RECORD OF PROCEEDINGS
AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS

IN THE MATTER OF:	DOCKET NUMBER:  BC-2004-02678
		INDEX CODE 131.05, 124.01
	 	COUNSEL:  None

	 	HEARING DESIRED:  No

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APPLICANT REQUESTS THAT:

Her rank of technical sergeant (TSgt) be reinstated with a date of rank (DOR) of 1 Aug 03.

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APPLICANT CONTENDS THAT:

She was and is going through medical exams, tests and referrals to specialists to determine the cause of different medical concerns/issues she is currently experiencing.  She was not processed through a medical board.  One of the letters in the medical records stated her weigh-ins should be deferred until a final diagnosis was obtained.  She has not received a final diagnosis; she does not know exactly what is wrong with her.  She is still having pelvic pain and wants to know what her diagnosis is besides diabetes, as that is under control with medication.  Since she was not sent to a specialist in the beginning, as she requested, she was affected in many ways, including her Enlisted Performance Reports (EPRs), and has had a great deal of stress.  She received no support from her superiors and she, and others, fear reprisals.  She should be able to receive her TSgt stripe, which she worked very hard to obtain.  She has used all the extensions allowed in her career and tried her best to lose weight and body fat (BF).  She provides an 11-page personal statement and copies of her medical records.

The applicant’s complete submission, with attachments, is at Exhibit A. 

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STATEMENT OF FACTS:

Promotional ineligibility because of weight is the same as all other ineligibility conditions outlined in AFI 36-2502, Table 1.1.  If on or after the Promotion Eligibility Cutoff Date (PECD) for the respective promotion cycle a member is in one of these conditions, he/she is ineligible for the entire cycle.  A member cannot test, cannot be considered for promotion if already tested and, if already selected, the projected promotion is cancelled.  

The applicant enlisted in the Regular Air Force on 26 Nov 86.

On 15 Apr 02, the applicant was entered in the 3-Month Exercise and Dietary Period because, on 8 Mar 02, she weighed 163 lbs and had a BF of 38%.  The weight and BF allowed for a woman the applicant’s height and age was 141.5 lbs and 32%, respectively.  She was cleared medically for the 90-day program.  

She was subsequently enrolled in Phase I of the Weight and Body Fat Management Program (WBFMP) on 3 Sep 02.  At the time she weighed 158 lbs and had a BF of 36%.  She was verbally counseled on 5 Nov 02 for unsatisfactory progress on 3 Oct 02.  

Medical entries, dated 14 Nov and 11 Dec 02, note the applicant complained of tingling in her right hand, missed periods and difficulty in losing weight.  Insulin resistance (metabolic syndrome) was considered.

On 9 Dec 02, the applicant gained 1% BF and weighed 162.5 lbs.  On 11 Dec 02, she was counseled she was being placed in weight status code 2, unsatisfactory progress, and was therefore ineligible for promotion, reenlistment, permanent change of station (PCS), formal training or voluntary retraining.  She was reminded she must lose at least 3 lbs or 1% BF per month in order to make satisfactory progress and future failures could result in stringent action being taken and, upon a fourth failure, a mandatory administrative discharge.  The applicant responded that she spoke to the First Sergeant about her current health problems due to two missed cycles and she hoped to be referred to a specialist so as to discover what the problem was as all the tests results were negative.

On 9 Jan 03, the applicant had gained 1/2 lb but had lost 1% BF.  

A 15 Jan 03 letter from a civilian neurologist reveals the applicant was referred because of tingling paresthesias in four digits of the right hand.  The applicant demonstrated no physiological evidence of peripheral neuropathy or entrapment at the wrist or elbow.  Anti-inflammatories and conservative management were recommended.

On 10 Feb 03, she gained 5 lbs and 3% BF.  A 24 Feb 03 medical entry notes the applicant had had no menstruation for five months and lab panels were unremarkable but suggested insulin resistance.

On 7 Mar 03, she was placed on a deferment due to a medical condition; as a result, the Feb 03 weight was excused.  She was not weighed during Mar 03 and was to be given a new start date in the WBFMP for having a medical condition that increased weight.  

