Canadian Armed Forces Military Personnel Instruction 11/04 – Canadian Armed Forces Medical Standards

1. Identification

Date of Issue: 2004-04-23

Date of Modification: 2025-02-28

Application: This Instruction applies to officers and non-commissioned members (NCM) of the Canadian Armed Forces (CAF Members)

Supersession: CFAO 34-30, Medical Standards for the Canadian Forces

Approval Authority: Chief of Military Personnel (CMP)

Enquiries: Administrative Response Centre (ARC)

2. Policy Direction

Policy Aims

2.1 The aims of this policy are:

1. to assist medical personnel in the description and assignment of specific medical employment limitations (MELs) and medical categories;
2. to provide stakeholders with background knowledge and a clear understanding of:
   1. factors comprising the number coded medical category system;
   2. the administrative management and file review process with regard to temporary and permanent MELs and medical categories; and
   3. the common enrolment medical standard and the particular circumstance in which a possible administrative waiver might be issued by the appropriate authority.

Purpose of CFP 154, Canadian Armed Forces Medical Standards

2.2 CFP 154, Canadian Armed Forces Medical Standards, provides direction to CAF health care providers and the chain of command concerning medical standards for CAF members based on pre-determined occupational imperatives.

2.3 Based on requirements specified and provided by military occupation codes (MOCs) advisors, CF H Svcs Gp HQ will publish, in an accessible format, a detailed description of the medical standards applicable to various MOCs of the CAF. This document will be known as CFP 154. It will be updated on a regular basis to ensure its contents reflect the medical standards’ requirements of the various MOCs.

Review and Revision/Amendment of CFP 154

2.4 CFP 154 will be reviewed on a regular basis, based on a cycle determined by the Surgeon General. Standards for specific MOCs will be revised and amended in response to direction provided by responsible MOC advisors.

3. Medical Categories

Factors Comprising Medical Category

3.1 The medical category of an individual is determined based on the results of a medical examination and an assessment conducted in accordance with CFP 154. Appropriate numerical gradings will be entered in the space provided on documents under the following factor headings:

Presentation of Information

3.2 Information relating to the factor headings may be presented as follows:

YOB - Year of Birth

3.3 The year of birth is expressed by the last two digits of the year of birth.

V - Visual Acuity

3.4 Visual acuity is graded from 1 to 5 with increasing numerical value indicating decreasing visual acuity.

CV - Colour Vision

3.5 Colour vision is graded as follows:

H - Hearing - Auditory Acuity

3.6 Auditory acuity is graded from 1 to 4 with increasing numerical value indicating a decrease in auditory acuity.

G - Geographical Factor

3.7 This factor is based on the requirements for appropriate medical care, both in type and accessibility. It is graded from 1 to 6 with increasing numerical value indicating greater requirement for medical care. For example, G2 is applied when there is either no requirement for scheduled medical care, or, when a requirement does exist, that scheduled follow-up occur no more frequently than every 12 months; whereas, a G5 category indicates that the member requires regular specialist follow-up.

O - Occupational Factor

3.8 Occupation involves physical and mental activity and stress. Physical or mental disabilities can limit a member's capability and performance of duties. The occupational factor is graded from 1 to 6 with increasing numerical value indicating greater limitations in employment. For example, O2 indicates no limitations, whereas O4 indicates that a member could be fit only for clerical duties because they have a physical disability or have demonstrated a mental incapacity to accommodate to the more severe and prolonged stressful demands of a military operational environment.

A - Air Factor

3.9 The air factor identifies the functional relationships in respect of aircrew and passengers and is graded from 1 to 7. A1 to A4 are aircrew factors and define the duties which a member can perform and specify limitations as to type of aircraft. A5 is assigned to non-aircrew who are medically fit to fly as passengers in CF aircraft. A6 is assigned to members who are medically unfit to fly in any capacity, while A7 is assigned to aircrew who are medically unfit for any flight duty but may still fly as passengers.

