Simplifying the Service Delivery Model for Medically Releasing Members of the Canadian Armed Forces

Mandate

The Office of the Department of National Defence and Canadian Armed Forces Ombudsman was created in 1998 by Order-in-Council to increase transparency in the Department of National Defence and the Canadian Armed Forces, as well as to ensure the fair treatment of concerns raised by Canadian Armed Forces members, Departmental employees, and their families.

The Office is a direct source of information, referral, and education for the men and women of the Department of National Defence and the Canadian Armed Forces. Its role is to help individuals access existing channels of assistance or redress when they have a complaint or concern. The Office is also responsible for reviewing and investigating complaints from constituents who believe they have been treated improperly or unfairly by the Department of National Defence or the Canadian Armed Forces. In addition, the Ombudsman may investigate and report publicly on matters affecting the welfare of members and employees of the Department or the Canadian Armed Forces and others falling within his jurisdiction. The ultimate goal is to contribute to substantial and long-lasting improvements to the defence community.

Any of the following people may bring a complaint to the Ombudsman when the matter is directly related to the Department of National Defence or the Canadian Armed Forces:

  • a current or former member of the Canadian Armed Forces 
  • a current or former member of the Cadets
  • a current or former employee of the Department of National Defence
  • a current or former non-public fund employee
  • a person applying to become a member
  • a member of the immediate family of any of the above-mentioned
  • an individual on an exchange or secondment with the Canadian Armed Forces

The Ombudsman is independent of the military chain of command and senior civilian management and reports directly to the Minister of National Defence.

Executive Summary

The Office of the Department of National Defence and Canadian Armed Forces Ombudsman (herein referred to as the Office) has received, and continues to receive, numerous complaints from current and former Canadian Armed Forces members who are transitioning or have transitioned from the Canadian Armed Forces to the programs and services of Veterans Affairs Canada. It is in this context that this review was launched.

The purpose of this review is to identify opportunities to improve service to the approximately 1,500 members who are released each year due to illness or injury.

This review is based on the assumption that:

The Canadian Armed Forces will determine whether an illness or injury is attributable to or aggravated by a member’s military service and that determination be accepted by Veterans Affairs Canada as sufficient evidence to support an application for benefits.

In May 2016, the Office completed a report titled Determining Service Attribution for Medically Releasing Members supporting this assumption1. During our research, it became apparent that the process for members of the Canadian Armed Forces who are transitioning to the services of Veterans Affairs Canada is neither user-friendly nor seamless.

The transition process is unnecessarily complex and difficult to navigate – especially for those who are ill or injured. Some may also be suffering from an operational stress injury. The current process requires members to re-tell their stories to many different people in three distinct organizations – thereby taking away from the energy required for medically releasing members to get well and move forward with their new lives outside of the Canadian Armed Forces.

The transition process is based on how the Canadian Armed Forces and Veterans Affairs Canada conduct business – as opposed to being designed to serve the needs of the members. It is neither timely nor responsive to their needs.

The findings of this review point to a number of fundamental issues that create challenges in achieving a successful transition from the Canadian Armed Forces to the programs and services of Veterans Affairs Canada:

  • Ill and injured members must prove to Veterans Affairs Canada that their illness or injury was attributable to or aggravated by their military service while the Canadian Armed Forces have all the medical and personnel information needed to support the claim.
  • The information systems of the Canadian Armed Forces, Veterans Affairs Canada, and the Service Income Security Insurance Plan are completely independent of each other.
  • Members are buried in paper-based systems: the complexity of the programs and processes is staggering for members who are well, let alone ill or injured members – some of whom may be suffering from an operational stress injury.
  • Uncertainty is created when a member is released from the Canadian Armed Forces before all benefits and services have been confirmed and are put in place.

These issues result in a transition process that is simply too difficult for some members to navigate and they unfortunately “fall through the cracks.”

Members of the Canadian Armed Forces who are medically released deserve to receive, on a timely basis, services and benefits that are consistent with their needs.

With this in mind, the Office has three recommendations to the Minister of National Defence that are complementary to the recommendation made in the paper Determining Service Attribution for Medically Releasing Members:

  1. It is recommended that the Canadian Armed Forces retain medically releasing members until such time as all benefits and services from the Canadian Armed Forces, Veterans Affairs Canada, and Service Income Security Insurance Plan have been confirmed and are put in place.
  2. It is recommended that the Canadian Armed Forces establish a Concierge Service for all medically releasing members. This service would serve as a focal point to assist members and their families for all administrative matters regarding the member’s transition.
  3. It is recommended that the Canadian Armed Forces leads, through a phased approach, the development of a secure web portal. The portal would contain information for all Canadian Armed Forces, Veterans Affairs Canada, and Service Income Security Insurance Plan programs and services. The portal would also enable members to input their information just once, and the portal would automatically apply for all services and benefits that would be consistent with the member’s needs.

The Prime Minister of Canada, the Minister of National Defence, the Minister of Veterans Affairs and Associate Minister of National Defence, the current and former Chiefs of the Defence Staff, the Standing Committee on Veterans Affairs, the Auditor General of Canada, and the Veterans Ombudsman have also all reached the same conclusion. The process for members medically releasing from the Canadian Armed Forces, transitioning to the services and benefits of Veterans Affairs Canada, is in need of significant improvements.

The cost to implement these recommendations would be miniscule relative to the annual Government of Canada budget for the departments – the Department of National Defence and the Canadian Armed Forces, as well as Veterans Affairs Canada – of 22.27 billion dollars.The issues concerning the transition process are real and have been debated for at least the past 13 years. In the words of the Chief of the Defence Staff, General Jonathan Vance, to the Conference of Defence Associations Institute Ottawa conference in February 2016 on the issue of a seamless transition:

“We’ve got to not pay lip service to this; we actually have to do it.”