A 31 Mar 03 letter from the Shaw AFB Department of Internal Medicine advised the applicant had been seen since Feb 03 for complaints of inability to lose weight and amenorrhea.  She had undergone extensive laboratory and radiological evaluation and been referred to gynecology for evaluation.  The applicant had some evidence of a metabolic process that could lead to obesity and difficulty with weight management.  The investigation was ongoing and deferral in the WBFMP was recommended until evaluation could be completed and a firmer diagnosis could be made.  Exercise and a low fat/calorie diet should continue.

A 17 Apr 03 medical entry reflected the applicant was advised to keep taking medication for her menstrual cycle problems, which are most commonly due to polycystic ovarian syndrome (PCOS).

On 10 Jun 03, she was reentered into the WBFMP weighing 175 lbs and having a BF of 41%.  On 18 Jul 03, she had lost 8 lbs and 7% BF.  

An 18 Jul 03 medical entry reflected a provisional diagnosis of PCOS and that the applicant had continued pelvic pain and weight management difficulties. 

She gained 2 lbs and 3% BF on 18 Aug 03.  

The applicant had been tentatively selected for promotion to TSgt during cycle 02E6 and was to have been promoted on 1 Aug 03.  However, on 18 Aug 03, after an unsatisfactory weight-in, her promotion line number was cancelled.

The applicant lost 2 lbs on 18 Sep 03.  A 25 Sep 03 medical report referred to her significant history of pain since Oct 02, and her desire for laparoscopic evaluation.  Laparoscopic examination was performed on 9 Oct 03, which resulted in the removal of a right ovarian cyst and fallopian tube.

On 4 Dec 03, she gained 1 lb, weighed 168 lbs and had a BF of 37%.

On 11 Dec 03, the applicant asked the Women’s Health Care Clinic for a definitive diagnosis of PCOS or not, to know why she did not have periods and to get answers so she could regain her rank of TSgt.  On 15 Dec 03, a pelvic ultrasound was normal.  On 29 Dec 03, she underwent hysteroscopy and curettage.

A 19 Feb 04 medical entry noted the applicant’s frustration with her delayed promotion due to her weight and abdominal circumference.  The applicant has a significant family history of diabetes and the possibility of PCOS had been considered.  The applicant’s weight was 171 lbs.  The physician noted the applicant had a hemoglobin A1C of 6.2 in Mar 03 and wanted to recheck for diabetes and hypothyroidism.  She was placed on additional medication based on the elevated random insulin level.

A medical entry dated 18 Mar 04, reported the applicant’s weight as 167 lbs and her abdominal size had decreased.  The basic metabolic panel was normal with the exception of glucose at 120, hemoglobin A1C at 6.1, and serum insulin level at 61.7 (upper limit of normal is 30).  Diagnosis was Type 2 diabetes mellitus.  The physician reported this explained the applicant’s central obesity and difficulty losing inches in her abdominal circumference and that she had put forth a good deal of effort in losing weight.  Further, it was likely that diabetes was the reason the applicant was in the weight program and also the reason why she had an abnormally high abdominal circumference.  

On 25 Mar 04, the applicant was recommended and selected for reenlistment.  According to the Military Personnel Data System, she reenlisted for two years on 4 Aug 04, giving her a date of separation of 3 Dec 06.  However, because of her grade and approximately 20 years of active duty, she will reach her high year of tenure (HYT) on 26 Nov 06.  [Note:  HQ AFPC/DPPPWB informally confirmed via email that, if the applicant’s TSgt grade was restored, supplemental promotion consideration for master sergeant would not be an issue because the first cycle based on her DOR would be 06E7, next year.  Also, HYT would no longer be an issue because, as a TSgt, it would automatically change to 2010.]

An 18 Jun 04 civilian endocrine record indicated a diagnosis of irregular menses probably secondary to PCOS.  There was no diagnosis of diabetes by the endocrinologist.  Insulin resistance had been noted as a possibility by the endocrinologist in an earlier note dated 23 Mar 04.

