A little help with VAC

[392]

I wouldn't hold your breath in waiting for a quick resolution - mine's been sitting at that step since June, when I received the same form letter (albeit with the info personalized to my specific claim) stating they received everything and it went to the decision making level on 01 Mar 12.

I inquired back in early Aug as to when I could expect an answer either way, and more or less was f*cked off with "as per your letter dated 23 Jun 12, your claim is sitting at the decision making level..."  :

16 weeks? Pfffffffffffffffffffffft  :facepalm:

 

[blackberet17]

I'll answer a couple questions on what I've been reading.

There are a couple options available to you, as per your first decision letter. If you are unhappy with any Official Decision, your first option is to request a Ministerial/Departmental Review. Do this first.

Following this, if you're not happy with that decision, request a Review from the Veterans Review and Appeal Board (VRAB). At this point, I suggest you either go through the Legion or the Bureau of Pensions Advocates. I honestly don't see much point in going through the RCL, since you'll be assisted by a BPA lawyer regardless. RCL Reps don't have the legal experience or VAC experience either to take you through the process.

If unhappy with the Review, request an Appeal, again this is through the VRAB. There's also one last step, Reconsideration, but there's two hoops to that one I won't get into here, unless someone has a question.

Throughout the VRAB process, you are represented by a BPA lawyer. And it's free. Now, note, they are responsible at all levels of the process, Review, Appeal, Recon; they represent current and former CF members, Veterans, and RCMP members, plus spouses and dependants. They've got quite a workload. A couple of them are friends, so I know how hard they work(most of them, anyway). Basic info here

All of this can take time. From original application to VAC, yes, expect a 16-week turnaround time. This really is just a ballpark figure. There are all sorts of delays which may come up, such as getting our service docs, opinions/reports from our doctors, and then a medical opinion from one of the doctors at VAC. Then, if possible and depending on the medical info on file, it may take a little longer to get an assessment of the condition (the %).

Here are VAC's Service Standards

This Stage 2/Stage 3/Stage 23 nonsense the Department is using only means so much. It doesn't mean anything to the person applying without a description of where the file's at.

The process suck, really, and VAC is trying to make improvements. But don't expect anything to change quickly...

 

[Wookilar]

If unhappy with the Review, request an Appeal, again this is through the VRAB. There's also one last step, Reconsideration, but there's two hoops to that one I won't get into here, unless someone has a question.

I'll pull that trigger.

I've got one at the appeal stage now, just got my letter from the BPA lawyer. I am not worried about time lines as I know it will be awhile. It seems pretty clear (to me and my armchair lawyer knowledge) that the VRAB, at the Review, made errors in both fact and law.

Add to that, since the Review hearing, DMEDPOL has now decided I breach U of S so I am likely looking at a 3B release in the next fiscal year, so my circumstances have certainly changed I would say. Or does that even matter?

If the VRAB at the Appeal decide in-line with the original Review decision, what do I need to do to push for the Reconsideration? Is there a more onerous level of proving an error of fact or law occurred?

Any advice you have would be appreciated.
Thanks.

Wook

 

[blackberet17]

It "should" be outlined in the Review decision why you were denied. I say "should", because - even though VRAB's been slapped enough times by the Federal Court to provide clear and concise reasons - sometimes the reasons aren't clear and concise.

The fact you are now going to be 3B released may change the game, but it's hard to tell. Without knowing the specifics of your file, I can't say.

For a Recon, you need to be able to prove the Review/Appeal panel committed an error of fact, or an error of law. Your BPA lawyer should be able to determine as much. Also, if I remember correctly, you can request a copy of the Review hearing. From there, you can determine if there were errors in any of your testimony as it appears in the decision, which you may think - because of omission, bad interpretation, etc. - were a factor in the decision.

It's more of a legal jungle than the Review or Appeal levels, because the new evidence you provide (another way of getting a Recon) must meet a four part test, as established by the Federal Court. I can't find a good clear outline of the process for you, but there are a couple of VRAB Recon decisions you can read on their web site, which should give you an idea.

You can also pm me as well if you have other questions.

 

[Rifleman62]

blackberet17:

For a Recon, you need to be able to prove the Review/Appeal panel committed an error of fact, or an error of law. Your BPA lawyer should be able to determine as much. Also, if I remember correctly, you can request a copy of the Review hearing. From there, you can determine if there were errors in any of your testimony as it appears in the decision, which you may think - because of omission, bad interpretation, etc. - were a factor in the decision.

By that I think you mean the written submission prepared by the BPA Lawyer, reviewed by the appellant, then "argued" by the BPA Lawyer at the closed door hearing that you, the appellant, are not allowed to attend. The Appeal Hearing.

Like Star Chamber. Stupid in these days. the Board needs to be shit canned.

Sounds like you are employed by VAC.

PS  .

......there are a couple of VRAB Recon decisions you can read on their web site

Send link.

 

[Wookilar]

The Review hearing (the most formal informal process I have ever been involved in I might add) I think is what blackberet is talking about.

As for not being in attendance at the Appeal, I thought I read that you could attend and observe the proceedings in Charlottetown, but not give evidence? Was that on the BPA site? I'm going to have a look around and see if I can find that again.

blackberet: Thank you for the info and insight. When I am able to put my questions in a more presentable manner, I will shoot you a pm.

 

[Rifleman62]

Wook:

The Review hearing (the most formal informal process I have ever been involved in I might add) I think is what blackberet is talking about.

