RECORD OF PROCEEDINGS
             AIR FORCE BOARD FOR CORRECTION OF MILITARY RECORDS


IN THE MATTER OF:      DOCKET NUMBER:  BC-2004-01337
            INDEX CODE 133.00, 126.02
            COUNSEL:  None

            HEARING DESIRED:  No

_________________________________________________________________

APPLICANT REQUESTS THAT:

Her promotion to technical sergeant (TSgt) be reinstated.

_________________________________________________________________

APPLICANT CONTENDS THAT:

Her demotion action should have been suspended pending  completion  of
medical evaluation.

Included is a supporting statement from the applicant’s commander.  He
believes the applicant  is  an  excellent  enlisted  member  with  the
ability for continuous success.  Review of  the  case  and  discussion
with the applicant’s military physician  revealed  the  applicant  has
Polycystic Ovarian Syndrome (PCOS) and  insulin  resistance,  and  was
unable to comply with the Air Force Weight  and  Body  Fat  Management
Program (WBFMP) to lose weight.  He told the applicant  on  4  Nov  03
that he agreed her grade  of  TSgt  should  be  restored.   He  whole-
heartedly endorses and recommends granting this appeal.

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

_________________________________________________________________

STATEMENT OF FACTS:

The applicant enlisted in the Regular Air Force on 2 Oct 84  when  she
was almost 26 years old and weighed approximately 128 pounds.  She was
sequentially promoted to the grade of staff  sergeant  (SSgt)  with  a
date of rank (DOR) of 1 Sep 91.  She was assigned to Cannon  AFB,  NM,
first to the 27th Component Repair Squadron as an inventory management
supervisor and ultimately to the 27th Logistics Readiness Squadron  as
the noncommissioned officer in charge (NCOIC)  of  Hazardous  Material
Pharmacy (HAZMAT).

By Dec 87, the applicant weighed approximately 140 pounds.  In Jun 90,
her weight was 147 and she was entered into a weight  loss  management
class, according to a 6 Jun 90  medical  entry.   She  apparently  was
unsuccessful in losing weight and weighed 148 pounds in  Nov  95,  two
pounds over her maximum allowable weight (MAW) for her age.   She  was
enrolled in the weight management program, but by 1998 her weight  had
increased to 168 pounds.

The applicant was selected for promotion to the grade of  TSgt  during
cycle 99E6 with a projected DOR of 1 Dec 99.

A 9 Aug 99 medical entry indicated the applicant weighed 165½ lbs  and
was on a monitored diet.  A 13 Sep 99 entry cleared the applicant  for
entry into the WBFMP.  The entry also reported the  applicant  was  30
years old at the onset of weight  difficulties  but  did  not  have  a
previous history of being in the WBFMP.

The applicant, age 40, was enrolled in the Sensible Weight Program  of
the WBFMP on 17 Sep 99.  As a result, her promotion was withheld.

On 6 Oct 99, the applicant was notified that her promotion to TSgt was
being withheld because of  her  entry  into  Phase  I  of  the  WBFMP;
however, if she met or was below the body fat (BF) standards  after  a
three-month Exercise and Dietary Period, she  would  be  entered  into
Phase II of the WBFMP.  Members in Phase II may assume a higher grade.

[Note:  Apparently the applicant made unsatisfactory progress  because
she was reentered into Phase I on 12 Jan  00,  weighing  162  lbs  and
having a BF measurement of 31%.  The record does not  contain  further
information.]

The applicant entered Phase II on 20 Sep 00, achieving  her  weight/BF
standard of 153¼/32%.  With this  satisfactory  progress,  by  Special
Order dated 26 Sep 00, she was promoted to the grade of TSgt  with  an
effective date of 20 Sep 00.

According to AF Form 393, which recorded her weigh-ins, she received a
Letter of Counseling (LOC) on 29 Dec 00 for  unsatisfactory  progress.
Based on her records, she apparently had gained 10 pounds by  the  end
of Nov 00.

On 23  Apr  01,  the  applicant  weighed  167  pounds.   All  official
measurements for the WBFMP were completed at the Health  and  Wellness
Center (HAWC) and were recorded on the member’s Form 108 as well as in
a log kept at the HAWC.  Apparently, there were some discrepancies  in
the recordings of the  applicant’s  BF  tape  measurements  that  day.
After being informed of her rights, she made a statement to the  first
sergeant and the section  commander  that  she  had  not  altered  her
measurements on the form.

