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ACVA Committee Report

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Government Response to the House of Commons Standing Committee on Veterans Affairs report entitled
Depleted Uranium and Canadian Veterans

The Government of Canada is pleased to respond to the Eleventh Report of the Standing Committee on Veterans Affairs: Depleted Uranium and Canadian Veterans. The Government has carefully reviewed the recommendations in the Standing Committee’s report and welcomes the opportunity to respond to each of the three recommendations.

Recommendation 1 :

That the Government of Canada support research efforts focusing on the treatment of illnesses that have complex or poorly understood causes, but that can in all likelihood be attributed to military service.

The Government of Canada fully supports this recommendation and recognizes the importance of research into the causes of illnesses that Veterans face. Research alone is not an end in itself and our Government’s focus will continue to adopt cutting edge research to inform effective treatment and supports for Canadian Veterans, with the ultimate goal of enabling Veterans to successfully re-establish in civilian life.

In Budget 2012, the Government of Canada committed $5M to support the development of a national network of patient-focused depression research targeted at suicide prevention, Post Traumatic Stress Disorder, and intervention. A further $200,000 was directed toward anti-stigma mental health training for health-care professionals. These investments are a leap forward for all Canadians, including Veterans, which will lead to better treatment and a deeper understanding of depression, suicide, and Post Traumatic Stress Disorder. 

Veterans Affairs Canada

In addition to these two new initiatives, Veterans Affairs Canada spends $1.2M on scientific research toward Veterans health. Specifically, Veterans Affairs has and will continue to:

  • Partner with Statistics Canada and the Department of National Defence on the Life After Service Studies The Life After Service Studies 2010 provided useful data on the health outcomes of Canadian Veterans. This information is being used to inform Veterans Affairs Canada policy, planning and programming and ultimately to improve health services for Veterans in Canada. Three major reports have been produced to date:
    • Income Study;
    • Survey on Transition to Civilian Life; and,
    • Canadian Forces Cancer and Mortality Study.

In partnership with Statistics Canada and the Department of National Defence, has commenced Life After Service Studies 2013, with findings to be released in the spring of 2014. The Life After Service Studies 2013 builds on Life After Service Studies 2010 findings and adds a component to study released members from the Reserve Force;

  • Collaborate with the Canadian Institute for Military and Veteran Health Research, whose mission is to focus research efforts on a number of topics, especially in the areas of mental health, complex health needs, with relevance to Veterans’ health; and
  • Support the development of applied research concerning the treatment of Veterans with mental health conditions using the vast network of Operational Stress Injury Clinics.

Department of National Defence

The Department of National Defence is the primary health care provider for members of the Canadian Armed Forces. The Department spends approximately $400M annually ($408M in FY 2012/13) to provide medical and dental services to Canadian Armed Forces personnel across Canada and overseas, including care and support to address illnesses and injuries with complex or poorly understood causes (e.g., mental health and blast-induced traumatic brain injuries). Canadian Forces Health Services, in partnership with Defence Research Development Canada, reinforce these efforts by sponsoring and conducting military-specific health research (approximately $10M/year). These organizations also work collaboratively to leverage research conducted by the wider medical community, across Canada and internationally, to continually improve the care provided to Canadian Armed Forces personnel.  These efforts include:

Canadian Forces Health Services conducted research into the possible causes of the symptoms experienced by Veterans of the Gulf War. In addition, it is participating in an ongoing study conducted by the North Atlantic Treaty Organization’s (NATO) Science and Technology Office to investigate medically-unexplained physical symptoms in military personnel. 

Canadian Forces Health Services remains involved with a number of international panels and working groups looking into the causes of, and mitigating where possible, occupationally-based illnesses arising from military service. This includes participation in the Occupational and Environmental Health Working Group with the United States, Great Britain, and Australia.

Defence Research and Development Canada and Canadian Institutes of Health Research collaborate with international partners to provide infrastructure and project support for clinical trials and other outcome-oriented health research that may be applied to military service. For example, in July 2003, the Canadian Institutes of Health Research’s Institute of Cardiovascular and Respiratory Health and Defence Research and Development Canada partnered with the National Institute of Health in the United States to develop the Resuscitation Outcomes Consortium. This research will contribute to the rapid development of promising scientific and clinical advances that will improve resuscitation outcomes. The important life-saving knowledge, methods, and techniques gained from this research will be used to save lives in combat situations.

