Why the Military Has Always Said No to Those Who Can't

The United States Army turned away Erik Holmstrom on Reception Day at West Point in 1995. He was a standout offensive lineman from Duluth with the body and the drive for it. The problem was an old ACL repair and a ligament that measured 0.03 centimeters too loose to meet deployment standards. The Army didn't apologize. It sent him home. That's how it's supposed to work.

That same standard is now at the center of a political firestorm over the Pentagon's gender dysphoria exclusion policy and the D.C. Circuit's June 2 ruling against it. The legal architecture of that fight matters, and my earlier piece in RealClearDefense laid it out in detail. But the deeper question gets less attention: why does the military exclude people from service based on medical conditions in the first place? The answer is not cruelty. It's arithmetic.

Combat readiness is the mission. Every personnel decision the military makes flows from that fact. The military doesn't owe anyone a uniform, and it never has.

The Department of Defense has published its accession standards in DoD Instruction 6130.03, Volume 1 for decades. Change 6, issued February 3, 2026, reflects what military medicine has learned over generations: some conditions are incompatible with the demands of service, not because the individual lacks character, but because the body or mind can't meet the mission requirement.

The list of disqualifying conditions is longer than most people imagine and more mundane than most politicians would admit. Severe nodulocystic acne is on it. So is a history of atopic dermatitis after the 12th birthday with residual lesions in characteristic areas. Applicants actively on isotretinoin, the standard Accutane treatment, don't qualify until four weeks after completing therapy — because severe acne on the chin or jawline can interfere with proper wear of a Kevlar chin strap in the field. Insulin-dependent diabetes disqualifies. Persistent asthma requiring medication after age 13 disqualifies. A history of ACL reconstruction is disqualifying, though often waivable depending on the branch and the functional outcome. The standards aren't arbitrary. Each one traces back to a deployment scenario where the condition creates a medical liability the mission can't absorb.

Consider what that means in practice. A cadet at West Point earns a taxpayer-funded education valued at more than $250,000. He plays on the football team, starts every game, and tears his ACL in the fourth quarter of the Army-Navy game in his junior year. The surgery goes well. Rehabilitation goes well. But if the ligament doesn't heal to spec before graduation, the Army won't commission him into a combat role. The investment stops there. That is a rational decision by an institution that cannot afford to send officers into a forward operating base who can't run to the wire. The military's job is to break things and win wars. Officers who can't deploy can't do that job.

The pool of eligible Americans is shrinking fast, and the numbers are difficult to excuse away. A 2020 Pentagon study found that 77% of Americans aged 17 to 24 are ineligible for military service without a waiver. The primary disqualifiers are not exotic conditions. Obesity accounts for 11%. Drug and alcohol abuse accounts for 8%. Medical or physical conditions account for 7%. In fiscal year 2023, the services turned away 52,000 applicants solely because of obesity — a figure that exceeded the Army's 41,000-recruit shortfall that same year. Obesity costs the military an estimated $1.5 billion annually in health care and readiness costs.

More than one in three young adults aged 17 to 24 is too heavy to qualify on weight alone. Among Gen Z, only about one in four is eligible for service at all. Vaping and nicotine use, which degrade pulmonary function and cardiovascular endurance, add to the picture. Drug use and criminal records round it out. The Council for a Strong America, a coalition of retired generals and admirals, has been raising this alarm for years. The supply of physically capable, mentally stable, drug-free young Americans who also want to serve is not infinite. The military cannot afford to fill a slot with anyone who brings a condition that forecloses full participation in the mission.

Gender dysphoria belongs in that analysis. The condition, by clinical definition, involves clinically significant distress lasting at least six months. The treatment protocol for those who pursue medical transition involves indefinite cross-sex hormone therapy requiring regular laboratory monitoring and a clinical supply chain that doesn't exist in the field. Surgical procedures, when pursued, are elective and extensive. The RAND Corporation's 2016 study, commissioned by the Obama Pentagon, estimated that male-to-female surgical transition would result in 135 non-deployable days, with hysterectomy adding 111 days. A Washington Free Beacon analysis of the RAND data calculated an average of 238 non-deployable days per individual when all procedure types are combined. That's nearly two-thirds of a year removed from the force for elective procedures.

Between 2016 and mid-2021, the Pentagon spent $11.58 million on psychotherapy alone for service members with gender dysphoria diagnoses. An additional $3.1 million covered 243 surgeries, and $340,000 went toward hormone therapy for 637 individuals. The $15 million total across five years isn't what breaks the defense budget. The readiness gap is. The Army's May 2025 separation guidance makes the operational reality plain: a service member with a confirmed gender dysphoria diagnosis is immediately non-deployable, and separation actions begin within 30 days.

This principle didn't originate with the current administration. The military's selection logic has been consistent since the Civil War: finite training budget, finite medical capacity, finite deployment slots. You fill them with people who can go where the mission requires and stay until it's done. The Army turned away men with flat feet, men with compromised eyesight, men with histories of psychiatric treatment — not because those men weren't Americans, but because the infantry doesn't carry passengers.

I spent time around Marine OCS candidates who were as mentally committed to service as anyone I've encountered. Some didn't make it through physical screening. The Marine Corps didn't apologize for that either. The mission defines the standard, not the candidate's desire to serve.

The counterargument runs like this: transgender individuals have served honorably, the medical costs are manageable, and exclusion is discriminatory. The first point is true. The second is a partial truth that ignores the deployability data. The third misunderstands what a military exclusion policy actually is. Employment discrimination law governs civilian workplaces. The military operates under a different constitutional framework precisely because its function is different. The Supreme Court established that clearly in Rostker v. Goldberg (1981), and the Court's May 2025 stay order in Shilling v. Trump confirmed that the executive branch retains broad authority over military personnel decisions. The question isn't whether someone wants to serve. The question is whether the armed services can execute their mission with that person in the force. That's the only test that has ever mattered.

The United States military is the most capable fighting force in human history. It remains so because it has applied a ruthlessly practical filter to who wears the uniform. An aging population, a deteriorating baseline of youth fitness, and a political culture that increasingly treats military service as a vehicle for social redress are converging on a readiness problem that no appellate court can solve.

The man who tears his ACL at West Point doesn't get a commission because he can't do the job. The recruit who's 40 pounds overweight doesn't ship to Parris Island because he can't do the job. The individual whose treatment protocol requires 238 non-deployable days and indefinite hormonal therapy doesn't go to a forward operating base because they can't do the job. That's not a political statement. That's a job description.

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Jay Rogers is a financial professional with more than 30 years of experience in private equity, private credit, hedge funds, and wealth management. He has a BS from Northeastern University and has completed postgraduate studies at UCLA, UPENN, and Harvard. He writes about issues in finance, constitutional law, national security, human nature, and public policy.

image: Marines and sailors with the 24th Marine Expeditionary Unit aboard the USS Iwo Jima (LHD-7) display equipment and demonstrate tactics to Marine Poolies recruited out of Long Island, N.Y., and Boy Scouts from troop 287 out of Greencastle, Pa., as they travel to participate in New York City's Fleet Week. Various units from II Marine Expeditionary Force and Marines Forces Reserve have organized under the 24th MEU to form the Special Purpose Marine Air Ground Task Force -New York. The Marines are embarking on the Navy’s Amphibious Assault Ships, the USS Iwo Jima (LHD -7) and USS New York (LPD-21) to take part in New York City's Fleet Week from May 25 to June 1. There, the Marines will showcase the capabilities of the MAGTF, and also honor those who have served by participating in a various of events during the Memorial Day weekend. (Photo by: Cpl. Nicholas J. Gillen)