BY ORDER OF THE AIR FORCE INSTRUCTION 48-133 …

1 BY ORDER OF THE secretary OF THE AIR FORCE AIR FORCE INSTRUCTION 48-133 7 AUGUST 2020 Aerospace Medicine DUTY LIMITING CONDITIONS COMPLIANCE WITH THIS PUBLICATION IS MANDATORY ACCESSIBILITY: Publications and forms are available for downloading or ordering on the e-Publishing website at RELEASABILITY: There are no releasability restrictions on this publication. OPR: AFMRA/SG3PF Supersedes: AFI10-203, 20 November 2014 Certified by: AF/SG3/4 (Maj Gen Robert I. Miller) Pages: 39 This publication implements Air FORCE Policy Directive (AFPD) 48-1, AEROSPACE & OPERATIONAL MEDICINE ENTERPRISE (AOME). This INSTRUCTION describes requirements for medical profiling on members with duty or mobility restrictions, case management of mobility restricted Airmen, and processes for improving medical deployability. This publication applies to all civilian employees and uniformed members of the Regular Air FORCE (RegAF), Air National Guard (ANG), Air FORCE Reserve (AFR).

2 This INSTRUCTION requires the collection and/or maintenance of information protected by the Privacy Act of 1974, authorized by Title 10 United States Code, Section 9013, secretary of the Air FORCE . System of records notice F044 F AF SG E, Medical Record System, applies, and can be found at Ensure all records created as a result of processes prescribed in this publication are maintained in accordance with Air FORCE INSTRUCTION (AFI) 33-322, Records Management and Information Governance Program, and disposed of in accordance with the Air FORCE Records Disposition Schedule located in the Air FORCE Records Information Management System. Refer recommended changes and questions to the office of primary responsibility (OPR) listed above; route AF Forms 847, Recommendation for Change of Publication; through the appropriate functional chain of command. This publication may be supplemented at any level, but all supplements must be routed to the OPR listed above for coordination prior to certification and approval.

3 The authorities to waive wing/unit level requirements in this publication are identified with a Tier ( T-0, T-1, T-2, T-3 ) number following the compliance statement. See AFI 33-360, Publications and Forms Management, for a description of the authorities associated with the Tier numbers. Submit requests for waivers through the chain of command to the appropriate Tier waiver approval authority, or alternately, to the requestor s commander for non-tiered compliance items. 2 AFI48-133 7 AUGUST 2020 SUMMARY OF CHANGES This document has been substantially revised and must be completely reviewed. It replaces AFI 10-203, Duty Limiting Conditions. Major changes include the inclusion of Airman availability management processes and the inclusion of Airmen medical readiness optimization (AMRO). Chapter 1 GENERAL PROVISIONS 4 Overview.. 4 Physical Profile System to include Physical Profile Serial Chart (PULHES).

4 4 Duty Limitations.. 5 Special Considerations.. 6 Chapter 2 GUIDANCE 8 Section 2A ROLES AND RESPONSIBILITIES 8 The Chief of Staff of the Air FORCE .. 8 Air FORCE Surgeon General (AF/SG).. 8 Major Command (MAJCOM)/ Chief of Aerospace Medicine (SGP), ANG/SGP or Air FORCE Reserve/Chief, Medical Operations Division (AFRC/SGO).. 8 Section 2B PROCEDURES AND GUIDELINES 8 Military Treatment Facility (MTF)/Commander (CC). Note .. 8 Military Treatment Facility/Chief of Aerospace Medicine (SGP).. 9 Military treatment facility (MTF)/Chief of the medical staff (SGH).. 10 Clinic providers (including specialty providers within the military treatment facility (MTF). Note: .. 10 Clinical consultants/medical specialists.. 11 Profile officer (PO).. 12 Medical standards management element (MSME).. 12 PH (or ARC Equivalent).. 14 Unit commanders.. 14 Airmen.. 15 Military personnel section (MPS).. 16 AFI48-133 7 AUGUST 2020 3 Air FORCE Personnel Center, Medical Standards Department (AFPC/DP2NP), Air National Guard/Chief of Aerospace Medicine (ANG/SGP), Air FORCE Reserve/Chief Medical Operations Division (AFRC/SGO).)