Canadian Institutes of Health Research

Since 2006, Canadian Institutes of Health Research invested approximately $3.7M in research directly addressing military and veterans’ health. The Canadian Institutes of Health Research supports the work of internationally-renowned researchers investigating complex health issues frequently associated with military service, such as post-traumatic stress disorder as well as mental illness, addictions and treatment, brain, spinal injuries, chronic musculoskeletal diseases, and infectious diseases. For instance, the Canadian Institutes of Health Research:

  • supported Dr. Jitender Sareen’s research concerning mental illness among military personnel involved in peacekeeping operations. This research demonstrated, for the first time, that Canadian military personnel acting in peacekeeping roles had an increased risk of suffering from mental health problems;
  • led the development of a catalyst grants competition in the area of mild traumatic brain injury. Through this competition, three projects were supported. One of these projects is led by Dr. Andrew Baker from St. Michael’s Hospital who is examining the possibility of developing innovative tests to detect mild traumatic brain injury in military personnel experiencing shock waves from an explosion. This research project will be of tremendous value in the clinical setting to diagnose and prioritize treatments for Canadian Armed Forces personnel; and
  • participates in the Canadian Institute for Military and Veteran Health Research’s working group, keeping the 13 Canadian Institutes of Health Research institutes abreast of current and emerging issues related to military and Veterans’ health.

Other research investments

Given the prevalence of multiple health conditions within the Veteran population, the diversity of Government’s investments in the Canadian research community is on the right track. Research results in multiple areas will translate into continued program and service improvements designed to support the health and well-being of Veterans and their families.

Recommendation 2 :

That Veterans Affairs Canada associate itself with an independent scientific organization, such as the Canadian Institute for Military and Veteran Health Research or the Council of Canadian Academies, to provide it with independent scientific advice on the state of scientific research, in Canada and elsewhere in the world, to support or disprove the existence of a link between military service and certain health problems that may be afflicting Veterans.

The Government agrees with this recommendation and relies heavily on independent scientific advice to inform the development of policies and programs that relate to Veterans’ health. Veterans Affairs Canada has partnered with a number of independent scientific bodies to further the understanding of the health issues faced by Veterans.

Specifically, Veterans Affairs Canada works with the following independent scientific organizations: 

Scientific Advisory Committee on Veterans’ Health (Scientific Advisory Committee)

Created in 2011, the Scientific Advisory Committee is an independent scientific committee comprised of five experts with collective proficiency in scientific, medical, and military matters with a mandate to provide expert advice to the Minister on specific Veterans’ health issues. The first issue studied by Scientific Advisory Committee was the human health effects of Depleted Uranium. In February, 2013, it published a report which confirmed earlier scientific research that found there was not enough scientific evidence to support a connection between the exposure to depleted uranium with the complex health problems faced by some Canadian Veterans. The expert advice it provides is used by Veterans Affairs officials to ensure disability decisions are based on the most current and scientific evidence.

Canadian Institute for Military and Veteran Health Research (the Institute)

Serving as a focal point for more than 25 Canadian universities that work together to address health research needs of military personnel, Veterans and their families, the Institute connects existing academic resources as well as facilitates the exchange of valuable information and the development of innovative research. Veterans Affairs supports the Institute by participating on steering committees and the annual forum. Further, through its involvement with the Institute, Veterans Affairs is partnering with a number of academic researchers on studies that will assist in better understanding the relationship between Veterans’ health and military service.

Senior International Forum (the Forum) Research Committee

Active since 2003, the Forum is a co-operative grouping of Deputy Ministers and other senior officials from Australia, Canada, the United Kingdom, the United States of America and New Zealand with a focus on exchanging information, identifying future strategic challenges and developing solutions to areas of common concern relating to each country's Veterans and their families. Currently chaired by Veterans Affairs Canada, the Forum strives to coordinate research efforts that relate to Veterans’ health which are critical to supporting decision making, informing policy, and providing an understanding of how countries deal with complex Veteran and military health issues. For example, this group organized the 2007 Baltimore symposium on “Successful Post-Deployment Mental Health Adjustment: An International Research Perspective.

