:
Good morning, everyone.
Pursuant to Standing Order 108(2) and the motion adopted by the committee on Tuesday, February 25, 2020, the committee is continuing its study of the backlog of disability benefit claims at the Department of Veterans Affairs.
We're very pleased this morning to have two different panels. On our first panel, from Union of Veterans' Affairs Employees, we have Virginia Vaillancourt, national president, and Mr. Mike Martin, communications.
Welcome to you both.
From the Royal Canadian Legion, we have Raymond McInnis, director, veterans services, Dominion Command, and Steven Clark, national executive director.
Thank you to all of you for being here.
Very quickly, I don't know if you've all been to a committee meeting before, but you'll each be given an opportunity to make opening remarks, and then we'll have questions.
My role is as referee to try to keep us on time.
I believe we're going to start with the Union of Veterans' Affairs Employees.
Ms. Vaillancourt, are you speaking today? The next 10 minutes is all yours.
:
Thank you for the opportunity to appear before the committee today. We're here this morning as representatives of the Union of Veterans' Affairs Employees, which is a component of the Public Service Alliance of Canada.
UVAE represents over 2,800 employees with Veterans Affairs Canada, including most of the front-life staff who deal with veterans and their families every day. We are here today to talk to you particularly about the work and challenges of case managers within Veterans Affairs Canada pertaining to their caseloads and the backlog of disability claims.
Veterans Affairs programs and services, like the needs of our veterans, are vast, complex and always evolving. Our case managers are one group of front-line staff who are subject matter experts in VAC services and benefits. They must understand applicable legislation and the various regulations, policies and acts that are used to determine eligibility for those services and benefits. They must know how to deal with mental health issues, crisis intervention, frustrated and sometimes angry clients and suicide prevention, and they must understand and use motivational interviewing techniques.
As you have heard from departmental officials and others, one of the major problems is that the backlogs and wait times for services continue to grow, and veterans are waiting longer for services. This is causing financial, physical, mental and emotional pain and hardships for veterans and their families. It is also having a direct impact on those on the front lines who are attempting to serve them. We wish we could tell you that this is a new development, but the backlog and increased caseloads for case managers at Veterans Affairs have been growing for years.
In 2015-16, the Minister of Veterans Affairs made a commitment to reduce case manager ratios to 25:1 in order to allow more time and focus on the needs of veterans and their families. This was also supported in a 2016 brief to the House of Commons by the veterans ombudsman.
Despite this promise and several attempts by the federal government since that time, VAC has failed to meet that target. By any metric, they have failed miserably, as you will see from the information we are about to provide.
This committee has already heard about the impact this has had on veterans and their families. This includes increased wait times and reduced services, fewer home visits, and fewer frequent physical and mental health interventions unique to the veteran population. This morning we will also tell you about the impact this is having on the front-line staff who work with veterans and their families every day.
When we learned that your committee was studying this issue, we started to gather information from case managers from across the country. In the last two weeks, we interviewed case managers from the regions about their caseloads, their working conditions and the impact this was having on their work and the veterans they serve.
My colleague Mike, who completed the interviews, is going to take over now and provide you with what he learned from those interviews.
There are a number of areas we wanted to report on from the interviews with our case managers. First of all, we asked them about their current caseloads. Here's what they told us. We would like to read this into the record.
This is how many individual veterans they are being asked to assist: 55, 55, 50, 66, 64, 56, 45, 53, 55, 40, 56, 46, 47, 50.
We asked if they could manage that workload. Here's what they told us: “Trying to manage this many cases is ludicrous, impossible”. “I'm trying to play catch-up, and I never can catch up”. “I try to make a difference every day, but this job is making me sick”. “I love my job and love helping vets, but I don't have the time to give them the attention they deserve”.
We asked about their working conditions. Here's what they told us: “We're just putting out fires; on to the next call”. “We don't have time to do proper intake, assessments, referrals, follow-up or consultation with providers”. “We used to do home visits every two or three weeks; now it's once a year”. “We're doing triage, focusing on high-risk cases, but even some of them fall through the cracks”. “We're dealing with complex mental health issues that need constant care and intervention, and we just don't have the time”. “Veterans and their families deserve better than this”.
