AFI 48-123 Changes for Sleep Apnea

Jason Perry

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I just posted the update to AFI 48-123 in the resources section of the site. Most notable are the changes for sleep apnea. Here they are:

"(Replace) 5.3.2.1.4. Obstructive sleep apnea or sleep-disordered breathing that causes daytime
hypersomnolence that cannot be corrected with life style modifications (i.e., 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.

(Add New) 5.3.2.1.4.1. 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) 5.3.2.1.4.1.1. 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) 5.3.2.1.4.1.2. 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.”

(Add New) 5.3.2.1.4.2. 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. "
 
I just posted the update to AFI 48-123 in the resources section of the site. Most notable are the changes for sleep apnea. Here they are:

"(Replace) 5.3.2.1.4. Obstructive sleep apnea or sleep-disordered breathing that causes daytime
hypersomnolence that cannot be corrected with life style modifications (i.e., 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.

(Add New) 5.3.2.1.4.1. 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) 5.3.2.1.4.1.1. 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) 5.3.2.1.4.1.2. 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.”

(Add New) 5.3.2.1.4.2. 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. "

Hmm, indeed all good information for OSA albeit I am reading it with an U.S. Army perspective!

Thus, I quite often comment that "possessing well-informed knowledge is truly a powerful equalizer."

Best Wishes!
 
I just posted the update to AFI 48-123 in the resources section of the site. Most notable are the changes for sleep apnea. Here they are:

"(Replace) 5.3.2.1.4. Obstructive sleep apnea or sleep-disordered breathing that causes daytime
hypersomnolence that cannot be corrected with life style modifications (i.e., 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.

(Add New) 5.3.2.1.4.1. 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) 5.3.2.1.4.1.1. 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) 5.3.2.1.4.1.2. 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.”

(Add New) 5.3.2.1.4.2. 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. "

Hello Jason, how long before these changes take effect? Is this draft or final?
 
Hello Jason, how long before these changes take effect? Is this draft or final?

I don't have access to AF pubs, but according to the attached memo, it has been in effect since January of this year. Since this memo expires 180 days after it being signed, I would say the AF has already updated AFI 48-123. You should be able to pull the latest and look at the summary of changes in the front of the pub.
 

Attachments

  • afi48-123.pdf
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This is a regulation particularly of interest to me. I wanted to ask about 5.3.2.1.4.2. I took a sleep study in September with a diagnosis of Moderate OSA with an AHI of 16. I've been on my CPAP machine consistently for a month now. I have received conflicting information about whether or not a full MEB will take place for me or not. The regulation requires an MEB for Moderate OSA, right? My PEBLO said that when we submit my package to IRILO, AFPC could decide to return me to duty and not proceed with an MEB. Is that right? Can AFPC blindly ignore regulations? Am I missing something? Please advise. Especially Jason Perry. I have some other conditions going on which I can comment on later.
 
the triggering of a medical review or a RILO, does not have to trigger a full MEB, your commanders statements, profiles, current/past history will determine if a MEB is required or not. In the current situation however going ahead into 2014, with full blown draw downs/TERA/ESP/RIF's etc. if you are put on full MEB for sleep apnea, or any other condition that even if found fit for duty would require an assignment limitation code, it would be best to consider admitting everything and having it examined for fitness vs hiding anything and hoping for the best. The first wave of reduction will be "volunteers" but if the past is any indication, many will not volunteer because of the current economy, the second and subsequent waves will be anyone with negative identifiers such as limitation codes, disciplinary issues, less than 5 EPR's, those in overage career fields, those with failed PT tests etc. it is going to be a gutting equal to the 92-94 draw down, that hit so many by surprise.
 
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