# CAF Ombudsman on medical release and support transition to VAC



## The Bread Guy (13 Sep 2016)

Just out today -- although it's a bit of overlap between the CFMS and VAC, I thought this recommendation brought it more into VAC territory - from today's report (also attached):


> We recommend that the CAF determine whether an illness or injury is caused or aggravated by that member’s military service and that the CAF’s determination be presumed by VAC to be sufficient evidence to support an application for benefits.


From what little I know from what I read around these parts, it sounds like that underlined bit might save a lot of process -- if accepted and implemented by Team Red, of course ...  

Also, I don't know enough about the systems to know how much dilly-dallying might happen on the military side before making determinations, or on the VAC side for accepting EXACTLY what the CF gives them - comes from watching too much "Yes, Minister".

More from the CF Ombudsman:


> As you would expect, the Canadian Armed Forces (CAF) maintains a high level of health and fitness requirements for individuals who serve in the nation’s military. With this in mind, some 1,500 members are medically released from the CAF each year. Approximately 600 of those members have illnesses or injuries directly related to their military service.
> 
> As has been well documented by media over the past several years, medically releasing members often find the transition to civilian life to be very challenging. Those members requiring services from Veterans Affairs Canada (VAC) often find themselves uncertain about what, if any, services will be available to them when they depart the military. The complexity of the transition process adds angst to an already stressful situation for the member and the member’s family.
> 
> ...


Nothing from VAC's Info-machine @ its web page as of this post -- ball's in your court, Team Red ... op:


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## PuckChaser (13 Sep 2016)

Used to be/still is a check box on the medical chit saying "Service connected illness: Y/N". That paper with the full medical file and a CF98 (if avail) should be all that's required. D MED POL should make the determination during the process that assigns the PCAT.


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## McG (13 Sep 2016)

I suspect that under such a system, attributing cause to an injury (is it service related or not) would become a precondition of conducting a medical release.

I anticipate the review process to determine if injuries are attributable to service will delay the release process for any cases where there is uncertainty.  So those members would continue to get a paycheque until it was known if VAC benefits are coming.


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## ballz (13 Sep 2016)

PuckChaser said:
			
		

> Used to be/still is a check box on the medical chit saying "Service connected illness: Y/N". That paper with the full medical file and a CF98 (if avail) should be all that's required. D MED POL should make the determination during the process that assigns the PCAT.



The CF-98 is designed for the member to report a service-related injury. That's why witness statements are attached. It is has a line at the bottom for the CO to state whether or not they believe the injury is caused by / related to the member's service requirements.

In other words, CF-98 for "x" injury and two members say "I witnessed this happen on DTG during Ex BLAH BLAH." CO signs it saying "This is attributed to the member's service." What more should VAC need? In these cases, I agree with the Ombudsman.

Of course, it gets more complicated when it's smaller injuries that add up over time... How many times can one tweak something over and over while they're young without submitting a CF-98 for every tweak and scratch they get, and then they turn 50 and it all catches up to them...


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## George Wallace (13 Sep 2016)

ballz said:
			
		

> The CF-98 is designed for the member to report a service-related injury. That's why witness statements are attached. It is has a line at the bottom for the CO to state whether or not they believe the injury is caused by / related to the member's service requirements.
> 
> In other words, CF-98 for "x" injury and two members say "I witnessed this happen on DTG during Ex BLAH BLAH." CO signs it saying "This is attributed to the member's service." What more should VAC need? In these cases, I agree with the Ombudsman.
> 
> Of course, it gets more complicated when it's smaller injuries that add up over time... How many times can one tweak something over and over while they're young without submitting a CF-98 for every tweak and scratch they get, and then they turn 50 and it all catches up to them...



It is even more complicated, as many of us older types never had CF-98's in our early years of Service.


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## the 48th regulator (13 Sep 2016)

And injuries get exacerbated with age, which were caused by service. This is for both Mental and Physical injuries.

All one needs is their attending Clinician to say so.

Whoop dee do, such wonderful news.........


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## PuckChaser (13 Sep 2016)

George Wallace said:
			
		

> It is even more complicated, as many of us older types never had CF-98's in our early years of Service.


