Keratoconus Entitlement Review, 2026 CanLII 107034

What happened

The keratoconus review arose under section 45 of the Veterans Well-being Act. A serving member of the Regular Force applied in January 2024 for pain and suffering compensation for keratoconus, a progressive thinning and bulging of the cornea, in the right eye. Veterans Affairs Canada denied the claim on May 6, 2025, and the applicant sought review before an Entitlement Review Panel of the Veterans Review and Appeal Board. The panel heard the matter on April 15, 2026.

The panel accepted the diagnosis and found the condition a permanent disability. The only open question was whether service caused, aggravated or contributed to it. On that question the applicant relied on a two-page letter dated July 4, 2025 from the applicant's nurse practitioner, written for the review. The author was a treating clinician giving a supporting medical opinion, not an expert retained for litigation. The letter was nonetheless the only medical evidence connecting the condition to service.

What the court did

The panel began by recognizing the letter's force: "At first glance, that medical opinion is strongly supportive of the causes of Keratoconus identified by the Applicant." It then reviewed the cited references and set out three of them:

• A government guideline that does not exist. The letter cited a 2023 Veterans Affairs Canada Entitlement Eligibility Guideline for eye conditions. The panel wrote: "There is no such EEG. Rather, it appears that the AI “hallucinated” a Government of Canada policy that would be supportive of the opinion."
• Two journal articles that could not be found. One was attributed to Clinical and Experimental Optometry, the other to Investigative Ophthalmology & Visual Science. The panel followed the links, checked each journal by issue, date and page, and searched by author and title. The articles "could not be found in these journals – or anywhere else."

The panel went beyond the citations. It could not find supporting scientific literature for most of the letter's medical conclusions and concluded that the substance of the opinion also appeared to be AI-generated and false. Unlike many decisions in this record, the keratoconus decision states AI use as a finding: "it has become clear that this clinician used Artificial Intelligence (AI) in generating their opinion and references." It added that the clinician "did not check the sources which formed the basis of their opinion." The holding on the evidence was one sentence: "The Panel finds that this medical opinion is not credible."

The panel then quoted guidance from the clinician's provincial nursing college on misinformation and on AI in nursing, including the standard that a nurse "uses credible research findings and applies evidence-informed practices," and observed that, on its face, the clinician appeared to be in breach of the standards of practice.

Where it stands

Without the letter, the panel found no credible medical evidence of a service relationship. It denied entitlement both for special duty service in Iran and Iraq and for Regular Force service. The decision notes the right to appeal to an Appeal Panel of the Board, which may affirm, vary or reverse it. The decision does not record any referral of the clinician to the college. No appeal decision was located as of October 21, 2026.

The keratoconus review is a benefits proceeding, not litigation, but its mechanism mirrors the expert matters in this record. As with the declaration excluded in Kohls v. Ellison, the tribunal set aside the opinion as a whole rather than the bad citations alone.

The obligation it engaged

Clause 4 of the Standard, checkability before adoption, is the clause the panel's method illustrates. It tested each reference by link, issue, page, author and title, which is the check the author should have run before signing. Clause 3, independent authority, follows: the letter attributed a position to a guideline of the very agency whose decision was under review, and the guideline did not exist. Clause 2, non-delegation, is engaged by the panel's finding that the substance of the opinion, not only its references, appeared to be machine-generated.

Clause 8, disclosure, is also engaged, since nothing in the decision indicates that the letter disclosed any AI use. The lesson for an expert witness reaches treating clinicians who write opinion letters: a supporting opinion is evidence, and a tribunal will weigh its references as closely as a retained expert's. In the keratoconus review, one invented guideline cost the applicant the only evidence on causation.

Sources

• Veterans Review and Appeal Board (copy hosted for the AI Hallucination Cases database) · April 15, 2026
  Keratoconus Right Eye, Entitlement Review decision, 2026 CanLII 107034

What could not be confirmed

The decision gives the hearing date (15 April 2026) but no separate decision date; the entry dates it to the hearing. The clinician and the applicant are not named here by design; the nursing college is redacted in the decision body and is not named here. The actor label is approximate: the author was a treating nurse practitioner giving a supporting opinion, not a retained litigation expert. The CanLII copy was not opened; no appeal decision was located as of 2026-10-21.