My waiver was approved by NGB/SG. Sure, the state surgeon may help or hinder (I’ve dealt with both), but the finally authority came from NGB.
Just make sure you have your ducks in a row with paperwork, second opinions, medical reports, etc., and know what those say inside and out. If SG rejects the waiver, FIGHT! NGB f’ed up my waiver the first time around, solely for the fact that the person reviewing it was sloppy and didn’t care to read all the way through the reports.