Veterans Affairs Committee on June 13th, 2016

[The Chair, Liberal, Neil Ellis]

Good evening, everybody.

I would like to call the meeting to order and to thank everybody for coming out tonight.

This is the Standing Committee on Veterans Affairs and tonight, pursuant to Standing Order 108(2), we are here for our study on service delivery to veterans. In front of us we have Walter Callaghan and Brenda Northey.

We'll start with each committee member introducing themself. We'll start with Ms. Lockhart and we'll give each member a minute or two or five to say who they are.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

I won't give you a five-minute spiel about who I am.

I'm Alaina Lockhart. I represent the region called Fundy Royal in New Brunswick.

I have an interest in serving on this committee because our community has always had lots of veterans, more so in the First and Second World Wars, and the Korean War, but we are transforming into this new age. Like many other Canadians, I feel that we have a duty to serve our veterans.

That's why I am honoured to be here, and I thank you for taking your time to come and I want you to know that we have open ears.

[Colin Fraser, Liberal, West Nova, NS]

My name is Colin Fraser. I'm the member of Parliament for West Nova, which encompasses the southwestern part of Nova Scotia and contains 14 Wing Greenwood.

Prior to going to law school and becoming a lawyer and then getting into politics, I worked at Vimy Ridge in France as a tour guide. Since that time it really has become a passion of mine to learn about the important contribution that the Canadian Forces have made in our history, and it's our obligation to make sure that those who serve our country so valiantly, the men and women, get taken care of properly.

That's why I'm so pleased that the first thing we're doing as a committee—and I am honoured to be on this important committee—is to undertake a study of service delivery to see how we can improve the way that our men and women in uniform, who become veterans afterwards, are treated by our government and to make sure that we're doing the absolute best job we possibly can.

I'm pleased that everyone could be here this evening. We certainly welcome all of your thoughts and opinions and look forward to hearing constructive criticism so that we can put forward recommendations to the government and try to move forward in a way that responds to the needs of our vets.

Thank you very much for being here. I certainly welcome all of your comments.

[Bob Bratina, Liberal, Hamilton East—Stoney Creek, ON]

My name is Bob Bratina. I'm the member of Parliament for Hamilton East—Stoney Creek. I was the mayor of Hamilton.

As the mayor of Hamilton I was the only mayor in Canada who had a senior advisor on military heritage and protocol, because Hamilton has a tremendous military heritage coming right up to the present day. But it had started to be forgotten to the point where the cenotaph where Remembrance Day is held was actually crumbling and in danger of falling down. We have completely rebuilt and rededicated that area and it's called Veterans' Place now.

The gentleman who was on my staff as an advisor for military heritage and protocol was the commanding officer of the Argyll and Sutherland Highlanders. The sad irony, given my wish to reacquaint Hamiltonians with their military heritage, was to have faced the very sad occasion of the loss of Nathan Cirillo's life at the National War Memorial, and all that entailed.

It's a very important thing for me.

I have a 95-year-old Dieppe veteran and I have 26-year-old Afghanistan veteran and other veterans in my city, and we intend to see that they're looked after.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I am Robert Kitchen. I am a member of Parliament for Souris—Moose Mountain. My riding encompasses the southeast corner of Saskatchewan, roughly 43,000 square kilometres.

I come from a very strong military background. I am an army brat. I spent many years travelling around with the military and while I was in the cadets, and then worked as a civilian instructor.

I think I bring a very rural focus to the committee rural focus. I dealing with a lot of veterans, whether they're aboriginal or first nation, who are returning to their communities. I focus on how we encompass and include them in the program and to make sure that their wishes are followed through.

I'm extremely honoured to be on this committee and I look forward to hearing what you have to say to us.

Thank you very much for coming.

[Alupa Clarke, Conservative, Beauport—Limoilou, QC]

Good evening, everyone.

Thank you very much for being with us tonight. It's an honour to have you here.

My name is Alupa Clarke, and I'm the MP for Beauport—Limoilou. It's a riding in the beautiful Quebec City, the oldest city in Canada. I'm also the official opposition critic for Veterans Affairs. I come from a military family. My father was military, my brother went to Afghanistan, and I just released last November.