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AIR FORCE EVALUATION:

HQ AFPC/DPF advises that unit commanders may approve a temporary medical deferral when recommended by the Medical Treatment Facility (MTF) WBFMP representative or a medical practitioner.  Review of the applicant’s case shows she was provided an exemption from Feb to Jun 03 and there is no indication the MTF requested additional waivers.  The WBFMP was administered in accordance with AFI 40-502; therefore, denial is recommended.

A complete copy of the evaluation is at Exhibit C.

HQ AFPC/DPPPWB notes the applicant’s line number was ultimately cancelled due to an unsatisfactory weigh-in on 18 Aug 03.  AFPC/DPF found the applicant was granted a temporary medical deferral but no additional waivers were requested or granted.  Therefore, denial is recommended.

A complete copy of the evaluation is at Exhibit D.

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APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant asserts the medical deferment expired in Jun 03 without a firm diagnosis being given.  The diabetes diagnosis in Mar 04 still did not resolve the pelvic pain and other female problems she was having.  She requested additional waivers, deferments or profiles but providers told her they could only give such excuses if she had a thyroid problem.  She tried very hard to lose weight, continuing to exercise even though it aggravated her pain symptoms.  She has since had a complete hysterectomy performed on 14 Dec 04.  Others on fertility treatments are deferred but she is not given a waiver despite her medical problems.  

A complete copy of applicant’s response is at Exhibit F.

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AFBCMR MEDICAL CONSULTANT ADVISORY:

The Medical Consultant provides details of the applicant’s medical conditions and treatment.  He advises PCOS is a hormonal disorder characterized by irregularity of menstruation, infertility, and hyper-androgenism (manifesting effects of excess male sex hormone in lab results or as acne and facial hair growth).  Approximately half of women with PCOS are overweight or obese.  Insulin resistance is present in approximately 10% of non-obese PCOS women and in a third of obese women with PCOS.  Obesity itself causes insulin resistance, so PCOS and obesity are both contributory factors to insulin resistance.  Obesity also enhances the conversion of estrogens to androgens.  PCOS with insulin resistance is not a direct cause for being overweight any more than adult onset diabetes, also an insulin resistant syndrome.  The applicant manifested some features suggestive of PCOS.  Any woman who gains weight could ultimately be given a diagnosis of PCOS based on less stringent diagnostic criteria.  The first line of treatment for overweight women with PCOS (as for adult onset, insulin resistant diabetes) is weight loss through diet and exercise.  Clinical studies have shown that women with PCOS can lose weight through diet and exercise, resulting in improvement in manifestations of the syndrome.  Weight loss is medically indicated in individuals with diabetes, glucose intolerance, insulin resistance, intermittent mildly elevated blood pressure, and PCOS.  None of these conditions warrants medical exemption from the WBFMP, and none of the applicant’s other medical problems warranted a waiver from the program.  Action and disposition in this case were proper and equitable and no change in the applicant’s records is warranted.

A complete copy of the evaluation is at Exhibit G.

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APPLICANT’S REVIEW OF ADDITIONAL EVALUATION:

The applicant disagrees with the Medical Consultant’s findings and recommendations.  As she has stated before, her health issues began around Oct 02 and she did not get the proper referrals or care she needed, which could have had an impact on her weight and abdominal circumference measurements.  She discusses the course of her difficulties with regard to diagnoses and treatment.  She contends she should have her TSgt rank reinstated as of Aug 03 because she was still under doctors’ care and a diagnosis had not been found.  Except for the one time, providers would not place her on a profile or before a medical board as they were still trying to determine a diagnosis.  The commander stated she could not defer her because she [the applicant] could not provide letters or profiles from medical providers.  She had to wait until she had missed six months of her menstrual cycles before the providers started reacting seriously.  She hopes the Board considers all aspects of her situation in making a decision on her request. 

A complete copy of the applicant’s response, with attachments, is at Exhibit I.

