ACVA Committee Report

Committee Recommendation 4

That the Canadian Armed Forces provide to the Committee an analysis of the causes of the current instability in the senior ranks of the Joint Personnel Support Unit.

Government Response

The Government does not agree with the Committee assessment that there is instability in the senior ranks of the Joint Personnel Support Unit. However, the CAF will provide the Committee with the requested analysis regarding turnover in leadership at the Joint Personnel Support Unit by December 2018.

Joint Personnel Support Unit staff vacancies, including vacancies at leadership positions, fluctuate in relation to factors which may include: ongoing staffing processes, retirements, regional availability of personnel, and extended leave. While turnover in leadership, including at the Joint Personnel Support Unit Headquarters, is a normal part of CAF operations, the Joint Personnel Support Unit organization is an all-around team effort where leadership is empowered throughout the organization from the Joint Personnel Support Unit Headquarters in Ottawa, to the regional components of the organization established across Canada.  

While personnel turnover can disrupt ongoing operations, the CAF has a mature personnel management system and makes a concerted effort to anticipate such turnovers before they occur and implement mitigation strategies to minimize impacts.

Joint Personnel Support Unit Renewal has resulted in the allocation of approximately 125 additional positions over the last two years. Many of these new positions are at senior rank levels, which will improve the functioning and services provided at the Joint Personnel Support Unit.

Committee Recommendation 5

That the Canadian Armed Forces prioritize the appointment of ill or injured members to its senior ranks, and provide measurable targets to monitor its progress.

Government Response

The CAF have a flexible and holistic approach to managing the employment of ill and injured members, including to the senior ranks of the Joint Personnel Support Unit. The Government is committed to ill and injured members and to ensuring that opportunities provided to them match their needs and aspirations. For example, for some ill and injured members, the Joint Personnel Support Unit will not be a suitable work environment, while for others it will provide challenging and meaningful employment. The Government is concerned that introducing measurable targets to monitor progress may have the unwanted effect of posting ill and injured members to the Joint Personnel Support Unit staff only to meet a target, when other, more suitable, positions are available to them.

The CAF will pro-actively offer Joint Personnel Support Unit staff positions to ill and injured members, when such employment is in line with the members’ medical employment limitations, which remains a paramount consideration.

Committee Recommendation 6

That the Canadian Armed Forces apply a measure of flexibility to the principle of Universality of Service, and that a modified duty category for suitable members be established.

Government Response

The Universality of Service principle provides that CAF members must be able to perform general military and common defence and security duties. This includes the requirement to be physically fit, employable and deployable for general operational duties. The Universality of Service principle allows the CAF to rapidly and effectively mount and sustain operations and to fulfill its defence mandate.

In line with Canada’s defence policy – Strong, Secure, Engaged – the CAF is undertaking a review of the Universality of Service principle with the intent of updating its policies, including the minimum operational standards.

Committee Recommendation 7

That the Government of Canada make the Department of National Defence responsible for the decision to attribute the cause or aggravation of an injury or illness to military service.

Government Response

Although the Government does not agree with this recommendation, VAC and the CAF are exploring mechanisms to improve the speed and quality of information being shared between departments. This will assist in simplifying and accelerating the process of attributing a disability to CAF service.

The decision regarding attribution to service is not a medical function; it is an independent administrative function that takes into account not only medical information, but also the findings from investigations and career information such as deployment and posting timelines that are not managed by healthcare providers in the CAF.

VAC has the mandate, personnel and experience to carry out the adjudication process and will continue to be required to maintain this capability to process applications from both members and Veterans. The vast majority of Veterans who apply for disability benefits do so after their release. Only approximately 25% of CAF members who apply for disability benefits do so prior to their release and the Government is working hard to ensure these applications are processed expeditiously and benefits are in place prior to release. Maintaining VAC as unilaterally responsible for the decision to attribute the cause or the aggravation of an injury or illness to military service for all Veterans would ensure consistency of decision-making and avoid duplication of services.

The importance of the physician/patient trust cannot be understated. Creating a system within the CAF to attribute the cause or aggravation of an injury or illness to military service would severely challenge the doctor-patient relationship and the integrity of physicians and health care providers in the CAF.

Moreover, in compliance with licensing body policies, treating physicians are not allowed to make a determination of fault or causality to eliminate potential conflict of interest and safeguard the doctor-patient trust. These determinations are made by third party examiners, who provide objective conclusions. As such, military physicians and civilian physicians working for the CAF have the right to refuse any direction that is contrary to their licensing body policies since ignoring these policies would place their license to practice at risk.

Committee Recommendation 8

That the Canadian Armed Forces provide more stringent guidelines to strongly encourage Canadian Armed Forces members, officers and medical personnel to fill out the Report of Injury, Disease or Illness (Form CF 98).

