HEADQUARTERS UNITED STATES AIR FORCE …

1 DEPARTMENT OF THE AIR FORCE HEADQUARTERS UNITED STATES AIR FORCE WASHINGTON DC afi 48 -123_AFGM4 29 January 2013 MEMORANDUM FOR DISTRIBUTION C MAJCOMs/FOAs/DRUs FROM: HQ USAF/SG 1780 Air FORCE Pentagon Washington, DC 20330-1780 SUBJECT: Air FORCE Guidance Memorandum to afi 48 -123, Medical Examinations and Standards By Order of the Secretary of the Air FORCE , this is an Air FORCE Guidance Memorandum immediately implementing changes to afi 48 -123, Medical Examinations and Standards. This AFGM supersedes afi 48 -123_AFGM3, 24 August 2012. Compliance with this Memorandum is mandatory. To the extent its directions are inconsistent with other Air FORCE Publications, the information herein prevails, in accordance with AFI 33-360, Publications and Forms Management. In advance of a rewrite of afi 48 -123, the attachment to this Memorandum provides guidance changes that are effective immediately.

2 The summary of changes is to change Cone Contrast Testing as the primary color vision testing in the Air FORCE . In addition it clarifies that accession medical standards apply at commissioning as per DoDI 6130-03, Medical Standards for Appointment, Enlistment, or Induction in the Military Services. This guidance in this Memorandum becomes void after 180 days have elapsed from the date of this Memorandum, or upon incorporation by interim change to, or a rewrite of afi 48 -123, whichever is earlier. CHARLES E. POTTER Brigadier General, USAF, MSC Assistant Surgeon General, Health Care Operations Attachment: Guidance Changes Cc: AFMSA/CC AFMOA/CC AFELM/CC 2 afi 48 -123_AFGM4 ATTACHMENT Guidance Changes The below changes to AFGM supersedes afi 48 -123_AFGM3, dated 24 August 2012, are effective immediately. References throughout to Space and Missile Operator Duty (SMOD) are hereby changed to Missile Operator Duty (MOD).

3 Change waiver authority in Attachment 2 for all Missile Operation Duty from AFSPC/SG to AFGSC/SG. (Replace) Retention of cadets at the UNITED STATES Air FORCE Academy and students enrolled in the ROTC scholarship programs. (Delete) UNITED STATES Air FORCE Academy (USAFA), AFROTC (after 2 contract years) cadets and Health Professions Scholarship Program (HPSP) when the student begins their third academic (USAFA Second Class) year. (Replace) Obstructive sleep apnea or sleep-disordered breathing that causes daytime hypersomnolence that cannot be corrected with life style modifications ( , weight loss, positional therapy, and proper sleep hygiene), positive airway pressure (CPAP, BiPAP, APAP, vPAP, etc.), surgery, or an oral appliance. The diagnosis must be based upon a nocturnal polysomnogram and the evaluation of a provider credentialed and privileged in sleep medicine.

4 (Add New) A trial of therapy with PAP up to 12-months may be attempted to assist with other therapeutic interventions, during which time the individual will be issued a mobility restrictive profile stating that they may deploy with reliable electricity at deployment billeting location if waived by the COCOM. (Add New) Airmen with severe or moderate obstructive sleep apnea (diagnostic Polysomnogram AHI/RDI greater than 15) and/or symptoms despite treatment and regardless of severity require an evaluation for a Medical Evaluation Board (MEB). (Add New) Airman with mild obstructive sleep apnea (diagnostic Polysomnogram AHI/RDI 15) once stable without adjustments for 90 days can have the Code 31 removed without any deployment restrictions after approval by the DAWG. The DAWG will ensure a duty limitation is placed on the 469 stating member requires reliable electricity at billeting when deployed ; see COCOM reporting instructions for guidance.

5 3 (Add New) If symptoms of hypersomnolence cannot be controlled with lifestyle modifications, positive airway pressure, surgery or an oral appliance, the standard is not met. The use of stimulant medications or supplemental oxygen for treatment of obstructive sleep apnea requires an MEB evaluation. If the use of positive airway pressure or other therapies for obstructive sleep apnea result in interference with satisfactory duty performance as substantiated by the individual's commander then the standard is not met and requires an MEB evaluation. (Replace) The USAF Aircrew Spectacle Frame Program defines and authorizes USAF aircrew eyewear. Authorized eyewear are identified under the Aviation Flight Frame (AFF) series as the AFF-OP (AFF), AFF-DR (AFD), and AFF-JS (AFJ). No other spectacle frames are authorized for use in USAF aircraft by USAF aircrew or USAF contracted aircrew.