The high caseloads and demanding working conditions have led directly to high staff vacancies and an employee retention problem, particularly at the case manager level within VAC.
In the Atlantic region, upwards of 25% of positions are vacant, and even more in bilingual areas. This is exacerbating an already difficult situation at the workplace. Here are some more quotes: “The pattern is to hire, train, give them their caseloads and then watch them transfer out or quit because of the workload”. “We've been short-staffed in our office for four years”. “The hiring process takes six months. That means we're without a body for at least that long”. “We need some incentives...to get people to stay as case managers. The turnover is killing us”.
Every single case manager we spoke to had suffered from stress and burnout to some degree. That included anxiety, sleeplessness, weight gain and physical, mental and emotional strain from their work. Here's some of what they told us: “We have to find outside ways to manage the stress. Some take leave, but then the workload is even higher when they come back”. “The intensity and pressure is relentless. Everyone in our office is suffering”. “Many vets are suicidal, and that has an impact on us. We take that home with us to our families”. “The support is just not there for staff”.
There were also some disturbing reports of bullying and harassment by managers within VAC toward the front-line staff. While this is not the case in all regions, some offices reported that negative attitudes and harassing comments by some of the managers made their already-stressful jobs even more difficult. Formal complaints did not achieve positive results, so this became another burden that case managers in those areas had to deal with, in addition to their heavy workload.
The backlog of disability claims has added another level of stress to the system for veterans and VAC staff. Case managers reported feeling it every day. Veterans and spouses are very angry and frustrated by the delays. They call and ask for information, and the case managers have nothing new to provide them. For the case managers, it is heartbreaking to see veterans and their families suffer, but they have no ability to help them. Even worse, this is a definite barrier to the case managers developing a positive working relationship with the veterans and their families. The trust is just often not there. Here are some of the quotes: “Vets are frustrated, angry and often screaming at us”. “We understand why they're pissed off. They don't have any money to live on”. “This impacts their treatment plans, and if their pension monies are held up, too, they are suffering. It hurts to watch this every day”. “Why does the website say it will take 16 weeks when it could take up to two years? Vets see that and they ask me what's going on. I have nothing to tell them”. “The veterans feel lied to, and so do we”.
The backlog has also created security concerns at a number of offices, including those located on bases. There is easy access and little protection for front-line staff. There were reports ranging from verbal abuse to threatening phone calls to actual in-person threats. Several case managers, male and female, reported feeling unsafe at work.
They have reported these incidents and local managers have requested action and additional security measures, but they are slow to be acted upon by headquarters. There is a quote: “Vets and their spouses yell at us all the time. I get it. They're frustrated and angry. But I have felt afraid for my physical well-being.”
On the GC case system and disengagement process, the changeover from the old CDSN into the new GC case system has caused and continues to cause problems for everyone in the VAC pipeline. From the case manager perspective, this change, as of April 1, 2019, was abrupt and not well planned. They do not feel adequately trained and they continue to have problems making the system work.
One of the impacts of this rapid change was that they received directions to disengage veterans who were on the old system as of April 1, 2019. They were given lists of veterans and asked to justify why those veterans were still on the system and were told to encourage them to transfer out of the programming into new streams like guided support.
This process felt and looked heavy-handed to the case managers who had to advocate for veterans who still needed support and had not gotten themselves to the point where they could be self-sufficient or employable. Yet in many areas there is continuing pressure to cut off veterans, and case managers are told they could be negatively affected if they do not follow this direction.
This is a very difficult time for case managers and the policy of active disengagement is still, to our knowledge, being actively pursued by VAC headquarters.
Another issue that was raised by many case managers when we spoke to them was the apparent change of direction by VAC when it comes to counselling services for spouses, children and families. Several case managers reported they had been directed to tell family members that they were no longer entitled to access counselling or to see a psychologist because of this policy change.
Understandably the clients are not happy about this change and the case managers are worried about the impact on spouses and children. Here are some quotes: “Kids are getting kicked off counselling when they have issues like 'If I'm good, maybe Dad won't kill himself'”. “Medavie Blue Cross has been calling social workers telling them they have to cut family members off”. “Cutting...family members off benefits like counselling is utterly ridiculous and short-sighted”. “I'm told to send these children to the provincial system, when I know there's a handful of programs and a year-long waiting list”.
