Veterans Affairs Committee on March 12th, 2020

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

—the presenter talked about digitization and how we could make the system faster online. Could I have a quick answer from the two of you? What do you think? Have you seen some cases and is it working better? Because when you do it online it has to be completed; there is no choice.

[Raymond McInnis]

Very quickly, as a veteran, I love using the My VAC Account. As a command service officer, I cannot stand it.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

Thank you.

And the union...?

[The Chair, Liberal, Bryan May]

Sorry, I have to cut you off there. I want to thank all of you for being here today and helping contribute to this study. We're going to suspend for two quick minutes to switch the panels, and we'll come back.

[The Chair, Liberal, Bryan May]

Good morning, folks.

We are continuing our study on the backlog in disability benefit claims with our second panel this morning.

From the Veterans Review and Appeal Board, we have Mr. Christopher McNeil, the chair; and Jacques Bouchard, the deputy chair. We also have, from the Canadian Armed Forces transition group, Major-General Andrew Downes, surgeon general, commander of the Canadian Armed Forces health services group; Brigadier-General Mark Misener, commander, Canadian Armed Forces transition group; and Mr. Brock Heilman, chief informatics officer, Canadian Armed Forces health services group.

Thank you to all of you for being here today on this beautiful, almost-spring morning. We're going to get started with the Veterans Review and Appeal Board. I believe, Mr. McNeil, you're going to start us off. The next 10 minutes is all yours.

[Christopher McNeil, Chair, Veterans Review and Appeal Board]

Thank you.

Mr. Chair and honourable committee members, thank you for the opportunity to appear before you today.

With me, as you know, is Jacques Bouchard, and I'm going to share my comments with Jacques today. I should note that Jacques is also a veteran of the Canadian Armed Forces.

At a high level, the primary mandate of the board is to ensure that veterans and their families receive the disability benefits to which they are entitled. We provide an independent appeal process to veterans, members of the Canadian Armed Forces, the RCMP, and their families who are dissatisfied with the outcome of their disability claim, either a denial of that claim, or they disagree with the extent of the disability being awarded.

VRAB offers two levels of review, an initial review of the Veterans Affairs decision and a further appeal if veterans remain dissatisfied with the initial review of the board. However, it is important to note that there is a third level of review, and veterans can always bring forward new evidence or a new argument and request that the previous decision of the board be reconsidered.

The board's role in the overall disability process is unique. Most importantly, it is often the first and only opportunity for veterans to appear in person and tell their story. Critical to our work is the legislative mandate to conduct our hearings in an informal and non-adversarial manner as much as possible. Regrettably, I acknowledge the board may not have always lived up to that promise. Jacques and I are committed to ensuring that we provide a hearing environment that is comfortable and welcoming to veterans and their families.

Over the past 18 months, we have aggressively reviewed and updated our process and training in this regard. More specifically, we are creating a more informal, less legalistic and more compassionate approach. This is especially important since many of the veterans who appear before us are vulnerable, and they face challenges simply meeting the daily activities of living.

Approximately 40% of the veterans who seek disability benefits have both physical and mental health concerns. We must have a system that is welcoming to veterans and their families and gives them the best opportunity to advocate for the disability benefits to which they entitled.

It is also important to note that, over the past two years, both the nature and the volume of our work has changed. The changes made by VAC resulting in higher favourability rates at the first application stage have caused a change in the nature of the cases we are hearing. For example, we are hearing more cases about the quantum of the disability being awarded rather than whether a disability was awarded.

In addition, VAC's implementation of more favourable policies on entitlement has created a boomerang effect. These positive initiatives have helped to process current claims faster and more favourably, but it has also opened the door for veterans previously denied entitlement or entitled at a lower level to come forward and have their claim reviewed. This is indirectly adding new claims to the mix.

In the last few years, we've heard about 5% of VAC's overall decisions for review. In 2018 we heard approximately 2,000 cases. This year we are experiencing a dramatic increase in the applications over last year, primarily due to the boomerang effect.

However, these challenges have created opportunities. For example, we have implemented a simplified hearing process for certain types of claims. This has allowed us to dramatically increase the number of cases we have been able to process and hear. A simplified hearing process provides a quicker, more streamlined option for veterans to have their cases reviewed. It has freed up capacity in the regular hearing schedule to hear more complex cases more quickly. In addition, it has the potential to ease the caseload burden at Veterans Affairs at the departmental review level.

I'd like to ask Jacques to tell you a little more about those things that we've been doing.

