# 2020-203 Medical and Dental Care, Medical treatment, Spectrum of care

Medical treatment, Spectrum of care (SoC)

Case summary

F&R Date: 2021-06-03

The grievor believed she should be reimbursed for out of pocket expenses incurred while undergoing vision therapy to treat a service-related injury. The grievor contended she had the support of both her military and civilian care teams, most whom were recommended by the Canadian Armed Forces (CAF) medical system. The grievor provided copies of medical evaluations showing she was deemed a good candidate for vision therapy and that, upon successful completion of the treatments, her condition had improved to a pre or near pre injury state. This was something that had not been accomplished by any of the treatments she had received within the Spectrum of Care (SoC). The grievor also provided evidence that at least two provincial governments currently cover the costs of vision therapy in certain instances, as well as documents showing that the Canadian Association of Optometrists recognizes the efficacy of these therapies and rehabilitations. The grievor further raised issue with the inability of the CAF SoC Committee to maintain pace with medical advancements. Specifically, the grievor pointed to their position on vision therapy being out of step with several medical bodies in Canada as well as the fact that the SoC Committee, by their own admission, has not been meeting as often as mandated.

The Surgeon General, acting as the Initial Authority (IA), denied the grievor redress. The Directorate of Medical Policies, acting as a subject matter expert (SME), provided feedback to the IA and maintained that vision therapy was not covered in the SoC. In their view, vision therapy was still an experimental treatment, meaning it was not compliant with the five principles for inclusion in the SoC. The IA concluded that, while the grievor's injury was service-related, the costs for the vision therapy treatments could not be reimbursed, as it was not covered by the SoC.

The Committee, based on the evaluations of the grievor's care team following her treatments, found that the vision therapy she underwent had a clear and positive effect on her condition and recovery. The Committee also noted several issues in the CAF's handling of the grievor's request for reimbursement. The SME relied primarily on the opinion of one medical professional while seemingly disregarding input from several others, including medical associations, when considering the grievor's request. The Committee also noted significant discrepancies between the SME's and the SoC Committee's evaluation of vision therapy and the position of Canadian Association of Optometrists. The latter supports the use of vision therapy to treat injuries like those suffered by the grievor. The Committee also noted that at the time of the grievance, the SoC Committee, which is supposed to meet twice a year, had not met in almost a year. The Committee found that the SME did not maintain an open mind when evaluating either vision therapy or the grievor's unique situation. The Committee attempted to ascertain whether an evaluation had taken place to see if the grievor's unique situation would qualify for an exception to the CAF SoC, but the SME was not able to confirm whether this had occurred. 

Based on a review of the Canadian Forces Health Services Group Instructions 5000-03 - Requesting Items or Services as CAF SoC Exceptions, the Committee recommended to the Final Authority that the grievor be granted redress by reimbursing the costs of vision therapy she incurred while seeking treatment for a service-related injury.

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