I'll turn it back to Virginia for some recommendations.
:
We realize that we've only given you a snapshot of what we've heard and what is happening across the country when it comes to how veterans' services are being provided, but we hope you will appreciate that from the perspective of the front-line workers, the case managers, this is a system in crisis, and it has been in crisis for far too long.
When we were talking to them, we also asked them to give their recommendations to help fix this problem. Here are their recommendations for change.
First and foremost, they want the caseloads to be lowered as quickly as possible to a manageable level. Twenty-five may not be possible in the short term, but that should be a goal over time, but there should not be another five years of waiting. They've already been waiting for five years since the initial promise to reduce caseloads to 25:1. There must be immediate change for the benefit of our veterans and the employees.
They also demanded that Veterans Affairs Canada immediately hire more front-line staff to clean up the backlog and start treating veterans in a timely manner with the respect they deserve. This too is a situation that has dragged on far too long, and we hope this committee will press the government and the department for swift action in this regard.
They also want better support systems for employees, more training and support for employees, and higher level training and support for managers and supervisors to help them do their jobs more effectively.
Finally, they would like the federal government to review their job descriptions and classification levels to ensure that they fully capture the important work they are engaged in.
Thank you for inviting us to meet with you to raise the issues, concerns and recommendations of our case managers. They have given us their voice to bring you these messages. Their hope and ours is that positive change can come for the benefit of veterans, their families and those who have the honour to serve them. Our veterans deserve better.
:
Honourable Chairman, members of the parliamentary steering committee on veterans affairs, good morning. It is indeed a great pleasure to appear in front of your committee once again.
On behalf of our dominion president, Mr. Tom Irvine, and our members, my name is Ray McInnis—I use Raymond when I'm in trouble with my mother, but that's okay. I am the director of veterans services at the national headquarters of the Legion. I am a retired chief warrant officer. I served 33-plus years in the regular and reserve forces.
With me today is the Legion's national executive director, Mr. Steven Clark, and we thank you for the work you do for our veterans and their families.
We support your study of the backlog of disability benefits claims at Veterans Affairs Canada. In a minute, I'd like to share some evidence-based advice, but first, I want to outline very briefly how we are equipped to give such advice.
As you may know, the Legion has been assisting veterans and their families since 1926, through our legislative mandate in both the Pension Act and the Veterans Well-being Act. We are the only veterans service organization in Canada that can help veterans and their families with representations to VAC and the Veterans Review and Appeal Board. We do it through our trained, professional and government-security-cleared command service officers and their assistants.
To give you a sense of how busy we are, last year our command service officers prepared and represented disability claims on behalf of over 4,000 veterans to VAC and over 300 reviews and appeals to the Veterans Review and Appeal Board. We also counselled almost 1,100 veterans for various reasons.
In addition to legion command service officers, every branch has an active and trained volunteer service officer to respond to the challenges facing our veteran community. With 1,400 branches across Canada, you can see that our branch service officers offer an essential network of support. They do not complete applications to VAC, but they are often our first line of contact.
When we assist a veteran or family member with a first application or departmental review, it is a very thorough process, and we monitor a veteran's file for life, inclusive of reassessments. We don't send VAC applications unless they contain a confirmed diagnosis. I can tell you, it's a lot of work, but we take great pride in what we do.
Here's what's changed significantly. The majority of our complaints now are about the backlog. We are asked daily about the status of applications. This is even after veterans have visited their My VAC Account and used the wait time tool. They still call us.
Why do they call us? They call us because the wait time tool does not account for the thousands of applications Veterans Affairs has to process before it can even get to yours. The tool provides information on averages over the last 90 days, not what you can realistically expect based on both the current backlog and when your own application was submitted. For example, today you'll get a 54-week processing estimate for a single condition. That estimate would only be valid if there were no backlog.
We'd also like the department to be more transparent and modify the wait time tool to reflect reality. Not only do we receive many unnecessary calls; we can't even tell veterans with any degree of accuracy when their claim will be processed and the decision rendered.
