Medical Records of U.S. Casualties of Iraq’s Chemical Weapons 22 Pages - Contributed by NYT News, The New York Times - Oct 13, 2014

BEASLEY BLISTER PROGRESSION**PHIPPS CLINIC

DAYl DAY 3 DAYS

I~~~

DAY 7 DAY 7 DAY 8 After Debridement

BEASLEY BLISTER PROGRESSION**PHIPPS CLINIC

DAY 3 DAYS DAY 7

~'I"""'Ii':' r" <r

.'fl h[Ur-H1

DAY 9 DAY 9 DAY 10/ After Debridement

SPC RICHARD BEASLEYPIDPPS CLINIC, BALAD, IRAQ, LSA ANACONDA

12MARCH2007BLISTER EXPOSURE FROM LIFTING ORDINANCE INTO

VEHICLE

HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE

Patient: BEASLEY, RICHARD TFacility: WX63AA

Date: 15 May 20071455 ASTClinic: 206 ASMC (ANACONDA)

Appt Type: ROUTNProvider:

AutoCites Refreshed by @ 15 May 2007 1534 ASTProblemsINJURY DUE TO WAR OPERATIONS BY GASES, FUMES, AND CHEMICALSCONTACT DERMATITIS DUE TO CHEMICAL PRODUCTSvisit for: follow-up examINJURY FROM TERRORIST EXPLOSION BLASTviolent traumatic event a terrorist attack

Active Medications

Medication Name StatusSILVER SULFADIA (SILVADENE)--TOP 1% ActiveCREACLiNDAMYCIN--PO 300MG CAP ActiveHYDROCODONE/BITARTRATEl ACETAMINOPH ActiveEN - 5/500MGMORPHINE 10MG/ML CARPUJET ActiveSILVER SULFADIA (SILVADENE)--TOP 1% ActiveCREASILVER SULFADIA (SILVADENE)--TOP 1% ActiveCREACLiNDAMYCIN--PO 300MG CAP ActiveSILVER SULFADIA (SILVADENE)--TOP 1% ActiveCREACLiNDAMYCIN--PO 300MG CAP ActiveSILVER SULFADIA (SILVADENE)--TOP 1% ActiveCREAHYDROCODONE/BITARTRATEl ACETAMINOPH ActiveEN - 5/500MG

AllergiesPatient has no known allergies

Screening Written by @ 15 May 20071455 AST

Sig Refills Last FilledQ DAY WITH BANDAGE CHANGE 15 Mar 2007

TID X 20 DAYS 15 Mar 20072 PO 30 MINS PRIOR TO FOLLOW-UP J 6 Mar 2007

10 MG 1M 20 Mar 2007WITH DRESSING CHANGE 28 Mar 2007

APPLY WITH DRESSING CHANGE 30 Mar 2007

TID 01 Apr 2007 .APPLY WITH BANDAGE CHANGE 12 Apr 2007

2 PILLS BID 13 Apr 2007WITH BANDAGE CHANGE 13 Apr 2007

1 Q 4-6 HRS FOR BREAKTHROUGH 13 Apr 2007PAIN

Appointment Reason For Visit: Administrative Evaluation Services; _

Selected Reason(s) For Visit: _Administrative Evaluation Services (New) Comments: LOD for Terrorist Attack I Chemical Exposure

FMP/SSN:DOB:peat: All USA ADMC Status:Insurance: No

Sex:

Tel H:Tc1W:CS:WS:

MName:BEASLEY, RICHARD T

Sponsor:Rank:

Unit:Outpt Rec. Rm:PCM:TeL PCM:

BEASLEY, RICHARD T

SPEClALIST 4 E4-A

WB60AA

STANDARD FORM 600 (REV. 5)Prescribed by GSA and ICMRFIRMR

nus INFORMATION IS PROTECTED BY THE PRN ACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESSTO THIS INFORMATION IS A VIOLA TrON OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED.