On 7 May 01, the applicant was notified of her commander’s  intent  to
impose nonjudicial punishment on her  for  intentionally  and  falsely
stating, on 24 Apr 01, to the first sergeant and the section commander
that she had not altered her BF tape measurements, and  for  willfully
and knowingly altering a public document,  to  wit,  whiting  out  her
official  tape  measurements  and  replacing  them   with   unofficial
measurements.  The applicant made a written statement,  asserting  she
had not changed the form and advising she was seeing a  specialist  to
determine why she was unable  to  lose  weight  despite  her  efforts.
However, on 11 May 01, the commander  found  her  guilty  and  imposed
punishment in the form of forfeiture of $500.00 pay per month for  two
months, 30 days extra  duty,  and  a  reduction  to  SSgt,  which  was
suspended until 13 Nov 01.  The applicant presented written matters in
appeal,  and  the  commander  provided  a  rebuttal  statement.    The
applicant’s appeal was denied on 24 May 01.

On 6 Jun 01, a pelvic exam disclosed a cyst and fibroid  and  reported
the applicant’s blood pressure had been elevated for two years.

According to AF Form 393, she received a Letter of Reprimand (LOR)  on
7 Jun 01 for unsatisfactory progress, and an  Unfavorable  Information
File (UIF) was established.  She was also placed on the Control Roster
(CR) for a second weight management failure.

On 25 Jun 01, the applicant requested  a  six-month  medical  deferral
from the WBFMP because she was on medication  that  had  bloating  and
weight gain as side effects.  The medication was an attempt to  reduce
the growths without resorting to surgery.  The applicant also  advised
she was diagnosed, on 24 May 01, as having a breathing disorder.

The WBFMP Medical Liaison  wrote  to  the  commander  on  28  Jun  01,
advising of the applicant’s workup for both  Obstructive  Sleep  Apnea
and Complex Right Ovarian Cyst and Uterine Fibroid.   The  Physician’s
Assistant  (PA)  reported  the  Sleep  Apnea  could  account  for  the
inability to lose weight and the growths could account for 5-7  pounds
in additional weight. The PA recommended the applicant be extended  on
active duty pending evaluation/treatment for two months  and  then  be
reevaluated.

In Aug 01, the applicant underwent removal of  her  uterus  and  right
ovary, but retained her left ovary.

According to the AF Form 393, she received another LOR on 31 Oct 01.

An 18 Dec 01 Memo for the Record (MFR) by the commander indicated  his
reluctance to discharge the applicant, a 17-year TSgt.  He reported he
asked her to be sure all her medical problems documented at the Clovis
hospital with her recent surgery were in her military medical records.

In a 11 Jul 02 Memo for the Record, the NCOIC Commander Support  Staff
reported the applicant’s WBFMP  folder  was  incomplete  with  missing
signatures  and  unaccomplished  administrative   action,   continuous
failure in the program was improperly  identified,  and  the  lack  of
response and administrative action had proven the file  to  be  almost
nullified.

On 7 Oct 02, the applicant met with the  squadron  commander  and  was
directed to extend for only three months in order to reduce the amount
of BF she was over.  She was also counseled to comply or at the end of
three months a decision would be made as to her continued service.

On 19 Mar 03, the squadron commander notified  the  applicant  of  his
intent to demote her from TSgt  to  SSgt.   The  commander  cited  the
applicant’s 15 failures to satisfactorily progress and 10 failures  to
weigh in.  Plus, she had failed every weigh-in since Aug 02 and failed
to show for weigh-ins three additional  times.   Also  cited  was  the
applicant’s falsification of the  AF  Form  108  and  making  a  false
statement.  The applicant acknowledged receipt of the notice  but  did
not respond.

A 21 Apr 03 Clinic Note reported the  applicant  had  been  in  weight
management for three years  and  had  a  definite  inability  to  lose
weight.  She had been diagnosed with  obstructive  sleep  apnea.   The
entry indicates she was to remain on profile until  all  lab  work  to
rule out insulin resistance was completed.  If insulin resistance  was
ruled out, she was to have  follow-up  evaluation  to  help  her  lose
weight and not lose a stripe.

Legal review on 23 Apr 03, found  the  case  sufficient  for  demotion
action.  On 24 Apr 03,  the  group  commander  directed  demoting  the
applicant to the grade of SSgt for failure to progress in the WBFMP.

Special Order dated 1 May 03, demoted the applicant from TSgt to  SSgt
effective and with a DOR of 24 Apr 03.

A 9 May 03 nutrition consultation noted the  applicant  was  diagnosed
with insulin resistance.  She was treated with  medication,  diet  and
exercise.  At this time, she weighed 170 pounds.

On 21 Aug 03, the applicant requested a letter stating  her  diagnosis
of insulin resistance and its effects on her weight.