We understand that the backlog is huge, and we do applaud the department for trying to streamline the decision process with veteran benefit teams, limiting the transfer of files and providing the authority to the teams to make the decisions, rather than requiring medical advisory consultation on the claims they do. They can also triage claims for disability benefits to expedite applications for veterans at a higher risk. We use it all the time for our “red zone” applications.
We also need to see consistency in the way that conditions related to certain occupations are handled. For example, we are seeing more unfavourable decisions rendered for those from the support trades who have musculoskeletal conditions, and we have discussed the issue with the department. We still don't have an answer on that yet, but it's there.
We are also supportive of the department's combining conditions that historically have been a consequence of the initial condition, as long as there's a confirmed diagnosis for it. It will be crucial to implement such measures as soon as possible.
I can tell you, I have been with the Legion for nine years, and I've never seen so many applications. We have reached out to veterans' organizations, including the Canadian Armed Forces and the RCMP to advertise our services. As a result, we have seen a steady increase in applications and departmental reviews right across the country.
The increase is also due to the change in what is referred to as the “partial entitlement” policy, which the department quietly changed in February 2018. The change benefited veterans who have received partial entitlements in previous years and can now apply to receive full entitlements in some specific cases.
This one change resulted in many more departmental reviews and appeals. As an example, historically, the Legion will complete approximately 80 departmental reviews in a year, but from August 2018 to December 2018, we completed 552. They were all favourable. In 2019, we completed 601 reviews, and most of these were due to the new partial entitlement policy.
In the end, we believe the department needs to further simplify its processes and get rid of some of the layers that may no longer be needed.
Finally, I'd like to share a couple of important points about the Legion's work, which may be good background for you and for your own work with veterans.
The Legion now offers a one-year free membership to all still-serving military members, retired military, RCMP and retired RCMP who have not yet had the opportunity to join the Legion. It is called the veterans welcome program. It is an opportunity to stay connected to the military and policing family, to honour and support those who served and sacrificed, and to strengthen the community.
Through our poppy fund, we raised and distributed close to $17 million in 2018 to support programs such as Leave the Streets Behind—our homeless veterans program—and to meet the essential needs of veterans and their families who have limited financial means. The poppy fund is available at all levels of the Legion and is accessible to veterans in need, including still-serving members and their families.
We work in close partnership with VAC and other funders to ensure our veterans and widows have a complete solution, so that they do not have to go without.
I will end on this thought. There is no quick fix to this major backlog. We do not see any end in sight. In fact, we believe that when the new transition groups are fully operational, more release personnel will be applying for benefits. There is a danger of the backlog becoming longer. We want to help the department avoid this disastrous scenario with some of the ideas presented earlier. We stand ready to help further.
Chairman, we thank you for the opportunity to make this presentation. We'd be happy to take any questions.
:
There are many areas. Hearing loss and tinnitus is a condition that is subjective. Once they have their entitlement, I see many veterans who start out at 2%, 4% or 6%, and they're coming back three and four times when they talk to their buddies and find out that they need a masking device at night. They probably already use a masking device in the form of a sleeping pill or a radio to go to sleep at night. If it is so subjective, which it is, why don't you just grant the tinnitus claims and then come up with an assessment that's comparable to what it is now from 0% to 11%, and if you've got it, you get it? If you don't have it, you don't get it. That's one easy way to take the tinnitus claims out instead of always coming back for an assessment.
As for PTSD, there are many conditions that are linked to PTSD once you start taking medication, so they're now looking at that because they'll will do one mental health condition and then they're coming back with GERD, or erectile dysfunction. Instead of doing another full application, just provide the diagnosis and have it linked to it.
Another part is departmental reviews. Three years ago, departmental reviews on Agent Orange.... The previous chair of VRAB returned them all to the department. They are still sitting with the department over two years later, and our veterans are very disgruntled.
When they write to the department, the department goes back and tells them that it's because of the backlog. It's not because of the backlog; it's in legal review. Be upfront, be transparent, and tell them why it's not being done, or do something about it. Just be transparent.
It's the same with the wait time tool. Let the veteran know what month you're working on. You're working on August 2018 on single condition, first applications. Tell them that, and then use the wait time tool from there. Just be transparent. The veteran will be happier. It will be in the ballpark, because right now we're throwing darts at a board as to when to expect a decision.