CHRONOLOGICAL RECORD OF MEDICAL CARE

Page 1 of 1

HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE

Patient: BEASLEY, RICHARD TFacility: WX63AA

Date: 02 Apr 20071438 CSTClinic: 206 ASMC (ANACONDA)

Appt Type: ROUTNProvider:

AutoCites Refreshed by @ 02 Apr 2007 2025 CSTProblemsINJURY DUE TO WAR OPERATIONS BY GASES, FUMES, AND CHEMICALSCONTACT DERMATITIS DUE TO CHEMICAL PRODUCTSvisit for: follow-up exam

Active Medications

Medication Name StatusSILVER SULFADIA (SILVADENE)--TOP 1% ActiveCREACLiNDAMYCIN--PO 300MG CAP ActiveHYDROCODONE/BITARTRA TE/ACETAMINOPH ActiveEN - 5/500MGMORPHINE 10MG/ML CARPUJET ActiveSILVER SULFADIA (SILVADENE)--TOP 1% ActiveCREASILVER SULFADIA (SILVADENE)--TOP 1% ActiveCREACLiNDAMYCIN--PO 300MG CAP Active

Sig Refills Last FilledQ DAY WITH BANDAGE CHANGE 15 Mar 2007

TID X 20 DAYS 15 Mar 20072 PO 30 MINS PRIOR TO FOLLOW-UP 16 Mar 2007

10 MG 1M 20 Mar 2007WITH DRESSING CHANGE 28 Mar 2007

APPLY WITH DRESSING CHANGE 30 Mar 2007

TID 01 Apr 2007

AllergiesPatient has no known allergies

Screening Written by @ 02 Apr 2007 1438 CST

Appointment Reason For Visit: CONTACT DERMATITIS DUE TO CHEMICAL PRODUCTS; _

Selected Reason's) For Visit: _CONTACT DERMATITIS DUE TO CHEMICAL PRODUCTS (Follow-Up) Comments:VitalsVitals Written by @ 02 Apr 20071438 CSTPain Scale: 3/10 Mild

Comments: no vitals needed

SO Note Written by @ 02 Apr 2007 1459 CSTHistory of present illness

The Patient is a 22 year old male.o Encounter Background Information:.

SubjectivePt is here for flu for exposure to a blister agent - mustard gas.

Physical findingsGeneral appearance:• General appearance:. 0 Patient was awake. 0 Patient was alert. 0 Patient was oriented to time, place, and person. 0 Patientappeared well developed. 0 Patient appeared well nourished. 0 Patient appeared well hydrated. 0 Patient appeared healthy.o Patient appeared active. 0 Patient appeared to be in no acute distress. 0 Patient did not appear chronically ill. 0 Patient did notappear acutely ill. 0 Patient did not appear poorly hydrated, 0 Patient did not appear acutely exhausted. 0 Patient did not appearuncomfortable. 0 Body odor was normal.

AlP Written by @ 02 Apr 2007 1500 CST

Name:BEASLEY, RICHARD TSex: M Sponsor:

Rank:

Unit:Outpt Rec. Rrn:PCM:Tel.PCM:

BEASLEY, RICHARD T

SPECIALIST 4 E4-A

WB60AAFMP/SSN:DOB:PCat All USA ADMC Status:Insurance: No

TeIH:

TeIW:CS:WS:

CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARDFORM 600 (REV. 5)Prescribed by GSA and TCMRFIRMR

THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESSTO THIS INFORMATION IS A VIOLATION OF FEDERAL LAW. VIOLA TORS WILL BE PROSECUTED.

Page 1 of2

HEALTH RECORD CHRONOLOGICAL RECORD OF MEDICAL CARE02 Apr 2007 1438 Facility: WX63AA Clinic: 206 ASMC (ANACONDA) Provider:

1. visit for: follow-up examComments: pt's wound was covered and silvadene was used.