Temporary medical Category (TCat)

3.10 A medical category may have to be lowered temporarily and this will be shown immediately following the digit to which it refers, and will consist of a capital T for “temporary” plus a numeral to indicate the expected duration in months of the temporary state, eg, (T3), meaning a temporary limitation imposed for three months.

4. Medical Category on Enrolment

Common Enrolment Standard

4.1 Recruits require a certain denominator in their medical category to be eligible for the widest selection of trades. Except when a recruit is being initially assigned to a trade requiring a better minimum standard, the minimum medical category for enrolment in the CAF is:

V4-CV3-H2-G2-O2-A5

4.2 However, where applicants possess special qualifications or skills, administrative authority, within Canadian Forces Recruiting Group Headquarters (CFRG HQ), may waive this standard if applicants meet the profile for the employment for which they are being considered.

5. Medical Employment Limitations – Career Implications

Medical Category Verses Medical Employment Limitations

5.1 The number-coded medical category system (the numeric figure) provides a simple way to communicate a member’s general fitness to the chain of command. However, the numeric figures are of little to no use by themselves unless they are accompanied by clearly stated MELs. Moreover, the Director Military Careers Administration Resource Management (DMCARM) gives little to no heed to the numeric figures. MELs on the other hand are fundamental and matter most in determining employability and deployability.

Note – The minimum medical standards for MOC are still published in CFP 154 Annex E, and are expressed using the category system.

Employment and Career decisions by DMCARM 

5.2 The importance of clearly stated MELs cannot be overstated. The permanent MELs represent the central issue around which employment and career decisions are made. Career decisions are the domain of, and rest with, DMCARM. 

Considerations on Which to Base MELs 

5.3 Within the process of assigning MELs, any decision to medically restrict the employment and deployment of a member must be based on considerations relating to the member’s medical condition, prognosis and recovery, the member’s safety, the safety of other CAF members and the public, the operational effectiveness and the member’s rights and freedoms. Any MEL should be based on the above-mentioned considerations. 

Purpose of Health Assessments Leading to the Determination of MELs 

5.4 Clinical health assessments of members leading to the determination and assignment of MELs are structured health reviews aimed at recovering from a medical condition, preventing further deterioration or disease, promoting health and ensuring members are fit for military duties without constituting a danger to themselves or others (concept of deployment medical readiness). 

Source Documents for Developing MELs 

5.5 In determining a member’s MELs, there are a number of sources of information that can assist the physician in developing accurate and concise limitations that will be understood by the operational element, including: 

1. the generic task statement;
2. the MOC task statement; and
3. consultants reports.

Context of Military Operational Environment when Considering MELs 

5.6 It is critical to consider the impact of the member’s medical condition in the context of a military operational environment. Therefore, the following factors should also be considered when determining MELs: 

1. the risk of a crisis in a given year;
2. the level of medical care that will be required in the event of a crisis related to the medical condition;
3. the potential consequences of a delay in medical treatment;
4. whether the potential mental or physical stress of an operational environment will place the member or others at risk or not; and 
5. any specific requirement related to medication use. 

MELs Tailored to Individuals 

5.7 Medical conditions vary in their impact on individuals and individuals cope differently with the stress that those conditions place upon them. As a result, it is possible to have two service members with the same disease and, based upon their unique responses, each could receive different permanent MELs, which could in turn result in different recommendations for career disposition from DMCARM. Employment and career decisions are the domain of, and rest with, DMCARM. 

Assessing Physicians Assign MELs and Medical Categories 

5.8 Assessing physicians assign MELs and medical categories based on their medical assessment of the member while considering the unique context of the military operational environment. 

Administrative Management and File Review of Temporary MELs and Medical Categories (TCat) 

5.9 If MELs have become such that a temporary change of medical category must be assigned for longer than a total of 12 months, DCOS Med Pol must review the file. 

5.10 Completion by the assessing physician, and review and approval by the Base/Wing Surgeon, of forms CF 2033, Medical Examination Record - Periodic Health Assessment and CF 2088, Notification of Change of Medical Employment Limitations, are of paramount importance in this process. DCOS Med Pol will then review the file and produce a medical statement of limitations. 

