Medical Standards (CFP 154)

Chapter 3

THE MEDICAL CATEGORY SYSTEM

The Medical Category

1. The medical category includes the year of birth (YOB) and six factors written in numeric form. It is expressed as:

• YOB - Year of Birth
• V - Visual Acuity
• CV - Colour Vision
• H - Hearing
• G - Geographical Factor
• O - Occupational Factor
• A - Air Factor

YOB	V	CV	H	G	O	A
51	3	1	2	3	2	4

OR 51/312/32/4

YOB - Year of Birth

2. Disease, rather than the normal aging process, appears to be a more important factor in the probability of debilitation as one ages. At the same time, it is known that many diseases show a prevalence which varies with age. As such, inclusion of the year of birth (YOB) in the medical category is reasonable. It is expressed by the last two digits of the YOB.

V - Visual Acuity

3. Visual acuity and refractive standards refer to the eye in its normal physiological state and not to situations where visual acuity and refractive status have been artificially altered by orthokeratology or radial keratotomy carried out within the previous twelve months. Visual acuity and refraction measurements resulting from orthokeratology or radial keratotomy within the previous twelve months are not deemed valid for the purpose of recruitment and employment. Visual acuity is expressed in grades from V1 to V5 according to the testing instructions shown at Annex A.

CV - Colour Vision

4. Colour vision measurement refers to the eye in its normal state and not to measurement through coloured contact lenses designed to "correct" colour vision defects. The instructions for the testing of colour vision are shown at Annex B. Three grades of colour vision are recognized: CV1, CV2 and CV3.

H - Hearing - Auditory Acuity

5. The ability to hear the spoken voice or audible signals, often against a considerable background of concurrent noise, is of paramount importance in certain trades. Auditory acuity is expressed in grades from H1 to H4, using an audiometer, and applying the findings as shown at Annex C. Hearing aids are not to be worn during measurement of auditory acuity.

G - Geographical Factor - General

6. It is essential to know geographically where a member can perform duties without significant limitations in effectiveness and/or important health risks to self or others. Three main factors are involved in this area:

1. Climate - Some medical conditions may limit deployment and effective employment in certain climatic zones. For example, some skin diseases may be exacerbated in hot, moist climates, while others may be aggravated in dry, cold climatic conditions. Similarly, certain peripheral vascular diseases are unfavourably affected by cold temperatures typically found in much of Canada during the winter months;
2. Accommodation/Living Conditions - Accommodations can vary throughout the world. It may be acceptable to permit members with certain medical limitations to serve in remote areas of Canada or in foreign countries, provided they are working and living in properly controlled accommodations and have ready access to reasonable messing facilities. Conversely, even in Canada a member may be required to live in the open, work in inclement weather for extended periods and subsist on minimal rations available only at irregular intervals. Every effort should be made to limit or reduce the risk of poor conditions on the health and safety of a member with a known medical condition; and
3. Medical Care Available - Historically, accidental injury, sickness and disease have always depleted military forces to a greater degree than the direct effects of combat. Battles are often sporadic, whereas readiness for combat is an ongoing necessity and the service member is constantly being exposed to disease and injury. Moreover, fully effective medical resources may not be readily available to support these military operations. Whether the situation is an armed conflict or an isolated peacetime posting, the level of medical care required is an important consideration in assessing a member with limitations arising from a known medical condition. The level of medical care required is fundamental to the awarding of an appropriate geographical factor.

Geographical Factors

G1 - assigned to the member who has successfully passed the stringent medical requirements for such unique duty as astronaut training;

G2 - assigned to the member:

1. who has no geographical limitations due to a medical condition; and
2. who is considered healthy and, at most, requires only routine, periodic or scheduled medical services no more frequently than every twelve (12) months (see definitions in Chapter 2, 4.c.).

G3 - assigned to the member:

1. who is considered likely fit for field exercises, sea environment, isolated postings and operational taskings for periods up to six (6) months;
2. who has a known requirement for scheduled medical service (see definitions in Chapter 2, 4.c.) by an MO but no more frequently than every six (6) months;
3. whose limitations resulting from a known medical condition do not pose an unacceptable risk to the health and/or safety of the individual or fellow workers in the operational/work environment;
4. who may require and take prescription medications, the unexpected discontinuance (unavailability) of which will not create an unacceptable risk to the member's health and/or safety; and/or
5. who may require a medical evaluation before being sent on the tasking.

G4 - assigned to the member:

1. who is considered unfit because of medical limitations inherent to the medical condition itself or because of the unacceptable risk to the health and/or safety of this person or to fellow workers imposed by the operational environment on the medical condition;
2. who may be on prescription medications, the unexpected discontinuance of which, for even a few days, is considered likely to create an unacceptable risk to the health and / or safety of this person (or to co-workers);
3. who may require close proximity to medical services/ready access to physician-directed medical care; and / or
4. who generally requires scheduled medical care by a MO more frequently than every six (6) months.

G5 - assigned to the member:

1. who requires scheduled specialist medical care more frequently than every six (6) months; and
2. who is considered unfit for duty in an area that does not have ready access to full medical services.

G6 - assigned to the member who is considered unfit for any work environment.

