# 2014-087 - Medical Employment Limitation (MEL), Period of Retention, Release - Medical

Case Summary

F&R Date: 2014–12–23

The grievor was diagnosed with asymptomatic hypertrophic cardiomyopathy (HMC) and assigned medical employment limitations (MELs) by the Director of Medical Policy (D Med Pol). The resulting Administrative Review of the MELs (AR/MEL) by the Director Military Careers Administration (DMCA) found the MELs to be in violation of the Universality of Service (U of S) principle and recommended a medical release.

Following additional representation from the grievor and his civilian cardiologist, including an opinion from a specialist stating that the grievor was fit to undergo the Canadian Armed Forces (CAF) EXPRES test, but avoid competitive sports, a Medical Board was convened. This Board considered HCM and its impact on CAF members and the grievor in particular. The Medical Board found that although the grievor had demonstrated the ability to pass the CAF EXPRES test, the physical and psychological stress of combat conditions, while impossible to quantitate accurately, was substantially higher than either the EXPRES test or competitive sports. The Medical Board concluded that the original MELs were still appropriate. As a result, the grievor was medically released.

The grievor argued that although diagnosed with HCM, he had no high risk factors associated with his medical condition and he was fit and capable of serving in the CAF. He therefore disputed the accuracy and validity of the MELs. As remedy, the grievor asked that his medical release be cancelled, that his MELs be amended to reflect his specialist's diagnosis, and that he be retained in his current position. Alternatively, he requested to be retained and permitted to transfer occupations.

As Initial Authority, the Director General Military Careers denied the grievance, observing that the MELs had been reviewed twice and both times were found to be non-compliant with the U of S.

The Committee had to determine whether the permanent MELs assigned to the grievor were justified and whether the subsequent CAF decision to release him reasonable and in accordance with policy.

The Committee noted that the grievor's argument depended on the opinion expressed by his civilian specialist that he could undergo the EXPRES test. However, after careful review of the reports submitted by the specialist, the Committee found them to consistently state that the grievor should avoid competitive sports just as D Med Pol had indicated. The Committee noted that if allowed to do so, the grievor would likely have successfully completed the EXPRES test. However, it also noted the D Med Pol observation that he might well suffer a heart attack while doing so. The Committee also acknowledged the undisputed evidence on file showing that the grievor's medical condition predisposed him to suffer increased risk of a heart attack when under increasing physical exertion. The Committee recognized that the grievor's condition was being managed by limiting the physical demands of his activities (i.e. not partaking in competitive sports) and agreed with D Med Pol that active service in the CAF is extremely physically demanding and, in fact, exceeds the demands of competitive sports. Accordingly, the Committee found that the assigned MELs were justified, based on the evidence presented and the lack of convincing medical evidence to the contrary.

Regarding the medical release decision, the Committee found that the MEL labelled "no sudden or sustained heavy physical exertion" prohibited the grievor from performing duties under physical stress and from being employed in any physical environment, thus placing the grievor in violation of the U of S. The Committee also noted that the grievor was deemed to be at high risk of developing severe complications requiring immediate specialist medical attention generally not available on a deployment.

Therefore, the Committee found that the decision to medically release the grievor was justified and recommended that the grievance be denied.

CDS Decision Summary

CDS Decision Date: 2015–04–10

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