# 2020-002 Medical and Dental Care, Medical treatment

Case summary

F&R Date: 2020-11-10

The grievor challenged the Director of Medical Policy (D Med Pol) decision to deny his claim for $6,000 for refractive lens exchange surgery to treat his hyperopia. As redress, he requested reimbursement of the surgery expenses.

The Initial Authority denied redress on the grounds that the Canadian Armed Forces spectrum of care (SoC) does not fund "any type of laser eye therapy."

The Committee acknowledged that the SoC does not specifically exclude refractive lens exchange surgery from its non-exhaustive list of therapies ineligible for funding. However, it accepted the D Med Pol's medical opinion that the procedure is in fact a type of elective eye surgery. It also noted that no provincial or territorial health insurance plan funds intraocular lens implant surgery to treat hyperopia.

The Committee rejected the grievor's submission that refractive lens exchange surgery was the “only option” to save his career. On the contrary, it found that the grievor's uncorrected vision category would not routinely result in a mandatory release, although it could result in a compulsory occupational transfer if his current occupation could not accommodate it. As the grievor's hyperopia could be accommodated by wearing prescription eyeglasses and his occupation did not contraindicate wearing glasses on the job, the Committee concluded that the grievor did not have to have elective surgery to save his career.

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

FA decision summary

The Director Canadian Forces Grievance Authority, as FA, agreed with the Committee's recommendation to deny the grievance. The FA noted that the grievor was subject to an administrative review/medical employment limitation after his medical category was put at V5 before the surgery restored his vision to a V1. However, the Initial Authority stated that the "new treatment could have resulted in a less positive outcome," which is why the requirement and authorization for it should be decided by medical experts and not the member alone. The FA found that the surgery was not a medical requirement and that the grievor's vision was correctable with eyeglasses. The FA found that the grievor's expenses were not reimbursable under the SoC.