Introduction

The Government of Canada has made a commitment to provide care for current and former ill and injured Canadian Armed Forces members. Through a variety of services, benefits, and programs (see Annex A), two federal departments have primary responsibility for fulfilling this commitment: the Department of National Defence and Veterans Affairs Canada.

The Department of National Defence provides for comprehensive medical and dental services for Regular Force members and in some cases Reserve Force members, depending on their class of service. Ill and injured members have access to additional support services, programs, and financial benefits. These include vocational rehabilitation and long-term disability benefits through the Service Income Security Insurance Plan (SISIP) (see Annex B), as well as some support to help navigate the administrative requirements and access benefits and services both before and after release from the Canadian Armed Forces.

The Department of Veterans Affairs Act mandates the Minister of Veterans Affairs with “the care, treatment or re-establishment in civilian life of any person who served in the Canadian Armed Forces,” and “the care of dependents or survivors.” Veterans Affairs Canada’s’ responsibility for veterans, who are eligible for re-establishment in civilian life, begins after their release from the Canadian Armed Forces. However, planning to support the transition begins before release.

Veterans Affairs Canada fulfills its responsibilities through a set of programs, benefits, and services under the Canadian Armed Forces Members and Veterans Re-establishment and Compensation Act (commonly referred to as the New Veterans Charter), the Pension Act, and the Department of Veterans Affairs Act.

Background

Approximately 5,500 members of the Canadian Armed Forces transition to civilian life each year. There are those who leave to pursue other career interests, those who retire after years of service, and those who release as they no longer meet the universality of service principle2 due to injuries or illnesses which may or may not be attributable to service.

The challenges facing members transitioning from the Canadian Armed Forces to civilian life have been topical in recent years – particularly as these challenges often relate to those leaving the Canadian Armed Forces after deploying abroad (usually multiple times), as well as those who deployed on domestic operations. The challenges, while considerable for many who are transitioning, are especially so for the approximately 1,500 members who are released each year as a result of illness or injury,3 of which approximately 600 are directly related to military service.

The Office has received, and continues to receive, numerous complaints from current and former members of the Canadian Armed Forces regarding transition. This category of complaints ranks second in terms of the frequency of complaints. There has been periodic media coverage about specific members who have not made a successful transition from the Canadian Armed Forces to civilian life.

To describe an easier transition from the Canadian Armed Forces to the programs and services of Veterans Affairs Canada, senior officials and politicians often use the words “seamless transition.” These words are also found in the literature of defence departments and veterans administrations in both the United States and Australia.

The concept of a “seamless transition” is not new. A Canadian Armed Forces paper titled Ready for Release published in July 2003 refers to a “seamless transition”.

The concerns for members of the Canadian Armed Forces transitioning to the benefits and services and programs of Veterans Affairs Canada are well placed.The Prime Minister of Canada, the Right Honourable Justin Trudeau, in his December 2015 Mandate Letter to the Minister of National Defence, the Honourable Harjit Sajjan, stated:

“I also ask you to work with your colleague, the Minister of Veterans Affairs and Associate Minister of National Defence, to ensure a seamless transition for Canadian Forces Members to the programs and services of Veterans Affairs Canada,”

and,

“…to work with the Minister of Veterans Affairs and Associate Minister of National Defence to reduce complexity, overhaul service delivery and strengthen the partnership between National Defence and Veterans Affairs.”

Transition from military to civilian society is multifaceted and government has a responsibility to ensure that the programs and services are both timely and responsive to the needs of transitioning members. This is especially true for those who have become ill or injured and are medically releasing from the Canadian Armed Forces.

The Minister of National Defence is aware of the challenges faced by medically releasing members. During his appearance before the Standing Committee on National Defence on 8 March 2016, he stated:

“One example of what we are working on is when somebody is injured in the Canadian Armed Forces they go through the medical system, but currently when you become a veteran you have to then explain the same injuries. We want to make that seamless. That is one of the gaps that we would like to fill.”

The Auditor General of Canada raised concerns about the transitioning process in the fall 2012 Report of the Auditor General of Canada to the House of Commons, Chapter 4: Transition of Ill and Injured Personnel to Civilian Life. The report states that:

“Canadian Forces Members and Veterans, as well as Departmental staff responsible for assessing eligibility and managing the delivery of services and benefits, find the transition process, lengthy, and challenging to navigate. Although National Defence and the Canadian Forces, and Veterans Affairs Canada recognize the challenges and have been working on the solutions, it remains difficult to access services and benefits in a timely manner. Reasons include the complexity of the eligibility criteria, lack of clear information on support available, the amount of paperwork involved, and case management services that require further improvement.”

Also, it states:

“There are long standing barriers to timely access to disability benefits, “and two of the barriers stated are: “…a complex application process and delays in obtaining medical and service documents from the Department of National Defence.”

Findings

The issue of transition is much broader than transitioning from the Canadian Armed Forces to being a recipient of the benefits and services of Veterans Affairs Canada. It is a transition from one way of life to another. Serving in the military is not just a job – it is a lifestyle that offers both exciting opportunities and significant operational risks. During their careers, members are part of a family that takes care of its own and provides many of the services that civilians must seek out for themselves, such as finding a family doctor or a dentist. There is really no equivalent profession to that of military service. Members have a proud sense of identity – some suffer from a loss of this sense of identity once they are no longer wearing the uniform. Most members who leave the Canadian Armed Forces have a successful transition, but far too many do not.