My goal, and our goal, is really to be able to see what has happened since 2006 with the new Veterans Charter, how the system improved or did not improve the situation for veterans, and to make sure that we make a report that will put forward new changes to the NVC so that veterans have the delivery of service they should have. I also think it's very important that we take a look at the internal workings of the department to make sure there's a culture that's open to veterans.

These are some of the subjects I would like to hear about tonight, if you have anything to say about them. Thank you very much for being here. I very much look forward to hearing what you have to say.

Thank you.

[Irene Mathyssen, NDP, London—Fanshawe, ON]

Thank you very much for being here. I appreciate your taking this time to come and talk to us.

I'm Irene Mathyssen, and I'm the member of Parliament for London—Fanshawe. I am also a vice-chair of the committee. I'm a member of the New Democratic Party caucus.

Unlike others on the committee, I have a long history with this particular committee. I've been an MP for ten and a half years. What has become very clear to me in those intervening years is that we've had lots of discussions, lots of reports, and lots of witnesses, and still we haven't been able to arrive at the solution to what are, I recognize, very complex problems, but the solutions are there.

I am eternally optimistic, despite ten and a half years of being an MP, that if, this time, we listen carefully and have the courage and the political will to make happen the things that should happen, we can get there. I'm determined that this is what I want to do, and no matter how much longer I have in this job, I want that to be part of what I and this committee accomplish.

Thank you again for being here.

[The Chair, Liberal, Neil Ellis]

Everybody didn't use up their two minutes, so I have about 22 minutes for my bio, so bear with me.

I'm a first-term MP, a former mayor of the city of Belleville. It's a great pleasure to be on the veterans committee and also an honour to be the chair. I'm a son of a World War II veteran who served and lied about his age. He served in the navy on the Uganda. I grew up in a neighbourhood in a navy house, with an army and air force house beside me. Being there made for an interesting childhood.

We're here tonight to listen to you and your story, and that's all you need to know about me.

I'll flip over to Mr. Callaghan.

Welcome.

[Walter Callaghan, As an Individual]

Thank you.

I'm going to read a statement I prepared. It may be easier instead of my going off on a long-winded, antagonistic rant.

To members of the Standing Committee on Veterans Affairs, thank you for this opportunity to provide a statement regarding service delivery to veterans by Veterans Affairs Canada.

My name is Walter Callaghan, and I served in the Canadian Forces from March 2001 until my medical release in August 2010. I suffer from chronic pain due to a severe back injury and struggle daily with the psychological distress symptomatic of my post-traumatic stress disorder diagnosis. Currently despite my injury, I am a Ph.D. student in medical anthropology at the University of Toronto, with my research focused on the subject of the experience of PTSD.

Despite being classified as permanently disabled several years ago, I still have to face constant paperwork to obtain approval for treatment of my condition. As an aside, I received a huge bundle of paperwork this morning that I have to fill out once again. It's aggravating.

I was taken off the rehabilitation program in January 2015 because my pension condition was deemed to have “reached the maintenance stage”. In other words, no further improvement was expected. The letter I received notifying me of this also stated, and this is a direct quote from the letter: “As your participation in the rehabilitation services and vocational assistance program is completed, your earnings loss benefit under the financial benefits program is no longer payable”.

In effect, I was told that because my injuries were permanent and that no further improvement was expected, I was no longer eligible for a key benefit. However I was not informed of the extended earnings loss benefit, which I was eligible for, because I was deemed permanently injured. This lack of information caused extreme anxiety, something that I think most of you have heard or can understand, is to be avoided when you have PTSD.

However, I would suggest that even having had access to the rehabilitation program in the first place makes me one of the lucky ones. I say this because I managed to get VAC to approve my claims for benefits, albeit it was a lengthy and arduous fight to obtain those approvals: it took four years for the back condition to be covered, and seven years for the major depression; and they're still not acknowledging the PTSD despite numerous reports and clinical material on it that have been sent to them.

Instead of the benefit of the doubt being applied, many veterans, especially those like me who served in the reserve force, face an adversarial bureaucratic system that amounts to little more than an insurance-minded scheme of denial by design.

A key example of this is that reserve force veterans almost immediately have their claims questioned as to the connection of their injuries to military service on the basis that the medical reports that are submitted with their claims are predominately written by civilian doctors. This being because reservists are largely unable to access doctors within the Canadian Forces, instead being required to use the civilian medical system.