[Jacques Bouchard, Deputy Chair, Veterans Review and Appeal Board]

Thank you, Mr. McNeil.

Mr. Chair and honourable members of the committee, I'm pleased to be speaking to you this morning.

I'll focus my remarks on the board's efforts to improve the veterans' experience by increasing its capacity to work, including through the implementation of a shortened or simplified process.

This approach enables us to group together cases that are less complicated and that more closely target similar concerns for which the outcomes are predictable. The shortened hearing process has generated a number of positive outcomes. We're hearing more cases in a much shorter period by using our resources more effectively.

We've also found that the decisions are predictable and consistent. As a result of the shortened process, we've heard approximately 400 cases and we expect to process 300 more cases in the near future. For example, this week, we heard 71 cases in a single day, whereas it would have taken us at least four weeks to reach that point with our usual process. Our goal is to give veterans our decisions as quickly as possible.

In summary, this shortened approach gives veterans and their families better and more timely access to justice. As we continue to simplify the shortened hearing process, we expect to receive even more claims from veterans and their families. Already this year, we're seeing a significant increase in claims received and hearings held compared to last year. To better respond to this upward trend, we must increase our capacity to process cases informally and in a less legalistic manner.

We're also pleased that the minister has supported our recent request to hire additional members of the Veterans Review and Appeal Board to help us address the increase in the number of cases. These job offers have been posted since March 2.

On behalf of Chris and myself, I would like to close by saying that the Veterans Review and Appeal Board is committed to ensuring that veterans and their families can obtain access to disability benefits while we build more capacity to further support those we serve.

Thank you for inviting us to appear before you today. We would be pleased to respond to any questions you may have.

Thank you.

[The Chair, Liberal, Bryan May]

Thank you very much.

Next we have, from the Canadian Armed Forces transition group, Brigadier-General Mark Misener. I believe you are going to start us off this morning.

[Brigadier-General Mark Misener, Commander, Canadian Armed Forces Transition Group, Department of National Defence]

Thank you, Mr. Chair and members of the Standing Committee on Veterans Affairs.

Thank you for the opportunity to be here today to provide information for your study and to answer questions on the subject of transition from the Canadian Armed Forces.

In 2017, the government launched the defence policy Strong, Secure, Engaged. Under this policy, a new Canadian Armed Forces transition group was stood up in December 2018 to support ill and injured members and to enable all Canadian Armed Forces members to seamlessly transition to post-military life.

As the commander of the Canadian Armed Forces transition group, I am responsible for ensuring that Canadian Armed Forces members and their families are provided with personalized, professional and standardized casualty support and transition services, whether they are returning to service or transitioning to civilian life. We are particularly targeting those who are ill and injured. Today, approximately 1,500 ill and injured personnel are posted to my unit for periods of six months or more. I am also directly supporting another 3,500 ill and injured members and their families by providing information, advocacy, referrals and delivery of numerous programs and services.

Services and support are provided to CAF members and their families through an integrated team with Veterans Affairs Canada and numerous other partners. Approximately 550 military and civilian staff members are organized into nine transition units and 32 transition centres, which are located on bases and wings across Canada and at the transition group headquarters here in Ottawa.

As the commander of the Canadian Armed Forces transition group, my current priorities are to continuously improve the care and support for our ill and injured members, their families and the families of the fallen, to implement a renewed and improved transition experience and to grow transition capability and partner integration.

We have made significant progress over the last three years by implementing innovative initiatives, improving existing programs and growing capacity to improve military members' experience as they transition to post-military life.

The Canadian Armed Forces transition group aims to provide professional, personalized and standardized support. Professional support means a transition group that's adequately resourced, with personnel in place who are properly trained. It also means a deepening integration with Veterans Affairs Canada, or VAC, to provide more closely coordinated service.

“Personalized” means a needs-based approach, which tailors services to the individual and their family. Lastly, “standardized” means that the same services are available to every member of the military and their family as they experience transition. This is an ambitious and complex undertaking that will take some time to build. Therefore, we've also launched the transition trial at Borden to implement some new initiatives and to test and adjust them prior to implementing them throughout the Canadian Armed Forces, or CAF.

Since transition is a shared responsibility between the CAF and VAC, close coordination and integration between both departments is vital in ensuring a successful and seamless transition from military to civilian life. Together with VAC, we've improved and we continue to enhance programs and services and to introduce new programs and services that are more aligned between the two departments.

