Rare Disease Patient Deemed Fit for Active Military Duty, Highlighting Systemic Flaws

A young man diagnosed with a rare disease, atypical hemolytic uremic syndrome (aHUS), received a fitness rating for active military service, raising alarms about the adequacy of South Korea's conscription system for individuals with uncommon medical conditions.

aHUS affects the body's complement system, a part of the immune system, and can be triggered by irregular sleep, intense physical training, or infections. These triggers can cause a rapid activation of the complement system, leading to the destruction of blood vessel linings. This can result in severe damage to the kidneys, brain, and heart, making military service a life-threatening endeavor for those affected.

The article highlights a systemic issue: the military's list of disqualifying diseases has not kept pace with the rapid increase in identified rare diseases globally and within South Korea. While over 10,000 rare diseases are known worldwide, South Korea officially designates and manages a growing number, from 926 in 2018 to a projected 1389 by 2026. This gap means that decisions about military fitness for individuals with newly identified or less-understood rare diseases often depend on the knowledge and judgment of individual military doctors.

This situation can lead to cases where individuals are initially deemed fit for active duty, only to be sent home from training centers after their inability to serve becomes apparent. The burden of proof often falls on the patient and their family to demonstrate their unsuitability for service. One parent of a child with phenylketonuria (PKU), a condition that can cause severe brain damage, recounted spending significant effort compiling medical records to secure a public service exemption for their child.

As South Korea contemplates a shift towards a selective conscription system, the article urges a parallel focus on establishing a robust and scientifically informed process to accurately identify individuals who should not serve. This, it argues, is a crucial national responsibility.

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My son's medical records and daily logs, compiled over his childhood, filled a box of A4 paper before we could get him a public service exemption.