Passports- You cannot order military passports here until you have medical clearance, from what I have heard from other spouses over in Japan, their base did not require this- this is a 6-8 week wait, we will be waiting with family when Sean leaves, this was not our original plan, but again I am just grateful we are going
Schedule Movers- They need 5 weeks in advance, you cannot schedule movers until your spouse has their official orders, official orders do not happen until the whole family has their medical clearance and passports.
Now I know why they give orders several months in advance. Do not wait to get started on these items! It takes a while, and I look forward to wrap all of this up! Feel free to comment, and add facts, opinions, and experience. I'm the first to admit that I am learning as I go.
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