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THE BOARD CONCLUDES THAT:

1.	The applicant has exhausted all remedies provided by existing law or regulations.

2.	The application was timely filed.

3.	Sufficient relevant evidence has been presented to demonstrate the existence of error or injustice to warrant reinstating the applicant’s promotion to the grade of TSgt.  The advisory opinions were noted, and we carefully considered the Medical Consultant’s conclusions and recommendations.  However, a thorough review of the applicant’s medical records compels us to disagree.  The applicant was entered into the 3-Month Exercise and Dietary Period on 15 Apr 02, and subsequently enrolled in Phase I of the WBFMP on 3 Sep 02.  Medical entries reflect she had missed periods, and insulin resistance was considered.  As of Feb 03, the applicant had had no menstruation for five months; lab panels were unremarkable but suggested insulin resistance.  On 7 Mar 03, she was placed on a medical deferment and referred to gynecology for evaluation.  The physician indicated there was evidence of a metabolic process that could lead to obesity and difficulty with weight management.  A 17 Apr 03 medical entry reflects the applicant was on medication for problems commonly due to PCOS.  She lost 8 lbs on 18 Jul 03 and a provisional 
diagnosis of PCOS, with continued pelvic pain, was made on that date.  She gained 2 lbs on 18 Aug 03 and, as a result, her projected promotion to TSgt was cancelled.  Her right fallopian tube and a right ovarian cyst were removed on 9 Oct 03 and, on 29 Dec 03, she underwent a hysteroscopy and curettage.  A medical entry, dated 18 Mar 04, reflected a diagnosis of Type 2 diabetes mellitus and the physician’s belief that this explained the applicant’s central obesity and difficulty in losing inches in her abdominal circumference.  She indicates she underwent a complete hysterectomy in Dec 04.  The Medical Consultant appears to assert that the applicant’s overweight condition brought about the insulin resistance, PCOS, and diabetes, and that she was capable of losing weight.  However, the medical entries appear to counter this assertion as many make note of the applicant’s significant, but unsuccessful, efforts to lose weight and contend that her medical problems may have contributed to her being in the weight program and having a high abdominal circumference.  Further, we are not completely convinced the medical problems that resulted in her hysterectomy were necessarily obesity related.  Whether the “chicken or the egg” came first could probably be argued on both sides but, in our view, the applicant did not receive the appropriate diagnoses or treatment until Mar 04, and should have been given a medical deferment until her female and metabolic issues had been resolved.  The applicant was selected for reenlistment and, given her medical history and the comments of her physicians in the many medical entries, we believe any doubt with regard to her ability to lose weight should be made in her favor.  We therefore recommend her promotion to TSgt be reinstated with a DOR of 1 Aug 03.

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THE BOARD RECOMMENDS THAT:

The pertinent military records of the Department of the Air Force relating to the APPLICANT, be corrected to show that she was promoted to the grade of technical sergeant, effective and with a date of rank of 1 August 2003.

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The following members of the Board considered this application in Executive Session on 19 May 2005 under the provisions of AFI 36-2603:

All members voted to correct the records, as recommended.  The following documentary evidence relating to AFBCMR Docket Number BC-2004-02678 was considered:

   Exhibit A.  DD Form 149, dated 20 Aug 04, w/atchs.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letter, HQ AFPC/DPF, dated 10 Nov 04
   Exhibit D.  Letter, HQ AFPC/DPPPWB, dated 29 Nov 04.
   Exhibit E.  Letter, SAF/MRBR, dated 17 Dec 04.
   Exhibit F.  Letter, Applicant, dated 6 Jan 05, w/atchs.
   Exhibit G.  Letter, AFBCMR Medical Consultant, dated
					28 Mar 05.
   Exhibit H.  Letter, AFBCMR, dated 31 Mar 05.
   Exhibit I.  Letter, Applicant, dated 3 May 05, w/atchs.

AFBCMR BC-2004-02678

MEMORANDUM FOR THE CHIEF OF STAFF

	Having received and considered the recommendation of the Air Force Board for Correction of Military Records and under the authority of Section 1552, Title 10, United States Code (70A Stat 116), it is directed that:

	The pertinent military records of the Department of the Air Force relating to     , be corrected to show that she was promoted to the grade of technical sergeant, effective and with a date of rank of 1 August 2003.