Government Response

Clear guidelines for the completion of the Report of Injury, Disease or Illness form are published in Defence Administration Orders and Directives. Commanding Officers are responsible to ensure that their personnel fill out the Report of Injury, Disease or Illness, when required. This duty will be further reinforced within an upcoming directive from the Chief of the Defence Staff.  

Committee Recommendation 9

That Veterans Affairs Canada, when it receives an application for benefits or services, inform the applicant of the approximate time required to process the request, and inform the applicant when the delay is extended.

Government Response

VAC has a number of initiatives underway to provide more timely and transparent information on application processing times. For example, applicants can check the status of their application and view a summary of their benefits through My VAC Account. The number of Veterans with a My VAC Account has nearly doubled over the past year, with more than 75,000 Veterans now using My VAC to access up to date information on their files. Furthermore, despite an increase of applications, the Department has made positive strides to reduce the complexity of the application process and decrease the amount of time applicants must wait for a decision.  The work to reduce complexity of application processes includes decreasing the number of forms. On this front, significant progress had been achieved in May 2017, when eight common VAC Medical Questionnaires were simplified, reducing them from 17 pages to two pages.

In addition, with the implementation of VAC’s new suite of 'Pension for Life' benefits in April 2019, My VAC Account will include enhanced status tracking for Pension for Life benefits. This enhanced status tracking will enable applicants to understand the process, the status of their application, and the estimated date of completion.

Going forward, the Department is developing a suite of revised service standards that will be meaningful to Veterans and their families. The goal is to ensure VAC’s service standards reflect realistic processing times so Veterans have accurate information.

Committee Recommendation 10

That the Canadian Armed Forces (CAF) add an electronic device to military identity discs to make it easier to transfer information over multiple deployments, and that the information on this device be sent to Veterans Affairs Canada when a CAF member is released.

Government Response

The current system uses identity discs (or ‘dog tags’), which are engraved with the CAF members’ Service Number, initials and name, religion, blood type and ‘CDN FORCES CDN’, in line with Geneva Conventions and best practices. These discs are issued to recruits soon after enrolment and releasing members may keep them. All information, including from both deployment and home-base service, is captured within CAF information systems. The Service Number acts as the personal identifier for each member and is applied to the software programs that track the member’s information to update and transfer it in an efficient and secure manner. Although information is currently transferred on an as-requested basis, significant efforts are underway to streamline and improve the timely and unimpeded access to relevant information.

Electronic devices would pose privacy and security issues. For example, encryption would be difficult and sensitive data could be easily accessed. Furthermore, loading and transferring data on devices would be challenging and would require standardization among hardware and software to allow for interoperability. This would represent a duplication of effort given that using the system described above achieves the same result.

Committee Recommendation 11

That Veterans Affairs Canada and the Canadian Armed Forces provide, through the Military Families Resource Centres, programs for spouses and family members on the challenges they may face during and after the military members’ transition to civilian life.

Government Response

The Military Family Services Program (MFSP) is the Canadian Armed Forces-wide community-based support program delivering coordinated, consistent national services for families, as well as a framework for families and communities to influence and manage local priorities and services.

The program has three components:

• all 32 Military Family Resource Centres, located on CAF bases and wings across Canada;
• the Family Information Line – a confidential, personal, bilingual and free service offering information, support, referrals, reassurance and crisis management, for members, Veterans and their families (immediate and extended) accessible by phone or online; and
• CAFconnection.ca – an online tool helping members, Veterans and their families connect with CAF communities locally and throughout Canada.

Recognizing that transition from military to post-service life can be challenging for military families, VAC and the CAF introduced the Veterans Family Program (VFP) in October 2015, to support the unique needs of medically releasing CAF members and their families. On April 1, 2018, the program expanded to include all medically released Veterans and their families.

The VFP provides CAF members, medically released Veterans and their families with training, information and support to transition with success not only individually, but with their families. It also provides:

• information and support for caregivers, especially those providing care and support to Veterans living with an operational stress injury;
• information and support to families in preparation for and adjustment to transition from military to post-service life
• training in mental health awareness that promotes the reduction of stigma and recognition of common mental health problems, and
• financial planning.

In addition to the VFP, Veterans and their families are eligible to receive:

• assistance through VAC’s case management services;
• assessment, diagnosis and treatment from the Operational Stress Injury Clinics; and
• mental health awareness through the Veteran-specific Mental Health First Aid program.

Veterans will also be eligible for assistance through Military Family Services, which should be recognized as the subject matter experts for all services relating to the support of military families in the CAF.

Committee Recommendation 12

That the Canadian Armed Forces, in cooperation with Veterans Affairs Canada, offer training to all releasing members and members of their families to prepare them for civilian life.

Government Response

The Committee’s recommendation correctly points out that it is not just CAF members, but also their families, who could benefit from training about the transition to civilian life. The existing educational programming, the CAF Second Career Assistance Network, is currently being expanded and placed online to allow members and their families to access information related to transition whenever and from wherever they like. In addition, transition training and education will be introduced so members and their families are made aware of the domains of well-being and the important factors to consider prior to transition.

