Veterans Affairs Committee on March 10th, 2015

[The Chair, Conservative, Royal Galipeau]

Mr. Lemieux, over to you.

[Pierre Lemieux, Conservative, Glengarry—Prescott—Russell, ON]

Thank you very much.

Thank you very much for being here.

When I was in the military, there was a process with a temporary medical category leading perhaps to a permanent medical category. I'm wondering if you might be able to explain that process to the committee. I ask because sometimes there is a perception that, “Oh, we have an injured soldier; he's out.” I don't think that's quite the case.

You had mentioned before that the process can take two to three years, depending on the condition. I'm wondering if you could perhaps walk us through the temporary category process, the permanent category process—with an injury that is either self-disclosed by a soldier or noticed by the system, let's say, when it's known that the soldier has an injury—and perhaps the timeframes involved. When you talk about the temporary category, phase one, can you explain some of the time periods that are involved in that?

[Col Hugh MacKay]

When members have been injured or become ill, whether they've come and reported it or somebody in the system has noticed it and asked them to have an assessment, their caregivers will usually take some time to evaluate their condition and try to see whether or not there is going to be much of a shift in those members' condition. The individual who has been wounded in Iraq, unfortunately, is not in a temporary medical category yet. He won't be in a medical category for some time, because we're going to need time to be able to assess and evaluate him. I think it's probably two, three, or sometimes six months before even the first temporary medical category may be assigned to an individual as the individual goes through the care workup and assessment.

A temporary category is usually six months. After an initial period of six months on a temporary category, very rarely would we put somebody in a permanent category. Almost always that person will have a second temporary category of six months. Usually after that second temporary category of six months, we are now well over a year into the process of this individual's illness or injury, so we are starting to get a good idea of what the prognosis is going to be. After that second temporary category, if we have good visibility of that prognosis, we may assign a permanent medical category.

There are conditions, however, where depending on the complexity of the case, it may take up to two years before a permanent medical category is assigned. After a permanent medical category is assigned, there is then the administrative process that has to be undertaken, and that can take six months to a year before a decision is made with respect to universality of service compliance. It's only at that time that a decision is made as to whether or not the individual will be released or be able to be retained within the Canadian Forces. Once that decision is made, I believe there is typically another six-month period of finalizing the transition. If we are starting to see that a member is going to have to leave the forces as we assign a permanent medical category, we'll really start the planning for what will be undertaken in that transition.

[Pierre Lemieux, Conservative, Glengarry—Prescott—Russell, ON]

Generally speaking, because I know it's dependent on each specific case, if I heard you correctly, you said it can take roughly six months or up to six months to determine whether or not you can even start with a temporary category process. If he's assigned a temporary category, that can last six months. There's usually a second temporary category window of another six months. At the end of that, the decision to move to a permanent category will take time on top of that. You mentioned perhaps up to two years depending on the nature of the injury. Then there's the administrative process of determining whether or not he can stay in the forces with his permanent category, and that can take six to twelve months. Then there's the actual administrative release process. When a decision is made that you don't meet the universality of service, you start the release process, and that can take up to six months. That's how you're coming up with a window of anywhere from, let's say, two years. You had mentioned three years and it looks as though it could take as long as four years.

[Col Hugh MacKay]

It can.

[Pierre Lemieux, Conservative, Glengarry—Prescott—Russell, ON]

It depends on the nature.

Perhaps you could shed some light on the difference between someone who has a permanent medical category and who does not meet the universality of service and therefore must be medically released and the person who has a permanent medical category and yet can be retained.

Are you able to give a generic example of each of those situations?

[Col Hugh MacKay]

Somebody with a permanent medical category who doesn't meet universality of service may be one of our patients who has had a heart attack and has a left ventricular ejection fraction of 25%, if you will, and is just not able to undertake the demands of military service and so would end up being released.

Somebody with perhaps a knee injury who has a permanent medical category and can only undertake restricted physical activity but who is still able to meet the universality of service may be retained. I'll also say, though, that there are people who have permanent medical categories, who do not meet universality of service, but who can be accommodated for a period of time within the organization.

Can that be up to three years?

[Colonel Marc Bilodeau, Director Medical Policy, Canadian Forces Health Services Centre, Department of National Defence]

It can be up to three years.

[Col Hugh MacKay]

So there are various categories and options. DMCA decides whether or not somebody will be accommodated, and that depends on where we are with respect to the trade the individual is in.

[Pierre Lemieux, Conservative, Glengarry—Prescott—Russell, ON]

This might dovetail with what you said earlier about making sure that there's a continuation of care. In other words, they could be retained for a longer period of time if DMCA says so and if that can be coordinated within the trade to allow them perhaps a smoother transition back into civilian life or into civilian medical care?

[Col Hugh MacKay]

That may permit that transition, but oftentimes it's not the accommodation that's undertaken in order to enable the smoother transition. It's not called an accommodation. We just extend the transition period. They are going to be released, and we try to extend that as much as possible to allow the transition to occur.

[Pierre Lemieux, Conservative, Glengarry—Prescott—Russell, ON]

Okay.

Thank you.

[The Chair, Conservative, Royal Galipeau]

In accordance with routine motions, the remainder of the questions and answers cannot exceed five minutes. I have a bit of flexibility, but not much.

It is now Mr. Chicoine's turn.

[Sylvain Chicoine, NDP, Châteauguay—Saint-Constant, QC]

Thank you Mr. Chair.

