Veterans Affairs Committee on May 9th, 2013

[Thomas Murphy]

We do. Our network is obviously a little larger than yours, so we have 156 or 157 hospitals across the country. There are dedicated mental health facilities in those locations.

In addition to the community-based outpatient clinics, we have what we call vet centres on top of that, which are smaller facilities that are at a community level. They're all headed up by the coordinated team, which has an expert at the national level and it goes all the way down to the lowest levels.

I know we're seeing very good results from the program of treatment, in that we have veterans coming in and asking for medical treatment for PTSD. This comes from sitting in the briefings and hearing the results, and from personal experience with my own family members. The course of treatment that veterans go through is highly effective in helping them live day to day with the effects of PTSD.

[The Chair, Conservative, Greg Kerr]

Thank you very much. We appreciate that.

We're now going to move on to our next committee member, Mr. Sean Casey from the Liberal Party.

Go ahead for five minutes, please.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you, Mr. Chair, and good morning, gentlemen.

I want to pick up on your last answer. You mentioned that you have 157 hospitals specifically for veterans. In this country, we are getting out of the veterans' hospital business. Could you explain to me the rationale or the benefit of having 157 facilities dedicated to veterans, as opposed to providing them with health care in the same space with the same people as the general population?

[Thomas Murphy]

That's a question so far out of my area of expertise that I couldn't answer it with any level of credibility.

[Robert Reynolds]

I will make one comment. I agree with Tom, but I will speak from...I am a service-connected disabled veteran, and I think our medical centres have the technology and advancements for traumatic, war-time injuries, more so than say a private hospital. They've also expanded to our community-based outpatient clinics and are trying to put the medical treatment and the communities closer to our veterans, who sometimes have more difficulty getting to a bigger hospital facility. And veterans interact a little better with their own kind than they do in a community type of setting.

[Thomas Murphy]

Let me answer one part of that question, now that I've had a moment to think about this.

We differ in the way we handle health care, in that it's the individual's responsibility to take care of himself financially when it comes to health care. When you come to our hospitals, anything that's service-connected is treated in our facilities. If you're rated high enough, 70% to 100% more, then anything medical that you need is treated by our facilities.

The other side of that is—and this is something I learned from the summit in Australia last summer—we spend a significant amount of money in the research and development world, funding development that is veteran-focused, like TPI, PTSD, artificial limbs, and other things that are specific and unique to veterans. Because of the structure that we have in place, we're able to move that research and development along a little faster than might be done in the private sector.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you for that.

In 2007 you had a Veterans' Disability Benefits Commission. It's my understanding that this commission rejected the option of replacing monthly disability benefits with a lump-sum payment. Can you provide us with more detail on why the commission rejected the lump-sum option, as compared with the monthly pension?

[Thomas Murphy]

I don't know the answer to that one off the top of the head, but I believe their report was published and made public. If you would like, I'd be more than happy to provide you with a copy of that report, with all of those details in it.

[Sean Casey, Liberal, Charlottetown, PE]

Thank you.

Do you know whether there has been any sort of analysis or comparison of the rates and manner of compensation in your veterans community, as compared with those who receive workers' compensation benefits? We've had at least one report in this country where there's been a comparison done. Has a similar thing been done in your country?

[Thomas Murphy]

We use a document called the VASRD, the VA “Schedule for Rating Disabilities”. The basic structure of it consists of increments of 10%, starting at zero and capping out at 100%. It's broken up into 15 different body systems: muscular, skeletal injury, neurological, etc. It breaks the body system up.

We're in the middle of a complete rewrite of that system. It's a five-year project. The final drafts will be sent to the next level of concurrence by the end of 2014. We're going back and looking at the advances in medical science and incorporating those advances into the new rating schedule. I'll give you a basic example that will be plain to anybody.

