VAC claim work relationship

[jrktms5]

Hello everyone, second post, I am providing a bit of background before I get to my reason for this Post I have been involved with VA since 2001 and unlike most VAC applicants I have had no issues until recently.
I have been awarded 2 pre chapter claims with no delay or appeal. However, I did have some issues with a recent submission, 2 yrs ago. I submitted a claim for low back issues X 3 conditions, which was originally denied as they were all grouped, re-classed, and submitted as  “Chronic Back Pain” not an official diagnosis,
*** Point Here - ensure that any diagnosis has an official name not a generic term***

So, I engaged the local claims adjuster and had a very in-depth Q&A with him. We agreed on a Admin review on my file.
Basically it’s a  process that is in place to conduct a review of supporting documentation if it was absent or missing, they can re-evaluate the file and in my case they awarded me a settlement, now because I disagreed with the settlement I appealed and with supporting info won a new settlement.

Here is my current challenge:

I ‘m have recently been diagnosed with a sleep disorder which requires a CPAP, still on the study, a heart condition (enlarged) and very mild Atrial fibrillation and I have HBP for 20 plus yrs, as well a hypothyroidism condition

From all the Doc’s it appears that the sleep disorder could be the root cause of all the other conditions, so if sleep is regulated, heart condition and BP will degrease. Reduced thyroid meds

I’m sure that there are others serving that have a similar condition and that all of these are claimable, what I want to know is
Has any one successfully applied and won on these conditions?. And the big question,
How was it related to work? no specific details plse.

 

[blackberet17]

It will, essentially, be up to you to demonstrate how your sleep disorder is related to some condition or factor of your military service.

Another way, would be to demonstrate, through the medical professionals you are working with and consulting, how your sleep disorder is related to one or another or more of your already pensioned/awarded medical conditions.

You could also look into whether your sleep disorder is related to any medications you may be taking for any of your pensioned/awarded medical conditions, or related to any surgery or medical attention you've received for those conditions.

Since you're vague on specific details (purposefully so, I do understand), it's hard to provide any kind of guidance or advice.

Say you have sleep apnea. Well, sleep apnea has a number of causes and risk factors, none of which are directly attributable to any service factors.

However, sleep apnea (depending on type) could be related, i.e. consequential in VAC terms, to another condition, which could be attributable to service.

You mentioned you have back issues (pensioned/awarded? Unclear). Well, those back issues may have been sufficient as to force you to decrease your physical activity levels. Because of this decrease, you gained weight. Excess weight is one risk factor of developping sleep apnea.

But so is your family history, being male, smoking, etc.

 

[stokerwes]

PTSD can cause sleep apnea.
There are many studies about this. Just google it.

 

[blackberet17]

PTSD can cause sleep apnea.
There are many studies about this. Just google it.

Caution on that: A few studies, not many. More stories than studies. Further, no studies accepted at this time by VAC to my knowledge, very few peer-reviewed studies, or generally accepted by other medical professionals/institutions.

In any case, VAC will require a strong medical opinion establishing a conclusive link btwn the PTSD and sleep disorder, based on medical science and all facts of file, before awarding.

 

[the 48th regulator]

Caution on that: A few studies, not many. More stories than studies. Further, no studies accepted at this time by VAC to my knowledge, very few peer-reviewed studies, or generally accepted by other medical professionals/institutions.

In any case, VAC will require a strong medical opinion establishing a conclusive link btwn the PTSD and sleep disorder, based on medical science and all facts of file, before awarding.

No, they won't.  I have claimed for it as a consequntial of PTSD, and I know of many other who have as well.  All I needed was my GP to sign off onthe paperwork, to indicated the sleep study was done.  It was easy peasy, and VAC was a great support in getting me a good provider (Although the cpap machine was covered by OHIP, VAC will cover everything else suchas maintenece)

dileas

tess

 

[blackberet17]

No, they won't.  I have claimed for it as a consequntial of PTSD, and I know of many other who have as well.  All I needed was my GP to sign off onthe paperwork, to indicated the sleep study was done.  It was easy peasy, and VAC was a great support in getting me a good provider (Although the cpap machine was covered by OHIP, VAC will cover everything else suchas maintenece)

Tess, that may be specific to your case, and should not be taken generally in all cases. I work at VAC, hence the words of caution.

 

[the 48th regulator]

Tess, that may be specific to your case, and should not be taken generally in all cases. I work at VAC, hence the words of caution.

Understood,

However I work at OSISS, and have seen many peers, and talked to my counter parts across the country that have been successful in working with their own peers, and VAC in finding consequential relationships with PTSD and other injuries/Illness such as Sleep Apnea, Hypertension, Bruxism, IBS, etc.