Illnesses and injuries are identified through health assessments at various points during a member’s career, such as: upon enrolment; pre- and post-deployment; through self-reporting; periodic health assessments; and pre-release.

Ill or injured Canadian Armed Forces members who are unable to perform the tasks required by their military occupation are assigned a medical employment limitation. If the Canadian Armed Forces judges their illness or injury to be permanent, an administrative review is launched to determine the most appropriate course of action: retention with or without restrictions; transfer to another military occupation; or release from the Canadian Armed Forces – generally within six months of the decision being rendered.

All medical treatments are authorized by the Canadian Armed Forces. All medical records and personnel records are held by the Canadian Armed Forces. The decision to release members on medical grounds is made by the Canadian Armed Forces.

Determining attribution to service is key

The availability of most benefits and services provided by Veterans Affairs Canada is dependent upon whether or not the injury or illness is attributable to military service. Simply put, if there is no proof of service relationship to an illness or injury, it could mean the denial of benefits and services.

A release from the Canadian Armed Forces without determination of attribution to service leaves the onus on the member to prove, to the satisfaction of a Veterans Affairs Canada adjudicator, that the injury or illness was attributable to or aggravated by the member’s military service.A willingness by the Canadian Armed Forces to state on the release message whether an illness or injury is attributable to or aggravated by service – and that the Canadian Armed Forces determination be presumed by Veterans Affairs Canada to be sufficient evidence to support an application for benefits – would open the door for significant improvements in the delivery of services and benefits.

For example, Veterans Affairs Canada’s currently published service standard for rendering a decision for disability benefits reads as follows: “A decision will be made within 16 weeks of receiving all information in support of your application.” The target is to achieve this standard 80% of the time. The period of 16 weeks stated in the service standard does not include the time for Veteran Affairs Canada to obtain the medical files from the Canadian Armed Forces – nor does it include the time it takes for members to obtain and submit documentation to prove their claims. Thus, the time that members must wait for a decision is generally longer than the 16 weeks stated in the service standard.

A willingness by the Canadian Armed Forces to provide a decision regarding whether an injury or illness is attributable to service would trigger a series of actions that could reduce the time required by Veterans Affairs Canada to process a Disability Award Application to just 4 weeks. This reduction in processing time is achievable as the Veterans Affairs Canada adjudicator would no longer have to gather evidence from both the member and the Canadian Armed Forces to determine whether the injury or illness was attributable to or aggravated by service. This determination is the first decision point and most fundamental step in the application process.

Similar reductions in processing times could be achieved for other benefits and services if other applications were processed simultaneously.

The determination by the Canadian Armed Forces as to whether an injury or illness is attributable to service does not in any way undermine Veterans Affairs Canada’s legislated responsibility to adjudicate applications for benefits. Both functions are distinct.

The Canadian Armed Forces are already required to determine attribution to service in a number of processes. For example:

  1. Entitlement to medical care for Reservists (QR&O 34.07).
  2. Entitlement to dental treatment for Reservists (QR&O 35.04).
  3. Eligibility to Reserve Force Compensation during a Period of Injury, Disease or Illness for Reservists (CBI 210.72) Government Employees Compensation Act.
  4. Eligibility for Reservists4 under the Government Employees Compensation Act.
  5. When a Board of Inquiry is convened following a serious injury, one of the findings – which has to be included in the final report – is whether the injury or death was attributable to military service (QR&O 21.47).
  6. The Minister of National Defence has experience determining attribution to service for Regular and Reserve Force members with respect to certain injuries under the Injured Military Members Compensation Act.
  7. To determine recipients’ eligibility for the Memorial Cross for members who served in the Canadian Armed Forces (other than the Supplementary Reserve) on or after 7 October 2001; and who died while in service.

A complex environment for the ill or injured

Many transitions are complex as the illnesses or injuries can be both physical and mental. Not only are members dealing with their recovery issues, they are also facing an uncertain future outside of the Canadian Armed Forces. To illustrate the seriousness of the medical issues being faced by some members, a report published on 3 July 2014 by Veterans Affairs Canada and co-authored with the Department of National Defence, titled Health and Well-Being of Canadian Armed Forces Veterans: Findings from the 2013 Life after Service Survey provides some insightful information. It states that:

 “Veterans Affairs Canada clients reported complex states of health. The great majority, more than 90% reported at least one physical health condition diagnosed by a health professional and about half reported at least one mental health condition. Two-thirds had 4-6 physical and mental health conditions, and a fifth had even larger numbers of comorbid conditions (presence of two or more conditions in the same individual).”

The current transition process, which requires members to re-tell their stories, is preventing members from moving forward with their lives as it keeps them focused on the past instead of their future.

The current service delivery model is complex and not user-friendly. The Canadian Armed Forces published The Guide to Benefits, Programs and Services for Serving and Former CAF Members and their Families. To highlight the complexity, the guide itself is over 80 pages long – not to mention the labyrinth of processes and myriad forms that must be completed.

There are many separate benefits and services available for members to consider, each with separate eligibility criteria, application forms, and processes (Annex A).

To add to the challenges for members, the current service delivery model is not integrated. It operates in silos. That is to say, applications for benefits are not coordinated and information is not automatically shared. Each application stream is independent and subject to three separate sets of processing rules. Ill or injured members are left to navigate through this maze of benefits and services to determine which ones may be applicable to their circumstances. Members then complete a separate application for each service or benefit selected. While some assistance may be provided from a variety of sources, there is no one person who can explain all the programs and services provided by the Canadian Armed Forces, Veterans Affairs Canada and the Service Income Security Insurance Plan. Annex C illustrates the current Service Delivery Model.

