# 2014-082 - Medical Condition, Medical Employment Limitation (MEL), Release - Medical

Case Summary

F&R Date: 2014–11–21

The grievor was placed on a permanent medical category (PCat) for intolerances to numerous demands of military duties.

Based on the medical report from her primary care physician, and the fact that she had passed the Canadian Armed Forces (CAF) EXPRES test, the grievor argued that her medical condition had improved enough that the Base Surgeon (B Surg) should have forwarded her medical file to the Director of Medical Policy (D Med Pol) for a new review. She further contended that a review by D Med Pol would have resulted in her Medical Employment Limitations (MELs) being removed, such that she would no longer have been in violation of the Universality of Service (U of S) principle and she could be retained in the CAF.

As the Initial Authority (IA), the Surgeon General found that the B Surg had acted reasonably in determining that there was no need to forward the grievor's medical file to D Med Pol for further review. The IA agreed with the B Surg conclusion that the medical report from the grievor's physician did not indicate any change to her underlying chronic medical condition and that her permanent MELs and medical release remained correct.

The Committee had to determine whether it was appropriate for the B Surg to refuse to forward the grievor's medical file to the D Med Pol for further review, and whether the grievor's PCat and MELs should have been reassessed.

The Committee first considered the Defence Administrative Orders and Directives 5023-1, Minimum Operational Standards Related to Universality of Service, which sets out the principles related to U of S, and noted that being physically fit is just one of the minimum operational standards that must be met in order to comply with U of S requirements.

Next, the Committee indicated that the grievor's medical file had been reviewed by three different levels of CAF medical experts; the B Surg, the D Med Pol and the Surgeon General, and they had all agreed that there was no change in the grievor's underlying medical condition (as opposed to her physical fitness) and that if the grievor's permanent MELs were removed and, if she was allowed to return to operational duties, her symptoms would most likely reappear and her condition worsen. The Committee noted that the grievor had not presented a compelling case to the contrary and that, in the absence of such evidence, it owed a considerable amount of deference to the professional opinions expressed by CAF medical subject matter experts. Accordingly, the Committee found that the decision of the B Surg not to refer the grievor's file to D Med Pol for revision was appropriate.

Finally, the Committee pointed out that CAF Medical Officers, as physicians, owe an ethical and professional duty of care to their patients that goes beyond just looking out for the needs of the CAF. As a physician, a Medical Officer's first priority is the well-being of a patient. Had the B Surg recommended removing the grievor's MELs, it would have meant returning her to a physically demanding operational military environment knowing that her chronic spinal condition could have been aggravated. The Committee found that the B Surg carried out his duty responsibly as a Medical Officer by putting the health of his patient first. The Committee concluded that the grievor's MELs were assigned to best manage her medical condition and that in her case, the evidence demonstrated that their assignment was beneficial to her symptoms.

The Committee recommended that the grievance be denied.

CDS Decision Summary

CDS Decision Date: 2015–06–02

The FA agreed with the Committee's findings and recommendation that the grievance be denied.