Disposition Written by @ 02 Apr 20071501 CSTReleased Without LimitationsFollow up: as needed in 2 day(s) or sooner ifthere are problems. - Comments: 1500 hoursInjury & Illness: Work Related; Onset Date: 4/2/2007; Battle Related; Category: Dermatological Cause: Battle Injury/IllnessAppointment Class: OutpatientE&M Code: 99212 - Estab Outpatient Focused H&P - Straightforward Decisions

Signed By @ 02 Apr 2007 2025

WX63AA

Name:BEASLEY, RICHARD T

FMP/SSN:DOB:peat:MC Status:Insurance: No

Sex:

TelH:

reiw:CS:WS:

M Sponsor:Rank:

Unit:Outpt Rec. Rm:PCM:TeI.PCM:

BEASLEY, RICHARD T

SPECIALIST 4 E4-A

WB60AA

CHRONOLOGICAL RECORD OF MEDICAL CARE STANDARD FORM 600 (REV. 5)Prescribed by GSA and ICMRFIRMR

THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (PL-93-579). UNAUTHORIZED ACCESSTO THIS INFORMATION IS A VIOLATION OF FEDERAL LAW. VIOLATORS WILL BE PROSECUTED.

Page 2 of2

'

1 - ~ 7 - (' S ; I ' : t 0 ~~I : :2027~2~265

1{/J OU.,. / OU4

Evaluation dates: 19 & 21 Jan OS •

•

Neuropsychological Assessment Walter Reed Army Medical Center

Neuropsychology S·ervlces 6900 Georgia A venue - Bldg 6, Room 30S5

Washington, D.C. 20307 Tel: (202) 782..0065 Fax: {202) 782- 7165

:.;~asg~ f2t ReferraJ:. SFC James Burns is a 34 year-old, Caucasian male who is approximately 8 . ·.:: ~~s s~tus post Sarin (GB) nerve agent exposure, while serving in OlF.

li! f a : SFC Bums was exposed to Sarin in May 2004, when handling and

•

transporting an lED in Iraq. Specifically, SFC Burns reports that he and his partner, both Explosive Ordinance Disposal specialists, were called to the scene of an lED explosion when it was believed that there was a risk for a secondary explosive in the spent device. He states that he picked up the device wearing gloves, Wlaware that it had contained Sarin. Once he and his partner detennined there was no risk ~~; a secondary explosio~ they placed the device in their vehicle and transported it back to their site. ~'..!ring this approximately 15 minute drive he states that they both began experiencing symptoms suggestive of exposure, to include nausea, headaches, blurred vision, wea~ess, motor incoordination, decreased visuai field, and confusion. Upon arrival at their unit they walked to the medical clinic to seek ·"'~ ·"' ~nd SFC Burns reports that it was during this time that his confusion increased significantly, and his __ -~~ v;: t:1e events over the next two days is "fuzzy.', He reports that he does not believe he received an

:::.~ -='Pi:le injection, but lmows he received a shower, oxygen, and eye drops. Medical records note the use of atropine ophthalmic ointment. SFC Bums remained inpatient for two days and was placed on quarters for two weeks. He states that his eyesight returned to nol'rnal during this time, but that it took several weeks for his stamina and endurance to return. Available medical records note that twelve days after the incident his symptoms were resolved or resolving. However, this specifically referred to the fact that he 1ad been headache free for two days, and that his vision had returned (although records note that after 30 · --::i~r~ut~s o:· reading he'd experience ocular pain). SFC Bums remained in haq until August 2004, when he .:cLu ... 1"lled to the states with his unit.

Currently SFC Bw·ns reports the following persisting symptom.S: brief headaches that occur daily and t'ass without intervention; decreased manual motor dexterity (he's apt to drop utensils, tools, pencils, ~~c . ); imbalance (he has fallen when bending to tie his shoes, trips downstairs1 and has bumped into the ~ .. va:J. in a hallway when carrying his 5 year-old); and difficulty with "recalling things." Examples he provides for recall difficulties include forgetting to pick up his 5 year-old from the bus stop twice, the first .tim·c having left work (approximately 1 mile from home) with the specific intent to pick him up but having driven on to another task not remembering his intended task until 10-15 minutes later. SFC Burns ~ 1 c:;<' reports decreased ability to multi .. task and a decreased "sense of direction'' as evidenced by having recently become lost in a very familiar hunting/hiking location. SFC Burns reports that be believes these sytnptonls have generally remained stable since his acute recovery from the exposure. He states that when he dropped iten1s during his. remaining months in Iraq he simply assumed that it was due to his gloves and the high temperature there, however since the symptoms remained upon his return he has become ~~. ':.·ea.singly concerned. He denies any change in emotional well being, personality, language functioning, . • ., r · -~:-.sory functioning. He continues to work a full duty day at Pine Bluff Arsenal, however he is not

.-:-·:: :""":--Jitted to work with explosives or handle a weapon.