Using Veterans Affairs Canada only as an example, a separate application form is required to be completed by members for each and every program. Depending on circumstances, a member could be required to complete up to 21 separate applications representing 118 pages, as shown in Annex D from the 186 forms listed on the Veterans Affairs Canada website.5 Many of the application forms request much of the same information. This is a burden that is placed on ill and injured members.

There is no vehicle jointly sponsored by the Canadian Armed Forces, Veterans Affairs Canada, and the Service Income Security Insurance Plan, that would allow members to seek all the information they need and to submit their information to generate all applications for benefits for which they have a need and are entitled to receive. Each organization has a separate website. There is no sharing of information between the sites. One member: three separate files, three separate case managers.

The United States and the United Kingdom have established a type of “Concierge Service” within their defence departments that is available to assist medically releasing members and their families with the transition process. The concierge, who may be military or civilian, is trained in all aspects of the programs and services that are available during and after transition. The concierge becomes the single point of contact for members and their families for all administrative matters. In addition, the concierge navigates, on behalf of members, the bureaucratic jungle that has been created by many years of legislative, policy and program changes. Annex E provides a brief overview of this international perspective.

Uncertainty

Members are being released from the Canadian Armed Forces before their medical and financial benefits are put in place.

As noted earlier in this report, there is a lack of coordination among the applications for benefits by the three potential paying organizations: Canadian Armed Forces, Veterans Affairs Canada, and Service Income Security Insurance Plan. With the current onus on the members to prove to the satisfaction of a Veterans Affairs Canada adjudicator that their illness or injury is attributable to service, some members are being released from the Canadian Armed Forces without knowing the amount of income or which medical services they will receive. This creates unnecessary stress for members and their families who are already reeling from a career ended by illness or injury, and who might also suffering from an operational stress injury.It is difficult to focus on recovery when an individual is also worrying about a potential interruption in income and an uncertain level of benefits and services. The United Kingdom Ministry of Defence6 and the United States Department of Defense7 both retain medically releasing members in their militaries until all services and benefits are put in place.

An April 2016 statement by the Office noted that some former Regular Force members are waiting up to 14 weeks beyond their release date and Reserve Force members up to 36 weeks, to receive their Canadian Armed Forces Pensions.

Recommendations

The issues concerning the transition process are real and have been debated for far too long. There is no “silver bullet” that will solve all the issues. These recommendations represent a practical, low cost first step to improving the transition process for members who are being medically released from the Canadian Armed Forces.

  1. It is recommended that the Canadian Armed Forces retain medically releasing members until such time as all the benefits and services from the Canadian Armed Forces, Veterans Affairs Canada, and Service Income Security Insurance Plan have been confirmed and are put in place.
  2. It is recommended that the Canadian Armed Forces establish a Concierge Service for all medically releasing members. This service would serve as a focal point to assist members and their families for all administrative matters regarding their transition. (See Annex F for the proposed Concierge Service process)
  3. It is recommended that the Canadian Armed Forces leads, through a phased approach, the development of a secure web portal. The portal would contain information for all Canadian Armed Forces, Veterans Affairs Canada, and Service Income Security Insurance Plan programs and services. The portal would also enable members to input their information just once, and the portal would automatically apply for all services and benefits that would be consistent with the member’s needs.

Resource Implications

There would be no incremental costs to Veterans Affairs Canada as the Department is already resourced to process applications for benefits and services. Any efficiency recognized as a result of these changes must be reinvested to further improve services.

There will be a small incremental cost to the Canadian Armed Forces. As noted previously in this report, the Canadian Armed Forces is already equipped to determine attribution to service for a number of other purposes. Many of the 1,500 cases will not require significant decision making time as illnesses or injuries incurred while on Special Duty Service are automatically considered by Veterans Affairs Canada to be attributable to service.

The estimated annual cost for a Concierge Service for the 1,500 medically releasing members is approximately 4.73 million dollars. This cost is based on the Veterans Affairs Canada’s standard of a 1:25 case manager to client ratio; which equates to 60 new staff being hired or contracted for by the Canadian Armed Forces at the mid-range salary of a civilian administrative position (AS-05).

The costs to develop a secure portal would be recovered by the savings realized in future years through more efficient and effective means of processing applications for benefits.

A decision to keep members on strength until all benefits and services are confirmed and in place would be minimal once the current backlog of pension applications is cleared and improvements to the transition process, such as those recommended in this report, are implemented.There should be no need to increase the Government of Canada’s combined annual budgets of $22.27 billion (Department of National Defence and the Canadian Armed Forces, as well as Veterans Affairs Canada)8 for a new budget pressure of 0.0002%.

Conclusion

Much of the complexity for transitioning members is a result of many years of incremental benefits and services being added with a corresponding increase in acts and regulations to enable the provision of the benefits and services. The current service delivery model does not provide adequate assistance to transitioning ill and injured members to navigate the benefits and services offered, as well as the paperwork that is required. The recommended service delivery model, in Annex F, largely addresses the underlying issues in this report.

The findings of this review point to a number of fundamental issues that create challenges in achieving a successful transition from the Canadian Armed Forces to the programs and services of Veterans Affairs Canada:

  • Ill and injured members must prove to Veterans Affairs Canada that their illness or injury was attributable to or aggravated by their military service while the Canadian Armed Forces have all the medical and personnel information needed to support the claim.
  • The information systems of the Canadian Armed Forces, Veterans Affairs Canada, and the Service Income Security Insurance Plan are completely independent of each other.
  • Members are buried in paper-based systems: the complexity of the programs and processes is staggering for members who are well, let alone ill or injured members – some of whom may be suffering from an operational stress injury.
  • Uncertainty is created when a member is released from the Canadian Armed Forces before all benefits and services have been confirmed and are put in place.

