National Defence Committee on May 12th, 2023

[The Chair, Liberal, John McKay]

I call this meeting to order. We have completed all the sound checks and all the weather reports, so we now know that it's a nice day here in Ottawa and elsewhere.

In our first hour we have, representing the Office of the National Defence and Canadian Armed Forces Ombudsman, Gregory Lick—a familiar face before this committee—and Robyn Hynes, director general of operations. Appearing virtually are retired Colonel Nishika Jardine and Duane Schippers, deputy veterans ombudsman.

Welcome, everyone.

With that, you have five minutes to make your opening statements.

Mr. Lick, I'll let you proceed for the next five minutes. Go ahead, please. Thank you.

[Gregory Lick, Ombudsman, National Defence and Canadian Armed Forces]

Thank you.

Good morning, committee members. Thank you very much for inviting me to discuss this important topic. There have been many studies on individual or collective aspects of the military-to-civilian transition, access to health care and barriers to accessing benefits and services in DND on the CAF and Veterans Affairs Canada sides.

Parliamentary committees and both of our offices have made many recommendations that either have yet to be implemented or will not be implemented. Simply put, it can be hard to hold the government to account in this regard.

We must get this issue right for members transitioning from military to civilian life. This process represents more than a change of jobs or retirement. For many members, the Canadian Armed Forces forms a critical part of their identity. Leaving the CAF, they lose that connection while facing physical, mental or moral injuries. If you do military transition well, you will have a good civilian.

My office issues follow-ups to recommendations contained in our systemic investigation reports. We have clear criteria by which we determine whether our recommendations are fully implemented, partially implemented, or not implemented at all. We posted these reports on our public website.

Since 2016, the results have not been promising regarding the topic you are currently studying.

In 2016 we released reports on three investigations: one on operational stress injuries in the primary reserves and two focusing on the process of transition from military to civilian life. We made eight recommendations, seven of which the minister accepted. None of the accepted recommendations have been fully implemented.

Let me be clear. Our office has a great relationship with the department and the CAF at the working level. Since 2018 the CAF has accepted and implemented all of our recommendations, which resulted from individual investigations. Ms. Hynes, who is the head of our operations group, and I are incredibly proud of that track record, but it's the recommendations stemming from our systemic investigations that often experience slow progress.

Take one important example: In 2016, our office recommended that no member of the Canadian Armed Forces should be medically released without all benefits and services, from all sources, including Veterans Affairs Canada, in place.

This committee made a nearly verbatim recommendation in 2018. So did the Senate subcommittee on veterans affairs. So too, in fact, did SSE initiative 28, in which the government set out its goal to “ensure that all benefits will be in place before a member transitions to post-military life”.

The government claims to have checked this initiative off its list, but according to our analysis, it has not.

How do we know this? Our office still receives cases. People are still falling through the cracks. Other organizations exist to provide emergency services to current and former CAF members, including those in the transition process, who are still called to help out. Perhaps worse, potentially many more veterans are not coming forward to indicate that they are unprepared for release, that their benefits and services are not in place and that a timely VAC adjudication is not on the horizon.

Whatever the reasons, we know that the principal problem is slow VAC adjudications. The backlogs have been well documented publicly, and the OVO can best address these issues. I can say with great certainty that this is not a people problem. You have people within VAC who want to do the right thing. It is a process problem. All the new hires and all the money spent to this point would have resolved the issues, were those were the root causes.

Solutions have been put forward. We know that improving processes related to service attribution and faster benefits and adjudication decisions would go a long way to improving the transition process.

We must act and be accountable for our actions. We must ensure that the closer we bring the adjudication of an illness or injury to the onset of the illness or injury itself with well-articulated causes and diagnoses by CAF medical personnel, the speedier the outcome will be in adjudication.

For example, the CAF expanded access to the Canadian Forces health information system, which houses medical information required by VAC staff to analyze files and render decisions on VAC benefits and services. However, VAC then put barriers in place, which cause delay and prevent staff from completing their work properly.