Bums, James

DOB:

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•

USA M

) -

(

•

AFOD-BE

DEPARTMENT OF THE ARMY 752nd Ordnance Company (Explosive Ordnance Disposal)

79th Ordnance Battalion (Explosive Ordnance Disposal) Pine Bluff Arsenal, Arkansas 71602

MEMORANDUM FOR RECORD

SUBJECT: Current Medical Complications of SSG James F. Burns

1 Dec 04

1. Since returning from Operation Iraqi Freedom, 10 Aug 04, I have been dropping items such as tools, soda cans, cups of water, pens, and pencils. I will stumble or nearly fall while standing up from a chair or turning around to change directions. While speaking, I will stutter or stammer and loose my thought in mid-sentence. In addition to these, I tend to be very forgetful and have very little short term memory.

2. I will get headaches that do not last very long but are more intense after physical training, mainly running. I will also feel a tingling sensation in my legs and hands on occasion but will subside after a short while.

3. POC is the undersigned at DSN

JAMES F. BURNS SSG, USA Team Leader

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JOI TER NURSING REC (All •haded area• mandatory for Joint Theater Trauma R&gistry data collection)

•

. ' . ......... Resus Care/Theater ........ 10 WRJST BAND ON

• •

AIRWAY BREATHING Breath Sounds CIRCULATION DEF CIT/NEURO ·~~Pa~t-e-nt~--~~-rr~~U-n~,a-b-o-re-d~--~R-,g-r-t--~L~e~ft--+S~k-i~n:~~~~------------~ Alert

0 Str1dor 0 Labored C Clear 0 D Warm DCool 0 Hot 0 Responds to Verbal 0 Drooling 0 Absert 0 Rales 0 0 Pink D PaJe 0 Cyanotic 0 Responds to PaJn 0 Obstructed 0 Retraction 0 Wheeze 0 0 Dry D Moist 0 Diaph 0 Unresponsive 0 Oral/Nasal Airway 0 Franng 0 Absent 0 Heart Sounds: GCS· l$ 0 BVM 0Ciear D Muffled Eyes I 4 Verbal I 5 0 Combi Tube Trachea: r idline CDev1ated CapJlla : Motor I 6 Total I 15 0 Intubated Chest Symmet : {circle one) 0 second (normal) Sphincter Tone 0 Other. Left> ual ht 0 >2 seconds del ed · O WNL 0 Weak O None

SECONOAR"' SURVEY. 't=H~E~A~D_IN~E~C_K~E~E~N~T--~H~EA~~~RA~C~IC ___________ -TA~B~O~ INAUGU Drainage: Rhythm: fat

ose {color 0 NSR (tachy/brady) 0 Distended CSF I - 0 V-flbl lach 0 Obese

E)eS Equal R 1 L

O'h r

Ftxed R 1 L Reac•tve R I L Dilated R I L

-----C·Spme Tender

y s 0

Dental InJury Yes O No

0 PEA 0 Non-tender 0 Asystore 0 Tender 0 Other 0 Rrgid

Pulses; 0 Guarding S = Strong D = Doppler 0 Rebound W = Weak A = Absent Tenderness

Caro 1d R __ L 0 Unable to Femoral R __ L Assess Brachtar R __ l 0 Open Wound

Radta l R __ L

Pelvis Stable: DYes 0 No

Binder: 0 Yes ,._,

ood at eatusNagina:

fJ Yes 0 No

EXTREMITIES Fracture/Dislocation: O RUE 0 RLE O LUE 0 LLE

otor RU + I •

LUE + I •

RLE + I -LLE + I •

LOG ROLL TIME: Back exam:

0 WNL

ns I

I

I

I

.. ..,

..

