Annex A - The Medical Category System

A-MD-154-000/FP-000

The Medical Category

1. The medical category includes six factors written in numeric form. It is expressed as:

V - Visual Acuity
CV - Colour Vision
H - Hearing
G - Geographical Factor
O - Occupational Factor
A - Air Factor

V	CV	H	G	O	A
3	1	2	3	2	4

OR 3/1/2/3/2/4

V - Visual Acuity

2. Visual acuity and refractive standards refer to the eye in its normal physiological state; that is, not wearing contact lenses or glasses. Visual acuity is expressed in grades from V1 to V5 according to the testing instructions shown at Appendix 1. If the member has had corrective laser eye surgery, refer to CF H Svcs Gp Instruction 4020-01 Laser Eye Surgery, Para 14 for guidance regarding updating the visual category following eye surgery. If an Aircrew has had corrective laser eye surgery, refer to AMA Directive 400-02, Laser Refractive Surgery for CAF Aircrew.

CV - Colour Vision

3. Colour vision measurement refers to the eye in its normal state and not to measurement through coloured contact lenses designed to "correct" colour vision defects. The instructions for the testing of colour vision are shown at Appendix 2. Three grades of colour vision are recognized: CV1, CV2 and CV3.

H - Hearing - Auditory Acuity

4. The ability to hear the spoken voice or audible signals, often against a considerable background of concurrent noise, is of paramount importance in certain trades. Auditory acuity is expressed in grades from H1 to H4, using an audiometer, and applying the findings as shown at Appendix 3. Hearing aids are not to be worn during measurement of auditory acuity. The numerical H factor does not address ability to understand speech.

G - Geographical Factor - General

5. Previous editions of CFP 154 have defined the Geographic Factor in relation to the environments a member can or can not tolerate. This definition has evolved to one based on the required proximity to medical care. This includes the requirement for scheduled medical care, as well as an assessment of the risk of recurrence or exacerbation of the medical condition and the level of medical care that would be required. Many of the questions suggested in CF H Svcs Gp Instruction 4154-00 Guidelines for the Application of Medical Employment Limitations should be considered in the assessment of the geographic limitations and should be reviewed prior to assigning the G factor.

Geographical Factors

6. The following table describes the circumstances associated with the assignment of specific geographic factors.

Geographic Factor	Is assigned to a member …
G1	who has successfully passed the stringent medical requirements for the unique duty of astronaut training.
G2	who has no geographical limitations due to a medical condition; and who is considered healthy and, at most, requires only routine, periodic or scheduled medical services no more frequently than every twelve (12) months (see Chapter 3).
G3	who has a known requirement for scheduled medical service (see Chapter 3) but no more frequently than every six (6) months; whose limitations resulting from a known medical condition do not pose an unacceptable risk to the health and/or safety of the individual or fellow workers in the operational/work environment; who may require and take prescription medications, the unexpected discontinuance (unavailability) of which will not create an unacceptable risk to the member's health and/or safety (e.g., thyroid, stable BP); who may require a specific medical evaluation before being sent on a tasking; who should require only basic levels of medical care in the case of a recurrence or exacerbation of the known medical condition, and/or whose assessed risk and level of care required equates to a “Green” area on the Medical Risk Matrix (Annex F)
G4	who generally requires scheduled medical care more frequently than every six (6) months ; and / or whose assessed level of risk equates to a “Yellow” area on the Medical Risk Matrix.
G5	who requires scheduled specialist medical care more frequently than every six (6) months; and whose assessed risk and level of care required equates to a “Red” area on the Medical Risk Matrix (insert link).
G6	who requires continuing medical care in an in-patient facility or equivalent.