Committee members, I am not all doom and gloom. I have seen the good promise that the CAF transition group could make. I hear this from members assigned to the transition units. It's going better. I am very much hoping they can reach full operating capability by 2024.

In 2025, we plan on launching an investigation to review how these initiatives will shake out. But I can almost guarantee that some of our recommendations will be the same as they have been for the last decade or more.

Additionally—

[The Chair, Liberal, John McKay]

Mr. Lick, the five minutes have passed.

[Gregory Lick]

I have one more paragraph.

Additionally—this is me personally—I have made it my mission before the end of my term to try to bring resolution to the many issues and challenges facing military families. The proper treatment of families weighs significantly on our ability to recruit and retain CAF members. We have seen through numerous statistics that family issues can contribute significantly to members' release. Therefore, the treatment of families is an issue of national security.

Thank you. I now turn it over to Colonel Jardine.

[The Chair, Liberal, John McKay]

Thank you.

Actually you don't. I turn it over to Colonel Jardine, but that's just a technical thing.

Colonel Jardine, we are all awaiting what you have to say for the next five minutes.

[Colonel, Retired) Nishika Jardine (Veterans Ombud, Office of the Veterans Ombudsman]

Good morning, Mr. Chair and members of the committee.

Thank you for inviting me to contribute to your study on challenges associated with medical release and transition to civilian life.

As the veterans ombud, my mandate is to receive and review complaints from clients of Veterans Affairs Canada, or VAC, who feel they have been treated unfairly. I can also review systemic gaps in or barriers to equitable access to VAC programs and benefits.

Understanding the impact of transition on veterans and their families has been a focus of the Veterans Ombuds for the past several years. In 2017, we published a qualitative study to better understand the factors that contribute to a successful transition from military to civilian life. Participants reported that their main challenges included finding a new sense of purpose, maintaining financial security, equating military experience with civilian work experience, and coping with the stigma around mental health.

Most new veterans will seek employment post service, both for financial reasons and to meet the need for a new sense of purpose. There are workplaces that understand what veterans bring to the table, but there are many more that do not.

VAC offers a career transition service to assist serving members and veterans in their journey to civilian employment. However, we have heard from veterans that there is still a gap in translating military competencies to civilian competencies, particularly in the officer occupations. Finding a job and finding purpose are for many veterans the same thing. When their service experience is unrecognizable to hiring managers, it can become a barrier to successful transition.

Veterans with a medical release have access to significant support, both on their way out of the CAF and then onwards from VAC. I am far more concerned about veterans who release voluntarily or for other reasons, particularly those with insufficient years of service to be immediately eligible to receive their CAF pension, which is the determining factor for access to the public service health care plan or the pensioners' dental services plan.

These non-medically released veterans with fewer than 20 or 25 years of service who may nevertheless have service-related illness or injuries are the ones I am most concerned about. Delays by VAC in adjudicating disability claims can have tangible impacts on their well-being.

VAC recently implemented a new program whereby some veterans who submit disability claims for mental health will have immediate access to treatment benefits. I believe this immediate access to treatment benefits should be extended to all disability claimants, or, as we recommended in 2018, VAC should triage claims according to unmet health needs.

In 2021, we recommended that VAC provide mental health support for family members in their own right, for conditions related to their veteran's service. Over the past months, I have heard heartbreaking stories of veterans' spouses and family members who are left to struggle on their own.

We say that when a member serves, their family serves with them. We say that families are the strength behind the uniform. And yet, it takes very little for these important people to be disconnected from help they need in their own right. I am more convinced than ever that we cannot continue to rely on spouses and families for their immeasurable, irreplaceable and invaluable support to the CAF's operational capacity and then not meet their mental health needs as a result of supporting a veteran during their service.