..

OM I I

I

I

. Tympan c r..~ embrane

Clear R L Blood R L

Pedal R __ L FAST DONE: S I NEG I NA 0 ABNL (describe)

JVO Distension: Flail

Pft TII:LtT f.ni:~TII='JCATION

~ DUKETT, PHILLIP '-

( 332 EMOG, AFTH, SALAD AB, Iraq

MTF Transferred from. MTF:

,_____.__~PAST MED H~ CURRENT MEDICATIONS ~

nown Cl Unknown one one

0 Respiratory hx 0 List Current Meds· 0 Seizure hx 0 Cardiac hx D HTN D DM 0 Ulcers 0 Other.

SubjeCt fo the Pnvacy Act of 1974 Pa e 1 of 3

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---•

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I

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SECONDARY SU

(AB)rasion

(AMP)utation

(AV)ulsion

(BL)eeding

(B) urn

(C)repitus

(D)eformity

(DG)Degloving

(E)cchymosis

(FX)Fracture

(F)oreign Body

(GSW)Gun Shot Wound

(H)ematoma

(LAC)eration

(PW)Puncture Wound (P)ain

(SS)Seatbelt Sign

(SW)Stab Wound

PRE-HOS

PROTE

Deltoid/Axiii~~Ext : Neck Prote¢tor: ""'

ET Intubation (Adnl changes in Notes)

Urina

Chest tub A-fine Thoracotom

R L

. . '

,-.......>Fitifih D~

Teeth D D D

oral

nasal oral

D nasal Amt D meatus ---· Color D su ra.

L R L R L R L R

• Site: •

. L R

0 ETC02 Change

0 BBS Post Int. D Verified

Suction Y N Heme Dip+ I­Results cc

Air Bood Air Blood

Time Test Time Test Time # Gau e IVF ~--~C-8-C----~--~~~T~&~S~--- I~

ABG T & C x Chemist UA PT/PTT HCG TEG Other

: (~as rst/ nt 10./SSN:'

SD(HA) September 05 332nd EMDG. Balad AFTH Subject to the Privacy Act of 197 4

• •• •

TIME TYPE TIME TYPE Chest Head

Abdom. Chest Abdom.

Pelvis Pelvis Extrem.

•

02 on: 02 off: Nasal cannula

NRB Mask 0 BVM D

AmtU Amt In

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Total: 8 · ,. ,

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Page 2 of 3

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PATIENT MOV . JVlt:.l'ff .. KECORD DATA P.C:~OTECTED BY PRIVACY A CT OF 1974 PERMANENT MEDICAL RECORD

(S) - Information needed to submit patient movement record

Sr-c.,...•o "' 1 - C ) I I"' PATIENT !DENT!F!CATION

(s) NAME (Last, First, Middle Initial) (s) SSN

(s) AGE

2.'{ ~s _S,E_X-r----:--~ (s) STATUS (s) SERVICE (s) GRADE (s) UNIT OF RECORD AND PHONE NUMBER

M F A~\-\y~ A<""\'\'\'( E 0 Sc..h ~~ c \6 ~ -. ~ s SECTlON ll VALIDATION INFORMATION

DATE OF BIRTH

CITE NUMBER

(s) Medical Treatment Facil1ty Orig ination and Phone Number (s)·Ready Date (Julian Date) APPOINTMENT DATE NUMBER OF ATTENDANTS l- . (s) ME (s) ON-MED

(s) Medica l Treatment Facility Destination d Phone Nu ber

. ._ -0 fV\a- S+c-~ l)l\; ~ "- tf~ < \ fJ~r/L Llt1 s) CLASSIFICATION 1A-5F

LITTER AMBULATORY

(s) Reason Regulated Max# Stops 'Max# RONS Altitude Restriction s CCATI

I

SECTION HI l OTHER INFORMATION

(s) Accepting Physician name. Phone Number and e-mail • • 1c1an na

(s) Origlne1tlon Transportation 24 Hour Phone Number (s) Destination Transportation 24 Hour Phone Number