Gentleman, could you tell me when Veterans Affairs comes into the picture once a decision has been made to medically release a member? Is the department notified immediately? What's the process for the transfer of medical information?

[Col Hugh MacKay]

Are you familiar with that?

[Col Marc Bilodeau]

There are basically two different ways that Veterans Affairs is informed. One is through a member application for VAC benefits. As soon as a member decides to apply for these benefits, then the VAC is informed and will do their review process.

That's separate from the medical administration of the specific case.

In a complex case where we know that VAC involvement will be required after release, we are trying to have them involved as early as six months before the release. Our case manager and the VAC case manager will get together with the member and try to support them and transfer the support from one organization to another during that transition period, six months before the release. This process is separate from the other process by which a member can apply for VAC benefits.

We have some issues now because some members are applying late for their VAC benefits and are not considered eligible for these benefits within the six months before release. We are trying to work on that and reduce that timeline by having our case managers be more proactive in inviting the members to apply. We cannot do it for them, as they have to do it themselves, but we are encouraging them to apply for benefits when it's a service-rated condition and they can opt in for some support from VAC.

[Sylvain Chicoine, NDP, Châteauguay—Saint-Constant, QC]

Thank you.

Often, Veterans Affairs doesn't have access to the member's medical records. How does the department get that information? Does the member have to consent? Sometimes, the member's medical records are transferred to Veterans Affairs, but other times, they aren't. What steps have to happen to make the transfer of medical records possible?

[Col Hugh MacKay]

The transfer of medical records is usually done on a request from Veterans Affairs, based on the request by the member to Veterans Affairs Canada.

We are not able to transfer files directly from the Canadian Armed Forces to Veterans Affairs Canada because of their regulations and the Privacy Act. When we receive a request from Veterans Affairs Canada, we need to take the medical record and sever any third-party information from those medical records.

For example, sometimes when you are encountering a patient, a physician may write in a clinical note that the member's spouse is having problems with mental health issues. It's not appropriate for us to give information about the spouse to Veterans Affairs Canada. We need to make sure that that kind of information is removed from all of the files. That creates a bit of a delay in our being able to process and transfer those files. I will say that we have increased the staff that are doing that severing right now. We've reduced the backlog of files from about 1,600 to 800. We are now able to process requests from Veterans Affairs Canada within 31 days, which is far better than we did about 6 or 8 months ago.

We cannot release those files without the member's authorization and a request to Veterans Affairs Canada.

[Sylvain Chicoine, NDP, Châteauguay—Saint-Constant, QC]

So the CAF member has to request it, not Veterans Affairs. Medical records aren't transferred automatically. The member has to give consent.

[Col Hugh MacKay]

That's correct.

[Sylvain Chicoine, NDP, Châteauguay—Saint-Constant, QC]

Very good.

Can the CAF member gain access to their medical file easily? I would think they absolutely have to ask for it. Are they told that they can request it upon their release?

[Col Hugh MacKay]

A member can request a sit-down meeting with the caregiver to go through the medical file at any time. The member would be able to sit down with the primary care provider to go through that file.

We don't usually make a copy of it and hand it over until it is time for the release. At that time we prepare a severed medical file, namely one that is severed of third-party information. Sometimes if we have a vaccination parade, we may vaccinate 100 people, and that list ends up on the medical file. So there are 100 names that shouldn't be there, and we need to make sure that that information is removed. When a member is to be released, the member will receive a copy of the medical file, unless they make a special request to receive a copy of it before that time.

[The Chair, Conservative, Royal Galipeau]

Mr. Hayes.

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

Thank you, Mr. Chair.

I want to focus a little bit on mental health services to get an understanding of the synergies between Veterans Affairs and DND.

You referred to a Canadian Forces rehabilitation program, and obviously there's a rehabilitation services and vocational assistance program through Veterans Affairs.

We just studied mental health. In the Auditor General's report, and specific to the Veterans Affairs rehab services, the Auditor General is really happy that the eligibility decision is made within two weeks, 84% of the time.

I want to understand the eligibility component. How is it determined that a member would need mental health services? What is the wait time to determine that?

Here I want to understand the synergies between the mental health services that are provided through Veterans Affairs versus Canadian Forces. If there are two complete distinct separate components, that leads me to think there's a duplication of services, and I can't imagine that's the case.

So, talk a little bit about shared efficiencies, and talk about the eligibility decision behind the receipt of mental health services.

[Col Hugh MacKay]

Our mental health program is primarily designed to deliver care to Canadian Forces members or reservists who are entitled.

That said, we do also have an agreement with the RCMP and Veterans Affairs Canada to be able to look after some veterans or RCMP members within our mental health program. We are also able to access the OSI clinics of Veterans Affairs Canada for some of our members if there is a need, and usually that would surface with a reservist because we may not have a base nearby where the reservist lives.

To be eligible for mental health care in the Canadian armed forces, you present to our clinic. Usually you present to a primary care clinic first to discuss whatever medical problem you have, and you are taken into our program.

Usually the management of a patient would start at primary care. If the primary care providers feel there a need for further specialist care, then the patient would be referred either to our mental health clinic or to the OTSSC depending on the nature....

Sometimes we undertake screening. We do screening with our periodic health assessments for mental health problems. We also do an enhanced post deployment screening about six months after people return from deployments. If we pick up somebody in that screening process, we'll call them in to have a discussion with them about what's going on with them, and determine whether or not it's time for them, or if they do have a mental illness we need to help them with.