That problem fixes itself over the years with attrition. There will still be folks without a CF98; degenerative conditions (tinnitus, bad back from rucks) that might not have a defined date of injury for traditional CF98 paperwork. Can work around that if the member's MO believes the injury/illness is service connected. You're not going to fill out a CF98 for an ISO, but your psychologist can be asked to provide opinion on whether it's service connected.


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## George Wallace (13 Sep 2016)

PuckChaser said:
			
		

> That problem fixes itself over the years with attrition.



That sounds like "the Budget will fix itself".  The CF 98 has not been around that long, (Mid '90's) that it will be decades before all those who never had CF 98's in their Service days have died off through attrition (if that is what you are saying?).


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## Blackadder1916 (14 Sep 2016)

George Wallace said:
			
		

> . . . The CF 98 has not been around that long, (Mid '90's) that it will be decades before all those who never had CF 98's . . .



The CF98 has been around a lot longer than that.  The first one that was raised on me was in Cornwallis in the 1970s (broken toe) and it was one of the documents that was taught on my TQ3 Med A course.  However I will agree that back in the old days the initiation of CF98s was sporadic at best and the staffing left a lot to be desired.  There were some changes in the mid-90s that corrected some of the problems but it's likely that there continues to be shortfalls.

As already mentioned one of the major issues is determining if a chronic condition (often manifesting as significant/limiting only after release/retirement) is service related.  If it can't be related to an "incident", then it becomes a long slog to provide proof that some part of your body wore out by over-use.  I'm going through it right now, made more difficult that all the records of me having been seen by an MO (who referred me to a civvy orthopod) and a couple of months of physio at the base before I retired from the Reg Force were missing from my med docs.  Couldn't even find copies of the specialist's report in his files or details of visits to my GP (post-retirement) - they have either been destroyed IAW records procedures or were all lost in the Calgary flood.


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## George Wallace (14 Sep 2016)

Blackadder1916 said:
			
		

> .........  There were some changes in the mid-90s that corrected some of the problems but it's likely that there continues to be shortfalls.



Thanks for the info on dates.  It was in the mid-90's that the CF 98 was really pushed for any injuries.  It was almost the first response heard when someone had an injury: "Do up your CF 98!", although the emphasis on witness statements still took a few years to be promoted.



			
				Blackadder1916 said:
			
		

> As already mentioned one of the major issues is determining if a chronic condition (often manifesting as significant/limiting only after release/retirement) is service related.  If it can't be related to an "incident", then it becomes a long slog to provide proof that some part of your body wore out by over-use.  I'm going through it right now, made more difficult that all the records of me having been seen by an MO (who referred me to a civvy orthopod) and a couple of months of physio at the base before I retired from the Reg Force were missing from my med docs.  Couldn't even find copies of the specialist's report in his files or details of visits to my GP (post-retirement) - they have either been destroyed IAW records procedures or were all lost in the Calgary flood.



What surprises me, is the fact that medical studies were done by the CF and Veteran's Affairs into the types of injuries and wear and tear on the body various Trades suffered on a regular basis.  Studies that showed what Trades were susceptible to "hearing loss", what Trades were susceptible to "knee injuries", what Trades were susceptible to "compressed discs of the lower back", etc. and yet the claimant has to go through numerous hoops to make a claim later in their life.  I find it frustrating that those studies are available, as would be your Service Records, and that bureaucratic processes will not match the two to come to a logical conclusion and decision.


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## PuckChaser (14 Sep 2016)

George Wallace said:
			
		

> That sounds like "the Budget will fix itself".  The CF 98 has not been around that long, (Mid '90's) that it will be decades before all those who never had CF 98's in their Service days have died off through attrition (if that is what you are saying?).


The problem will never go away, as there are some injuries that won't have a CF98. It will slowly become more and more of a minor issue as those who joined prior to the injury documentation push retire, reducing the load on the system for larger investigations on files without CF98.