:
The front-line staff never see a bonus. Unfortunately, the employees who obtain the bonuses are the EX levels, and that's it.
Actually, we recently completed an ATIP request regarding the performance pay bonuses that the EX levels get. In 2017-18, the employer paid out over $1.04 million in bonuses. In 2018-19, they paid out over $1,051,477 in bonuses. For instance, the EX-1 levels, which are area directors and some of the branch directors, got over $8,000 in 2018-19. The EX-4s, which are the ADMs or the director general levels, got over $56,000 in bonuses at the end of December, which is disheartening to see.
Of course, when you do the ATIP request for the ADM for service delivery, they black it out because there's only one. I can only imagine that if the EX-4s are getting $56,000, his will be much higher.
We are continuing our study on the backlog in disability benefit claims with our second panel this morning.
From the Veterans Review and Appeal Board, we have Mr. Christopher McNeil, the chair; and Jacques Bouchard, the deputy chair. We also have, from the Canadian Armed Forces transition group, Major-General Andrew Downes, surgeon general, commander of the Canadian Armed Forces health services group; Brigadier-General Mark Misener, commander, Canadian Armed Forces transition group; and Mr. Brock Heilman, chief informatics officer, Canadian Armed Forces health services group.
Thank you to all of you for being here today on this beautiful, almost-spring morning. We're going to get started with the Veterans Review and Appeal Board. I believe, Mr. McNeil, you're going to start us off. The next 10 minutes is all yours.
Mr. Chair and honourable committee members, thank you for the opportunity to appear before you today.
With me, as you know, is Jacques Bouchard, and I'm going to share my comments with Jacques today. I should note that Jacques is also a veteran of the Canadian Armed Forces.
At a high level, the primary mandate of the board is to ensure that veterans and their families receive the disability benefits to which they are entitled. We provide an independent appeal process to veterans, members of the Canadian Armed Forces, the RCMP, and their families who are dissatisfied with the outcome of their disability claim, either a denial of that claim, or they disagree with the extent of the disability being awarded.
VRAB offers two levels of review, an initial review of the Veterans Affairs decision and a further appeal if veterans remain dissatisfied with the initial review of the board. However, it is important to note that there is a third level of review, and veterans can always bring forward new evidence or a new argument and request that the previous decision of the board be reconsidered.
The board's role in the overall disability process is unique. Most importantly, it is often the first and only opportunity for veterans to appear in person and tell their story. Critical to our work is the legislative mandate to conduct our hearings in an informal and non-adversarial manner as much as possible. Regrettably, I acknowledge the board may not have always lived up to that promise. Jacques and I are committed to ensuring that we provide a hearing environment that is comfortable and welcoming to veterans and their families.
Over the past 18 months, we have aggressively reviewed and updated our process and training in this regard. More specifically, we are creating a more informal, less legalistic and more compassionate approach. This is especially important since many of the veterans who appear before us are vulnerable, and they face challenges simply meeting the daily activities of living.
Approximately 40% of the veterans who seek disability benefits have both physical and mental health concerns. We must have a system that is welcoming to veterans and their families and gives them the best opportunity to advocate for the disability benefits to which they entitled.
It is also important to note that, over the past two years, both the nature and the volume of our work has changed. The changes made by VAC resulting in higher favourability rates at the first application stage have caused a change in the nature of the cases we are hearing. For example, we are hearing more cases about the quantum of the disability being awarded rather than whether a disability was awarded.
In addition, VAC's implementation of more favourable policies on entitlement has created a boomerang effect. These positive initiatives have helped to process current claims faster and more favourably, but it has also opened the door for veterans previously denied entitlement or entitled at a lower level to come forward and have their claim reviewed. This is indirectly adding new claims to the mix.
In the last few years, we've heard about 5% of VAC's overall decisions for review. In 2018 we heard approximately 2,000 cases. This year we are experiencing a dramatic increase in the applications over last year, primarily due to the boomerang effect.
However, these challenges have created opportunities. For example, we have implemented a simplified hearing process for certain types of claims. This has allowed us to dramatically increase the number of cases we have been able to process and hear. A simplified hearing process provides a quicker, more streamlined option for veterans to have their cases reviewed. It has freed up capacity in the regular hearing schedule to hear more complex cases more quickly. In addition, it has the potential to ease the caseload burden at Veterans Affairs at the departmental review level.
