# 2013-057 Medical and Dental Care, Dental Services

Case Summary

F&R Date: 2014–05–30

Upon enrolment, the grievor underwent a forensic dental examination which indicated that he required “considerable” dental work. A treatment plan was prepared by the Canadian Armed Forces (CAF) dental staff to address his dental issues. Dental consultations and treatments continued during his service in the Regular Force as well as during a period of Class “B” Reserve Service that exceeded six months duration. Upon completion of the Class “B” service, the grievor consulted with civilian dental specialists and commenced additional dental treatments at his own expense, incurring significant expenses. He subsequently submitted a grievance alleging that he had suffered dental pain throughout his Regular and Reserve Force service and had incurred financial expenses due to the failure of CAF dental staff to provide proper dental care. As remedy, he requested reimbursement of his out-of-pocket dental expenses.

The Director General Health Services, acting as the Initial Authority (IA), denied the grievance, stating that the CAF dental records confirm that following basic training, Canadian Forces Dental Services immediately began providing the dental care deemed necessary for the grievor to reach the required operational fitness levels. The IA was satisfied that comprehensive dental care was provided and continued throughout the grievor's CAF career.

The issue before the Committee was whether the grievor received timely, appropriate and reasonable dental care while serving in the CAF. During its review, the Committee obtained CAF subject matter expert (SME) comments from the Director Dental Services who stated that the grievor had been accorded proper dental care pursuant to the Spectrum of Care policy, which states that CAF members are entitled to dental care only until their release from the CAF. The CAF SME noted that prior to the grievor's release it became evident that there was some deterioration in the grievor's dental condition. However, it was not possible to proceed with the recommended treatment given the limited time available prior to the grievor's release.

In order to properly assess the grievor's dental condition, as well as the standard of dental care that he received from the CAF, the Committee commissioned an independent review of the grievor's dental file by a specialist in oral and maxillofacial surgery. In reviewing the level of dental care provided to the grievor, the civilian expert concluded that the grievor had poor oral hygiene prior to joining the military, and that it did not improve while he was in the military. The civilian expert found that the grievor received appropriate dental treatment while he was serving in the CAF and that the responsibility for his symptoms, the need for dental treatment, the dental deterioration and the progressive tooth loss was solely his own. The expert noted that the grievor chose to undergo expensive elective dental implant therapy and that the grievor's decision to undergo surgical procedures such as bone grafting and implant placement was considered a luxury and not a basic dental necessity.

The Committee accepted the conclusions of the civilian expert and agreed that the decisions made by CAF dental staff were reasonable and appropriate in the circumstances and that the difficulties experienced by the grievor did not result from a lack of effort on the part of the CAF Dental Services but rather, were a result of the grievor's extremely poor dental condition.

Based on the findings of the civilian expert, the Committee concluded that the grievor had not been prejudiced by the CAF in this matter. The Committee found that there was no entitlement for reimbursement of the grievor's subsequent private dental expenses, incurred after the grievor was released from the CAF. Accordingly, the Committee recommended that the Chief of the Defence Staff deny the grievance.

CDS Decision Summary

CDS Decision Date: 2014–11–26

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