5.11 DCOS Med Pol is the authority for granting extensions on TCat beyond 12 months.

Administrative Management and File Review of Permanent MELs and Medical Categories (PCat) 

5.12 If MELs have become such that a permanent change of medical category is assigned, the file must be reviewed at DCOS Med Pol. 

5.13 Completion by the assessing physician, and review and approval by the Base/Wing Surgeon, of CF 2033 and CF 2088 are of paramount importance in the successful conclusion of the administrative process. DCOS Med Pol will then review the file, give the final approval, and produce a medical statement of limitations for consideration by DMCARM, during the administrative review (AR)(MEL). 

5.14 DMCARM reviews the medical statement of limitations and the original CF 2088 and takes career action. 

AR (MEL) Process by DMCARM 

5.15 The AR (MEL) process involves the review of the member’s employability in light of assigned employment limitation(s) associated with a permanent change in the member's medical condition. The aim of the process is to determine the member's suitability for further service in keeping with CAF policies and regulations. The career decisions associated with the AR (MEL) process are the domain of, and rest with, DMCARM. 

Requirement to Inform the Patient that an AR (MEL) will be Required 

5.16 Members should be informed as early as possible that their MELs are such that they will require an AR (MEL) done at DMCARM. No clinician (physician, physician assistant, nurse practitioner) or case manager should try to predict the outcome of the AR (MEL) for a member. The member should simply be advised that the medical file will be sent to DCOS Med Pol for review and approval, and from there to DMCARM for an AR (MEL). Employment and career decisions are administrative in nature and are the concern of DMCARM. 

Disclosure Process 

5.17 Every effort is made to make the AR process open and fair. The principles of Procedural Fairness, applied to all AR cases, dictate that: 

1. a member be notified of any administrative proceedings, including an AR that could have a significant impact on the member’s career;
2. subject to exemptions required by law, members being considered for possible career action must be provided with copies of all the material that will be used in reaching a decision; and
3. the member has the right to submit for consideration any written, or other, material which the member feels would assist the Approving Authority in reaching a just decision. 

5.18 A disclosure package includes all documents, including the administrative review synopsis. Once provided with the documents, the member has 15 working days to forward to the unit CO any written representation as well as any documents to be submitted to the Approving Authority. Should the member require more than the allotted 15 days in order to prepare a representation, a request by message or e mail must be sent by the CO within the original 15-day period. The member's written representation as well as any additional material that the member wishes to submit and the disclosed documents, will be reviewed by the Approving Authority in arriving at a final decision. 

5.19 Any medical documents submitted by the member as part of his written representation will be forwarded by DMCARM to DCOS Med Pol in order to obtain a medical assessment as to their bearing on the member's present medical condition and associated medical employment limitations. 

Processing Regular Force Medical Files with Change of MELs and Medical Categories 

5.20 Processing Regular Force Medical Files with Medical Employment Limitations Changes (PDF) 

Note –

ASCS (Aeromedical Standards Clinical Services)
DRDC (Defence Research & Development Canada)
CDHM (Consultant in Diving &Hyperbaric Medicine)
CMB (Central Medical Board) 

Management of Aircrew Medical Files at CMB and by the ASCS Surgeon at 2 H Svcs Gp 

5.21 Central Medical Board (CMB) must review all aircrew health assessments leading to a change in the medical category profile (temporary categories -TCat - longer than 3 months, or permanent categories - PCat. The medical file will be reviewed to ensure completeness of testing and documentation and accuracy. Communication with the originating medical unit may be required for clarification or completeness. 

5.22 Based on the information provided, CMB will apply aeromedical judgment and recommend an Air Factor (for the medical category profile) and medical employment limitations. 

5.23 All medical files received and reviewed at CMB are forwarded to the ASCS Surgeon at 2 H Svcs Gp HQ for review and approval. From there, the files will be returned to the originating unit for TCat of 12 months or less. For TCat longer than 12 months and PCat, the medical files will be routed from the ASCS Surgeon at 2 H Svcs Gp HQ to DCOS Med Pol for final approval. 

