# Decision Letter



## Hawksley (12 May 2014)

I just received my decision letter on friday in regards to my disability claim pertaining to an injury I suffered directly relating to my regular force service.  I first submitted my application on 14/JAN/2014, and it took exactly 16 weeks to the day for my decision.  Relatively quick in my opinion.  I provided as much information and documentation as possible.  I was granted a favorable decision, however, NO disability award at this time because Veterans Affairs Canada requires more information from me due to the fact my injury has still not stabilized at this point...2 years after the initial injury, and surgery last August 2013.  Veterans Affairs is requesting I be medically examined by one of their staff.  Where is this medical examination to take place?  Are they paying for my travel and expenses related directly to this appointment when it happens?  I am still currently serving as well, therefore I am not eligible to use the treatment benefits I was granted either.  How long after the medical examination before I should hope/expect a decision?  What does the medical exam entail?  Any and all info is appreciative.  Thanks   Cheers!


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## stokerwes (12 May 2014)

No two cases are the same. But here's how it worked for me, I'm still serving. I contacted VAC and they made an appointment with the local VAC office Dr. My mileage was paid, I would imagine  depending on how far away your local VAC office or the Dr. they recommend is you would be entitled to meals, etc. The VAC Dr. examined me and then asked me several dozen questions. This is where you need to think about the days when your injury is at its worst as far as symptoms and how it affects your day to day life. The process took the better part of a forenoon. The Dr. went over what they thought the disability would rate as far a % on the lump sum award. They were within a few 5% of the final decision. I don't think all the Dr.'s do this it's purely speculation on the Dr.'s part. Once your examination document is complete and VAC receives it they will send you a copy and statement of the date they received it and how long before a decision should be made. I think it was about six weeks after the exam that I received the final decision from VAC. As far as treatment benefits, the CAF will take care of that until you release and then VAC will take care of the medical. Some benefits that are available through VAC are not available through the CAF healthcare system, but so far I have only encountered one instance of that, Bio-feedback.


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## blackberet17 (13 May 2014)

1) A favourable decision of entitlement IS the awarding of disability award. You just haven't been awarded a medical impairment rating yet, which is the whole medical examination process.
2) Depending on what the medical condition is, VAC requires at minimum 6 mos from time of surgery to demonstrate the condition has stabilized. Surgery AUG 13, app JAN 14, there's five mos, decision recent, we're now at eight mos, I'm a little surprised they didn't consider it stabilized. They must have seen something one of the reports to show there may still be an issue, hence the medical examination requirement. You will be examined by one of the VAC doctors...thankfully, not staff. It's not an MIR you're going to, where you're lucky if you actually see a doctor, and not a Med Assistant.
3) Travel expenses for you to attend the appointment should be covered. This info should be detailed in either your decision letter, or further documentation you'll receive under separate cover in about a week's time, which will include your VAC Health Benefits card. If unsure still, contact your CM or DO, or call the 1-800 number.
4) Medical examination itself will depend on what the condition is. Since you haven't been specific, it's hard to tell you  if you're curious, you can search for the Medical Questionnaire which may be related to your condition. If it's your knee, there's a Med Quest: Knee Conditions, etc. The Med Quest will give you an idea of what tests the VAC doc will do to assess your condition.


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## Hawksley (13 May 2014)

Thank you for the info.  I appreciate it.  I am now currently waiting for the Veterans Affairs medical examiner to contact me witha date for the examination.  Luckily for me, she is located at my local VAC office in the city which I reside.  In terms of why I may not have been deemed stabilized at this point, is likely because I am still experiencing significant amounts of pain in the injured/repaired site.  The injury was to my left ankle.  Ligamentous tear of left ankle with avulsion fracture of medial malleous.  I had a modified brostrom surgery, arthroscopy, peroneal tendon repair, and deltoid ligament repair all in same surgery setting last august.  I have been undergoing extensive rehabilitation since then, but hit a wall several months ago.  I was finally sent for a new MRI in Gatineau by my OS very recently (2 weeks ago), and discovered most of what was repaired during that surgery last August is healing somewhat good, however, there appears to be a small 10% tear in my posterior tibialous tendon now, which may have happened several days following my surgery in an accident.  Regardless, the pain is to the point of relatively unbearable at times, and has for the most part completely restricted me from taking part, enjoying and doing things that I used to enjoy doing with my daughter and recreationally.  Ive even had to purchase another vehicle, as my previous vehicle is a standard transmission, and I cannot push the clutch in safely to drive the vehicle anymore.  Im not entirely sure when or IF my ankle condition will stabilize soon or if ever.  I cannot guess or assume something like that.  So in the meantime, how does a VAC medical examiner provide the correct information for an adjudicator to make a reasonable decision on a disability award percentage and sum?  I have searched, found and studied the medical questionnaire pertaining to ankle injuries as well.......kind of vague if you ask me. lol  I have my part 1 medical coming up this week (thursday) and part 2 next week.  My medical file has been sent off to D MED POL for whatever it is they are going to do with it.  I have been on 4 TCats since the date of injury.  However, only 2 were "counted", because the MO here on base did not properly submit and finalize the first 2 that were assigned to me.  I only now have 6 years served and 4 years off from the pension.  Unfortunately for me, I cannot meet the physical requirements of my job as an infanteer now due to this injury.  Upsetting, confused & unsure of what now lies ahead for me.  Anyway, heres to hoping one foot leads the next foot.  Again, thanks to those in response.   I cannot thank enough to those willing to help or offer sound & efficient advice.  Cheers!