VAC’s Career Transition Services further helps releasing members, Veterans and their spouses or common-law partners when it comes to finding a career that is best suited for them post-service. The program offers qualified career counselors who understand the challenges of career transition, provide one-on-one career counseling, and help with resume writing, interview preparation and job-finding assistance.

Committee Recommendation 13

That Veterans Affairs Canada (VAC) review the overall well-being, including topics such as financial security, access to housing, and mental health status of Veterans, to ensure they are sufficient, and prepare a report detailing their findings every five years; and that VAC identify ways to capture data on families where possible.

Government Response

The Government of Canada expects all federal departments to embrace performance measurement practices, including full implementation of the 2016 Policy on Results. As part of this Policy, departments are required to maintain a Departmental Results Framework (DRF), which is published annually through their Departmental Plans and later reported on through their Departmental Results Reports. VAC recognizes the importance of regularly monitoring and reporting on results to adapt programs, benefits and services to better support Veterans and their families. Ensuring Veterans and their families maintain a high-level of well-being across a broad array of indicators is an important priority. In fact, VAC’s DRF includes multiple indicators directly related to well-being.

VAC’s DRF includes a range of performance measures to monitor and report on how Veterans and their families are managing and thriving in post-service life. For instance, there are indicators to gauge both Veterans’ physical and mental health, as well as financial security for Veterans and their families. These are just two areas of the DRF, with others helping to paint a more complete picture. For all of these indicators, VAC collects data on a regular basis, which puts the Department in a strong position to entertain requests for specific information.

2018-19 Departmental Results Framework (VAC)

There are other opportunities to track the well-being of families as a whole. Enrollment and participation in programs and benefits – such as Career Transition Services, the Caregiver Recognition Benefit, and the Education and Training Benefit – will also be important sources of data to dive deeper into how spouses and children transition to post-service life.

Specific to the issue of housing, the Government launched Canada’s first ever National Housing Strategy in November 2017, recognizing that housing is a key aspect of building an inclusive society and providing economic security for all Canadians. This 10-year, $40 billion plan focuses on meeting the needs of vulnerable populations, including Veterans and a number of other groups. Under the National Housing Strategy, legislation will require the Government to table a detailed report every three years on progress toward the Strategy’s targets and outcomes. VAC will work the CMHC to ensure data on Veteran Housing and Homelessness is used to inform decision-making.

The initiatives above, combined with VAC’s risk-based internal audits and evaluations, will enable the Government to assess and report on Veterans’ well-being on an annual basis.

Committee Recommendation 14

That Veterans Affairs Canada accelerate its process to approve services by third parties on the list of authorized suppliers when case managers or service officers determine that these services would help Veterans make a successful transition.

Government Response

VAC is committed to provide approvals and authorizations for services from third parties as expeditiously as possible. Direct and early communication between the service provider and the Veteran’s case worker will help ensure timely pre-authorization.

The process of assessment and diagnosis by appropriate health professionals is important and critical to developing successful treatment plans for Veterans. For some Veterans, assessment and diagnosis may need to take place over a period of time, especially if their health issues are complex.

The current process is: 1) VAC staff obtains the required information from the Veteran and the service provider and approves services. The approval is effective on the date this decision is made; 2) VAC notifies Medavie Blue Cross immediately of the decision; and 3) Medavie Blue Cross notifies the service provider of the approval. VAC contracts with Medavie to process treatment benefits on its behalf.

Committee Recommendation 15

That the Canadian Armed Forces and Veterans Affairs Canada harmonize treatment options offered by healthcare professionals to transitioning serving members and Veterans.

Government Response

The CAF and VAC are committed to aligning health related benefits and services where possible to help ensure a seamless transition for serving members and Veterans.

The CAF and VAC Medical Oversight Implementation Team and the Administrative/Direct Report Initiative Team are currently reviewing gaps and differences between the CAF spectrum of care and VAC healthcare benefits and services. While recommendations and action plans are in development, implementation of some initiatives has already begun. For example, the CAF and VAC Alignment of Medication Formularies working group has completed and implemented alignment of mental health, musculoskeletal and analgesic formularies (list of approved drugs).

Currently, members who are medically releasing have a medication review as part of their transition process. This review highlights any medications they are taking which might not be covered under VAC's formulary. In those cases, steps are taken to ensure entitled coverage will continue after release for eligible Veterans.

This process, however, does not happen for all releasing members. In an effort to bridge any potential gap in service, CAF and VAC have been working closely to align drug formularies. The two departments have been reviewing drugs one class at a time and have recently completed a review of 113 medications used to treat mental health conditions and made the appropriate changes to ensure continuity.

For example, VAC has recently added the drugs Doxepin (trade name Silenor) and Lamotragine (trade name Lamictal) as regular benefits in the drug formulary to match the CAF drug benefit list. Eligible Veterans would now be covered for this drug in the same way by VAC as they would have been while serving in the CAF.