I'd like to ask Jacques to tell you a little more about those things that we've been doing.
Mr. Chair and honourable members of the committee, I'm pleased to be speaking to you this morning.
I'll focus my remarks on the board's efforts to improve the veterans' experience by increasing its capacity to work, including through the implementation of a shortened or simplified process.
This approach enables us to group together cases that are less complicated and that more closely target similar concerns for which the outcomes are predictable. The shortened hearing process has generated a number of positive outcomes. We're hearing more cases in a much shorter period by using our resources more effectively.
We've also found that the decisions are predictable and consistent. As a result of the shortened process, we've heard approximately 400 cases and we expect to process 300 more cases in the near future. For example, this week, we heard 71 cases in a single day, whereas it would have taken us at least four weeks to reach that point with our usual process. Our goal is to give veterans our decisions as quickly as possible.
In summary, this shortened approach gives veterans and their families better and more timely access to justice. As we continue to simplify the shortened hearing process, we expect to receive even more claims from veterans and their families. Already this year, we're seeing a significant increase in claims received and hearings held compared to last year. To better respond to this upward trend, we must increase our capacity to process cases informally and in a less legalistic manner.
We're also pleased that the minister has supported our recent request to hire additional members of the Veterans Review and Appeal Board to help us address the increase in the number of cases. These job offers have been posted since March 2.
[English]
On behalf of Chris and myself, I would like to close by saying that the Veterans Review and Appeal Board is committed to ensuring that veterans and their families can obtain access to disability benefits while we build more capacity to further support those we serve.
Thank you for inviting us to appear before you today. We would be pleased to respond to any questions you may have.
Thank you.
:
Thank you, Mr. Chair and members of the Standing Committee on Veterans Affairs.
Thank you for the opportunity to be here today to provide information for your study and to answer questions on the subject of transition from the Canadian Armed Forces.
In 2017, the government launched the defence policy Strong, Secure, Engaged. Under this policy, a new Canadian Armed Forces transition group was stood up in December 2018 to support ill and injured members and to enable all Canadian Armed Forces members to seamlessly transition to post-military life.
As the commander of the Canadian Armed Forces transition group, I am responsible for ensuring that Canadian Armed Forces members and their families are provided with personalized, professional and standardized casualty support and transition services, whether they are returning to service or transitioning to civilian life. We are particularly targeting those who are ill and injured. Today, approximately 1,500 ill and injured personnel are posted to my unit for periods of six months or more. I am also directly supporting another 3,500 ill and injured members and their families by providing information, advocacy, referrals and delivery of numerous programs and services.
Services and support are provided to CAF members and their families through an integrated team with Veterans Affairs Canada and numerous other partners. Approximately 550 military and civilian staff members are organized into nine transition units and 32 transition centres, which are located on bases and wings across Canada and at the transition group headquarters here in Ottawa.
As the commander of the Canadian Armed Forces transition group, my current priorities are to continuously improve the care and support for our ill and injured members, their families and the families of the fallen, to implement a renewed and improved transition experience and to grow transition capability and partner integration.
We have made significant progress over the last three years by implementing innovative initiatives, improving existing programs and growing capacity to improve military members' experience as they transition to post-military life.
[Translation]
The Canadian Armed Forces transition group aims to provide professional, personalized and standardized support. Professional support means a transition group that's adequately resourced, with personnel in place who are properly trained. It also means a deepening integration with Veterans Affairs Canada, or VAC, to provide more closely coordinated service.
“Personalized” means a needs-based approach, which tailors services to the individual and their family. Lastly, “standardized” means that the same services are available to every member of the military and their family as they experience transition. This is an ambitious and complex undertaking that will take some time to build. Therefore, we've also launched the transition trial at Borden to implement some new initiatives and to test and adjust them prior to implementing them throughout the Canadian Armed Forces, or CAF.
Since transition is a shared responsibility between the CAF and VAC, close coordination and integration between both departments is vital in ensuring a successful and seamless transition from military to civilian life. Together with VAC, we've improved and we continue to enhance programs and services and to introduce new programs and services that are more aligned between the two departments.