Judgments frequently made by Veterans Affairs Canada in denying these claims is that the very nature of the supporting documents having been completed by civilian doctors indicates that the injuries are due to non-service incidents, because if the incidents were service-related, then a military doctor would have signed off on the documents.

Even when claims are finally approved in favour of the veteran after lengthy appeals and reviews and reapplications, they are generally done so at a lower level on the fifth scale, with the argument being made that the injuries weren't fully due to military service; that there was some factor from our non-military life that played a role in our injury, even when there is nothing to indicate this. This is particularly prevalent in cases of operational stress injuries and post-traumatic stress disorder.

Associated with this and aggravating to veterans with PTSD is the challenge of malingering or non-compliance when the veteran chooses treatment modalities other than pharmacotherapy. The reality is that the side effects of pharmacotherapy are often worse, both subjectively and objectively, than the condition for which they're being prescribed. When the veteran, in consultation with their clinical team, decides to opt for alternatives to being drugged up, this seems to be an immediate red flag for Veterans Affairs Canada, which then challenges the severity and even the reality and authenticity of the veteran's injury.

This argument has also been used to deny initial claims for benefits, asserting that since the veteran is not on medication, then the veteran does not have a claim condition or that a condition is not severe.

Given that many veterans, again especially reservists, are required to pay out of pocket for any medications prescribed until their claims are approved, and with the awareness that the initial diagnosis, if it can even be called that, is done through a very brief assessment, frequently by a non-specialist medical doctor, generally not a psychiatrist or psychotherapist, it should not be at all surprising that many veterans, particularly with an operational stress injury, do not have the extensive records of pharmacotherapy when applying initially to VAC for benefits.

These systematic forms of denial by design impact the physical and psychological health of far too many veterans. In the cases of PTSD or other operational stress injuries, these denials tend to occur at a time of increased vulnerability, when the veteran has finally reached out, likely while in a state of near crisis. To have the authenticity of one's claims questioned at such a time does little more than aggravate the level of psychological distress, potentially increasing the severity of that psychological distress to the point that suicide occurs.

In the end, it doesn't really matter what programs or benefits are available if the veteran cannot access them. It is incredibly problematic that a key barrier to access is this failure by Veterans Affairs Canada to operate under the auspices of benefit of the doubt instead of relying on an insurance-minded bureaucratic culture of denial by design.

Thank you for listening to me.

[The Chair, Liberal, Neil Ellis]

Thank you.

Ms. Northey.

[Brenda Northey, As an Individual]

To follow that presentation is going to be very difficult, but I'm presenting, actually, from a different perspective. I've tried to be a service provider to veterans, and people like Walter. I just want to talk about my experience going forward so that it may help other service providers.

My background is that I have an MBA, but I am also accredited in an area called logotherapy, which is based on Viktor Frankl's meaning base. I'm not sure if a lot of you are familiar with him, but he wrote probably the most famous book on that, Man's Search for Meaning. It was all about his experiences as a prisoner in some of the worst concentration camps in World War II. It talked about how if people had a sense of purpose, something to look forward to, they were able to survive the worst suffering. I've applied that theory as well. I've been a patient at the Mayo Clinic, and I've experienced the world's best case-management system, which puts our own medical system to shame. I used both of those combined to work with the homeless, single mothers, and also with people with severe mental health issues to get them employed.

Part of the committee that I created for those with severe mental health.... We had an integrated approach, so we had at least 10 or 12 organizations involved. The goal at the end was to absolutely work with the client to be able to move a client forward. I was asked by some of the veterans' case managers there to come and work for veterans. That's my background.

Going forward, I applied to what's called the MDC service delivery model. I don't know if you know of that. I hear a lot of talk in your meetings about the JPSU service stream. This is a separate service delivery stream. Multidisciplinary clinics, I think, is the long term for it. It's a great idea. What it does is it allows us to combine the medical and the psychosocial together, which I think is wonderful. That's similar to the JPSU site. What it does not allow, though, is employment. I think that's a critical aspect for going forward. Whether it's part-time, full-time, or even if it's unpaid, volunteer, it's critical, from my experience, that people have a reason to get up in the morning, to have some value to contribute.