The recommendations contained in this report are game-changers for those who are being medically released. The security and peace of mind that comes from knowing you will remain on the Canadian Armed Forces payroll until all the services and benefits are in place will significantly reduce unnecessary stress – thereby allowing members to focus on getting well and moving forward with their lives.  The aforementioned recommendations are fundamental to the creation of a new service delivery model that is more timely and consistent with the needs of the members.

Significant concerns about the transition process were flagged by the Auditor General of Canada as early as the fall of 2012. Since then, approximately 5,500 members have been medically released from the Canadian Armed Forces and have had to wrestle not only with their illnesses or injuries, but also with a transition process that is overly complex and difficult to navigate. It is understandable that there is often media coverage of members falling through the cracks – sometimes with catastrophic results – because of a transition process that has failed them in their time of greatest need.

The Prime Minister of Canada, the Minister of National Defence, the Minister of Veterans Affairs and Associate Minister of National Defence, the current and former Chiefs of the Defence Staff, the Auditor General of Canada and the Veterans Ombudsman, have all raised concerns about the transition process.In the words of the Chief of the Defence Staff, General Jonathan Vance to the Conference of Defence Association Institute in February 2016 on the issue of a seamless transition:

“We’ve got to not pay lip service to this; we actually have to do it.”

Annex A | Support for Ill and Injured Serving and Former Canadian Armed Forces Members

 

Support Offered by the Department of National Defence (DND) and Canadian Armed ForcesAvailable to Serving Members
(pre-release)		Available to Former Members
(post-release)
CF Case Management X  
Comprehensive Health Care X  
Operational Trauma and Stress Support Centres X  
Operational Stress Injury Social Support X X 
Military Family Resource Centres X X
(Pilot)
OSISS Family Peer Support Network X  
Chaplaincy Services X  
Soldier On Program X X
Vocational Rehabilitation Program for Serving Members X  
CF Member Assistance Program X X
CF Accidental Dismemberment Insurance Plan (SISIP) X  
Education Reimbursement X  
Skills Completion Program X  
Second Career Assistance Network X  
CF Return to Work Program X  
Joint Personnel Support Unit/Integrated Personnel Support Centres X X
CAF Transition Services X X
SISIP Financial Services,  Long Term Disability  (LTD) X
(Coverage only)		 X
(Coverage + Payment) 
SISIP Financial Services, LTD Vocational Rehabilitation Program X X
Home Modifications Benefit X  
Home Modifications Move Benefit X  
Vehicle Modifications Benefit X  
Home Assistance Benefit X  
Attendant Care Benefit X  
Caregiver Assistance Benefit X  
Designated Assistant Benefit X  
Next of Kin Travel Benefit X  
The Road to Mental Readiness Program X  
Allowance Loss of Operational Allowance X  
SISIP – Term Life Insurance X X

 

Support Offered by Veterans Affairs Canada (VAC)Available to Serving Members
(pre-release)		Available to Former Members
(post-release)
VAC Case Management X X
Treatment benefits for awarded condition 1 (if not provided by DND) X  
Treatment benefits for awarded condition   X
Integrated Personnel Support Centres X X
Transition Interview X  
Operational Stress Injury Clinics X X
Operational Stress Injury Social Support X X
VAC Assistance Line X X
Disability Award X X
Veterans Independence Program X X
Career Transition Services X X
Public Service Health Care Plan   X
Long-Term Care   X
Rehabilitation Program (medical, psycho-social, and vocational)   X
Financial Benefits (for example, earnings loss, permanent impairment allowance, supplementary retirement benefit, CF income support)   X

 

Annex B | Service Income Security Insurance Plan

The Service Income Security Insurance Plan (SISIP) is a division of the Canadian Armed Forces Morale and Welfare Services Directorate.9 It provides tailored and unbiased financial solutions to over 150,000 serving and former and Canadian Armed Forces members.

The programs and services offered include:

  • Long Term Disability (including Vocational Rehabilitation)
  • Term Life Insurance
  • Financial Counselling (remedial assistance in the resolution of financial distress, with access to loans and grants of the Forces Personnel Assistance fund)
  • Financial Management Education (for recruits and officer cadets)
  • Financial Planning and investments (Mutual funds provided through FundEx Investments Inc.)
  • CAF Group Retirement Savings Plan (an online investment service)

The Service Income Security Insurance Plan – Long Term Disability (SISIP LTD) is sponsored by the Treasury Board of Canada, administered by Service Income Security Insurance Plan Financial, and Manulife Financial is the insurer.10 The Long Term Disability Plan is meant to provide replacement income protection, providing veterans with 75 per cent of their pre-release salary, less applicable reductions when released for medical reasons, or, if not medically released, if they qualify as totally disabled.11

Annex C | Existing Business Process Map

Existing Business Process Map

Annex C Atlernative Text

The first activity of the transition process is:

1.     CFHS Nurse Case Manager conducts a  complexity assessment with the member
2.     Transition is deemed complex
3.     Sends referrals for ITP & confirms CA results to DMCA
4.     Base Wing surgeon recommends Permanent CATEGORY  (PCAT)
5.     D Med Pol reviews and confirms Medical Employment Limitations (MEL)
6.     D Med Pol approves CF2088 / PCAT
7.     Is the member a high risk to breach the universality of service?

If yes to the member being a high risk of breaching universality of service, then proceed to activity #9 – DMCA initiates an AR/MEL  and sends an advisory message to the unit as well as scenario “Complex (A)”
If no to the member being a high risk of breaching universality of service, then proceed to activity #8 – the transition process ends here, Return to Work process may start.