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## blackberet17 (13 May 2014)

Bring copies of the most current medical information with you to your medical examination, and submit it also to VAC, through your DO.

KEEP COPIES FOR YOURSELF OF EVERYTHING.

It's quite possible that because further surgery may be required, you may have to wait another six mos. Unfortunately, under the New Charter/2006 Table of Disabilities, temporary assessments for an awarded condition are no longer given.

I'm not sure what D Med POL may do, but some of the guys here are much more familiar with CF med process than I.

Best of luck. If you have more VAC questions, feel free to PM me.


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## Hawksley (3 Aug 2014)

Just an update.   I had my medical examination with a VAC medical examiner on July 2 2014.  The medical exam, and all remaining information was sent to Charlottetown and received there on July 10 2014.  I am now awaiting the adjudication and disability assessment percentage rating.  Im not sure how long this will take.  The entire application was to take 16 weeks as told to me multiple times via VAC.  I already received a favorable decision resulting in Treatment benefits and full entitlement 5/5 for the injury sustained.  I was then informed by VAC that they would process the remaining part of my claim asap and return with a decision and assessment as quickly as possible for me.  I have since (in the past few days), contacted VAC and expressed my concern, and explained how much red tape they have and how difficult they make things on Veterans in regards to how they handle claims and offer absolutely no confidence to Veterans when it comes to timeframes etc.  Since that letter, I finally was contacted back, and practically dismissed by VAC on what I said, as they entertained me around all my questions and concerns, and then they concluded by telling me my claim will be finalized for me on October 22 2014.  This is ludacris, outrageous, and utter BS!  What a disgrace to Veterans all over.  I would be embarrassed to admit being employed by VAC to anyone.  Well done VAC. Well done.  And really glad they continue to keep me in the dark about my assessment decision.  I can hardly wait to submit my other claim for hearing loss after being blown up.  Great!


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## blackberet17 (7 Aug 2014)

All I can say, Hawksley is...patience.

As a CAF member, and VAC employee, I understand your frustration. And I don't often mention I work here when with my mil friends...although, most of the guys in the Regiment know anyway. It can be a hard slog.

I often suggest to folks who have concerns and issues to register them with their Member of Parliament or the VAC Ombudsman. The red tape and etc is due to legislation and policies - IOW, politicians and policy wonks.

Regarding your assessment decision, all of the med info will be assessed against Table 17.12 - Loss of Function - Lower
Limb - Ankle, which can be found at http://www.veterans.gc.ca/eng/services/after-injury/disability-benefits/benefits-determined/table-of-disabilities/ch-17-2006#t12

Taking the information from the med exam, and all the other med info you've provided, the Adjudicator compares it against Table 17.12 to determine a Medical Impairment Rating. When the rating is determined, it's then compared to Tables 2.1 and 2.2, with your Quality of Life questionnaire http://www.veterans.gc.ca/eng/services/after-injury/disability-benefits/benefits-determined/table-of-disabilities/ch-02-2006.

If you have any further questions on that part of it, let me know.

FYI: Once the med exam is complete, the 16 week clock restarts.


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## Hawksley (26 Sep 2014)

Just an update.  On July 2 2014 I was seen by a VAC medical examiner.  For the most part, it went well I believe.  The examiner spent more time talking and asking questions than actually physically examining my injured ankle.  Anyway, I am STILL waiting for an award decision.  It has now been over 12 weeks and yet still nothing.   When I contact VAC, I just get a generic answer and a refusal to inquire further for me.  It has now been well over 36 weeks since the date of my initial filing of the disability application.  Seems like somewhat of a runaround and joke to me.  It also upsets me, as to the fact I have another claim for hearing loss and a recent diagnosis of ptsd due to some unfortunate situations in Afghanistan, on the back burner waiting to be submitted.  Who knows how those will end up in the VAC system.  Very upset and angry about this entire thing.


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## bigcletus (26 Sep 2014)

I really hate to be the one, BUT with VAC you'd better have patience, lots of it.  The system is designed to say "no" on first app.  Unfortunately, that's just the way it is.  Be ready with an appeal too.


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## maniac (27 Sep 2014)

He has a favourable decision.  He has options when he has that, like reassessment after 2 years.  An appeal is not always necessary and can take up to the same length of time.


