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The fact that he missed a medical exam isn't uncommon. It happens all the time, whether regular military, reserves, or the guard.
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Not when the government spent 1 million dollars to train you how to fly, and THEN you miss a reqired, scheduled physical.
Missing physicals isn't that much to get worked up about, if you make them up. But there isn't any evidence that Bush ever took steps to get a make-up physical to get flying again. THAT is why it is a big deal.
He was grounded for the rest of his service. An expensive pilot just sitting around? Nah. Doesn't add up. The NG would have been very eager to either discipline him for that and/or get him certified to fly again.