A 17 Sep 03 letter from the Women’s Health  Nurse  Practioner  to  the
applicant’s commander advised for years the  applicant  had  untreated
PCOS, now called  insulin  resistance,  which  led  to  her  having  a
hysterectomy and greatly contributed to her weight problem.   Further,
the medication she was now taking would take about eight  weeks  until
full effects were noticed.  The Practitioner requested  the  applicant
not be punished by taking away a  stripe  but  instead  be  granted  a
waiver until the full effects of the medication  she  was  now  taking
could be assessed.  On 18 Sep  03,  the  applicant  also  submitted  a
letter requesting reinstatement of her TSgt rank, contending  she  was
demoted before the medical evaluation was completed and she was  being
punished for having an affecting condition  requiring  medication  for
the rest of her life.

A lab report,  dated  17  Feb  04,  had  handwritten  notes  that  the
applicant’s weight had dropped from 170 pounds on 23 Jan 04 to 158 lbs
on 17 Feb 04.

On 6 May 04, the Secretary of the Air Force Personnel Council  (SAFPC)
determined the applicant served satisfactorily for 3 months, 4 months,
and 24 days in the highest  grade  held  as  a  TSgt,  and  should  be
advanced  on  the  retired  list  to  that  higher  grade,  under  the
provisions of Title 10, USC, Section 8964, when her  years  of  active
service and time on the retired list totaled 30 years.

The applicant retired in the grade of SSgt on 1 Nov  04  due  to  High
Year of Tenure (HYT).  She will be advanced on the retired list to the
grade of TSgt on 1 Oct 2014.

_________________________________________________________________

AIR FORCE EVALUATION:

HQ AFPC/DPF contends unit commanders may approve a  temporary  medical
deferral when recommended by  the  Medical  Treatment  Facility  (MTF)
WBFMP representative or  a  medical  practitioner.   Members  are  not
weighed or measured for the period of the deferral.   Review  of  this
case gives no indication the applicant’s MTF requested such a  waiver.
Denial is recommended because the WBMFP was administered in accordance
with AFI 40-502.

A complete copy of the evaluation is at Exhibit C.

HQ  AFPC/DPPPWB  advises  the  policy  of  rendering   an   individual
ineligible for promotion  when  in  Phase  I,  Weight  Status  Code  2
(Unsatisfactory Progress) of the WBFMP was made in 1995 by senior  Air
Force  leaders  in  an  effort  to  tie  maintaining   standards   and
performance to promotion.  It is not in the best interest of  the  Air
Force to promote an individual who does not meet the weight  standards
required  when  performing  varied  Air  Force  missions.    Promotion
ineligibility because of weight is the same as all other ineligibility
conditions outlined in AFI 36-2502.  If, on, or  after  the  Promotion
Eligibility Cutoff Date (PECD) for the respective cycle a member is in
one of these conditions, he/she is ineligible for  the  entire  cycle.
This means a member cannot test or be  considered  if  already  tested
and, if  already  selected,  the  projected  promotion  is  cancelled.
DPPPWB concurs with DPF’s recommendation to deny.

A complete copy of the evaluation is at Exhibit D.

_________________________________________________________________

APPLICANT'S REVIEW OF AIR FORCE EVALUATION:

The applicant is concerned the medical basis for her  request  is  not
being considered.  At the time the action was taken  against  her  she
was undergoing tests for insulin resistance, five years after she told
medical personnel she suspected something was wrong because she  could
not lose weight.  She was punished by Article 15 for  altering  an  AF
Form 108 and uttering a false statement;  should  she  be  continually
punished for this?  She questions  why  a  21  Apr  03  medical  entry
concerning the  insulin  resistance  issue  was  not  addressed.   She
asserts she was under medical care for  a  weight  management  problem
long before she entered the WBFMP.  Her  commander  was  informed  she
tested positive for insulin  resistance  and  had  shown  symptoms  of
having the condition  for  years.   The  commander  told  her  on  two
separate occasions  he  would  restore  her  stripe,  but  this  never
happened.  She encloses the medical records she provided in her appeal
and asks the Board to consider the  medical  evidence  supporting  her
claim.

A complete copy of applicant’s response,  with  attachments  (same  as
Exhibit A), is at Exhibit F.