8.     Transition process ends - Member may proceed to return to work process
9.     DMCA initiates administrative review/MEL and sends an advisory to the unit
10.   Does the member waive his/her rights?

If yes to the member waiving his/her rights, then proceed to activity # 15 – DMCA adjudicates AR/MEL
If no to the member waiving his/her rights, then proceed to activity # 11 – DMCA sends disclosure package to the unit Commanding Officer

11.   DMCA sends disclosure package to the unit Commanding Officer
17.   Unit Commanding Officer submits disclosure package to the member
12.   DMCA awaits member’s written representation
13.   Is the member’s transition deemed complex?

If yes to the member’s transition being deemed complex, then proceed to activity # 14 – DMCA holds the file until receipt of the Integrated Transition Plan
If no to the member’s transition being deemed complex, then proceed to activity # 15 – DMCA adjudicates AR/MEL

14.   DMCA holds the file until receipt of Integrated Transition Plan
15.   DMCA Adjudicates AR/MEL
16.   DMCA issues release message

Note: the transition process branches out into two (in no specific order):
1) activity 18 – unit Commanding Officer informs the member of the decision and
2) activity 30 – IPSC submits the release message to VAC

18.   Unit Commanding Officer informs the member of DMCA’s decision then proceed to scenario “JPSU (B)”

Scenario: Posting to JPSU (B) –
19. Commanding Officer recommends the member be posted to JPSU?
If yes to the Commanding Officer recommending the member be posted to JPSU, then proceed to activity 20 – DMC approves posting to JPSU
If no to the Commanding Officer recommending attaching member to JPSU, then proceed to activity 21 – member remains in his/her unit
Scenario “Posting to JPSU” ends while transition process continues at activity 30 – IPSC Services Manager submits release message to VAC

30.   IPSC Services Manager submits referral to VAC
31.   IPSC Services Manager coordinates and supervises the release transition plan
32.   VAC Client Service Agent receives referral from IPSC
33.   Does the member have an ITP?

If yes to the member having an ITP, then proceed to sub-scenario “VAC Case Management (C)
If no to the member having an ITP, then proceed to activity 33a – VAC Client Service Agent contacts CFHS Nurse Case Manager to determine the need for a case conference

33a. VAC Client Service Agent contacts CFHS Nurse Case Manager to determine the need for a case conference
34.   VAC Client Service Agent conducts a transition interview, completes RRIT-R, and obtains consent from the member to share information with other service providers
35.   Is Case Management required based on risk?

If yes to a case management being required, then proceed to activity 38 - scenario “VAC Case Manager (D)”
If no to a case management being required, then proceed to activity 36 – VAC Client Service Agent adjudicates

36.   VAC Client Service Agent adjudicates
37.   VAC Client Service Agent follows-up as per established standards determined by risk levels

Scenario: Complex (A)

This scenario begins at activity #3 - CFHS Nurse Case Manager sends referrals for an integrated transition plan (ITP) to SISIP, VAC Case Manager and IPSC Services Manager and confirms complexity assessment result to DMCA

Note:  the Complex process branches out into two:
1) activity #22 – IPSC Services Managers obtains consent from the member to share information with other service providers and
2) sub-scenario “VAC Case Management (C)

22.   IPSC Services Manager obtains consent from the member to share information with other service providers
23.   IPSC notifies JPSU of ITP
24.   JPSU informs DMCA of ITP
25.   IPSC Services Manager informs VAC Case Manager of ITP
26.   IPSC Services Manager receives confirmation from SISIP regarding proposed Vocational Rehabilitation Plan (VRP)
27.   IPSC coordinates the ITP
28.   Inter-disciplinary team develops ITP and submits to JPSU including recommendations for release date
29.   JPSU sends recommendations to DMCA
Transition process resumes at activity #15 – DMCA adjudicates AR/MEL

Sub-Scenario: VAC Case Management (C)

50.   VAC Case Manager consults with CFHS Nurse Case Manager and SISIP
51.   VAC Case Manager is a member of the inter-disciplinary team
Note: VAC Case Manager provides on going coordinated case planning with CFHS and conducts a joint case conference with CFHS (minimum one month pre-release)

Scenario: VAC Case Manager (D)

38.   VAC Case Manager assesses the member
39.   Is Case Management required?

If yes to case management being required, then proceed to scenario “Risk Level (E)”
If no to case management being required, then proceed to activity #40 – VAC Case Manager notes decision

40.   VAC Case Manager notes decision
41.   VAC Case Manager follows-up with member following decision
42.   VAC Case Manager follows-up with the member post release as per standards and based on risk level – Transition Process ends here.

Scenario: Risk Level (E)

43.   Is the member engaged?

If yes to the member being engaged, then proceed to activity #46 – VAC Case Manager requests an assessment and determines needs for case management
If no to the member being engaged, then proceed to activity #44 – VAC Case Manager attempts to engage the member

44.   VAC Case Manager attempts to engage the member, then proceed to activity #45 - VAC Case Manager follows-up with the member post release as per standards and based on risk level
45.   VAC Case Manager follows-up with the member post release as per standards and based on risk level – the transition process ends here
46.   VAC Case Manager requests assessment and determines needs for case management
47.   VAC Case Manager advises and consults with CFHS Nurse Case Manager
48.   VAC Case Manager opens case plan with member and completes CNCI
49.   VAC Case Manager adjudicates on VAC services/benefits or treatment
Transition process resumes at activity 45 - VAC Case Manager follows-up with the member post release as per standards and based on risk level

Annex D | Veterans Affairs Canada Application Forms

(See: 12)