O - Occupational Factor - General

7. The physical and mental activity and the stress associated with employment within a specific MOC, although often difficult to describe and measure in an objective and reproducible manner, are important aspects in the grading of the occupational factor. The demands on the member may vary with the MOC, as well as with the geographical locale. In general, the associated mental stress is not described in any detail, unless a specific MOC or medical condition(s) (usually psychiatric) so dictates. In these cases, consultation with a military psychiatrist should describe acceptable levels of mental stress for the particular member. Annex D serves as a concise guide to the expected tasks and duties of all military personnel. Members with medical conditions which impose limitations should be assessed against both the Generic and the MOC Task Statements. In this way, an appropriate O factor can be assigned. Many of the questions suggested in paragraph 4 of Chapter 2 should be considered in the assessment of the occupational limitations and should be reviewed prior to assigning the O factor.

Occupational Factors

O1 - assigned to those rare members who have successfully completed medical screening for such unique duties as astronaut training.

O2 - assigned to the member who has no employment limitations of a medical nature

O3 - assigned to the member who has some specific employment limitation(s) which can be clearly and specifically detailed, and which prevent the member from fully meeting the Generic or the MOC task statements.

O4 - assigned to the member:

1. who has sufficient limitations such that employment in an operational scenario is, on balance, compromised;
2. who is generally restricted to light duties only, i.e., general office tasks, including delivering mail, parcels and supplies and maintaining a stock room (these tasks involve lifting and carrying objects of variable weight and bulk and require the ability to walk and climb stairs while carrying out these duties);
3. who is capable of working a full eight (8) hours per day; and / or
4. who is considered fit for shift work as long as it is stable (i.e., shifts don't change rapidly).

O5 - assigned to the member:

1. who is generally restricted to sedentary duties such as clerical / desk work only, which do not involve lifting and carrying objects or climbing stairs or ladders with these materials (typically these individuals are capable of acting as a receptionist, answering telephones, and doing typing and some light office filing);
2. who is capable of working up to eight (8) hours per day but generally at his / her own pace;
3. who is not considered fit for shift work; and
4. unfit for any military work.

O6 - assigned to the member who is unable to work in any capacity.

A - Air Factor - General

8. Aircrew and Non-aircrew Flying Category - There is a requirement for air operations and transportation to express the functional capacity of the member in terms of his/her ability to perform in an aircraft. Pilots and crew of highly manoeuvrable or highspeed aircraft must be medically fit to meet situations considerably different from those encountered by the crew of large, long range but more stable aircraft. The cabin crew of the multi-passenger aircraft have yet another function. The final "A" factor is graded from 1 to 7 and identifies the functional relationships that pertain to aircrew, passengers and those who are unfit to fly.

Air Factors

A1 - assigned to pilots who are medically fit for unrestricted duty in all CF aircraft;

A2 - assigned to navigators, flight engineers, observers and helicopter reconnaissance observers who are medically fit for unrestricted duty in all CF aircraft where such positions are required;

A3 - assigned to those aircrew members for whom a medical restriction has been identified. An A3 classification will always clearly stipulate the specific limitations to be imposed;

A4 - assigned to all aircrew who are medically fit for unrestricted airborne duty but whose duties do not entail actual operation of the aircraft to which they are assigned. If such individuals were to become incapacitated they would not create a hazard to aircraft operation nor impede the safe return of the aircraft to the ground. An A4 classification may be annotated "While So Employed" (WSE) when it is assigned to members of MOCs which are not normally associated with flying. Air Traffic Control and Air Weapons Control personnel must also maintain an A4 category for unrestricted employment;

A5 - assigned to all non-aircrew members of the CF who are medically fit to fly as passengers in CF aircraft;

A6 - this grade is assigned to all CF members who are considered medically unfit to fly in any capacity; and

A7 - this grade is assigned to all aircrew personnel who are medically unfit for any flight duty in CF aircraft but who may still fly as passengers.

Temporary Grading

9. Occasionally, it becomes necessary to temporarily lower one or more factors of the medical category. The validity of such temporary reductions shall not exceed six (6) months, but a temporary category may be renewed once (i.e., maximum 12 months temporary medical category status). This time frame should allow an accurate estimate/assessment of prognosis for almost any medical condition. As soon as the member's condition is stable or is not expected to significantly improve in the foreseeable future, a permanent category should be assigned, even before the end of the 12-month period of temporary category. A statement regarding prognosis shall be made in Section 3 of the CF 2033 and Section 2 of the CF 2088 at the earliest reasonable time. In the rare case where additional temporary status beyond 12 months may be warranted for extenuating circumstances, the case must be reviewed by D Med Pol Standards.

Common Enrolment Medical Standard

10. A Common Enrolment Medical Standard (CEMS) is required for recruit candidates in order to ensure that they remain eligible for assignment to the widest range of MOCs. All applicants, except Canadian Rangers, must initially meet this minimum standard, although they may require a more rigid (higher) standard to enter/be assigned to some MOCs. The CEMS is:

V	CV	H	G	O	A
4	3	2	2	2	5

OR 432/22/5

Medical Standards for Military Occupations

11. The minimum medical category required for members in the various MOCs is shown at Annex E.

12. There are no minimum medical standards for Canadian Rangers, whether on enrolment or during their service. If required to assess Canadian Rangers, medical personnel should describe the applicable employment limitations and inform appropriate administrative authorities.