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## George Wallace (14 Sep 2016)

PuckChaser said:
			
		

> The problem will never go away, as there are some injuries that won't have a CF98. It will slowly become more and more of a minor issue as those who joined prior to the injury documentation push retire, reducing the load on the system for larger investigations on files without CF98.



I still get the impression that you feel that once a person Retires, they magically disappear.


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## CountDC (14 Sep 2016)

me too and I for one will not just disappear after retirement nor do I have a 98 for every little injury over the years that has accumulated in issues.  Hopefully I won't need to go down that road but guess I should review my med records to see what is there in regards to injuries.


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## George Wallace (14 Sep 2016)

From CBC:

Reproduced under the Fair Dealings provisions of the Copyright Act.



> Wounded soldiers face extra bureaucratic hurdle on way to benefits
> *Forces ombudsman says system of determining benefits 'defies logic' and must be changed*
> By Murray Brewster, CBC News Posted: Sep 13, 2016 7:39 PM ET Last Updated: Sep 13, 2016 7:43 PM ET
> 
> ...




More on LINK.


This is fine and good for those still Serving.  Once one retires, their Medical Records are no longer held by the CF after one year.  They are sent to the National Archives.  You can request a copy of your Medical Records on Release, but will VAC accept them?  Mine arrived on a disc as scanned doc in a .pdf format, with no order in which pages were scanned, and no guarantee that complete page was scanned.


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## Teager (14 Sep 2016)

George Wallace said:
			
		

> This is fine and good for those still Serving.  Once one retires, their Medical Records are no longer held by the CF after one year.  They are sent to the National Archives.  You can request a copy of your Medical Records on Release, but will VAC accept them?  Mine arrived on a disc as scanned doc in a .pdf format, with no order in which pages were scanned, and no guarantee that complete page was scanned.



George when I requested mine you can get the paper version or the disc version. I was told if I wanted paper I would have to wait much longer. AFIK you can still opt for paper but since we are trying to save trees they prefer everyone go the disc route.


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## George Wallace (14 Sep 2016)

Teager said:
			
		

> George when I requested mine you can get the paper version or the disc version. I was told if I wanted paper I would have to wait much longer. AFIK you can still opt for paper but since we are trying to save trees they prefer everyone go the disc route.



I was told, due to the work load, that the paper was next to impossible.  The disc version took something like nine or ten months to get.
Either way, it still involved someone scanning my docs.....Photocopy or Scanned would take the same amount of time as both would have been done on the same machine.  Cost of paper vs cost of disc.  Postage may have differed a bit.  

[Edit to add:  Quality of 'your copy' depended on person doing the reproduction/copying.]


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## blackberet17 (14 Sep 2016)

George Wallace said:
			
		

> What surprises me, is the fact that medical studies were done by the CF and Veteran's Affairs into the types of injuries and wear and tear on the body various Trades suffered on a regular basis.  Studies that showed what Trades were susceptible to "hearing loss", what Trades were susceptible to "knee injuries", what Trades were susceptible to "compressed discs of the lower back", etc. and yet the claimant has to go through numerous hoops to make a claim later in their life.  I find it frustrating that those studies are available, as would be your Service Records, and that bureaucratic processes will not match the two to come to a logical conclusion and decision.



Those studies form part of the basis for the VAC Entitlement Eligibility Guidelines (EEGs, available online), and are used in determining the service connection.

The big thing to remember, though, is while a specific trade may be more susceptible to one condition than another trade (i.e., artillery or armour to hearing loss and tinnitus; infantry to knee/lumbar disc), it comes down to time spent doing the activity(ies) which led to the condition claimed. It's one thing for a supply clerk to claim a lumbar condition due to moving and lifting supplies and such - but he/she has to have been doing the activity X amount of time over a X minimum amount of years in order for the claimed condition to be attributable to service. There is also the caveat (for lack of a better word) whereby blunt trauma could accelerate the development of the condition (such as osteoarthritis in the knee in a 30 year old due to blunt trauma - fall, sports-related, etc., - compared to knee OA in a 45 year old due to repetitive stress on the knee during 10+ years of service, from running, ruck marches, etc.).

The EEGs are also based on medical consensus as to cause-effect relationships.