In the past, on release, new veterans were pretty much on their own to figure out how to thrive as they returned to civilian life. There was and continues to be great support for those who are released for medical reasons, but that was not and is not necessarily the case for everyone else.

Over the past few years, there has been a growing recognition that the transition from military to veteran is not just a simple matter of handing back your uniform and your ID card. Just as entering the CAF is a bit of a shock—basic training is designed, after all, to instill discipline, leadership, teamwork, service before self, putting yourself in harm's way and, yes, using weapons—leaving the CAF can be just as significant. I firmly believe that once you've successfully completed basic training, you are forever changed. You are never truly civilian again. When we leave the CAF, we are veterans.

Over the past several months, I have visited a number of the transition centres. I'm encouraged by what I see. Extending strong support to all new veterans in the same way that has been done for medically released veterans will go a long way to easing the transition from military back to civilian life. As the veterans ombud, I am focused on the important and lifelong relationship between veterans and Veterans Affairs Canada. The transition centres have a huge role to play in getting that relationship off on the right foot.

Thank you again for the invitation to contribute to your work for the Canadian Armed Forces and our veterans.

I look forward to your recommendations.

Thank you.

[The Chair, Liberal, John McKay]

Thank you, Colonel Jardine.

Ms. Gallant, you have six minutes.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Thank you, Mr. Chairman.

To the ombudsman, Mr. Lick, would you please outline the steps that are involved in the process of being medically discharged?

[Gregory Lick]

I could take probably the whole hour to do that, but what I'll do is hand it to Ms. Hynes to take you through those steps and some very general things.

We can also forward information to you in written format afterwards, to give you some of that detail.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Okay, but can I get the shortest possible answer right now, please?

[Gregory Lick]

Absolutely.

[Robyn Hynes, Director General of Operations, National Defence and Canadian Armed Forces Ombudsman]

There are three main phases to medical release. The first phase is the period of time between when the injury or the diagnosis of the illness happens and when the director of military careers administration makes the decision on whether or not the member will be medically released. There are times, of course, when a member is injured and is capable of returning back to work.

The second phase is the period of time between a member's receiving the decision that they will be medically released and the actual release date. It's about the planning that goes into the transition of the medical release to ensure continuity of care, for example, before that member is released.

Finally, the last phase is the period between when a member is released and up to two years after, when they may be eligible for a number of benefits and services through the Canadian Armed Forces, SISIP and Veterans Affairs Canada.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

We still have a situation in which soldiers are medically released due to injuries they incur on the job, yet when they go through the transition process and are in civilian life, they have to go to a civilian doctor in order to be assessed for which benefits they will receive. They're being released from the military due to their injuries, and they get to the veterans stage and have to prove that they have the injuries.

How can that contradiction be solved so that they don't have to fight after they've just been kicked out of the military because of the injuries and they don't have universality of service?

[Gregory Lick]

It's an excellent question. It is one that we've already studied and made a recommendation on, in this case. It makes sense that the people who are treating you, who have knowledge of the military environment in which you work—the same as a company—will examine you and are currently your doctor already. They will make that attribution. When you break your leg parachuting out of a plane, it's kind of obvious that it happened on the job. You don't need a civilian doctor to tell you that.

That's why we made the recommendation that the CAF would be best suited to making that attribution of “injury due to service” type of thing. That would be our solution. There may be elements within the CAF about how to do that, but they're the ones with the best knowledge.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

What steps need to be taken to have a seamless transfer between DND and CAF to Veterans Affairs, and a seamless interprovincial transfer of documents during service with the CAF versus immediately after discharge?

[Gregory Lick]

On the first element of it, to reiterate what I just said, essentially the earlier that service attribution of an injury is made before they release from the Canadian Armed Forces, the better and the more efficient the adjudication would be in VAC. What we've recommended before and what we continue to recommend is to have that service attribution done before they release, so that the adjudication of whatever benefits they should receive is done much more quickly.

