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

_________________________________________________________________

APPLICANT REQUESTS THAT:

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

_________________________________________________________________

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.

_________________________________________________________________

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.

_________________________________________________________________

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.

_________________________________________________________________

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.

_________________________________________________________________

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.

_____________________________________________________________

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.

_________________________________________________________________

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.

_________________________________________________________________

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.

_________________________________________________________________

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

                 Mr. Richard A. Peterson, Panel Chair
                 Ms. Dorothy P. Loeb, Member
                 Ms. Marcia Jane Bachman, Member

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.




                                   RICHARD A. PETERSON
                                   Panel Chair



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.





   JOE G. LINEBERGER

   Director

   Air Force Review Boards Agency