I don't know the med process on the CAF-side very well, aside from my own med exams since I got in...but any determination CAF might make (or D Med Pol) would be based solely on the member's service health records, from what I can determine and read in various places. VAC, on the other hand, and by extension VRAB, looks at the larger picture. D Med Pol may determine a claimed condition is NOT related to service - as there is no CF 98, no visits to the MIR, etc. Their determination may be based solely on paperwork - presence and/or lack thereof. VAC/VRAB would have the member's declaration (attached to the Application for Disability Benefits), additional witness statements the member could gather post-release (even something from 9D can help), add to which VRAB's "benefit of doubt" provision and it's access to the member themselves, through oral testimony at Review hearings.

VAC and DND are trying to work together - but it's only really started to in the last two years. DND is very close hold, and has refused to share information (as has VAC, no doubt) about its members.

There was a time when, as a member released, they were greeted by a VAC rep. I harken back to the Second World War, when it appeared as though the returning soldier was in the med tent and then in the VAC tent as he got off the boat and turned in his kit. We are slowly getting back to those days, thankfully - but there is a high lack of awareness of access to VAC on CAF bases amongst releasing personnel.


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## Szczep (14 Sep 2016)

beret17, you are correct, you do not know much about the military med system, but seem to be very quick with defending VAC.
I believe, not so long ago , you were accusing someone of milking the system, even though he/she only asked a simple question.
Do you have someone from your family working for VAC?

Cheers


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## gryphonv (14 Sep 2016)

Szczep said:
			
		

> beret17, you are correct, you do not know much about the military med system, but seem to be very quick with defending VAC.
> I believe, not so long ago , you were accusing someone of milking the system, even though he/she only asked a simple question.
> Do you have someone from your family working for VAC?
> 
> Cheers



You have blackberet17 mixed up with another member. It was my post that someone came in about milking the system, and it was someone with less than 2-3 years of service. blackberet17 has been very helpful on a lot of info on here with the inner workings of VAC. He is one of our best resources with that, I am unaware of any other members here that work with VAC that post as much info as they do. So in short, blackberet17 is an asset we don't want to lose on here. He is definitely not in the game of accusing people of stuff.  

One thing you have to remember, the people in VAC are not inherently bad. The system has a lot of bureaucracy that they must abide to. They have checklists to follow, everything is pretty streamlined for how they can and can't approve something. The people at VAC get a bum deal on being the target of our displeasure. Unfortunately we target our angst at people who are only using the tools provided to them. If you want them to have better tools, you need to target your angst much higher in their CoC.


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## Teager (14 Sep 2016)

Szczep said:
			
		

> beret17, you are correct, you do not know much about the military med system, but seem to be very quick with defending VAC.
> I believe, not so long ago , you were accusing someone of milking the system, even though he/she only asked a simple question.
> Do you have someone from your family working for VAC?
> 
> Cheers



As gryphonv said  blackberet17 is a valuable resource here and I don't see him defending VAC but simply explaining the processes that VAC has. It's well known he works for VAC and is also in the military. He usually helps put the record straight with the procedures of VAC and helps us with information that can be difficult to find from VAC.


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## Szczep (14 Sep 2016)

Then I stand corrected. Sorry

Cheers


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## The Bread Guy (20 Sep 2016)

This from the CF Ombudsman:


> Medically releasing from the Canadian Armed Forces is complicated. The burden has taken its toll on members transitioning from military to civilian life, and their families.
> 
> In 2014, my office and the Office of the Veterans Ombudsman set out to map the transition process for medically releasing Canadian Armed Forces members. As a result of this, the first visual process maps of the medical release processes for both Regular and Reserve Force members were developed. Both sets of maps represent an overview of the key steps and players involved; from the time a member sustains an injury to her or his release from the Canadian Armed Forces.  The maps also seek to better inform members of the different actions required.  The objective of this joint mapping initiative was to construct a model of the current reality. It is important to keep in mind that each stakeholder in the medical release process has different roles, priorities, and a unique perspective on the transition process. The visual maps, representing this process, are a high-level illustration of the activities that take place among stakeholders.
> 
> ...