The goal is to better enable our personnel to successfully transition to civilian life by improving training and readiness, promoting recruitment and employment, and nurturing collaboration between the sectors that employ veterans. Close collaboration and ongoing work continue with our VAC colleagues through the joint steering committee governance framework and joint priorities that keep changing based on mandates and government priorities.
[English]
It's an inevitable reality of military service that everyone will eventually transition out of the forces. Being exposed to transition-related information and education earlier in a member's military career will positively contribute to both member and family readiness and ease the reintegration back into civilian society.
The transitioning member and his or her family need to be fully prepared to re-enter civilian life by creating a comprehensive transition plan, a plan that addresses the entire spectrum of what it takes to be ready to transition: health, purpose or employment, financial, housing, social support and integration, and life skills. Therefore, numerous transition resources and tools have been created to enable CAF members and their families to better understand and plan for this inevitable transition.
[Translation]
In summary, my goal and the goal of the Canadian Armed Forces transition group is to ensure that all CAF members and their families are informed, prepared and empowered for a successful transition. This is an ambitious endeavour and one that we've made much progress towards, but also one that will require more effort and time to complete. I want to thank the committee again for this opportunity to answer questions.
:
Mr. Chair and members of the Standing Committee on Veterans Affairs, thank you for the invitation to discuss elements of the Canadian Armed Forces health system and our strong working relationship with Veterans Affairs Canada. I'm joined by Brock Heilman, a retired colonel and our chief informatics officer.
[English]
As you are likely aware, the Canada Health Act specifically excludes Canadian Forces members from provincial and territorial health insurance programs. lnstead, the Canadian Forces has its own equivalent health system that provides comprehensive medical and dental care to military members and other entitled persons in Canada and at bases and operations overseas.
[Translation]
The Canadian Forces health services group, made up of a wide range of military and civilian professionals, is the organization responsible for the operation and care delivery in this health system.
[English]
We are able to provide most of the required care directly through our network of primary care clinics at 37 locations, but there are services we have to purchase from the civilian health sector, like in-patient care, advanced diagnostics, and care from certain clinical specialists and other health service providers.
[Translation]
Our electronic health record, known as Canadian Forces health information system, or CFHIS, is available in all our clinics, as well as on deployed operations and aboard Royal Canadian Navy ships.
[English]
The CFHIS is an important platform enabling team-based care and integrating different departments in the clinic like primary care, mental health, dental and physiotherapy. It also facilitates care to our highly mobile military population, as the health record is available regardless of which military clinic a member attends.
The CFHIS is also a useful tool in sharing medical information with VAC. Over the past couple of years, the CAF has worked very closely with Veterans Affairs to create the technical, privacy and logistical conditions to allow VAC adjudicators to directly access CFHIS files for CAF personnel who have applied for VAC benefits.
[Translation]
The Canadian Forces health services group is committed to the provision of high-quality care to protect and optimize the health of military members, and to ensure that those leaving the CAF are able to transition back to the provincial and territorial health systems as smoothly as possible.
[English]
I would like to thank you for your attention, and we look forward to your questions.
:
Thank you very much for that question.
This is a very important issue for us as well, because we know that a successful transition requires people to have faith in the system and to trust the services that are being provided.
In the health services group, we have done what we can, as I mentioned in my opening comments, to provide the information in as timely a fashion as possible, and also to provide it in a way that makes it easier for the adjudicators to access.
I think an important distinction that needs to be highlighted is that when we're providing care to military members, it doesn't matter to us whether the person was injured or ill as a result of duty or not. We treat them the same way.
Veterans Affairs adjudicates based on the link to service, so they have a somewhat different mandate, and perhaps they would be better positioned to answer that part of the question. They also have to consider the degree of a disability, and so on, which is not something we're focused on. We're focused on the provision of care to return the person to the best level of health we can.
:
That's a totally valid point.
To make a further link, I'll go over to you, General Misener. I was shocked at how many currently serving people have reached out in the last couple of weeks as we stood up this committee to focus on the backlog issue. VAC explained, in its previous testimony by some of its officials, that part of the challenge with currently serving personnel is that diagnosis is not complete. However, this backlog issue is big.