(s} Insurance Company Address • Phone# Policy# Relationship to policy holder

(s) VJaivers (med equip, etc)

SECTION IV •

CLINICAL INFORMATION

(s) Allergies LABS (Date and time drawn in Zulu)

Nlt..oA WBC HGB H CT Other Labs

(s) WEIGHT: (S) Blood type Vital Signs (Date and time taken in Zulu)

battle casualty disease Date Time (Zulu) Pulse Resp Pain Levei:

f,( /10

Last Pain Med: 0 2 /LPM: Route: ~--~-n-o-n--b-att_l_e-in-ju ....... ry _ __.__ ____ ~-~Zd AU

l 1/64

CLINICAL ISSUES I I Baseline 02 Sat If Applicable

Infection Control Precautions: LMP:

Date of last bowel movement: I

High Risk for Skin Breakdown yes no

Initial appropriate boxes:

Yes No •

es No

Vision Impaired Voiding difficulty

Cardiac Hx *Takes long-term meds

Diabetes *Will sef-medicate

I I

Temp

SPECIAL EQUIPMENT (Check all that apply}

Suction Traction Orthopedic devices GTHER:

Ventilator Ventilator Settings:

DiET iNFORMATiON (Check ali that app~y)

NPO Soft Full Lig Cl Liq

- Meq K - -Renal Gm Protein Gm Na Mag Sulfate -- - • •

cc/hr Discontinue for Fiight Tube Feeding Type Motion Sickness Has adequate supply of med 1---+r~

TPN:

Ears/Sinus Problems Knows how to take meds ~--------------+-~~~ Respiratory difficulty (verbalized understanding)

Cardiac Diabetic cal Infant formula: Pediatric Age:

*Medication listed on physician's orders Other( specify):

SECTION V PERTINENT CLINICAL HISTORY (Transfer Suml'pary)

V.VU 'k_. kQ ~. o C.. ·h fi\Wf-Cll <d d 1\. l t Jl U {, V :

W'W\LW\ -+~ ,j(l.f. -l2.a_ Lo(\~·~o.t- ~ ~ ~" B ~ 1 " • Nov L_, :-+}, 1 "~ " ~U-

·-. z:,~

l t W (tJI\-' " t7' (,c_ bY\ I u.S ) "V' , '

Physician's Signature

I

Dateffime

Dateffime

~o Av6 o<o l~t u Signature of Clearing Flight Surgeon

AF IMT 3899, 20060819, V1

PATIENT MOVEMENT RECORD (continuation}

DA TA PROTECTED BY PRIVACY ACT OF 1974 PERMANENT MEDICAL RECORD

PATIENT MOVEMENT PHYSICIAN ORDERS {for continued care in the AE system and at enroute stops)

SECTION I. PATIENT IDENTJFICATION

1. NAME (Last. First, Mrddle Initial) •

2 GRADE 3 SSN#

4. ALLERGIES I 5. ORIGINATING MTF 6. DESTINATIO MTF ... ..

SECTION ll. MEDICATION ORDERS (Drugs and IVs) SECTION Ill. OTHER ORDERS (ProceduresJ TreatmentJ V/S Frequency, ETC}

yes no patrent will self-medrcate w1th the followrn medrcalions:

0 ~6° Diagnosis:

I

i

erate 0 Severe 0 . a to ogy Results:

PAS

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r

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. ACYACTOF \ \'f. (last Flrst,Middle Initial) 1974

PROGRESS NOTE PERMANENT MEDICAL RECORD

;_~. ETT, PHILIP J

DATE/TIME(ZULU)

NOTES

History :

A/E DWMMC 233 M t d G . 2008 092 0. TBI Scree n: Negative. DOI:16AUG08. C/ C: Pt exposed t o us ar as whlle handling unexp l oded munitions. Was Decon in Bal ad. Sustained large painful blis t e rs to R thl h. rr1ved LRMC on 19AUG08 t o Internal Medicine / Dermato logy Cl~nic . Evaluate d :