The goal is to better enable our personnel to successfully transition to civilian life by improving training and readiness, promoting recruitment and employment, and nurturing collaboration between the sectors that employ veterans. Close collaboration and ongoing work continue with our VAC colleagues through the joint steering committee governance framework and joint priorities that keep changing based on mandates and government priorities.

It's an inevitable reality of military service that everyone will eventually transition out of the forces. Being exposed to transition-related information and education earlier in a member's military career will positively contribute to both member and family readiness and ease the reintegration back into civilian society.

The transitioning member and his or her family need to be fully prepared to re-enter civilian life by creating a comprehensive transition plan, a plan that addresses the entire spectrum of what it takes to be ready to transition: health, purpose or employment, financial, housing, social support and integration, and life skills. Therefore, numerous transition resources and tools have been created to enable CAF members and their families to better understand and plan for this inevitable transition.

In summary, my goal and the goal of the Canadian Armed Forces transition group is to ensure that all CAF members and their families are informed, prepared and empowered for a successful transition. This is an ambitious endeavour and one that we've made much progress towards, but also one that will require more effort and time to complete. I want to thank the committee again for this opportunity to answer questions.

[Major-General A.M.T. Downes, Surgeon General, Commander, Canadian Forces Health Services Group, Department of National Defence]

Mr. Chair and members of the Standing Committee on Veterans Affairs, thank you for the invitation to discuss elements of the Canadian Armed Forces health system and our strong working relationship with Veterans Affairs Canada. I'm joined by Brock Heilman, a retired colonel and our chief informatics officer.

As you are likely aware, the Canada Health Act specifically excludes Canadian Forces members from provincial and territorial health insurance programs. lnstead, the Canadian Forces has its own equivalent health system that provides comprehensive medical and dental care to military members and other entitled persons in Canada and at bases and operations overseas.

The Canadian Forces health services group, made up of a wide range of military and civilian professionals, is the organization responsible for the operation and care delivery in this health system.

We are able to provide most of the required care directly through our network of primary care clinics at 37 locations, but there are services we have to purchase from the civilian health sector, like in-patient care, advanced diagnostics, and care from certain clinical specialists and other health service providers.

Our electronic health record, known as Canadian Forces health information system, or CFHIS, is available in all our clinics, as well as on deployed operations and aboard Royal Canadian Navy ships.

The CFHIS is an important platform enabling team-based care and integrating different departments in the clinic like primary care, mental health, dental and physiotherapy. It also facilitates care to our highly mobile military population, as the health record is available regardless of which military clinic a member attends.

The CFHIS is also a useful tool in sharing medical information with VAC. Over the past couple of years, the CAF has worked very closely with Veterans Affairs to create the technical, privacy and logistical conditions to allow VAC adjudicators to directly access CFHIS files for CAF personnel who have applied for VAC benefits.

The Canadian Forces health services group is committed to the provision of high-quality care to protect and optimize the health of military members, and to ensure that those leaving the CAF are able to transition back to the provincial and territorial health systems as smoothly as possible.

I would like to thank you for your attention, and we look forward to your questions.

[The Chair, Liberal, Bryan May]

Thank you, both.

First up for questions we have MP Lloyd.

[Dane Lloyd, Conservative, Sturgeon River—Parkland, AB]

I'm passing my time on to MP Ruff.

[The Chair, Liberal, Bryan May]

Go ahead, MP Ruff.

[Alex Ruff, Conservative, Bruce—Grey—Owen Sound, ON]

Thanks for coming.

My first question will be for the Veterans Review and Appeal Board.

One of the things that has come up from feedback that has been coming in to me is that a lot of files that are being processed—obviously we are here to deal with the backlog—are taking weeks well past the 16-week standard and, in some cases, years, yet when that file or claim comes to you, your success rate or your determination a lot of the time is saying that it's the wrong claim, the wrong adjudication or determination, and it gets turned over.

I acknowledge that you said that there is more favourable.... The standard is sort of changing, but I find it somewhat disheartening that it's taking weeks or months when they come up with the wrong decision for it to get to you guys to turn that around.

What is the base concern there? Why is that happening?

[Christopher McNeil]

I guess it's important to remember that we hear 5% of the overall cases, so a good news story is that the claims of 95% of the people who apply to VAC accept its decision at some level. Whether they are satisfied, I can't speak to, but they accept it.