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## gryphonv (20 Sep 2016)

This is a good move. I know when I started my medical release, there was a lot of stress involved. Mostly due to the dearth of quality info available for easy access. 

The system also takes a very long time, too long I have to admit. Especially people who want to move on and have come to terms with the fact their military career is ending.  Some are older and are facing the prospect of retraining for a new career. To them time is a valuable resource. Not one they want to waste, sitting at a desk or whatever when they could be enrolled in a training program. 

Yes there is the Life Long Learning Plan that can help in some cases, but that is still very limited in scope as it requires payment up front, something which not a lot of people can do. And it is still even harder to get permission to do it during working hours. 

Even though I am now out, I look forward to the package they come up with.


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## McG (27 Sep 2016)

Seems to be some good recommendations from the Ombudsman here.  This might delay many medical releases by a few weeks, but it would also cut the time between release decision and approval of benefits.


> *Watchdog seeks change to army discharge*
> Ombudsman pushes for reforms to financial support for personnel deemed unfit for deployment because of service-related injuries
> Gloria Galloway
> The Globe and Mail
> ...


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## Wookilar (28 Sep 2016)

I read, and listened to, the Ombudsman's recommendations (on As It Happens last night), but from my experience there are a few issues with the procedures he is recommending.

One is how VAC/SISIP deal with files when we transition out. When I released, I was trying to go back to school. My release date was Sep 11. School started on Sep 4...It took an extra year before I could start school because neither SISIP nor VAC would process my file until I "belonged" to their respective organization. That's not how it's supposed to work now, bit it did and I was in no shape to fight it properly.

And all my CAF Case manager told me and NinerD on one of our last meetings with her that "if you see a rainbow, you just know everything will be alright." Niner almost went over the desk lol

So yeah, there are some serious problems with the transition from one org to the other. However, I do not see VAC or SISIP willing to give up relatively large chunks of their organizations' purpose to the CAF in return for....reduced budgets/profits (wrt Manulife). I'd put $100 down on the fact that the various unions in VAC would lose their collective (pun intended) tiny little minds over Adjudication being cut by some imaginary percentage let alone the support staff that exist solely for Adjudication. It would be turned into another public relations war over cuts to vets when in all actuality it's about their jobs, not our lives.


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## McG (28 Sep 2016)

PS in VAC can be moved to DND if there is a shift in the balance of work required.  Either way, the crown is the employer.  Job protection need not be a factor.


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## Lightguns (28 Sep 2016)

If done this is a great step forward. The process now is highly detailed but once you cross the release line, you feel like you are pushed out the airlock.  Everything in my case did not go well.  9 months to first pension cheque, 11 months to dental, 15 months to drug coverage, 60% of the drugs not covered and the covered alternates were ineffective.  The only thing that worked and worked well was SISIP, 28 days to after release, I had a first cheque.  The rest was a 15 month David vs Goliath battle, that only ended because someone on the inside checked the GAL and gave me a phone number to the right guy in the DND pension office just before it closed.  God bless that individual, he deserves a place in Haven.  My pension had been accessed by someone at 0% and my file shipped to archive somewhere in Quebec, as far as they were concerned on the 1-800, I had served for 34 years and never paid any pension dues because their records said so and that was the end of it.  But one man, found my file in the archive, found the error, fixed it BUT I had to work around to get him on the file and even had to cry and beg to get him to believe me.  Medical release was the worst experience of my military career.


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## Wookilar (28 Sep 2016)

After 2+ decades, I have to agree. I have to say, especially as a (I would like to think) fairly forward thinking, out-side the paper box admin type, I have never been so disappointed in a particular set of gears in the great machine we call the CAF. My pension was delayed by almost 5 months, still don't know why. For us, SISIP was on the ball as well and got my first deposit end-Oct (release mid-Sep). 
One of my bud's released last Fall and it took over 9 months for his return of contributions.

How are we really supposed to live for that long? The case manager warns you that you should save up money because it may take time before everything kicks in but how can you ever plan for shit like this?

And what really gets me, there is no administrative or technological reason why it takes so bloody long!


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