Dx : R Thigh Mu s t a rd Ga s Exposure. Plan t o TCC CONUS for : >60 day me dlcal management . Denies PMH: PSH:. Asse ssment: AOx3 , NAD. Ambulates with mini mal difficul ty. Bl~sters now open, covered wi th cream a nd d r e s s ing. Dr ess i ngs not saturated, c hanging d~lly. Can tol erate prolonged s itting . Pa in is s ignificantly decreased with o i ntme nt. 1:10 Wlth meds, 3:10 without meds. Wi l l have a mple supply o f meds and can self medicated as needed. No other p hysical l i mi t a tion s . No discomfort wi t h flying. Has Mil ID for travel. No vis1ble wounds or b r uises . Can egress / d i g res s AC wi t hout a s sistance . Can c arry own bag s and Wlll use cart at airport. Use o f s t a nda rd and MRSA contac t p r e c a u t 1ons for Ac inotebactor as pe r AFI 41 - 307 ATCH 12. May fly c ommer c i a l as per MD n o te I highly recommended DWMMC AE. Sa f e Flig ht . CDR NC US N. Pt pre f erence is :

DWMMC PROGRESS NOTES DO NOT REMOVE

(REVERSE)

Vers1on 1 0 0.0

PHYSICAL PROFILE For use of this form, see AR 40-501 ; the proponent a ency is the Office of the Suroeon General.

u i 1. MEDICAL CONDITION: (Description in lay terminology) 0 1NJURY? Or 0 ILLNESS/DISEASE? 2. CODES (Table 3. P 1 7-2 AR 40-501) Temporary 3 s'p k1dney removal left ,. ~- ·

Permanent

4. PROFILE TYPE - --- -- - ---- --a TEMPORARY PROFILE (Expiration date YYYYMMDD) (Limited to 3 months duration) ----2009/11/05 • -- - - -b PERMANENT PROFILE (Reviewed and validated as a minimum with every periodic physical exam or after 5 years from the date of issue) _ _

- -·~ c IF A PERMANENT PROFILE W ITH A 3 OR 4 PULHES, DOES THE SOLDIER MEET RETENTION STANDARDS lAW CHAPTER 3 AR 40-501?

(IF USARIARNGIARNGUS SOLDIER NOT ON ACTIVE DUTY SEE PARA. 9-10 & 10-26, AR 40-501 1F SOLDIER DOES NOT MEET RETENTION STANDARDS.)

5 FUNCTIONAL ACTIVITIES FOR PERMANENT AND TEMPORARY PROFILES (If any answer (a-f) is NO then the profile should be at least a 3) - -- -- - - - - - - --- -

a ABLE TO CARRY AND FIRE INDIVIDUAL ASSIGNED WEAPON - - - -

- - -f. IS SOLDIER HEAL THY WITHOUT ANY MEDICAL CONDITION THAT PREVENTS DEPLOYMENT?

6 APFT YES NO ALTERNATE APFT (Fill out if unable to do APFT run otherwise NIA) - -

N/A --------------------~-N/A

--N/A

--- --------- ----t-- ---2 MILE RUN APFT WALK ./ ----4-----+- ---

./ APFT SWIM ----------- ---~· -·----+- - -1--- ---

./ APFT BIKE

-APFT SIT -UPS

-APFT PUSH UPS

7. STANDARD OR MODIFIED AEROBIC CONDITIONlNG ACTIVITIES (Check all applicable boxes)

-.--

L H 1 E ' S L ~

1 1 l 1 1

YES NO

- r-./ -

./ ./

YES NO -

./

./ -

./

- -- - ---- -

-

-

-

--

--

UNLIMITED RUNNING OR RUN AT OWN PACE & DISTANCE ------+--- ./ UNLIMITED WALKING OR WALK AT OWN PACE & DISTANCE -- ,/

--4----·-

UNLIMITED BIKING -- / OR BIKE AT OWN PACE & DISTANCE v - --------+-_:_--+----I-

UNLIMITED SWIMMING OR SWIM AT OWN PACE & DISTANCE ./

8. UPPER BODY WEIGHT TRAINING (See FM 21-20) 1 ./ 1

9. LOWER BODY WEIGHT TRAINING (See FM 21-20) I ./ I 10. OTHER· e .g. Functional hm1tattons and capabilities and other comments: (May continue on page 2) 11 . THESE PARAMETERS ARE OPTIONAL USE AS NEEDED