Management of Divers Medical Files with CDHM and Base Surgeons Halifax/Esquimalt 

5.24 The Consultant in Diving and Hyperbaric Medicine (CDHM) must review all divers health assessment leading to a change in the medical category profile (temporary categories -TCat - longer than 3 months, or permanent categories - PCat. The medical file will be reviewed to ensure completeness of testing and documentation and accuracy. Communication with the originating medical unit may be required for clarification or completeness. 

5.25 Based on the information provided, the CDHM will apply medical judgment pertinent to the diving environment and recommend medical employment limitations. 

5.26 All medical files received and reviewed by the CDHM are forwarded to the Base Surgeon Halifax / Esquimalt for review and approval. From there, the files will be returned to the originating unit for TCat of 12 months or less. For TCat longer than 12 months and PCat, the medical files will be routed from the Base Surgeon Halifax / Esquimalt to DCOS Med Pol for final approval. 

Retention Without Career Restrictions or Compulsory Occupational Transfer Following the AR (MEL) 

5.27 Members who have permanent MELs but whose file was reviewed by DMCARM within the AR (MEL) process and were retained (in their MOC) without career restrictions (RWOR) or given a compulsory occupational transfer (COT) are deemed employable and deployable. They are therefore declared medically fit for deployment unless they are later found to have new MELs that would preclude them from deploying. 

Individual Risk Assessment for the Determination of Medical Employability and Deployability Given the MELs 

5.28 In determining whether the employment and deployment of a particular member is appropriate given the MELs, an individual risk assessment needs to be completed and the following factors considered: 

1. The MOC of the member;
2. The generic task statement and MOC task statement;
3. The medical condition of the member in relation to the conditions under which the member may have to serve;
4. The required access to medical services (type and level) vs the available access to such medical services in theater;
5. Whether the degree of risk to operational effectiveness or to member or group safety is increased to a level greater than that already inherent in the employment or operation;
6. Previous deployment to a hostile theater of operations or employment in such areas that might render the member more vulnerable to the worsening of the medical condition;
7. The nature of the theater, operation or environment to which the member will be deployed;
8. The nature of the mission to be conducted; and 
9. The nature of the duties the member will be called upon to perform.

Temporary Categories (TCat) 

5.29 Members who have been assigned, on a temporary basis, MELs and medical categories that will preclude them from deploying are declared medically unfit for deployment until their condition no longer warrants such temporary MELs and categories. 

5.30 However, members who have been assigned, on a temporary basis, MELs and medical categories that do not prevent them from going on the deployment will then be declared medically fit for such deployment. 

Permanent Categories (P Cat) 

5.31 For members whose MELs have become such that a permanent change of medical category is assigned, the file must be reviewed at DCOS Med Pol who will produce a medical statement of limitations and send it along with the original CF 2088 to DMCARM for administrative review - AR (MEL) - concerning employment and career decisions. 

5.32 If the permanent MELs are such that they will preclude the member from deploying, that member is declared medically unfit for deployment, while awaiting the recommendations for career disposition from DMCARM. 

5.33 If the permanent MELs are such that they do not prevent the member from going on the deployment, that member can then be declared medically fit for such deployment, even though the AR (MEL) is not completed. 

5.34 Any concern or query that Base/Wing Surgeons (from or supporting the originating medical unit) have with regard to a case in particular can be discussed with DCOS Med Pol at any time during the administrative review.

6. Responsibilities

6.1 The following table identifies the responsibilities associated with this instruction, maintaining CFP 154 and for the management of change of medical category profiles and MELs.

7. References

Acts, Regulations, Central Agency Policies and Associated DAOD 

• N/A

Other References

• CFP 154, Medical Standards for the Canadian Forces 
• Form CF 2033, Medical Examination Record (Periodical Health Examination) (this document can only be accessed on the DWAN)
• Form CF 2088, Notification of Change of Medical Employment Limitations (available in hard copy only)