O - Occupational Factor - General

7. The physical and mental activity and the stress associated with employment within a specific MOSID, although often difficult to describe and measure in an objective and reproducible manner, are important aspects in the grading of the occupational factor. The demands on the member may vary with the MOSID, as well as with the geographical locale. In general, the associated mental stress is not described in any detail, unless a specific MOSID or medical condition(s) (usually psychiatric) so dictates. In these cases, consultation with a military psychiatrist should describe acceptable levels of mental stress for the particular member. Annex B serves as a concise guide to the expected tasks and duties of all military personnel. Members with medical conditions which impose limitations should be assessed against both the Generic and the MOSID Task Statements. In this way, an appropriate O factor can be assigned. Many of the questions suggested in CF H Svcs Gp Instruction 4154-00 Guidelines for the Application of Medical Employment Limitations should be considered in the assessment of the occupational limitations and should be reviewed prior to assigning the O factor.

Occupational Factors

8. The following table describes the circumstances associated with the assignment of specific occupational factors.

Occupational Factor	Is assigned to a member …
O1	who has successfully completed medical screening for astronaut training.
O2	who has no Medical Employment Limitations (MELs).
O3	who has some specific MELs which can be clearly and specifically detailed, and which may prevent the member from fully participating in common military tasks.
O4	who may be unable to tolerate the inherent psychological stress of an operational environment; who is generally restricted to light duties only, i.e., general office tasks, including delivering mail, parcels and supplies and maintaining a stock room (these tasks involve lifting and carrying objects of variable weight and bulk and require the ability to walk and climb stairs while carrying out these duties); is unable to perform one or more tasks listed on the Generic Task Statement (see Annex B); who is capable of working a full eight (8) hours per day; and / or who is considered fit for shift work as long as it is stable (i.e., shifts don't change rapidly).
O5	who is generally restricted to sedentary duties such as clerical / desk work only, which do not involve lifting and carrying objects or climbing stairs or ladders with these materials (typically these individuals are capable of acting as a receptionist, answering telephones, and doing typing and some light office filing); who is capable of working up to eight (8) hours per day but generally at his / her own pace; who is not considered fit for shift work; and/or who is unable to tolerate any military work.
O6	who is unable to work in any capacity.

A - Air Factor - General

9. The CF medical category system includes an Air Factor. The Air Factor designates the medical fitness for flight duties for CF Aircrew and the medical fitness for flight as a passenger for non-aircrew. All of these delegated authorities are referenced in the AMA Directive 100-01 Medical Standards for CF Aircrew.

Air Factors

10. The following table describes the circumstances associated with the assignment of specific air factors.

Occupational Factor	Is assigned to a member …
A1	Assigned to pilots (00183) medically fit for unrestricted duties
A2	Assigned to Air Combat Systems Officers (ACSO) (00182), Flight Engineers (00021), Airborne Electronic Sensor Operators (AESOP) (00019) and Mission Specialists medically fit for unrestricted duties in air operations
A3	Assigned to any CF member with a medical operational flying or flight controlling restriction. The specific restriction must be defined as part of A3
A4	Assigned to Search and Rescue (SAR) Specialists (00101), Aerospace Controller (AEC) (00184 including Air Traffic, Air Weapons Controllers), Aerospace Control Operator (AC Op) (00337 including Air Traffic, Air Weapons), Loadmasters (00170-01), Flight Stewards (00165-01), Flight Attendants, Aeromedical Training Officers (AMTO) (00197), and Flight Technician – Aeromed (00334-05), Flight Surgeons (00196-04), Flight Nurses (00195-01), Flight Medical technicians (00334-01) medical fit for unrestricted duties in air operations
A5	Assigned to non-aircrew CF personnel medically fit to fly as passengers in CF aircraft
A6	Assigned to CF personnel unfit to fly in CF aircraft
A7	Assigned to CF aircrew medically unfit to carry out MOSID-specific aircrew duties

Temporary Categories (TCats) and Permanent Categories (PCats)

11. Frequently, it becomes necessary to temporarily change one or more of the medical category factors while waiting for a medical condition to stabilize enough to allow for it to revert back to the previous Med Cat. The validity of most temporary changes shall not exceed six (6) months, but a TCat may be renewed once (i.e., maximum 12 months temporary medical category status).