Not too long ago, a knee-replacement surgery put somebody flat on their back for six months, and then there was another six months of recuperation. My cousin had his hip replaced and 90 days later we were on the golf course walking around. The advances in medical science in a case like that...I would've paid 100% disability for 14 months under the old system, but under the new system, with the advances of medical science, I don't need to pay that individual for 14 months. They're fully functional and back to work in 90 to 120 days. That kind of advance in medical science needs to be captured in our rating schedule.

If you take that and expand it to all the different body systems, you can see that there's going to be a multitude of things that need to be changed. The document we have was originally written in the 1940s, and it's been a series of actions going forward. Every couple of years, we'll update our version or change a few things and move it forward. This is the first time since 1945 that it's a top-to-bottom restructure of the entire document, body system by body system.

[The Chair, Conservative, Greg Kerr]

Thank you very much. That's all the time we have for that.

We now go to government member Mr. Bryan Hayes, please.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Mr. Chair, I just want to bring this to your attention. Mr. Reynolds has not had an opportunity to make his opening comments. He wanted to, and he's not going to get that opportunity if we do our rotation. Then we'll get his opening comments at the end.

[The Chair, Conservative, Greg Kerr]

What we're going to do is finish this five-minute round. We'll let him speak, and then we'll do another five-minute round.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Thank you, sir. I just wanted to make sure you were aware of that.

[The Chair, Conservative, Greg Kerr]

Yes.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Thank you, gentlemen.

Veterans Affairs Canada has a ratio nearing 31 case-managed veterans to one case manager. In the United States, do you provide case management to your veterans?

[Thomas Murphy]

That's a great question. What we just did was reorganize our regional offices into lanes, and they're based on the complexity of the claim. The first one is the express lane. They are simple, one or two issues. They are very straightforward, and they are done at a pace that's two to three times of the regular cases. It's 20% to 30% of our workload that goes through the express lane.

The next one is called the core lane, and that's where the majority of the workload goes through. A veteran comes in and he has 8 or 10 issues. He now goes through the core lane, to somebody with more experience, a little more background, and a little more depth of knowledge.

The third one is the special mission lane, and this is the one you're talking about. We reduced the workload on those individuals and concentrated them in a case management type of environment, so the veteran who has multiple amputations or severe head injuries, the veteran who really needs to be helped and who we need to spend some time with in one-on-one communication, now goes through that special lane.

What we did not do is go to the level that you just described, which is a 31:1 ratio. We don't have it detailed to that level.

[Robert Reynolds]

But for our severely wounded, ill, or injured we do have federal recovery coordinators who provide that type of case management. Again, those are for our most severely disabled, and we work very closely with the branches of service. For example, the Marine Corps has a Wounded Warrior Regiment. I have a full-time employee on that staff. Our special operations unit down in MacDill has the same thing. The army has one.

So we have employees who are embedded, and we do case management, but again, it's for our most severely wounded, ill, or injured.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

In the case of a special mission stream, you wouldn't be able to answer how many case managers there are, in terms of a ratio?

[Robert Reynolds]

I don't know it off the top of my head, but I can get that to you.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

Yes, thank you. I'd be interested in knowing that.

[Robert Reynolds]

Okay.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

I'll carry on.

The veterans independence program here in Canada is focused on providing home and health supports to allow veterans to stay in their homes as they wish. We'd much sooner have our veterans stay in a home. It's less burdensome to the taxpayer, quite frankly.

Does the United States system focus on keeping veterans in their homes as they seek to maintain their independence?

[Thomas Murphy]

We have a program called Aid & Attendance. It's needs-based as opposed to “Because I'm a veteran, I'm entitled to...”. It's not based on the average ability of a veteran, but it's focused on exactly what you're talking about: an elderly veteran living at home needs home health care, somebody to come in and help him, or he needs a spouse to be there or a family member to come in. There are costs to all of that. We have the ability to step in and provide some money to help either offset those costs or provide for those costs in the first place.

Yes, it's targeted to keep the veteran in their home and allow them to continue living independently.

[Bryan Hayes, Conservative, Sault Ste. Marie, ON]

What services exactly are provided through that program?