BY ORDER OF THE AIR FORCE INSTRUCTION 48-133 SECRETARY OF THE AIR FORCE 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 www.e-Publishing.af.mil. RELEASABILITY: There are no releasability restrictions on this publication. OPR: AFMRA/SG3PF Certified by: AF/SG3/4 (Maj Gen Robert I. Miller) Supersedes: AFI10-203, Pages: 39 20 November 2014 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). 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 http://dpclo.defense.gov/Privacy/SORNs.aspx. 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. 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 1.1. Overview. ................................................................................................................. 4 1.2. Physical Profile System to include Physical Profile Serial Chart (PULHES). ........ 4 1.3. Duty Limitations. ..................................................................................................... 5 1.4. Special Considerations. ............................................................................................ 6 Chapter 2—GUIDANCE 8 Section 2A—ROLES AND RESPONSIBILITIES 8 2.1. The Chief of Staff of the Air Force. ......................................................................... 8 2.2. Air Force Surgeon General (AF/SG). ...................................................................... 8 2.3. 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 2.4. Military Treatment Facility (MTF)/Commander (CC). Note ................................. 8 2.5. Military Treatment Facility/Chief of Aerospace Medicine (SGP). .......................... 9 2.6. Military treatment facility (MTF)/Chief of the medical staff (SGH). ...................... 10 2.7. Clinic providers (including specialty providers within the military treatment facility (MTF). Note: .............................................................................................. 10 2.8. Clinical consultants/medical specialists. .................................................................. 11 2.9. Profile officer (PO). ................................................................................................. 12 2.10. Medical standards management element (MSME). ................................................. 12 2.11. PH (or ARC Equivalent). ....................................................................................... 14 2.12. Unit commanders. .................................................................................................... 14 2.13. Airmen. .................................................................................................................... 15 2.14. Military personnel section (MPS). ........................................................................... 16 AFI48-133 7 AUGUST 2020 3 2.15. 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). ................................... 16 Chapter 3—ESTABLISHING AND DISSEMINATING DUTY LIMITATIONS 17 3.1. General Requirements. ............................................................................................. 17 3.2. Fitness restrictions (FR) and fitness assessment exemptions (FAE). ...................... 17 3.3. Duty Restrictions (DR) Only. .................................................................................. 18 3.4. Mobility Restrictions (MR)...................................................................................... 18 3.5. Pregnancy-Related Duty and Fitness Limitations. ................................................... 19 3.6. Multiple Action AF Form 469. ................................................................................ 21 3.7. External Duty Limitations (Civilian or Sister Service). ........................................... 21 3.8. Dental. ...................................................................................................................... 21 Chapter 4—AIRMEN MEDICAL READINESS OPTIMIZATION (AMRO). 22 4.1. Purpose..................................................................................................................... 22 4.2. Critical success factor 1: Team AMRO Time. ......................................................... 22 4.3. Critical success factor 2: Standard Work. ............................................................... 22 4.4. Critical success factor 3: AMRO board. ................................................................. 23 4.5. Metrics. .................................................................................................................... 25 Chapter 5—LIMITED SCOPE MILITARY TREATMENT FACILITIES (LSMTFS) AND MEDICAL AID STATIONS (MASS) 27 5.1. Definitions. .............................................................................................................. 27 5.2. 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 1.1. Overview. 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. 1.1.1. This publication provides the requirements for communicating medical recommendations, return to duty instructions, and potentially unfitting conditions to commanders. 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. 1.1.2. 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. 1.1.3. 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,