# 2021-138 Pay and Benefits, Medical Condition, Medical Treatment, Spectrum of Care

Medical Condition, Medical Treatment, Spectrum of Care (SoC)

Case summary

F&R Date: 2021-09-06

The grievor challenged the denial of a request for an exception to the Spectrum of Care (SoC) for laser therapy for a dermatological condition. He requested t an exception to the SoC be authorized. 

The Director Medical Policy (D Med Pol), a subject matter expert,  explained that in accordance with the decision of the SoC Committee in 2017 and the health care benefits listed as supplemental to the comprehensive coverage for Canadian Armed Forces members, laser treatment for dermatological conditions is only covered for specific conditions. The grievor did not suffer from any of these conditions. Therefore, the D Med Pol concluded the grievor was not eligible for the reimbursement requested. 

The Initial Authority (IA) found that the treatment requested by the grievor was not included on the list of comprehensive medical services. The IA concluded that the analysis conducted by the D Med Pol was thorough. It demonstrated that the decision to deny the request for funding of the laser treatment of the grievor's skin condition was reasonable, justified and in accordance with policy. The IA did not afford redress. 

The Committee asked the D Med Pol to assess whether funding for laser therapy for the grievor's condition could be provided as an exception. The Committee found that the D Med Pol's assessment determined that the treatment was not considered medically necessary. The Committee found this to be a reasonable determination based on the grievor's individual case.

The Committee found that the test used by the D Med Pol is not a part of the Canadian Forces Health Services Instruction 5000-03 (Requesting Items or Services as Canadian Armed Forces Spectrum of Care Exceptions). According to the test used, the only cases that would qualify as exception are those that typically pertain to new treatments that have not yet been presented to the SoC Committee.  

The Committee found that no consideration was given to whether the treatment sought by the grievor could be provided as a Quality of Life treatment resourced from non-public funds.  

The Committee recommended that the Final Authority not afford redress. 

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