As you work with VAC, you should put out a more positive answer, and say it can be achievable, and definitely not deter people from applying; especially for the reasons you gave.  Since you work there can you bring forth hard copy evidence that supports your post?

dileas

tess

 

[pinger206]

Just my 2 cents worth,

    I am old charter since the early 1980's. Been re-assessed, denied, approved, consequential, and new app'd many times and have seen too many dynamics. Case managers are not the same, do you have a pimple or are you paralysed  " specific to your case " , 1/5 or 5/5? , Accentuated or mitigated?    DVA , BPA, Legion or do have a lawyer? The recent cutbacks amidst the recent DVA flak speak volumes to say the least.
  pinger206

 

[blackberet17]

Understood,

However I work at OSISS, and have seen many peers, and talked to my counter parts across the country that have been successful in working with their own peers, and VAC in finding consequential relationships with PTSD and other injuries/Illness such as Sleep Apnea, Hypertension, Bruxism, IBS, etc.

As you work with VAC, you should put out a more positive answer, and say it can be achievable, and definitely not deter people from applying; especially for the reasons you gave.  Since you work there can you bring forth hard copy evidence that supports your post?

dileas

tess

Not without getting into protected information, tess.

Yet as there is an 86% approval rating for all claims to the Department, there's positivity for you

By way of a strong medical opinion, what I meant was an opinion which was supported by medical evidence and medical concensus, i.e. tests and accepted medical "knowledge", for lack of a better word. Having your GP indicate testing was done which demonstrated a link between the two conditions may have been sufficient. Yet this may not be sufficient in all cases.

A portion of it is in the language. What seems stronger to you, a doctor speaking to the probability of a consequential relationship, or the possibility of a consequential relationship?

For example, stress and hypertension. The links of a relationship between those two are not conclusive (see Mayo Clinic http://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/stress-and-high-blood-pressure/art-20044190). But you could have in your possession a well written, medically supported, opinion from a cardiologist, say, which is sufficiently conclusive as to establish the probability of a consequential relationship between service-related stress and your hypertension, even though medical concensus has not itself established or accepted a strong conclusive relationship between the two conditions.

I never said it was unacheiveable, nor was I attempting to deter. Just because I work at VAC does not mean I need to "put out a more positive answer"...that's like going to a mechanic at Crappy Tire and expecting him/her to give me a thumbs up on my car. All I did was indicate what would be required by VAC, as in any application for disability pension/award, to support a claim: a strong (i.e. well worded, speaking to probability not possibility) medical opinion, based on all of the facts on the file and medical concensus, establishing a consequential relationship.

 

[Rifleman62]

blackberet17:

By way of a strong medical opinion, what I meant was an opinion which was supported by medical evidence and medical concensus, i.e. tests and accepted medical "knowledge", for lack of a better word. Having your GP indicate testing was done which demonstrated a link between the two conditions may have been sufficient. Yet this may not be sufficient in all cases.

A portion of it is in the language. What seems stronger to you, a doctor speaking to the probability of a consequential relationship, or the possibility of a consequential relationship?

Does it really, really matter as your case goes to the VAC Adjudicator (clerk), who is not a medical professional, nor licensed. The Adjudicator (clerk) uses the online Merck Medical Manual, to decide the applicants case, overruling licensed, professional medical practitioners of various disciplines who have actually seen your warm body.

Yet as there is an 86% approval rating for all claims to the Department, there's positivity for you

FBS!

 

[blackberet17]

blackberet17:
Does it really, really matter as your case goes to the VAC Adjudicator (clerk), who is not a medical professional, nor licensed. The Adjudicator (clerk) uses the online Merck Medical Manual, to decide the applicants case, overruling licensed, professional medical practitioners of various disciplines who have actually seen your warm body.

Approx four years ago, the essential qualification for an Adjudicator was changed to be someone with, at minimum,  a specialization in nursing (or something along those lines, I can't find the original poster). All new Adjudicators hired since that time must have a background in health services.

The Adjudicators also have access to over a dozen medical professionals within the Department to whom more complicated cases are referred for a medical opinion.

The Merck Manual is but one resource we use, as are: the DSM-IV; the Mayo Clinic; the New England Journal of Medicine; the Compendium of Pharmaceuticals and Specialties; Harrison's Principles of Internal Medicine; Le Larousse médical; the Medicine of the National Academies Press; the AMA Guides to the Evaluation of Permanent Impairment; the Statements of Principles by the Department of Veterans Affairs (Australia); the 2005 Health Study of Australian Veterans of the Korean War and the 2003 Mortality Study of Australian Veterans of the Korean War.