Name of Application# of Pages
Application for Career Transition Services 5
Application for Critical Injury Benefit 4
Application for Disability Benefit 5
Application for Earnings Loss Benefit 5
Application for Permanent Impairment Allowance/Supplement 5
Application for Retirement Income Security Benefit 7
Application for Supplementary Retirement Benefit 2
Application for Assistance/Trust/Benevolent Funds 6
Canadian Armed Forces Income Support – Initial Application 5
Direct Deposit Request 3
Family Caregiver Relief Benefit Application 6
General Medical Questionnaire 4
Medical Questionnaire: Activities of Daily Living 12
Public Service Health Care Plan (PSHCP)
Eligibility for Clients of Veterans Affairs Canada (VAC)		 6
Quality of Life Questionnaire 4
Rehabilitation Program and Vocational Assistance Application 8
Rehabilitation Program and Vocational Assistance Services Application 22
Application for Attendance, Clothing, and Exceptional Incapacity Allowance 1
Statutory Declaration 2
VAC/Client Agreement 1
Veterans Independence Program Application 5
Total Pages 118

 

Annex E | International Overview

United Kingdom13

The United Kingdom Ministry of Defence (MoD) includes some responsibility for the administration of certain veterans benefits. The United Kingdom MoD has a partnership with a civilian contractor, Right Management, to provide the Career Transition Partnership (CTP) – which is designed to offer service personnel a more personalized and relevant resettlement process. This provides service leavers14 the advantage of more seamless support from one point of contact rather than a number of different organizations. All service leavers will use CTP, regardless of how long they have served or their reason for discharge. In the United Kingdom, the military determines whether an illness or injury is related to service and thus relieves the member of the onus of having to prove this relationship to the Veterans Branch of the department. A key support is the “Defence Recovery Capability” where all wounded, injured or sick personnel are appointed a Personal Recovery Officer. This officer, who is engaged by the Ministry of Defence, could be military or civilian and is the single point of contact for the soldier and their family. The key function of the officer is to coordinate the numerous agencies engaged in the member’s recovery plan. Members are not released from the service until all aspects of their recovery plan is in place.

United States15

The United States has a separate Department of Defense (DoD) and Department of Veterans Affairs (VA), which work together to support the transition of members from military to civilian life.

The DoD and VA introduced the Integrated Disability Evaluation System (IDES) in 2008.16 The two departments are working together to make the disability evaluation more simple, seamless, fast, and fair.

IDES provides a single set of examinations and single disability evaluation used by both departments. The DoD uses the system to decide if service members who have been wounded, became ill, or injured are still eligible to serve. If they are not, they give them a VA disability rating before they leave the service. This tells the service member the amount of compensation and benefits they can receive from the VA. Upon discharge, VA finalizes the decision and formally awards benefits.

To make the system fast and fair, there are shortcuts such as informal boards and longer processes a service member can choose, as well as opportunities to get decisions reviewed along the way. DoD Physical Evaluation Board Liaison Officers and Military Service coordinators provide guidance to Service members. Legal Counsel is also available at no cost to the service member if they dispute the decision.

This cooperative arrangement between the DoD and the VA, which includes an E-Benefits Portal containing information from both departments, strives to achieve a smooth transition for ill and injured members transitioning out of the military.

The E-Benefits Portal allows members to go online and apply for the benefits and services of both departments, as the medical and personnel history accumulated during the members’ service is available to the member in this portal.

If a member is unable to meet the service requirements, the DoD determines whether or not the illness or injury is a result of his or her military service. Further, because a comprehensive medical examination is conducted while the service member is on active duty, the onus is not on the member to prove to VA that medical conditions existed while in service. Members stay on the DoD payroll until such time as the transition measures are put in place.

Australia17

The Australian Defence Force (ADF) provides a range of support services to assist ADF members planning to leave Defence to make the transition to civilian life.

One of the key supports is the ADF Transition Centres. These centres are staffed by Australian Public Service personnel to assist military personnel and their families to move smoothly back to civilian life. These centres are located around Australia generally near or on major defence establishments. Outreach visits may also be arranged where there is no local centre.

The staff provides advice and assistance by:

  • guiding members through administrative requirements
  • tailoring the process according to the nature and circumstances of the transition
  • informing members of Defence-provided benefits for which they may be eligibleproviding advice about services provided by other government departments and external agencies

Annex F | Proposed Business Process

Proposed Business Process

Annex F Alternative Text

1.     The D Med Pol approves PCat and determines whether the illness or injury is service related or not (service attribution).
2.     The next step is the assignment of a concierge to assist the member and his/her family with all administrative matters related to their release from the Forces. This service continues until the member is released.
3. 4. & 5.     The concierge assists the member in filling the necessary applications for step 3 - SISIP benefits, step 4- Veterans Affairs Canada benefits/services and step 5 - the DND pension application.
6.     Is the member’s transition deemed complex?

If yes to the member’s transition being deemed complex, then proceed to:
1)   a referral assignment of VAC Case Manager and IPSC Transition services (DND)
2)   Initial joint case consultation between CFHS and VAC Case Managers
3)   Development of an Integrated Transition Plan (ITP)

Transition process resumes at step 7- DMCA performing an administrative review of medical employment limitation (AR/MEL)

If no to the member’s transition being deemed complex, then proceed to step 7 - DMCA performing an administrative review of medical employment limitation (AR/MEL)

7.     DMCA performs an administrative review of the medical employment limitation (AR/MEL)
8.     DCMA generates a medical release message with service attribution clearly stated.
9.     The member continues to be engaged in the CFHS case management process from the date of the release letter to the proposed release date.
10.   Is there an integrated transition plan?