On the second part of your question, on the transfer of documentation, we're actually seeing it better in terms of transfer from CAF to Veterans Affairs. That's happening better now, particularly because there are more electronic documents. The issue that you raised about transferring it to civilian doctors is a particularly difficult one, though. I don't really have a solution for that one per se. Making them electronic.... One of the things that we heard from a number of people is that putting them on a CD nowadays, when most computers don't have CD players.... It's something as simple as that, having it put on a memory stick with appropriate security. Those are the small things that cause a lot of irritation for people. It would make the transition more seamless in terms of that transferred documentation.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

Do you find that there's a difference between provinces in the transfer of records and transfer of care, or is it the same level of time and difficulty across the board?

[Gregory Lick]

I couldn't really comment on that. I think that question would be better for the surgeon general in terms of how they might find that transfer of documentation. I don't think we have received any complaints in that regard that I know of.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

How quickly can an injured soldier see a specialist when still in the forces?

[Gregory Lick]

Very quickly.

[Cheryl Gallant, Conservative, Renfrew—Nipissing—Pembroke, ON]

There was a report recently that said that doctors in the military were told to under-report adverse reactions to one of the shots that they're given.

In your report you mention that one of the potential problems is inaccurate or incomplete reporting. One, has this come to your attention, and have you looked into it? Two, if all the medical aspects of what's happened to the soldier are not recorded, will that have an impact eventually should there be any consequences to that when they are out of the forces?

[Gregory Lick]

On the latter part of your question, absolutely. If the medical documentation is not full and complete, it doesn't talk about the reasons for the injury and things like that, then the adjudication becomes slower. They have to find other information. They may have to look through other documents, maybe not medical in nature. Maybe they're deployment documents, where they were deployed to, those types of things.

The issue about complaints that come to our office is certainly not about direction to under-report. That is not what we hear. The issue might be that medical professionals are not putting all the information in that they require. The same thing likely happens in civilian medical systems as well, but in this case, the VAC has to use that information to make adjudication. If it's not complete, then the adjudication process becomes slower. The more complete the documentation, the faster the adjudication.

[The Chair, Liberal, John McKay]

We're going to have to leave it there.

Mr. May, you have six minutes.

[Bryan May, Liberal, Cambridge, ON]

Thank you, Mr. Chair, and thanks to both witnesses for being here today and helping us with this study.

I hope I'll get both questions in for both of you, but I'll start with Mr. Lick.

I understand the ombudsman's office is currently conducting a systemic investigation, with a specific focus on mental health. Can you share with us today any of the preliminary insights from that investigation?

[Gregory Lick]

Certainly. Since we haven't provided it to the minister just yet, we'll cover a few of the findings but not the recommendations.

In that regard, the systemic investigation, which we have just completed and are just about to provide to the minister, was for the purpose of looking at how our primary reserve is treated in comparison to regular force personnel on domestic operations with regard to their mental health.

There are certainly some issues there, similar to what we just talked about with Ms. Gallant in terms of that continuity of care. If something happens on a domestic operation.... Certainly, you can have mental health issues as a result of many domestic operations, including going into long-term care homes, which we saw over the pandemic.

One of the issues is that there is not enough information, and primary reservists and leadership teams may not be aware of all the benefits, services and supports they can receive as a result of injury—whether it's to mental health or physical health—acquired on a domestic operation.

Communication about that information is really important to make sure that primary reservists, in this case, understand what they could receive. Also, making sure that periodic health assessments are done.... In this case, primary reservists, me being one of them.... During my career as a reservist, I received two PHAs during my 17 years.

It's supposed to happen much more often than that. We've seen that not all primary reservists receive those periodic health assessments. It's very difficult, then, to understand, after a domestic operation, if they have received an injury from that domestic operation or if they have aggravated an injury that they may have already had. In this case, we're talking about mental health.

Those are just a few of the areas of findings that we've found. We will be making recommendations to the minister and to the department in that regard.