FBS!

http://www.veterans.gc.ca/eng/about-us/reports/departmental-audit-evaluation/2010-08-disability-pension-award/4-3-1
http://www.thespec.com/opinion-story/4358005-canadian-veterans-do-get-their-benefits/
http://www.vrab-tacra.gc.ca/Facts/QuickFacts-faitsenbref-eng.cfm *VRAB specific

Note on *. The 85% total (51% + 34%) has been the trend for the last five plus years at the Board. Remember the process, if you aren't satisfied with a VAC decision, request a review at VRAB, 51% favourable review. Not satisfied, request appeal at VRAB, 34% favourable appeal. That's how it's calculated, I believe. I'm not a math person.

More current statistics should be in the last report tabled to the Standing Committee on Veterans Affairs (ACVA), but I'm having trouble with their site. Anybody else having any luck?

 

[Rifleman62]

blackberet17:

Approx four years ago, the essential qualification for an Adjudicator was changed to be someone with, at minimum,  a specialization in nursing (or something along those lines, I can't find the original poster). All new Adjudicators hired since that time must have a background in health services.

The Adjudicators also have access to over a dozen medical professionals within the Department to whom more complicated cases are referred for a medical opinion.

Well, you find the poster and publish it here. I have been looking on and off for several years to find the qualifications and experience of the Adjudicator who can read a file and overturn an i.e. Surgeon Specialist with years and years of education, practice (in the medical sense) and has actually examined the patient.

I always wanted to know who had the power to jerk Vets around.

How many of these Adjudicators at VAC have the vague qualification you site and how many do not have any medical qualifications at all including First Aid? From that answer we will know the majority have no medical qualifications at all.

Every time a VAC client gets his/her prescription (or script as VAC calls it) for their pensioned condition approved it is counted as an approval. If you got pain killers prescribed and Safeway fills the prescription for a three month period; bang a a VAC approval stat. Fill the prescription four times a year; four VAC approval stats.

 

[TCBF]

I am surprised VAC still exists.
After WW1, the veterans had to organize and demand the gummint commit to helping them.
But, Canada was an agragarian society with no social safety net. It was work - or starve, and if you came back from the war all busted up, you could not work the farm.

Nowadays, we have so much stuff: welfare, unemployment, Workman's Comp, etc., that nobody starves unless their parents are whackjobs.

It is only a matter of time before that self-licking icecream cone known as VAC is stood down, and we are all transferred to the provincial WCBs.

And then... God help us all.

 

[blackberet17]

blackberet17:
Well, you find the poster and publish it here. I have been looking on and off for several years to find the qualifications and experience of the Adjudicator who can read a file and overturn an i.e. Surgeon Specialist with years and years of education, practice (in the medical sense) and has actually examined the patient.

Because you asked oh-so nicely...this is the poster from 2010.

COMMON ESSENTIAL QUALIFICATIONS:

EDUCATION:
Graduation with a diploma or certificate from a recognized university or college in any of the following areas: social sciences, business, social work, health care, health care administration or public administration.
AND
Experience in the provision of advice or analysis to management in the development of policy, programs or services or rendering decisions on Government programs.

EXPERIENCE:
Experience in providing advice and guidance on complex issues to senior management.

Abilities and Skills (Common Essential Qualifications):
Ability to analyse, interpret and make recommendations.
Ability to communicate orally and in writing.
Ability to work as a team player.
Ability to lead a project, program or people.
Ability to prioritize and work effectively under pressure.

Personal Suitability (Common Essential Qualifications):
Judgement
Effective Interpersonal Relations
Initiative
Dependability


--------------------------------------------------------------------------------

Official Language Proficiency : English Essential


Asset Qualifications :
Education:
University Degree in the field of Health Sciences.
Post secondary diploma in the field of Health Sciences.

Experience:
Experience in the delivery or management of a disability program.
Experience in the adjudication of Government programs, services or benefits.
Experience in the adjudication of VAC disability benefits.
Experience in providing advice and guidance on complex disability issues.
Experience in the development and maintenance of the Table of Disabilities and/or Entitlement Eligibility Guidelines.
Experience conducting research on medical or disability-related conditions.

How many of these Adjudicators at VAC have the vague qualification you site and how many do not have any medical qualifications at all including First Aid? From that answer we will know the majority have no medical qualifications at all.

"Vague qualification"...nothing vague up there, I just couldn't remember the original requirements. It was in 2010 after all.
As to how many Adjudicators have the qualification, this is not information to which I have access. If you want it, ATIP it, you have the right. I personally know a half dozen of the folks up in Adjudication, and they all have backgrounds in health care.

