I did a 1st class with EKG prior to returning to the USA with Dr Kikuchi in Tokyo/HND. Great guy. Located in the JAL domestic terminal. Yeah not OKA but easy rt flight on a LCC Peachi or Skymark. With the Jpy/USD exchange still pretty cheap. Best of luck. Normally a Flight Surgeon on base can issue up to a 2nd class medical. Course it has been a long time since I left active duty, so things probably have changed.