CAF - Medical Release Process

Transcript

The authority for employment and career decisions, including medical release, has been delegated by the Chief of Defence Staff (CDS) to the Director of Military Career Administration (DMCA).

The Director of Medical Policy (D Med Pol) provides medical advice and assigns Medical Employment Limitations (MELs). D Med Pol does not make employment, career, or release decisions.

This slide provides an overview of the timeline for a typical medical release.

Bear in mind that the timelines represented in this slide are approximate, so there may be a little more or less time between different steps or phases in your situation.

The Canadian Forces Health Services Group 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). MELs are administrative constraints on a member’s work schedule, tasks, roles, environments or geographical location as a result of a medical condition. When you have a health condition, MELs may be assigned in order to allow time for you to heal.

The Temporary Medical Category (commonly referred to as the TCat) plays an important role to protect you following a serious illness or injury, giving you time to heal or recover before resuming full duties.

When you have a health issue, your Health Care Provider may assign an initial TCat that includes specific MELs and duration (usually 3, 6 or 12 months).

If you require more time to heal beyond the initial TCat period, you may be placed on a second TCat. Keep in mind that the restrictions assigned on a TCat do not expire once the TCat period has elapsed; the TCat period simply communicates to the Chain of Command how long your recovery should take. You must be assessed by a Health Care Provider in order to have a TCat lifted.

A TCat may or may not include a period of work interruption or sick leave.

Generally, when you experience an illness or injury, you will heal with time. However, some medical issues persist despite rest and appropriate treatment over the course of a 12 month period. In such cases, your health care provider may assign a third TCat, if they feel that recovery is possible with more time.

However, if a health issue persists beyond 12-18 months, it may then be considered a permanent condition and your health care provider may recommend permanent MELs, also known as a Permanent Medical Category (PCat).  This determination depends on many factors such as the individual’s level of health, the natural history of the disease, other co-morbid conditions, etc.

These permanent MELs are first recommended by your health care provider, then reviewed by the Base/Wing Surgeon, then sent to D Med Pol, Standards Section. D Med Pol is the Authority for assigning permanent MELs.

It is a common misconception that D Med Pol medically releases mbrs. As mentioned in the first slide, D Med Pol has no such authority.

As the CAF’s medical advisor, D Med Pol will assign MELs based on the medical condition and prognosis. However, D Med Pol does not make employment or release decisions. D Med Pol receives and reviews over 5000 files annually. There is an 8 month(plus) turn around time on these files currently, due to staff shortages.

When your file is sent to D Med Pol, you may be referred to Case Management by your health care provider.

After this referral is made, a Nurse Case Manager will meet with you, if they have not already done so, to conduct an interview and analysis of your transition needs. Access to Case Management services is based on need and may commence at any stage in the health continuum process, even immediately following the time of injury, if the injury is severe. However, a referral from a health care provider is required; a member may not self-refer.

Once permanent MELs are assigned, and depending on how restrictive your MELs are, your file is either sent to your CO or to DMCA for administrative review. Highly restrictive permanent MELs are sent to DMCA for file review, while less restrictive MELs are sent to the mbr’s CO.

This slide describes a recent change.

MELs used to be assigned by D Med Pol Standards with a designation of being either “Low-risk” or “High-risk” of breaching Universality of Service (U of S), as laid out in DAOD 5023-1.

However, this practice was ceased in early 2018. It was deemed not to be appropriate, since D Med Pol is the CAF medical advisor only and has no authority to make employment or release decisions.

D Med Pol has no influence on U of S and therefore will not provide comment as to which MELs may or may not breach U of S.

Determining and enforcing U of S is an employer (DMCA) responsibility. As noted earlier, DMCA has been delegated the authority, by the CDS, to decide if a member will be released or retained.

DMCA reports to the Director General Military Careers (DGMC), and their role is to judiciously apply the administrative review process for CAF members relating to, for the purpose of this presentation, Medical Employment Limitations (MELs).

The Administrative Review (Medical Employment Limitations), AR/MEL, is the staff process used to evaluate the requirement for and to develop a recommendation for administrative career action when the medical situation of a CAF member calls into question the viability of continued service on the part of that member. DMCA’s process typically takes 6 months from the time they receive the AR/MEL.

The principle of Universality of Service (U of S), or "soldier first" principle, holds that CAF members are liable to perform general military duties and common defence and security duties, not just the duties of their military occupation or occupational specification. This may include, but is not limited to, the requirement to be physically fit, employable and deployable for general operational duties.

