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Chapter 4 - Medical Employment Limitations and Medical Categories

A-MD-154-000/FP-000

The Canadian Forces Health Services has the mandate and the responsibility to describe and communicate to the chain of command as well as to administrative and employment authorities, a clear, concise medical opinion regarding any health-related employment limitations and their effects on the CAF member’s ability to perform expected tasks and duties safely and effectively without jeopardizing the health and safety of others, or compromising unit operational effectiveness. This information is expressed in the form of Medical Employment Limitations (MELs).

The process described in this chapter is essentially the practice of occupational medicine. It requires professional medical judgment and common sense as well as a sound knowledge of the member’s work conditions, an appreciation of Canadian societal expectations and norms and some awareness of the legal considerations involved.

This chapter covers the following subjects:

  1. Medical Employment Limitations (MELs)
  2. Medical Categories (Med Cat)
  3. Task Statements
  4. Risk Matrix

Part I - Medical Employment Limitations

A MEL is an administrative constraint on a CAF member’s work schedule, tasks, roles, environment(s), or geographical location imposed as a result of a medical condition determined through a formal medical assessment process. It is used to determine the member’s Medical Category (Med Cat).

  1. Describing and Assigning MEL(s)
    1. Background Instructions:
      1. CF H Svcs Gp Instruction 4154-00 Guidelines for the Application of Medical Employment Limitations (in development)
      2. CF H Svcs Gp Instruction 4154-02 Guidelines for the Application of Medical Employment Limitations – Medication (in development)
      3. CF H Svcs Gp Instruction 5020-07, Changes of Medical Category or Employment Limitations
    2. Instructions Specific for Mental Health Illnesses:
      1. CF H Svcs Gp Instruction 5100-16, Guidelines for the Application of MEL(s) to Personnel Suffering from Mental Health Illness
      2. CF H Svcs Gp Instruction 4154-05 Guidelines for the Application of Medical Employment Limitations – Mental Health Disorders (in development)
      3. CF H Svcs Gp Instruction 5100-05, Addiction Rehabilitation Program Base Addiction Counsellor
    3. Instructions Specific for Systemic Illnesses:
      1. CF H Svcs Gp Instruction 4154-01 Guidelines for the Application of Medical Employment Limitations - Gastrointestinal Diseases (in development)
      2. CF H Svcs Gp Instruction 4154-03 Guidelines for the Application of Medical Employment Limitations - Cardiovascular Diseases (in development)
    4. Instructions Specific for Post-Surgical Issues:
      1. CF H Svcs Gp Instruction 4020-01, Laser Eye Surgery
      2. AMA Directive 400-02, Refractive Laser Surgery for CAF Aircrew
    5. Instructions Specific for Pregnancy:
      1. CF H Svcs Gp Instruction 3100-23, Medical Administration of Pregnant Members
      2. DAOD 5003-5, Pregnancy Administration
  2. Restrictions: Duty and Individual Limitations
    1. DAOD 5003-0, Restrictions on Duty and Individual Limitations
    2. DAOD 5003-1, Restrictions on Duty - cancelled 2017-01-25 see DAOD 5516-4
    3. CF Mil Pers Instruction 11/04, Medical Fitness for Duty
  3. Directorate of Military Careers Administration (DMCA) Administrative Review of MELs
    1. DAOD 5019-2, Administrative Review
    2. CF Mil Pers Instruction 11/04, Medical Fitness for Duty
    3. Medical Risk Matrix
    4. CANFORGEN 134/12, Decentralization of Authorities Related to Remedial Measures and Administrative Actions

Part II – Medical Categories

The Med Cat is a numeric profile assigned to each individual CAF member that summarizes key information to the Chain of Command (CoC) about a member’s employability and deployability within their MOSID. This numeric profile is of little value to the CoC unless it is accompanied by clearly stated MELs, if they are occupationally warranted. The Med Cat cannot be assigned until MELs have been determined. The assignment of MELs is outlined in CF H Svcs Gp Instruction 4154-00 Guidelines for the Application of Medical Employment Limitations and other Instructions in Part I – Medical Employment Limitations. The assignment of the Med Cat is outlined in Annex A, The Medical Category System. The factors included in a Med Cat are:

  1. Assigning Medical Categories
    1. Annex A, The Medical Category System
      1. Appendix 1, Instructions for Testing Visual Acuity
      2. Appendix 2, Instructions for Testing Colour Vision
      3. Appendix 3, Table of Hearing Standards
    2. Annex E, Minimum Medical Standards for Officers and Non-Commissioned Members

Part III - Task Statements

The roles and objectives of the CAF require all members to serve in a variety of geographic locations and environmental conditions. The MOSID-Specific Task Statements at Annex D contain the essential occupational tasks compiled by the Branch Advisors for each MOSID and serve as a guideline in assigning job-related MELs. The Generic Task Statements at Annex B contain the common requirements expected of all CF members and define the concept of “Universality of Service”. The physical factors are indicative of the extremes of exertion and range of motion required of all CAF personnel during the performance of Core Tasks and General Duties. The stress factors are indicative of the circumstances and conditions under which all CAF members must be capable of performing their duties.

The six common military tasks which form the new Minimum Physical Fitness Standards for Universality of Service are described in Annex C. These tasks are derived from real operational scenarios which have been identified and described by military subject matter experts, and have been scientifically validated by the PSP Directorate of Fitness. The four components of the FORCE Evaluation were designed to simulate the physical demands and movement patterns of the six common military tasks. The FORCE Evaluation standards are derived from the minimal acceptable standards on the six common tasks.

Note that all documents in Annexes B, C and D were not developed nor are they maintained by CF H Svcs Gp.

  1. Annex B, Generic Task Statement – All CAF Members
  2. Annex C, Operational Definitions – The New Minimum Physical Fitness Standards (MPFS) for Universality of Service and the FORCE Program
  3. Annex D, MOSID Task Statements

Part IV – Medical Risk Matrix

The Medical Risk Matrix at Annex F was developed to assist DMCA in making administrative career decisions on CAF members who were assigned a Permanent Med Cat (PCat) by DMed Pol/ Med Stds. The information provided is used to translate MELs into a stratified risk matrix, based on prevalent scientific evidence to predict likely future occurrence and its consequence. DMCA takes into consideration an acceptable level of risk to the health and safety of CAF members if an appropriate level of medical care is not readily available, while at the same time taking into account the implications for operational effectiveness.

  1. Annex F, Medical Risk Matrix

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