PT to tolerance Crunches ok. No sit-ups. Lifting or carrying max weight 45 or d'stance No gear

Th1s temporary profile is an extens1on of a temporary profile fi rst issued on

12 TYPE NAME & GRADE OF PROFILING OFFICER Amy E Hawkins, MPAS, PA-C CPT, SP

15 ACTION BY APPROVING AUTHORITY

16. TYPE NAME & GRADE OF SENIOR PROFILING OFFICER OR APPROVING AUTHORITY

19. ACTION BY UNIT COMMANDER (See para 7-12, AR 40-501) -

THIS PROFILE REQUIRES A CHANGE IN THIS SOLDIER'S MOS or DUTY ASSIGNMENT

20 COMMENT

.I

Running maximum distance tolerance Prolonged standing - maximum time per episode Marching with standard field gear except rucksack max distance

Impact activities such as jumping max# reps in one day

RE :> 14. DATE (YYYYMMDD) 2009/10/15

APPROVED I

NOT APPROVED

17. SIGNATURE 18. DATE (YYYYMMDD)

YES NO ----~--- -----\-c

-~

1f this is a per. nanent orofile with a PULHES senal of 3 or 4 refer to block 4c

21 . TYPED NAME & GRADE OF UNIT COMMANDER 22. SIGNATURE 23. DATE (YYYYMMDD)

24. PATIENT'S IDENTIFICATION (For typed or wotten entries gtve Name(last, first), grade, SSN; hosp1tal or med1cal facility)

Dukett, Phili James

SGT SBTMC

25. UNIT WALUBO - 0014 IN BN 01 B CO

26. ISSUtNG CLINIC, PROVIDER E-MAIL & PHONE NUMBER

PROFILING OFFICER (Or Approving Authority if applicable) IS RESPONSIBLE FOR ENSURING THE PULHES & DATE OF PROFILE ,5 ENTERED INTO MEDPROS. ORIGINAL COPY POSTED IN MEDICAL RECORDS, 1 COPY TO UNIT COMMANDER, 1 COPY GIVEN TO SOLDIER, 1 COPY TO MILPO.

DA FORM 3348, FEB 2004 OA FORM 3349 MAY 86 IS OBSOLETE THIS INFORMATION IS PROTECTED BY THE PRIVACY ACT OF 1974 (Pl-93-579). UNAUTHORIZED ACc'ESS TO THIS INFORMATION IS AVIO APO V1 .01 Page 1 of 1

LATION OF FEDERAL LAW. VIOLATORS WILL BE

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ct'lv U'=>UKt: L UK M~U Uo-XXXX •

All rCQuncd ctem.) oo tht l•st mu~t

1. Narno (L s t. Jrst. Ml)

c Li D 4 .. dl 5. Date ctur n to Hood S. Re(iuested L v 0 tos

8. ..m. il Addr ..,.., (AKO)

9. S p. ration 0 t (Frorn

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Turn •n ~,ed•cat Records with DO Form 2766 Insert u

*Schedule Household Goods Derive as

ep ration te (From Army}

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·complete On-line OOIM Users training (for Hood e-maH accoont holders)

Reactivate Auto Insurance Update expired drivers license I vehicle registration I TX vehide inspection

Signature Title

CDR 11SG Signatu,.. & Date

7. Origin I Deployment Date

11. Orders fn Hand

ES I NO~~'"!"i

Date

• More information on these topics can be found in the Iraqi Freedom Reintegration Handbook included in your -.wlcome packet