If your MELs are not compliant with U of S you will be released.  This is non-negotiable and it becomes a matter of when and how.  DMCA may offer retention if the service requires it for a period of up to 3 years, or offer a period of transition if the member requires it based on medical grounds (Severely Ill & Injured with complex transition needs), also for a period of up to 3 years.  It’s important to note that the 3 year period is the maximum and a period of retention or transition does not automatically come with that time allowed, and that the two can not be combined i.e. the max period a mbr will serve after the DMCA decision is 3 years, not 6.

One of the first things that will occur when your file is passed to DMCA is that an advisory message will be sent out to inform you that an AR(MEL) process has been initiated

This is followed closely by DMCA sending out a package that contains all the information that will be used to make a decision on your file.  This is referred to as Disclosure.

“Representation” is any information you believe the board should have in order to make a decision. 

It is important to note that if you wish to request a release date that coincides with the end of an academic semester or term in order to take advantage of CF Education Reimbursement program IAW CANFORGEN 094/10, this is the best time to make your transition-related upgrading or training plans known to DMCA

Should you chose to waive disclosure (i.e. tell DMCA that you do not want to see the information they will use), they will go ahead with the review and render a decision.  This will speed up the process considerably. The process of Disclosure is simply submitting a memo waiving Disclosure and expressing a desire to speed up the process. When DMCA receives this they aim to process the file within a week.

Retention Subject to Employment Limitations

There are a number of factors DMCA takes into consideration before offering a period of retention.  This offer is only on a temporary, transitional basis if there is:

 a critical shortage in the CAF member’s military occupation; or

 a requirement for a specific skill set that you possess.

You must be capable of working full time and performing all military duties of your position except those related to your MELs

A specific military position must be available in which to employ you and assigned by your career manager

The retention cannot exceed 3 years and always ends in a 3(b) release

The CAF can terminate the retention at any time should circumstances change

The release decision message will set a date of release which can be earlier if you so desire.  Many people release before the end of their period of retention

When DMCA has considered all the information available to them, they will render a decision and a release message will be sent

 Although DMCA will provide 6 months notification wherever possible, you may opt to get out before the 6 months have expired

 This will be a very busy period of time for you, and if you have not done so already, you may want to consider researching information on programs and services to help you in this transition by contacting your local PSO as a start.

Here is a list of local contacts that can help you navigate the Medical Release process.

DMCA recommends that members start with engaging your local Chain of Command. Most questions can be answered at the unit level, as Adjutants and Chief Clerks already know most of the procedures. If they don’t have the answer, your Chain of Command may engage DMCA.

Your local IPSC and Case Manager can also provide guidance through the process.

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The authority for employment and career decisions, including medical release, has been delegated by the Chief of Defence Staff (CDS) to the Director of Military Career Administration (DMCA).

The Director of Medical Policy (D Med Pol) provides medical advice and assigns Medical Employment Limitations (MELs). D Med Pol does not make employment, career, or release decisions.

This slide provides an overview of the timeline for a typical medical release.

Bear in mind that the timelines represented in this slide are approximate, so there may be a little more or less time between different steps or phases in your situation.

The Canadian Forces Health Services Group 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). MELs are administrative constraints on a member’s work schedule, tasks, roles, environments or geographical location as a result of a medical condition. When you have a health condition, MELs may be assigned in order to allow time for you to heal.

The Temporary Medical Category (commonly referred to as the TCat) plays an important role to protect you following a serious illness or injury, giving you time to heal or recover before resuming full duties.

When you have a health issue, your Health Care Provider may assign an initial TCat that includes specific MELs and duration (usually 3, 6 or 12 months).

If you require more time to heal beyond the initial TCat period, you may be placed on a second TCat. Keep in mind that the restrictions assigned on a TCat do not expire once the TCat period has elapsed; the TCat period simply communicates to the Chain of Command how long your recovery should take. You must be assessed by a Health Care Provider in order to have a TCat lifted.

A TCat may or may not include a period of work interruption or sick leave.

Generally, when you experience an illness or injury, you will heal with time. However, some medical issues persist despite rest and appropriate treatment over the course of a 12 month period. In such cases, your health care provider may assign a third TCat, if they feel that recovery is possible with more time.

However, if a health issue persists beyond 12-18 months, it may then be considered a permanent condition and your health care provider may recommend permanent MELs, also known as a Permanent Medical Category (PCat).  This determination depends on many factors such as the individual’s level of health, the natural history of the disease, other co-morbid conditions, etc.

These permanent MELs are first recommended by your health care provider, then reviewed by the Base/Wing Surgeon, then sent to D Med Pol, Standards Section. D Med Pol is the Authority for assigning permanent MELs.

It is a common misconception that D Med Pol medically releases mbrs. As mentioned in the first slide, D Med Pol has no such authority.

As the CAF’s medical advisor, D Med Pol will assign MELs based on the medical condition and prognosis. However, D Med Pol does not make employment or release decisions. D Med Pol receives and reviews over 5000 files annually. There is an 8 month(plus) turn around time on these files currently, due to staff shortages.

