# 2019-086 Medical and Dental Care, Medical condition, Medical treatment

Case summary

F&R Date: 2020-03-03

The grievor was diagnosed with persistent tinnitus and tinnitus retraining therapy (TRT) was recommended by a civilian specialist. This treatment was not approved by the Canadian Forces Health Services Group (CF H Svcs Gp) as it was not deemed to be within the Canadian Armed Forces (CAF) Spectrum of Care (SoC). The grievor argued that the treatment is approved through Veterans Affairs Canada and should also be provided by the CAF. The grievor also contends that the CAF SoC does not take into account all care afforded to the civilian population, and that inclusion of treatments under the SoC is based on the subjective view of the CF H Svcs Group.

The Initial Authority (IA), the Commander CF H Svcs Group, notes that the decision to deny TRT was in accordance with the CAF SoC and clinical practice guidelines and that there does not appear to be an exceptional reason to approve the treatment. The IA relied on advice from the Director of Medical Policy (D Med Pol), who noted that TRT lacks strong evidence to support its use in clinical medicine.

The Committee found that the clinical practice guideline provided by D Med Pol supported their determination that TRT did not conform to the SoC requirement to be evidence-based medicine. D Med Pol confirmed that they actively monitor provincial guidelines and, at this time, no tinnitus therapies are covered by provincial health care plans. As such, the Committee found that tinnitus therapies do not currently meet all of the necessary CAF SoC principles.

The Committee asked D Med Pol whether the tinnitus therapies could be approved through the CF H Svcs Grp Instruction 5000-3, Requesting Items or Services as Canadian Armed Forces Spectrum of Care Exceptions. D Med Pol responded that there were currently no studies showing that tinnitus therapies had any real medical benefit. The Committee considered this argument to be a reasonable basis for not approving funding under this instruction.

The Committee recommended that the Final Authority (FA) not afford redress.

FA decision summary

The Director Canadian Forces Grievance Authority, acting as FA, agreed with the Committee's finding that the tinnitus retraining therapy was not funded by the CAF SoC or recommended by the CAF or any Canadian provincial health care plan. The FA also found that the grievor's situation does not meet the definition of "exceptional circumstances as per the Canadian Forces Health Services Group Instruction 5000-3". Therefore, the FA agreed with the Committee's recommendation not to afford redress to the grievor.