The President of the United States of America, authorized by Act of Congress, July 9, 1918, takes pleasure in presenting the Air Force Distinguished Service Medal to Major General Paul Kendall Carlton, Jr., United States Air Force, for exceptionally meritorious and distinguished service in a position of great responsibility to the Government of the United States. General Carlton distinguished himself as Commander, 59th Medical Wing, Lackland Air Force Base, Texas, and Lead Agent, TRICARE Region VI, San Antonio, Texas, from 26 September 1994 to 24 May 1999. During this period, his outstanding leadership, vision, integrity, courage and commitment to the Air Force mission and Military Health Systems pushed the Wing to the forefront of Air Force medicine. His improvement of ambulatory services, outreach initiatives, and response to military reductions had positive impact throughout the Air Force Medical Service. His liaison work creating a regional trauma consortium had a lasting effect throughout the Department of Defense. He skillfully guided implementation of TRICARE Senior Prime throughout the San Antonio and Texoma areas. He was a key leader in the genesis, development, and deployment of modular medical readiness capabilities culminating the in the implementation of the Critical Care Air Transport Teams and the Mobile Field Surgical Teams–each a key component of the Air force Global Engagement mission. He was the architect of the strategic planning process, which laid the foundation for implementing the medical center’s rightsizing, and readiness initiatives. The singularly distinctive accomplishments of General Carlton reflect the highest credit upon himself and the United States Air Force.