When your file is sent to D Med Pol, you may be referred to Case Management by your health care provider.

After this referral is made, a Nurse Case Manager will meet with you, if they have not already done so, to conduct an interview and analysis of your transition needs. Access to Case Management services is based on need and may commence at any stage in the health continuum process, even immediately following the time of injury, if the injury is severe. However, a referral from a health care provider is required; a member may not self-refer.

Once permanent MELs are assigned, and depending on how restrictive your MELs are, your file is either sent to your CO or to DMCA for administrative review. Highly restrictive permanent MELs are sent to DMCA for file review, while less restrictive MELs are sent to the mbr’s CO.

This slide describes a recent change.

MELs used to be assigned by D Med Pol Standards with a designation of being either “Low-risk” or “High-risk” of breaching Universality of Service (U of S), as laid out in DAOD 5023-1.

However, this practice was ceased in early 2018. It was deemed not to be appropriate, since D Med Pol is the CAF medical advisor only and has no authority to make employment or release decisions.

D Med Pol has no influence on U of S and therefore will not provide comment as to which MELs may or may not breach U of S.

Determining and enforcing U of S is an employer (DMCA) responsibility. As noted earlier, DMCA has been delegated the authority, by the CDS, to decide if a member will be released or retained.

DMCA reports to the Director General Military Careers (DGMC), and their role is to judiciously apply the administrative review process for CAF members relating to, for the purpose of this presentation, Medical Employment Limitations (MELs).

The Administrative Review (Medical Employment Limitations), AR/MEL, is the staff process used to evaluate the requirement for and to develop a recommendation for administrative career action when the medical situation of a CAF member calls into question the viability of continued service on the part of that member. DMCA’s process typically takes 6 months from the time they receive the AR/MEL.

The principle of Universality of Service (U of S), or "soldier first" principle, holds that CAF members are liable to perform general military duties and common defence and security duties, not just the duties of their military occupation or occupational specification. This may include, but is not limited to, the requirement to be physically fit, employable and deployable for general operational duties.

If your MELs are not compliant with U of S you will be released.  This is non-negotiable and it becomes a matter of when and how.  DMCA may offer retention if the service requires it for a period of up to 3 years, or offer a period of transition if the member requires it based on medical grounds (Severely Ill & Injured with complex transition needs), also for a period of up to 3 years.  It’s important to note that the 3 year period is the maximum and a period of retention or transition does not automatically come with that time allowed, and that the two can not be combined i.e. the max period a mbr will serve after the DMCA decision is 3 years, not 6.

One of the first things that will occur when your file is passed to DMCA is that an advisory message will be sent out to inform you that an AR(MEL) process has been initiated

This is followed closely by DMCA sending out a package that contains all the information that will be used to make a decision on your file.  This is referred to as Disclosure.

“Representation” is any information you believe the board should have in order to make a decision. 

It is important to note that if you wish to request a release date that coincides with the end of an academic semester or term in order to take advantage of CF Education Reimbursement program IAW CANFORGEN 094/10, this is the best time to make your transition-related upgrading or training plans known to DMCA

Should you chose to waive disclosure (i.e. tell DMCA that you do not want to see the information they will use), they will go ahead with the review and render a decision.  This will speed up the process considerably. The process of Disclosure is simply submitting a memo waiving Disclosure and expressing a desire to speed up the process. When DMCA receives this they aim to process the file within a week.

Retention Subject to Employment Limitations

There are a number of factors DMCA takes into consideration before offering a period of retention.  This offer is only on a temporary, transitional basis if there is:

 a critical shortage in the CAF member’s military occupation; or

 a requirement for a specific skill set that you possess.

You must be capable of working full time and performing all military duties of your position except those related to your MELs

A specific military position must be available in which to employ you and assigned by your career manager

The retention cannot exceed 3 years and always ends in a 3(b) release

The CAF can terminate the retention at any time should circumstances change

The release decision message will set a date of release which can be earlier if you so desire.  Many people release before the end of their period of retention

When DMCA has considered all the information available to them, they will render a decision and a release message will be sent

 Although DMCA will provide 6 months notification wherever possible, you may opt to get out before the 6 months have expired

 This will be a very busy period of time for you, and if you have not done so already, you may want to consider researching information on programs and services to help you in this transition by contacting your local PSO as a start.

Here is a list of local contacts that can help you navigate the Medical Release process.

DMCA recommends that members start with engaging your local Chain of Command. Most questions can be answered at the unit level, as Adjutants and Chief Clerks already know most of the procedures. If they don’t have the answer, your Chain of Command may engage DMCA.

Your local IPSC and Case Manager can also provide guidance through the process.

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