# 2022-326 Medical and Dental Care, Medical Treatment, Spectrum of Care

Case summary

F&R Date: 2024-04-23

The grievor requested funding under the Canadian Armed Forces (CAF) Spectrum of Care (SoC) for surgeries to remove excess skin following significant weight loss. He explained that for years he has struggled with negative mental and physical effects from the excess skin. The grievor contends that the surgeries should be covered under the “health promotion” and “comprehensive medical care” categories of the CAF SoC. He further explains that funding the surgeries would be more economical for the CAF compared to the ongoing costs for pain and stress management, psychology, and physiotherapy.

The CAF Surgeon General, acting as the Initial Authority (IA), concurred with the Director Medical Policy recommendation to deny funding for the surgeries. The IA explained that most provinces only consider on a case-by-case basis whether to fund certain plastic surgery procedures when they are deemed medically necessary. As the grievor's medical records did not demonstrate medical necessities for the surgeries, the IA concluded that they were not eligible for coverage under the CAF SoC.

The Committee concluded that the grievor was not entitled to coverage for the surgery as it was not deemed medically necessary. The Committee found that while the grievor's circumstances met some of the principles to recommend entitlement under the CAF SoC, they do not meet the parameters for all. As such, the Committee found that the grievor was not aggrieved. The Committee further noted that this grievance offers an opportunity for the CAF SoC Review Committee to consider how due consideration may be better afforded to medical treatment that would help maintain over health, including mental health, and operational effectiveness as a means of promoting personnel retention.