_________________________________________________________________

AFBCMR MEDICAL CONSULTANT EVALUATION:

The Consultant advises that PCOS is a hormonal disorder  characterized
by  irregularity  of  menstruation,   infertility,   hyper-androgenism
(excess male sex hormone effects such as acne and facial hair  growth,
or lab evidence of excess androgens), and small cysts  affecting  both
ovaries.  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.  The principle
treatment of overweight PCOS patients is weight loss, which results in
significant improvement  in  symptoms.   When  insulin  resistance  is
present, treatment with metformin is  often  used  as  an  adjunct  to
weight loss based on its effect to reduce insulin resistance and  help
with weight loss.  The applicant manifested some  features  suggestive
of PCOS.  However, the medical records  do  not  clearly  establish  a
significant history  or  findings  of  significant  irregular  menses,
androgenic manifestations, or characteristic multiple  ovarian  cysts.
PCOS  with  insulin  resistance  is  not  a  direct  cause  for  being
overweight any  more  than  adult  onset  diabetes,  also  an  insulin
resistant syndrome.  There are PCOS patients with and without obesity,
so PCOS alone is not the sole cause of obesity.  Studies of overweight
PCOS patients has demonstrated resting metabolic rates are the same as
control subjects (without PCOS) and 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,
and PCOS, and all are able to lose weight when caloric intake is  less
than energy expenditure.  None of  these  conditions  warrant  medical
exemption from the WBFMP.  In fact,  the  applicant  demonstrated  the
ability to lose a  significant  amount  of  weight  through  diet  and
exercise between Sep 99 and Sep 00.  The Consultant finds  no  medical
reason why the  applicant  could  not  repeat  her  past  success  and
therefore recommends denial.

A complete copy of the Consultant’s evaluation is at Exhibit G.

_________________________________________________________________

APPLICANT’S REVIEW OF CONSULTANT’S EVALUATION:

A complete copy of the Consultant’s evaluation was  forwarded  to  the
applicant on 13 Dec 04 for review and comment within 30 days.   As  of
this date, this office has received no response.

_________________________________________________________________

THE BOARD CONCLUDES THAT:

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

2.    The application was timely filed.

3.    Insufficient relevant evidence has been presented to demonstrate
the existence of error or injustice.  After a thorough review  of  the
evidence  of  record  and  the  applicant’s  submission,  we  are  not
persuaded her  grade  of  TSgt  should  be  reinstated.   The  Medical
Consultant asserts obesity itself causes insulin resistance,  so  PCOS
and obesity are both contributory factors to insulin  resistance.   He
adds PCOS with insulin resistance is not  a  direct  cause  for  being
overweight any  more  than  adult  onset  diabetes,  also  an  insulin
resistant syndrome.  Weight loss is medically indicated in individuals
with diabetes, glucose intolerance, insulin resistance and PCOS.   The
Consultant contends none of these conditions warrant medical exemption
from the WBFMP.  He points out periods when the applicant demonstrated
her ability to lose weight.  The military and medical  records  appear
to support his position.  We truly sympathize with the  applicant  and
acknowledge her battle with weight was very difficult.   However,  she
has not shown it was impossible for her to lose weight.  Further,  she
appears to have been given many opportunities to comply with Air Force
standards.  We agree with SAFPC’s conclusion that  the  applicant  did
serve satisfactorily in the highest grade held and are  satisfied  she
will be advanced to the grade of TSgt in  2014.   We  therefore  agree
with the recommendations of  the  Medical  Consultant  and  adopt  the
rationale expressed as the basis for our decision that  the  applicant
has not sustained her burden of having suffered either an error or  an
injustice.  In view of the above and absent persuasive evidence to the
contrary, we find no compelling basis to recommend granting the relief
sought.

_________________________________________________________________

THE BOARD DETERMINES THAT:

The  applicant  be  notified  that  the  evidence  presented  did  not
demonstrate the existence of material error  or  injustice;  that  the
application was denied without a personal  appearance;  and  that  the
application will only be reconsidered upon  the  submission  of  newly
discovered relevant evidence not considered with this application.

_________________________________________________________________

The following members of the  Board  considered  this  application  in
Executive Session on 3 February 2005 under the provisions of  AFI  36-
2603:

                 Mr. Thomas S. Markiewicz, Chair
                 Ms. Renee M. Collier, Member
                 Ms. Cheryl V. Jacobson, Member

The following documentary evidence relating to AFBCMR Docket Number BC-
2004-01337 was considered:

   Exhibit A.  DD Form 149, dated 23 Feb 04, w/atchs.
   Exhibit B.  Applicant's Master Personnel Records.
   Exhibit C.  Letter, HQ AFPC/DPF, dated 25 Aug 04.
   Exhibit D.  Letter, HQ AFPC/DPPPWB, dated 16 Sep 04.
   Exhibit E.  SAF/MRBR, dated 24 Sep 04.
   Exhibit F.  Letter, Applicant, undated.
   Exhibit G.  Letter, AFBCMR Medical Consultant, dated 9 Dec 04.
   Exhibit H.  Letter, AFBCMR, dated 13 Dec 04.




                                   THOMAS S. MARKIEWICZ
                                   Chair