12. An initial TCat may be assigned for 12 months in exceptional circumstances where there is no benefit to the member to be re-assessed at the 6 month point. Examples would include pregnancy or situations where there will be a prolonged delay in accessing definitive therapy.

13. A 12 month time frame should allow an accurate assessment of the prognosis for most medical conditions. As soon as the member's condition has plateaued and/or is not expected to significantly improve in the foreseeable future, a PCat should be assigned, even before the end of the 12-month period of TCat. A statement regarding prognosis shall be made in the PHA at the earliest reasonable time.

14. In the rare case where additional temporary status beyond 12 months may be warranted for extenuating circumstances, the case must be reviewed and approved by D Med Pol /Medical Standards section. Guidelines for the application of and approval authorities for TCats and PCats are in CF H Svcs Gp Instruction 5020-07 Changes of Medical Category or Employment Limitations.

TCat for AC, Divers and Submariners

15. Guidelines for the application and approval authorities for TCats and PCats for Aircrew, Divers and Submariners can be found in the following Orders and Instructions respectively:

1 Cdn Air Div Orders Flight Surgeon Guidelines
AMA Directive 100-01, Medical Standards for CF Aircrew
DAOD 8009-0, Canadian Forces Diving
CF H Svcs Gp Instruction 4000-04, Diver Periodic Health Assessment and Medical Administration
DAOD 5003-7, Service in Submarines
CF H Svcs Gp Instruction 4030-71, Medical Fitness for Submarine Service and Wet Pressurized Escape Training

Common Enrolment Medical Standard

16. A Common Enrolment Medical Standard (CEMS) is required for recruit candidates in order to ensure that they remain eligible for assignment to the widest range of MOSIDs. All Reg Force and P Res applicants must initially meet this minimum standard, although they may require a more stringent (higher) standard to enter/be assigned to some MOSIDs. The CEMS is:

V	CV	H	G	O	A
4	3	2	2	2	5

OR 4/3/2/2/2/5

17. The minimum medical standard for enrolment into COATS is V4 CV3 H3 G3 O3 A5. Though, under special circumstances, Cdn Forces Recruiting Group may waive this standard for some COATS applicants up to a V5 G4 O4. There are no minimum medical standards for enrolment into Canadian Rangers.

Medical Standards for Military Occupations

18. The minimum medical category required for members in the various MOSIDs is shown at Annex E.

19. Any CAF member of the Canadian Randers, COATS or Supp Res is required to meet the minimum operational standards if attached, seconded or transferred on consent to the Ref F or P Res. See DAOD 5023-1 Minimum Operational Standards Related to Universality of Service.

Medical Category on Release

20. A Medical Examination for Release is required for all Regular Force members. It is also required for all Reserve Force members who report a duty-related illness or injury, no more than 6 months prior to the projected date of release. An updated medical category and appropriate MELs are to be assigned in the same way as during a Periodic Health Assessment. Any new MELs are to be processed through DMed Pol/Med Stds Section. Guidance for policies related to Release Medicals can be found in CF H Svcs Gp Instruction 4000-03 Release Health Assessment.

21. Temporary MELs may not be awarded on a Release Medical. For a condition that is not yet stable, the proposed MELs should reflect the expected outcome of treatment or the overall prognosis. For example, if the member is leaving with a recently broken ankle, then the MEL should be based on expected outcomes in 18 to 24 months (which would be the anticipated length of TCats prior to a PCat).

22. It is also important that the MELs reflect the most up to date MELs for that particular condition. For example, a member with MELs granted 10 years prior for a condition that D Med Pol now gives different MELs for should have their MELs updated.

23. In rare cases, there may not be time to make appropriate assessments prior to the Release Date. In that situation, consideration should be given to awarding an MEL of:

“G3 requires assessment by a Medical Officer prior to re-enrolment”

Appendices to this Annex

Appendix 1 - Instructions for Testing Visual Acuity
Appendix 2 - Instruction for Testing Colour Vision
Appendix 3 - Table of Hearing Standards

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