I think you're in a unique position for these currently serving people. Some of them aren't working for you directly, because some of them actually still serving in operational units, because, despite the claim that they're entitled to, they still completely meet the universality of service and can keep serving.
As they're transitioning out, I think there's an opportunity here for you, the CAF and DND, to utilize your expertise and efficiencies. Sometimes you have your own challenges, but at the same time, in my viewpoint, you are more efficient than maybe VAC to help prepare those cases so that as people transition out, they're not contributing to the backlog at all because you've prepped them and prepped those files, much like the Legion helps a lot of people who reach out that way.
Would you care to comment on that, please.
It's great to see a fellow Nova Scotian here. Thank you for being here, all of you. It's much appreciated.
I wanted to ask a question, first, to your group.
I understand that VAC has been reviewing the findings of VRAB—which I think is what you called yourself, if I can use that abbreviation—in an effort to understand how they can do better. VAC reports that its approval rate has increased by approximately 20%, which I think is a great outcome.
I wanted to ask you, first of all, if you sense that change. Second of all, digging a little deeper on this, what do you see as the main reasons that the board is disagreeing with VAC? Could you talk to those two things, please?
:
Yes, and Ray McInnis talked about it.
At VAC, early in 2018, our legislation essentially allowed us to award entitlement on a full basis or on a partial basis. VAC reviewed those partial entitlements and realized that there was a huge subjectivity in it: there was no fairness in the system, and two veterans similarly situated could end up with two different amounts of disability. So they implemented a policy that essentially said that if you have partial entitlement, everybody will be awarded four-fifths or five-fifths. Obviously, that opened the door to a whole bunch of people who had been previously awarded at one-fifth, say, to come forward and say, “I want the benefit of the new, more favourable adjudicator”, and there's simply no provision needed on basic principles of fairness or in law to deny them that opportunity to bring it forward, and so all of those cases are coming back.
On hearing loss and tinnitus, between us and VAC, I'd say in excess of about 95% has been awarded in the last year. There are a whole bunch of hearing loss cases out there. Hearing loss was much more restricted when I started five years ago, and you had a very difficult chance, unless you could establish something. So there is a group of veterans who are now bringing it forward and saying again that, “I want the benefit of that more favourable, more informed, updated policy”, and we must give them that opportunity.
:
Thanks very much for the question.
I guess to answer directly, I think we're doing fairly well on it. Since we stood up the transition group, we've grown our capability in the organization. I've also been able to up-rank the rank of the commanding officers and, therefore, devolve more authority down to them. That's also allowed me to implement a protocol for readiness to transition. Right around the time we stood up, I've asked them all, I've directed them all, that before anybody gets out, they're going to do a transition interview directly with them and their sergeant major.
Really what we're doing is working through it, in an interview, one-on-one or they can bring their family with them. We're working through the domains of well-being to assess their readiness to transition. I talked about professional, personalize, standardize, and on a very personal level, we're looking at each of their domains of well-being and assessing. Therefore, regardless of what happened before, sort of 90 to 100 days before they leave, we're looking at where they are, if they're ready for transition and, if not, if they need more time and what would they do with it.
Generally, it's to learn more about ourselves. It's to confirm that we've done a good job, and if not, it's also just to confirm if there's anything else we can do in a reasonably short amount of time to better prepare that member and the family to transition.
:
Yes. Thanks again for the opportunity.
I guess I would say I think it's ongoing, but it's that continuous collaboration.
When it comes to transition, we have a fairly robust governance structure set up with Veterans Affairs called the joint steering committee. In that, we have the seamless transition task force that has implementation teams below it. These are joint teams where we sit together, work together very closely, whether we're trying to improve something or introduce something, and I think that's key. It's back to what General Downes said: Avoid the unintended consequences. Make sure that, because there are two departments doing different things, when one side is envisioning doing something, the other side is well aware and mitigates those unintended consequences, and vice versa.
I guess the last thing is that close collaboration continuously improves. There's a lot of work going on in Veterans Affairs and with us in the digitization realm. It's trying to be smart, smart in how we bring this to bear; and again it's what General Downes says, getting something right before we move on to the next thing.