6 These modifications were implemented to meet the integration requirements of the new tri-service chem/bio protective ensemble called the Joint Service Aircrew Mask (JSAM); the current helmet mounted targeting system known as the Joint Helmet Mounted Cueing System (JHMCS); and the new Joint Strike Fighter (JSF) advanced helmet/mask ensemble. Color Vision. (Replace) All flying/special operational duty personnel or other career fields requiring color vision testing will be tested using Color Cone Contrast (CCT). PIP 1 and PIP 2 testing is no longer required unless sister service school requires or a trained asset is testing CCT the first time and fails CCT, refer to (Replace) Passing score on the CCT is defined as 75 or greater monocularly on each of the three colors, red, green and blue. For additional implementation instructions and disposition of Airmen with failing scores, refer to the AFMS KX at: (Delete) Note: All USAFA and ROTC cadets receiving initial flight physicals during the 2009-2010 academic year will be held to the 10/14 PIP I standards.

7 For the purposes of this AFI, the academic year will end 1 Jul 2010. All other aircrew who were previously qualified for flying duties based on the previous 10/14 PIP I and fail the new 12/14 PIP I standard will be considered for waiver in their current weapon system after appropriate evaluation. A formal ophthalmologic evaluation must be accomplished to determine the type and degree of color vision defect. (Replace) Flying Class I. Color vision deficit or anomaly of any degree or type. (Replace) All Flying Class I applicants must pass color vision testing using CCT during the initial FC I exam. If passed, subsequent MFS color vision screening testing includes the following approved tests by AF/SG. 4 (Delete) . (Delete) (Renumber) F2 Plate (able to correctly identify number, location and orientation of squares, tested monocularly, performed only during the Medical Flight Screening exam).

8 (Renumber) Confirmatory testing by the ACS on any history of color screening test failure, to include Anomaloscope may be required. (Delete) (Replace) Flying Class IA/II/III: Must possess normal color vision as demonstrated by passing CCT. Testing must be accomplished at each PHA. (Add new) Follow up testing for previously waived color defectives will include testing as determined by AFMSA/SG3PF. (Add new) For trained aircrew/special operational duty personnel who pass one test but fail the other, DNIF is NOT automatically required but the examining flight surgeon must notify the ACS within 3 duty days. Trained aircrew/special operational duty personnel must still have their waiver processed. (Delete) (Delete) (Delete) (Renumber) Color defective aircrew with a valid waiver may wear issued neutral gray tinted sunglasses and laser eye protection when operationally authorized.

9 However, aircrew with defective color vision are not authorized to wear the yellow High Contrast Visor (HCV). (Renumber) AFMSA retains certification/waiver authority for all color vision Section 6J-Missile Operations Duty (Replace) Missile Operations Duty (MOD) Standards. The medical conditions listed in Chapter 5 and Section 6J are cause to reject MOD personnel for initial accession into the missile operator (AFSC 13 SXC) career field unless a waiver is granted. Missile operator candidates (AFSC 13 SXC), must meet all MOD standards. The certification authority for initial 5 MOD examinations and waivers is AFGSC/SGP. For continuation of Missile Operator Duty, the member must meet retention standards per Chapter 5 and MOD standards noted in Section 6J unless a waiver is granted by AFGSC/SGP. For conditions listed in Chapter 5, ensure an MEB has been completed or assignment limitation code evaluation has been performed and final disposition made prior to submission of a waiver request.

10 (Replace) Defective Color Vision. Color vision screening done at base level must be performed monocularly using the Cone Contrast Test (CCT). The minimum passing score is 75 for each color tested in each eye. (Replace) Corrected visual acuity worse than 20/20 in the better eye near and distant. Note: Individuals found on routine examination to be less than 20/20 in the better eye in either near or distant, or both, but correctable to at least 20/20 near and distant in one eye may continue to perform Missile Operations duties until the appropriate corrective lenses arrive. These lenses must be ordered by the most expeditious means. (Replace) A hearing profile worse than H-2 for initial selection or worse than H-3 for continued MOD duty. (Replace) Unsatisfactory AR-MOD. (Replace) Medication (See Approved Missile Operation Medication List on AFMSA Knowledge Junction).