I've been at this for two years. I went through the political stream first, and the politicians said that I was duplicating my service. I then went through the bureaucratic stream, and I was told that I couldn't do my service, which was to do that three-pronged approach, providing the medical, the psychosocial, and the employment, similar to the JPSU stream. They didn't allow it, and the reason that they didn't allow it—if you speak to the bureaucrats—is because the employment services are offered under the new Veterans Charter, and the MDC service agreement is provided under the old Veterans Charter.

Now, I found that interesting, because the old Veterans Charter obviously started many years ago. This new MDC agreement was started about three years ago, which is after you moved into the new Veterans Charter. So there's a little bit of confusion as to why you would set up a new funding stream based on an old charter that—I think I hear—you're trying to eliminate. That's one suggestion or thought I'd bring forward to the committee.

The second is that when you look at the employment services, they're being offered under the public works department. From what I gather, there's really not many criteria, because there are no outcome measures. I've heard that from the top. I've heard that from the bottom line and front line. I've also heard it sideways, from the ombudsman. So in terms of my question, when you choose to have a service agreement with employment agencies, if you're not basing it upon client results, why are you giving exclusive contracts to organizations that are not having to come back to you and prove their client results?

I hope I haven't confused you.

I looked at a Veterans Affairs report on rehabilitation that came out in December 2014, in which they measured how many of the veterans in the rehabilitation stage got jobs. The number had increased to 28%. So 28% of your total are the people who got jobs. That was an improvement from 20%.

To give you a standard, in the civilian population in Ontario now, employment contracts have about an 85% success rate. That to me is extremely high, but it's also looking at the fact that they keep those jobs for now six months as opposed to three months. In the civilian population we're looking at higher standards.

I hear around the table how some of you have had veteran experience. When I think back, I was ignorant when I started this. I was told by some veterans of how great the veterans are who got world-class training. Looking at the history of Vimy Ridge, I didn't know enough about the Canadian contribution. General Currie at that time told 40,000 of his troops the night of Vimy Ridge that each soldier had been given their purpose, information, and I believe a map. The importance of it was that each person had a purpose. They knew exactly what they were doing. It was the first time in history, I believe, any soldier, forget even Canadian, had been given this sheet.

The role of purpose, the role of feeling valued, is something that I think has been lost in a lot of these service providers. I think it's focused a lot on what we call performance measures. I have submitted to the committee a briefing that was all about an outcome-driven and meaning-based approach. It can be applied through the JPSU stream. When I first started, it could be applied as one stop, separate from and outside of the defence department and the veteran, but funded by the veterans department.

I'm not sure how far to go. I was expecting two minutes.

I'll just cut it off there.

[The Chair, Liberal, Neil Ellis]

Okay. Thank you.

We'll start off questions with Mr. Kitchen.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Thanks to both of you for your presentations.

Hopefully throughout this we can hear a little bit more from you, Brenda, and you can expand on your comments. I look forward to hearing more. Hopefully, the questions will prompt some of that.

Walter, we've heard throughout this about the medical incidents that are not reported, especially in our reg force. When they're not reported, they never happened. You alluded to that a little bit in your talk. I'm wondering if you can expand on the reporting mechanism that you recall was available to you at the time.

I assume with the reservists it was the same thing, or were the forms different? Were they the same forms, whether you were a reservist or reg force, with that same concept that if you fell and hurt yourself, and you didn't report it, then it never happened?

[Walter Callaghan]

The form is the same. It's the CF 98, as I recall. That's for reporting any incident that causes injury. In general those are only used for physical injuries. With psychological injuries, it's not that you're on the field, you see something, and it's “Oh my God, I'm hurt”, because that's not there.

For the physical injuries the forms are exactly the same. The problem is that especially with the operational stress injuries, those occur generally a lot longer after the offence. There's no real ability to go back and say it was this or that incident. On top of that, the idea that we can actually track these back to a single incident only applies in certain forms of PTSD. There's this misconceived idea that all PTSD is identical. There are so many different causative mechanisms to it. When you have one that's coming out of the extended wear and tear of seeing one thing after another, or from being in stress for long periods of time, you can't identify that single moment, which makes it almost impossible to actually utilize the CF 98 in the first place. For the physical injuries we have the reporting mechanism.