International Society for Traumatic Stress Studies (the Society)

Since 2010, Veterans Affairs Canada has worked closely with the Society, which is an international, multidisciplinary organization that promotes the advancement and exchange of scientific knowledge and advice. This connection has proved particularly valuable as a means to obtain information concerning the impacts of severe stress and trauma and to exchange the latest developments in trauma research, treatment strategies, policy approaches, and theory.

Partnerships with Academia

Veterans Affairs Canada has worked with Queen's University and the Universities of Sherbrooke and Manitoba on five projects. These projects build on the work conducted in the Life after Service Studies program of research looking at topics such as the relationship between income and mental disorders, impacts of co-morbid physical and mental health, how Veterans with mental health conditions integrate into the civilian workforce, and the relationship between chronic pain and well-being. The participation of Veterans Affairs Canada researchers has ensured that the work is relevant to Veterans and it has enhanced partnerships with some of the country’s leading researchers in this field.

Recommendation 3 :

That Veterans Affairs Canada consider introducing a flexible mechanism that would make it possible to assess the connection between military service and certain medical conditions whose causes are complex, difficult to identify or poorly understood.

The Government agrees that a flexible approach to assessing the relationship between medical conditions and military service is required to ensure that Veterans are able to access the services they need to successfully transition from military to civilian life. The New Veterans Charter provides greater access to health care services as Veterans who are medically released can access necessary services through Veterans Affairs Canada's Rehabilitation Program regardless of whether the medical condition causing the medical release is related to military service or not. And when it comes to Vocational Rehabilitation, Veterans who are medically released for any reason may make use of this important program. Nothing like this existed under the former benefit program for Veterans, the Pension Act. In addition, internal practices enable a flexible approach to assessing a medical condition, such as:

Entitlement Eligibility Guidelines (the Guidelines)

The Guidelines are internal policy statements intended to assist in the preparation and submission of applications and in adjudication. They are a tool that complements the exercise of decision-making conducted in accordance with legislation and the principles of administrative law.

The Guidelines are used to help Veterans Affairs establish causal links between medical conditions and military service; however, they are not intended to be a textbook of medicine or of causation. They are based on peer-reviewed scientific literature and research and assist disability adjudicators in understanding medical conditions, including those which are complex or poorly understood, and the factors which could reasonably cause or aggravate them. Guidelines reduce burden on Veterans to provide medical evidence on the relationship between their disability and military service. Where the Guidelines do not fully address the need of the adjudicators or the claimed disability, the adjudicators have the ability to consult Departmental Medical Advisors.

The Guidelines are updated on a regular basis in order to reflect relevant changes in policy and advancements in science. As a result, Veterans Affair Canada’s adjudication process has greater flexibility in linking disability to military service.

Special Duty Service

Veterans Affairs Canada also has flexibility when Canadian Armed Forces personnel incur a disability in a designated area or operation in which they face elevated risks given the unknown environmental and operational factors (called Special Duty Service) which could lead to health problems. Benefits of this flexibility include:

  • coverage 24/7 for any medical condition that reasonably onsets during that service.
  • provision of disability benefits without a causal link between the claimed health problems and military service.

This ensures that these Veterans have easier and timely access to disability and related health benefits. This process was key in adjudicating complex disability benefit claims relating to Gulf War service.

Veterans Affairs Canada will continue to strengthen and build on these internal flexible mechanisms to ensure that, where there is reasonable evidence to link a medical condition to military service, disability benefits are provided. 

Conclusion

The Government is pleased to provide assurance to the Committee, to Veterans, serving Canadian Armed Forces personnel, their families, and to all other Canadians, that it will continue to support scientific research as well as maintain policy and program flexibility in order to improve the health, well-being, and the quality of life for Canadian Veterans and their families. 

The Government of Canada thanks the Committee and the witnesses who appeared before the Committee on this subject. A great deal of effort and thoughtful consideration underpins the report.  Its recommendations serve as a useful guide to the Government moving forward in its commitment to providing Veterans and their families with the support they need and deserve.