5 16 Chapter 3 ESTABLISHING AND DISSEMINATING DUTY LIMITATIONS 17 General Requirements.. 17 Fitness restrictions (FR) and fitness assessment exemptions (FAE).. 17 Duty Restrictions (DR) Only.. 18 Mobility Restrictions (MR).. 18 Pregnancy-Related Duty and Fitness Limitations.. 19 Multiple Action AF Form 469.. 21 External Duty Limitations (Civilian or Sister Service).. 21 Dental.. 21 Chapter 4 AIRMEN MEDICAL READINESS OPTIMIZATION (AMRO). 22 22 Critical success factor 1: Team AMRO Time.. 22 Critical success factor 2: Standard Work.. 22 Critical success factor 3: AMRO board.. 23 Metrics.. 25 Chapter 5 LIMITED SCOPE MILITARY TREATMENT FACILITIES (LSMTFS) AND MEDICAL AID STATIONS (MASS) 27 Definitions.. 27 Responsibilities.. 27 Attachment 1 GLOSSARY OF REFERENCES AND SUPPORTING INFORMATION 30 Attachment 2 PULHES SERIAL PROFILE CHART AND ACCEPTABLE AUDIOMETRIC HEARING LEVELS 36 Attachment 3 TEAM AIRMEN MEDICAL READINESS OPTIMIZATION (AMRO) TIME CHECKLIST 38 4 AFI48-133 7 AUGUST 2020 Chapter 1 GENERAL PROVISIONS Overview.

6 This publication establishes instructions for the documentation and administrative management of Airmen with medical conditions that may impact their ability to perform their military duty. These procedures have been developed to ensure maximum utilization and readiness of personnel, while preserving their health and minimizing risk of further injury or illness. This publication describes appropriate courses of action for the Disability Evaluation System (DES) and Air Reserve Component (ARC)-specific non duty-related disability evaluation system (NDR-DES) pre-screening disposition when individuals have medical conditions potentially affecting their continued fitness for military service or deployability in the AF, as outlined by the standards per AFI 48-123, Medical Examinations and Standards. This publication provides the requirements for communicating medical recommendations, return to duty instructions, and potentially unfitting conditions to commanders.

7 This publication will provide commanders the opportunity to optimally utilize Airmen under their command. Refer to AFI 41-200, Health Insurance Portability and Acountability Act (HIPAA), for guidance on HIPAA compliant communication for commanders. Commanders (CCs) may consult with the medical unit s senior profile officer (SPO) to maximize use of personnel with duty limiting conditions (DLCs). An assessment based on operational risk of personnel assigned to a unit is critical to maintaining unit readiness at the highest degree possible. Purpose of AF Form 469, Duty Limiting Condition Report. The AF Form 469 is used to describe physical limitations and recommend Duty Restrictions (DR) and Mobility Restrictions (MR) to the CC when there is a potential risk to an Airman s health, safety and well-being, the safety of the mission, or the ability of the Airman to effectively accomplish the mission.

8 Additionally, the AF Form 469 is used to convey limitations related to the AF Fitness Program as well as fitness assessment exemptions (FAE). In general, the AF Form 469 will describe an Airman s limitations and FAE/clearance. Purpose of AF Form 422, Notification of Air FORCE Member s Qualification Status. The AF Form 422 is used to communicate medical clearances and resulting qualification between the medical field and Air FORCE Personnel Center (AFPC). It shall be used for, but is not limited to, the following medical processes: retraining, permanent change of station (PCS), professional military education (PME), etc. The AF Form 422 describes what an Airman is qualified to do based on medical assessment, requirements in the Air FORCE Officer Classification Directory and Air FORCE Enlisted Classification Directory, and other similar guidelines (unless specifically directed otherwise, as in paragraph of this publication).

9 Physical Profile System to include Physical Profile Serial Chart (PULHES). The physical profile system classifies individuals according to physical/functional abilities and long-term availability for worldwide duty in accordance with (IAW) AFI 36-2101, Classifying AFI48-133 7 AUGUST 2020 5 Military Personnel (Officer and Enlisted), Air FORCE Officer Classification Directory and Air FORCE Enlisted Classification Directory. Applicability. The physical profile system applies to the following categories of personnel: Applicants for appointment, enlistment, and induction into military service. Officer categories within the Regular Air FORCE (RegAF) and ARC: USAF Academy and Reserve Officers Training Corps cadets. Students in the Uniformed Services University of Health Sciences and Health Professions Scholarship Program. PULHES determinations are descriptions of transient or permanent limitations to functioning which are used for establishing suitability for career fields or Air FORCE Specialty Code (AFSC).

10 A PULHES determination can be established on an AF Form 422, or other forms as directed. Once a PULHES determination is established, it is considered current unless updated during appropriate medical reviews. See Attachment 2 for PULHES chart. Duty Limitations. Duty limitations will be entered on the AF Form 469. (T-2) Duty limitations are a type of profile which will indicate what the member cannot do based on his/her current occupational duties with resultant mobility and/or fitness restriction (FR) if appropriate. The maximum allowable duration of the AF Form 469 following review in lieu of (RILO) of medical evaluation board (MEB) will be dependent upon the date for a follow up RILO as indicated on the FL4 from AFPC/Medical Retention Standards Branch (DP2NP). The expiration date for the profile will be the same as the date for follow up required on the FL4. (T-2) For any other duty or mobility restrictions assignment availability codes (AACs) 31, 37, or 81, the maximum allowable duration of the AF Form 469 is 365 days.