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## stokerwes (28 Sep 2014)

Just have lotsof patience. Submit your claim and just forget about it. Counting weeks will only make you pissed off. Regarding your other claims don't wait until your ankle claim is done. Submit them all. The OSI will take some time depending on your situation, flr that the SOP is usually an initial 10% and then a reassesment at a later date once stablized.
I've been there waiting and it drove me bonkers. It not VAC it is the system they are forced to use, that and the fact the adjucation take a bit of time. Your treatment benefits are forwhen you release. Rght no you have the CFHS, for the most part I would say it's better than wbat you wodget anywhere else.
Having said all that here's to speedy decision on your claim.


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## Roy1985 (30 Sep 2014)

Anyone who was a still serving member before 2012 ever apply to be on the VIP program through VAC before it became an online application? If so, did you ever meet with someone through VAC to fill out an assessment for the application? (where they take down all of your injuries and limitations for why you need to be on the VIP) 

I did this process back in 2010 while still serving. A VAC case manager did my assessment through which they gained all of my health details. The case manager then disclosed all of my health details to their friend (happened to be my wife's ex husband who she has children with) The privacy commissioner has declared that this was not a breech of privacy because I was still serving, hence still serving members aren't assigned a case manager therefore it was my choice to disclose my information. 

The new system is done entirely online since 2012 I believe. But if you were a still serving member before that and applied for the VIP program through someone at VAC please let me know ASAP.


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## downhillslide (20 Oct 2014)

20 weeks and counting. With no firm date in sight and vague answers to pointed questions. Nothing new here.


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## Hawksley (6 Nov 2014)

I received an assessment decision on my ankle injury claim today.  I was assessed at 10%.  Pretty much exactly what I figured they would come up with.  Not what I came up with.  I figured the next bracket up would have been the correct choice.  Now, 2 new claims will be filed .  One is for hearing loss, and the other is for a recent ptsd diagnosis tracing back to when I was blown up overseas a few years ago.  Im sure this process has just begun all over again.  Maybe it wont take them a year to figure it all out this time.


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## Hawksley (26 Nov 2014)

So.....after receiving my assessment decision, I had taken the payment electoral form to my closest district office to be sent in on my behalf.  I already had direct deposit set up ahead of time via my vac account.  I have now been waiting 21 days and it has yet to be payed to me.  I have been told it was mailed to Matane, Quebec for scanning before then being sent to head office in Charlottetown for payment to me.  It has yet to even be scanned and noone can or will provide me with any more detail or information than that.  Due to my injury, I had to use my finances to purchase a different vehicle and now I am short funded and lack financial stability to help me through the next month and more specifically the Christmas and holiday season. Thanks to VAC.


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## blackberet17 (28 Nov 2014)

Hawksley said:
			
		

> So.....after receiving my assessment decision, I had taken the payment electoral form to my closest district office to be sent in on my behalf.  I already had direct deposit set up ahead of time via my vac account.  I have now been waiting 21 days and it has yet to be payed to me.  I have been told it was mailed to Matane, Quebec for scanning before then being sent to head office in Charlottetown for payment to me.  It has yet to even be scanned and noone can or will provide me with any more detail or information than that.  Due to my injury, I had to use my finances to purchase a different vehicle and now I am short funded and lack financial stability to help me through the next month and more specifically the Christmas and holiday season. Thanks to VAC.



You could send a Secure Message through your My VAC Account, or call the 1-800 number to see what the problem is. I've heard of issues with Matane and other payment processing centres. I am surprised it's taken 21 days however.


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## Hawksley (1 Dec 2014)

Yes....I have contacted VAC many many times concerning this claim and have been met with no answers and conflicting information every single time I call.  When I send a secure message, I wait almost 6-7 business days for a reply and then when I do get a reply like last week, it was an answer to someone elses question and had absolutely nothing to do with what I asked.  VAC, upon me contacting them again, apologized for the wrong answers and mixups.  That is ludacris and unacceptable in the least.  I have just gotten off the phone with VAC yet again, & was told it was scanned on Nov. 27 in Matane.  The VAC representative then proceeded to tell me I would be paid in 2 weeks from the day it was scanned..."guaranteed".   Time will tell.  That would put the last day at 11 Dec 2014.  I am well past tired of VAC lies, lack of information, confliction, unbelievable mistakes, & ridiculous turnaround times. Enough with the "red tape" crap.  For the longest time, I was gullible and actually believed that nonsense.  But after almost a full year of battling for this one claim, I see VAC for whats really going on and its disgusting.


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## blackberet17 (2 Dec 2014)

Write to your MP, your MLA, contact the Veteran's Ombudsman, etc. Mike Blais and Coy. The more noise made...

Squeaky wheel gets the grease.

Trust me, Hawksley, I understand and know your frustration. I see it a lot.

Until the Feds realise the budget cuts they made actually DID impact services, it's status quo, and the only people who can say as much are the ones waiting on answers, and those trying to process the work, doing more with less.


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