Then we get that 5%. Yes, our favourability rates are going up as well, and they are going up partly because we are applying the same favourable rules that VAC is applying, but they come to us for a couple of reasons. The primary reason is that they're missing some evidentiary component. Often the only way that can be supplied is through the voice of the veteran.

There is no better system than that. I wish there were, but you have to come and tell your story. Yes, there are mistakes. This is a people business; there will always be mistakes. Adjudicators make mistakes. They maybe apply a policy in a different way than we might apply it, but the primary reason is new evidence.

[Alex Ruff, Conservative, Bruce—Grey—Owen Sound, ON]

I guess based on that, a potential recommendation would be to allow, somewhere in that process, those more complicated cases that are potentially denied at that first stage through VAC to have an outlet for the members themselves to present that evidence.

[Christopher McNeil]

I guess the challenge is that VAC builds its adjudication policies in this wide net to capture that sort of 90 percentile. I'm not sure you could accommodate that kind of direct testimony. We're reducing that down to say 10%. It would be a challenge, I guess, is all I can tell you.

[Alex Ruff, Conservative, Bruce—Grey—Owen Sound, ON]

My next question is for the Canadian Armed Forces, both to the transition group and to you, sir, the surgeon general.

I appreciate the changes that you've brought in in the last couple of years.

One of the biggest complaints we're hearing from veterans is that sort of acceptance of why they're being released from the Canadian Armed Forces, and VAC demanding additional medical evidence or not. I think that transition or process is hopefully going to get fixed in the near term, but one of the challenges that we keep hearing is that you've been released from the Canadian Armed Forces for condition X, yet they go over to VAC, and that's being overruled or additional evidence or medical support is being demanded. I guess any way that you can help fix that....

Do you want to comment on that from the surgeon general's perspective?

[MGen A.M.T. Downes]

Thank you very much for that question.

This is a very important issue for us as well, because we know that a successful transition requires people to have faith in the system and to trust the services that are being provided.

In the health services group, we have done what we can, as I mentioned in my opening comments, to provide the information in as timely a fashion as possible, and also to provide it in a way that makes it easier for the adjudicators to access.

I think an important distinction that needs to be highlighted is that when we're providing care to military members, it doesn't matter to us whether the person was injured or ill as a result of duty or not. We treat them the same way.

Veterans Affairs adjudicates based on the link to service, so they have a somewhat different mandate, and perhaps they would be better positioned to answer that part of the question. They also have to consider the degree of a disability, and so on, which is not something we're focused on. We're focused on the provision of care to return the person to the best level of health we can.

[Alex Ruff, Conservative, Bruce—Grey—Owen Sound, ON]

That's a totally valid point.

To make a further link, I'll go over to you, General Misener. I was shocked at how many currently serving people have reached out in the last couple of weeks as we stood up this committee to focus on the backlog issue. VAC explained, in its previous testimony by some of its officials, that part of the challenge with currently serving personnel is that diagnosis is not complete. However, this backlog issue is big.

I think you're in a unique position for these currently serving people. Some of them aren't working for you directly, because some of them actually still serving in operational units, because, despite the claim that they're entitled to, they still completely meet the universality of service and can keep serving.

As they're transitioning out, I think there's an opportunity here for you, the CAF and DND, to utilize your expertise and efficiencies. Sometimes you have your own challenges, but at the same time, in my viewpoint, you are more efficient than maybe VAC to help prepare those cases so that as people transition out, they're not contributing to the backlog at all because you've prepped them and prepped those files, much like the Legion helps a lot of people who reach out that way.

Would you care to comment on that, please.

[The Chair, Liberal, Bryan May]

We're actually past the time, but I'll give you an opportunity to answer that question. Just keep it brief.

[BGen Mark Misener]

Yes, that's exactly what we're working on, better preparing people and better educating them earlier; working more closely with VAC earlier in the process and really trying to change from a culture of release, where you're only thinking about release at the last part of your career, to thinking about it much earlier. Throughout your career, you're starting to put in place the necessary pieces to be ready for the inevitable time when you take your uniform off.

Yes, we take this very seriously. We do it in many ways with Veterans Affairs, and as we reinvent the transition experience moving forward, what we're trying to do is make those folks better prepared.

[The Chair, Liberal, Bryan May]

Thank you very much.

We go over to MP Amos, please, for six minutes.

[William Amos, Liberal, Pontiac, QC]

I believe the time is allocated to Mr. Samson.

[Darrell Samson, Liberal, Sackville—Preston—Chezzetcook, NS]

No, it's yours.