Veterans Affairs Committee on Nov. 15th, 2016

[Col Andrew Downes]

I actually have the answer to your original question. I must have missed it then. We do know that people who deploy come home with higher levels of mental illness. We know that.

Again, it gets back to the original couple of comments. It's not so much the deployment; it's what happens to you on deployment that makes a difference in terms of risk for mental illness.

Mostly it was people working under the army command who were exposed to these more psychologically traumatizing events, but we certainly did have a few people from the navy and the air force who were exposed to similar things as well.

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

Can you provide for this committee your reference list for the studies you have done?

[Col Andrew Downes]

I will do that, yes.

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

Thank you very much.

If a soldier is deployed, and while in theatre exhibits signs of PTSD, what is the standard treatment for that soldier?

[Col Andrew Downes]

Do you mean when someone is in theatre?

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

Yes.

[Col Andrew Downes]

An individual who is identified as having symptoms, perhaps related to PTSD or another mental illness, would typically be referred to a primary care physician for an initial assessment. Subsequently, there would be a referral made to the deployed mental health team, if there is one, such as we had in Afghanistan.

A decision would then need to be made as to whether the individual should be retained in theatre, perhaps returning to their unit to continue their mission, or perhaps doing another role, or be returned home for further care. That decision is made on an individual basis, based on the severity of the symptoms as well as the role that individual would play.

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

Would any particular drugs be administered in such situations to keep them deployed?

[Col Andrew Downes]

If somebody required an antidepressant, for example, or medications that we would use to treat PTSD, they would not typically be retained in theatre. The symptoms would likely be significant enough that staying there could cause them to worsen.

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

My questions earlier were about how to transition the medical information from DND to VAC.

If the doctors have filled out those forms for the soldier, could a military doctor fill out those forms for Veterans Affairs? If a soldier needs those forms filled out, could they have a military doctor fill out those forms for them?

[Col Andrew Downes]

Yes, and we do fill them out.

[The Chair, Liberal, Neil Ellis]

You have twenty seconds.

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

Okay. When a doctor fills out a form that indicates some sort of pensionable condition or non-pensionable condition, are there any repercussions for doing that sort of thing?

[Col Andrew Downes]

Are there any repercussions to the physician for doing that?

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

That's correct, for a military doctor.

[Col Andrew Downes]

There are none that I am aware of. I see no reason why there would be.

I should point out that when we see patients, the forms we fill out are part of our own medical record. Veterans Affairs Canada has its own forms, which look for very particular information to help determine whether the injury or illness was related to service. Those forms are sent to us, and we fill them out.

[The Chair, Liberal, Neil Ellis]

Thank you.

I just want to clarify. You mentioned that if they had issues, they could be sent home. Who makes that decision? Is it the doctor, the person, or the chain of command?

[Col Andrew Downes]

It is typically the physician, with input from the individual and potentially the chain of command. We make a recommendation to the chain of command that a particular person should be repatriated for medical reasons. The chain of command would likely not know what the reason was.

[The Chair, Liberal, Neil Ellis]

Okay. Are those decisions always followed? Are doctors orders always followed? Can the chain of command overrule the physician?

[Col Andrew Downes]

The chain of command can, at its peril.

[The Chair, Liberal, Neil Ellis]

Okay.

[BGen Hugh MacKay]

I would clarify that the chief of the defence staff put out a directive that medical employment limitations assigned by physicians are to be followed by the chain of command. If we gave a direction that the individual needed to be sent back, then the chain of command would follow that.

[The Chair, Liberal, Neil Ellis]

Okay. Thank you.

Mr. Rioux.

[Jean Rioux, Liberal, Saint-Jean, QC]

Thank you, Mr. Chair.

I will continue along similar lines.

Some of the witnesses we've heard from said that, when CAF members leave for medical or other reasons, they had difficulty in getting their records. They explained that they had to wait a long time before getting them and often didn't receive them at all. The same was true for the historical records.

What is your experience? Do you think people can get their historical records and the final diagnosis quickly?

[Col Andrew Downes]

I'm going to answer in English if you don't mind.

Are you talking about medical records or other documents?