In the case of reservists, when we're doing our weekend exercises, which is what the majority of our work involves, or when we're doing our training nights, and we get injured, we don't want to leave our guys, and so we don't necessarily report it. A number of times, when I was with 25 Field Ambulance reserve unit here in Toronto, I had to drag people away and say, “No, sorry, you're injured. We have to treat you.” There was an avoidance. When the weekend or the training night was over, and they went to see their GP, there would be no CF 98 reported from that unless the member came back and said, “By the way, here's a doctor's report.” It becomes such a quagmire that a lot of it's not even there.

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

I hope you don't mind my mentioning that we had a chat beforehand. You indicated that part of your service was almost as if you were a first responder, in the medical aspect of it as a first responder. We talked a bit about first responders and the service.

Again, I realize you're doing a Ph.D., so I'm going to sort of pick your scientific brain.

Do you see a potential where there might be a form, or some way that we could provide a way for that to be reported right away?

[Walter Callaghan]

For the single incident type of situation?

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Yes, or even an accumulative one.

[Walter Callaghan]

I'll speak first to the idea of the single incident. There should be a mechanism in place to figure out which med techs, the corporals, master corporals, and sergeants in the medical service, are actually on site when something happens. That would be one way of tracking that. You may have a potential down the road, as this person was involved.

It is the same with the small-level hospital sites that we set up, the medical reporting centres, and the field hospitals when we're out on exercise. Having an idea of who was actually out there and then tracking that back, having some mechanism of knowing that an incident occurred, someone was injured, that these medical techs, people in the medical service, were handling it or were there and present, could be one way of generating that kind of material.

With regard to the sustained, long-term form, the wear-and-tear form of an operational stress injury, I don't think there is any real way of tracking that, because there are situations that don't bother us.

In my case, it's more the knowledge of soldiers that I recruited, trained, or commanded who were injured. That's what tore me down. How do you record that? There's no mechanism to go I was involved in training this person and they went off a year later and got hurt. I know this, and I turn around and start having intense guilt moments.

There's no way of recording that in any form within the Canadian Forces. It became a situation where I was questioned as to whether it was really that bad. “Well, yes. It damn well was that bad.”

[Robert Gordon Kitchen, Conservative, Souris—Moose Mountain, SK]

Great, thank you.

I'll turn it over.

[The Chair, Liberal, Neil Ellis]

Ms. Lockhart.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Both of you bring really interesting perspectives, and I hope we get to touch on both as we continue.

Mr. Callaghan, I would like to thank you for your service to begin with, and also for articulating so easily all of the things that we have been talking about over the last little bit.

If I had check boxes, you kind of hit a lot of them when we're talking about service delivery, paperwork being one. With regard to receiving a letter, for instance, when there's a change in your benefits, or notification that you're not going to receive benefits, do you think it would be helpful if you had one-on-one contact with a case manager or what have you, to walk you through this process, rather than receiving documentation in the mail?

[Walter Callaghan]

Here's the funny thing: the documentation was signed by my case manager. This is a case manager that because of the overload that each case manager is handling, I hear from maybe once every six months. Previous case managers broke the rules by actually providing me with their phone numbers or their email to make it easier for me to contact them when something was happening.

The rules within Veterans Affairs require me to call a 1-800 number that is only operating from 9 a.m. to 4 p.m. eastern standard time. Even if the people on the other end of the phone are in B.C., if the call is from Toronto, they cut it off.

I have to leave a voicemail message because she's so busy that she's never available to take a call, and then I have to wait for her to call back, which of course uses up the minutes on my phone. I'm not exactly wealthy enough to have a high-end plan, so I ration out the 200 minutes a month that I have.

The My VAC thing that's being set up is so problematic that I've never actually managed to sign in through it. I have a case manager. She could have been able to put this through one on one with me. It was when I freaked out and went through the entire system and managed to get a hold of her—thanks also to the ombudsman's office who helped intervene—that I found out I was not actually being cut off of benefits; I was being shifted. This was a form letter that was sent out.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

So for you this could have gone much better had you been able to meet with your case manager either by phone or personally, to walk through what the decision was and to talk about what future benefits you were eligible for. Is that fair to say?

[Walter Callaghan]

If I could have contacted her immediately by phone or by email and actually been able to get an immediate reply instead of spending a weekend freaking out. I say this because I believe the letter arrived on a Friday, so good luck actually getting someone then.

[Alaina Lockhart, Liberal, Fundy Royal, NB]

Maybe we could fix that. Not knowing creates a tremendous amount of anxiety as well. I can appreciate that.