Every time a VAC client gets his/her prescription (or script as VAC calls it) for their pensioned condition approved it is counted as an approval. If you got pain killers prescribed and Safeway fills the prescription for a three month period; bang a a VAC approval stat. Fill the prescription four times a year; four VAC approval stats.

Negative. The statistics are compiled from received Applications for Disability Pension/Award, Requests for Departmental Review, and Applications for Review/Appeal at VRAB. Note, VAC and VRAB keep separate statistics for reporting purposes, and each organization indicates 85-6% approval rating.

 

[blackberet17]

A current work description for the Disability Adjudicators should be obtainable from VAC HR. I'm looking into the process, and if it's something I can post.

MTF

 

[blackberet17]

Found it. Didn't have to go back as far as I did, it was just the last time I remembered a competition was in 2010.

Here's the Disability Adjudicator poster for a competition run in 2013:

Essential Qualifications :
Education:
Registration as a registered nurse in a province or territory of Canada.


Experience:
Experience in analysing written material and reporting on this analysis in a written format.
Experience in the interpretation and/or application of legislation or policy.


Ability to communicate orally.
Ability to communicate in writing.(WCT 345 may be administered.)
Ability to identify critical issues, apply relevant legislation, regulations and policies and prepare a written decision.


Judgement
Initiative
Effective Interpersonal Skills


--------------------------------------------------------------------------------

Official Language Proficiency : Various Language Requirements

Other Official Language Information :
English essential and Bilingual Imperative CCC/CCC


Asset Qualifications :
A degree in nursing from a recognized University.

Experience in adjudicating benefits for government programs.
Experience in rendering decisions for disability benefits at Veterans Affairs Canada.
Experience as a member of the Canadian Forces.
Experience in dealing directly with clients/applicants

 

[Fishbone Jones]

Thanks for posting this and we understand you have no control on the bureaucracy you work for. I have no intenet to shoot the messenger.

I'll bet the ex military Dr, that is now the head trauma surgeon at my local hospital, would love to know his diagnosis was dismissed by an RN or non medical civie who's claim to fame may be no more than a degree in business from a College :

Actually he does know and thinks the system is a total farce.

So do most Veterans, whether they've received an award or not.

 

[Jed]

I am surprised VAC still exists.
After WW1, the veterans had to organize and demand the gummint commit to helping them.
But, Canada was an agragarian society with no social safety net. It was work - or starve, and if you came back from the war all busted up, you could not work the farm.

Nowadays, we have so much stuff: welfare, unemployment, Workman's Comp, etc., that nobody starves unless their parents are whackjobs.

It is only a matter of time before that self-licking icecream cone known as VAC is stood down, and we are all transferred to the provincial WCBs.

And then... God help us all.

Yep, I think you are looking into the future.  If, no when, this gets dumped into the WCB process it will become even more of a bureaucratic nightmare for the run of the mill ex troop to receive due process.

Currently you already have to make it a full time job or mission to fill out all the prerequisite forms and supporting paperwork to receive ones due compensation.

 

[ModlrMike]

WCB tends to be a provincial domain. Personally, I doubt VAC will be suffled off to WCB any time soon.

 

[blackberet17]

Thanks for posting this and we understand you have no control on the bureaucracy you work for. I have no intenet to shoot the messenger.

I'll bet the ex military Dr, that is now the head trauma surgeon at my local hospital, would love to know his diagnosis was dismissed by an RN or non medical civie who's claim to fame may be no more than a degree in business from a College :

Actually he does know and thinks the system is a total farce.

So do most Veterans, whether they've received an award or not.

It is a bit of a farce some days. But it is also reality. Nurses probably make make more money in provincial jurisdictions than they would working for FPS. The competition poster above indicated a salary range of $69,732.00 - $76,970.00 per year.

I've done a quick search, and some provincial jurisdictions, depending on specialty/licence, pay nurses up into the $100k range. RNs make roughly the above range, while an LPN would jump at being in that range. Higher specialty nurses obviously make more. http://nursesunions.ca/sites/default/files/contract_comparison_english.pdf

It's much harder to get doctors to work for VAC. They make double in private practice or provincial jurisdiction than they would working for FPS.

But again, I'll remind folks of the fact there are a dozen doctors who do work for VAC, and they are frequently consulted (you'll find they medical opinions in your files, too) by the Adjudicators. MGen (or is it BGen? Beer!) (ret'd) Hillary Jaeger is back working with VAC, for example.

It's not a perfect system, and we're hamstrung by legislation. Another reality.