If yes to the member having an integrated transition plan (ITP), then proceed to:
1)   Joint case conference/joint development of transition plan between CFHS and VAC Case Managers
2)   Ongoing coordinated transition case planning between CFHS and VAC Case Managers
3)   Joint case conference CAF/VAC transition plan review (minimum once month prior release)
4)   Release date
5)   Ongoing VAC Case ManagementEnd of transition process

If no to the member having an integrated transition plan (ITP), then proceed to:

1)   Referral to IPSC transition support services (DND)
2)   Referral for transition interview (VAC)
3)   VAC transition interview and risk assessment

a.   Member is low risk, then proceed to:

i.   Release date
ii.  End of transition process

b.   Member is moderate to high risk, then proceed to:

i.   Referral to a VAC Case Manager
ii.  Release date
iii. Post release follow-up
iv. End of transition process

 

Annex G | Scope and Methodology

The scope of this work was to review and analyze the current service delivery model from point of attribution to service to point of transition as well as make recommendations on a design of a service delivery model that considers effectiveness, efficiency and a successful outcome from a member’s perspective, while positioning authority for determination of attribution to a department.                

The methodology consisted of pursuing multiple lines of enquiry. This included a review of the current legislation, policy, and business processes of the Canadian Armed Forces and Veterans Affairs Canada related to the transition of ill and injured members from the Forces to civilian life. Research was conducted on the business practices of organizations with similar program mandates: the Federal Workers’ Compensation Service administered by Labour Canada, selected provincial workers’ compensation programs, and the existing practices of key NATO allies, such as the United States, Australia, and the United Kingdom.

The research included a literature review, website searches, and in some cases teleconferences with key individuals with program responsibilities in the applicable jurisdictions.

Endnotes

  1. “We recommend that the CAF determine whether an illness or injury is caused or aggravated by that member’s military service and that the CAF’s determination be presumed by VAC to be sufficient evidence to support an application for benefits.”
  2. Principle of Universality of Service – Canadian Armed Forces members must be able to perform general military duties and common defence and security duties, not just the duties of their military occupational specification. This may include but is not limited to, the requirement to be physically fit, employable, and deployable for general operation duties. Source: http://www.forces.gc.ca/en/about-policies-standards-defence-admin-orders-directives-5000/5023-0.page
  3. Testimony by Gen. (Ret.) Walter Natynczyk, Deputy Minister, Veterans Affairs Canada, before the House of Commons Standing Committee on Veterans Affairs. Source: http://www.parl.gc.ca/content/hoc/Committee/421/ACVA/Evidence/EV8154626/ACVAEV05-E.PDF, 10 March 2016.
  4. Reservists include Primary Reservists, Canadian Rangers, and Cadet Organizations Administration and Training Services Officers
  5. Accessed on 23 June 2016
  6. Commodore John Lea RN, Health and Wellbeing, CDP Service Personnel Support, Ministry of Defence, United Kingdom, interview, May 2016
  7. Thomas J. Murphy, Principal Deputy Under Secretary for Benefits, Veterans Benefits Administration, Washington DC, interview, May 2016
  8. Treasury Board of Canada Secretariat. 2016-17 Reports on Plans and Priorities, Planned Expenditures, Veterans Affairs Canada, and the Department of National Defence and the Canadian Armed Forces
  9. Service Income Security Insurance Plan. Source: https://www.cfmws.com/en/aboutus/sisipfs/pages/default.aspx, accessed May 2016
  10. Service Income Security Insurance Plan Service Income Security Insurance Plan Vocational Rehabilitation Program. Source: https://www.cfmws.com/en/aboutus/sisipfs/insurance/pages/vocational-rehabilitation-program.aspx, accessed May 2016.
  11. “totally disabled” – is defined as being released from the Canadian Armed Forces and that there is clear and objective medical evidence, which confirms that you are incapacitated by a medically determinable physical or mental impairment, which is preventing you from performing any and every duty of any substantially gainful occupation or employment for which you are qualified by education, training or experience, Service Income Security Insurance Plan Service Income Security Insurance Plan Long Term Disability (LTD). Source: https://www.cfmws.com/en/AboutUs/SISIPFS/Insurance/Pages/Long-Term-Disability.aspx, accessed May 2016.
  12. Veterans Affairs Canada, Forms, Source: http://www.veterans.gc.ca/eng/forms, accessed as of 23 June 2016
  13. United Kingdom Ministry of Defence, A Welfare Guide for the Service Leaver: Transition to Civilian Life. Source: http://www.army.mod.uk/documents/general/ADR002441_TransitionToCivilianLifeWeb.pdf, accessed June 2016.
  14. Leaver – is defined in the United Kingdom as a service member who releases from the military service.
  15. United States Department of Veterans Affairs. Source: http://www.benefits.va.gov/benefits/, accessed June 2016.
  16. United States Department of Defense, Office of Warrior Care Policy. Source: http://warriorcare.dodlive.mil/disability-evaluation/ides/, accessed May 2016.
  17. Australian Defence Force, ADF Transition Handbook. Source:  http://www.defence.gov.au/DCO/Transitions/ADF-Transition-Handbook.pdf, accessed May 2016
  18. Letter from Prime Minister to Minister of National Defence Source: http://pm.gc.ca/eng/minister-national-defence-mandate-letter, November 2015
  19. Letter from Prime Minister to Minister of Veterans Affairs and Associate Minister of National Defence. Source: http://pm.gc.ca/eng/minister-veterans-affairs-and-associate-minister-national-defence-mandate-letter, November 2015
  20. Department of National Defence and Canadian Armed Forces. Source: http://www.forces.gc.ca/en/honours-history-medals-chart/other-mem-cross.page
  21. Source: http://www.ombudsman.forces.gc.ca/en/ombudsman-questions-complaints-helpful-information/transition-phases-index.page
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