Probably, but lets hear it from him. Also would like to see the link he stated was available.

 

[blackberet17]

By that I think you mean the written submission prepared by the BPA Lawyer, reviewed by the appellant, then "argued" by the BPA Lawyer at the closed door hearing that you, the appellant, are not allowed to attend. The Appeal Hearing.

The written submission is submitted to VRAB prior to the Appeal hearing. For the hearing itself, it may proceed via written or oral presentation by your BPA lawyer. And Wook is right, you can be present at the Appeal hearing, but at your own expense (contrary to a Review hearing, where certain travel costs are covered). In fact, all hearings are open to the public.

While you may not be able to present ORAL evidence (i.e. testimony) at the Appeal hearing, one slight way around that is to represent yourself. Your BPA lawyer will council you against it, but it is your right to do so, and they'll be in the room with you anyway. It's a little tricky, and a bit of a grey area as to what would happen, but you could slip in oral testimony by representing yourself. One thing I haven't seen done yet is a client, instead of preparing a written document, send in a cd/dvd whatever format, of them providing new evidence. It might be a way around the "no oral testimony".

Basic info on BPA and the process here, as well as on VRAB and the process here.

Sounds like you are employed by VAC.

Is that a problem, Rifleman62?

Oh, wanted clarify something I said earlier: "Also, if I remember correctly, you can request a copy of the Review hearing. From there, you can determine if there were errors in any of your testimony as it appears in the decision, which you may think - because of omission, bad interpretation, etc. - were a factor in the decision."

You can request, I do believe but haven't gotten a straight answer yet, a copy of the audio recording of the Review hearing. Then do a comparison between what's been transcribed in the decision to what you actually said. I haven't seen anyone do it yet, and would suggest it to those who feel their testimony was misinterpreted or something key was omitted.

By way of links, VRAB's posted depersonalized copies of decisions dealing with all sorts of subjects, from common conditions seen at VAC to legislation to medical issues here. I haven't had the chance to root through it myself to find Recon decision examples, but when I do, I'll post it here.

 

[Rifleman62]

Is that a problem, Rifleman62?

No. I think you are assisting with education of VAC procedures, etc.

....you can be present at the Appeal hearing, but at your own expense.

Just a little catch that!

Look forward to you finding and posting the links.

A family doctor's opinion, while helpful, isn't going to carry as much weight as one from an orthopedic surgeon

possibly, possibly not. I waited eighteen months after being referred (a requirement) for an appointment with the orthopedic surgeon. The wait piles on and does not treat.

Otolaryngology - head and neck surgery. Well my surgeon's two letters for treatment of less than $400 was refused at the treatment center by a clerk. Maybe the clerk consulted the Merek on line medical manual, or spoke to a VAC GP. Maybe. But they over turned the Otolaryngology surgeon who recommended the treatment. Fourteen months of back and forth for -$400!

A number of the Disability Adjudicators have medical experience, many with a nursing background (they're the ones signing the letters)

A number..... How many DA's are employed by VAC? How many have a professional medical qualification. Do they have to be licensed by the province?

Does VAC not allow the professional designation in a signature block? I have never seen one on a document signed by a DA, and I have seen lots from many people.

By the way, please post the employment requirements for an Adjudicator. I periodically look, but have not found the qualifications.

 

[blackberet17]

I'm not going to quote, it's getting messy!  ;D

The links I provided in my last post will help you find what you were looking for. If not, let me know, and I'll do some further digging. Won't be this weekend (LG-1 conversion course), but possibly during the week.

Did the VAC response say why they turned down the treatment? You can pm on this if you like.

There are roughly 50 Disability Adjudicators. I know of four personally who are nurses, and one who is a retired pharmacist. The unit was recently reclassified, and the new classification requires at minimum a background in nursing. Those who don't have such a background have been grandfathered in, but any new hires will have to meet the minimum. Only reason I know this is because they posted an advertisement, and I applied. It took so bloody long for them to go through the process, I asked a couple friends there what was going on, and they said the process was on hold while they were going through a reclass. It took about three years from start to finish, and in the end, they cancelled the advert, taking the one person with nursing experience who applied.

Doctors practice (egads) medicine. Do nurses? Anyway, provincially, like in all provinces and states I believe, nurses must be licensed. As for what VAC requires, I don't know. Does it have to be current? Must they be in "good standing" like doctors with their respective colleges? Good question.

I'll need some time to get the employment requirements from HR. Even Client Service Agents now, they want people with experience in health care.

We all had to change our signature blocks to follow Treasury Board "common look and feel" requirements in the last couple of years. I don't know if there's a policy against adding professional designations, but I don't feel the need to put mine on my block. I'm not that important anyway :rofl:

 

[Sythen]

My second question is about my second claim, which was not granted. I won't type out the exact wording but basically during BMQ I got plantar fasciitis. They said it was not granted because after going through physio, I no longer filed complaints about it. Problem was, both the doctor at the MIR and the physio therapist told me it simply can't be cured and after physio, that is as good as its gonna get so I saw no point in continuing to complain about something that wasn't gonna go away, and I still have a lot of pain from it.

How often is it that a medic won't record something spoken about during your release medical? I finally got a call back from pension advocates and the woman I spoke with was very combative. When I released, I spoke with the medic about a couple different ongoing problems, including my plantar fasciitis. The other problems have resolved themselves, but the woman on the phone said there is nothing documented and was really pushing the line of since I wasn't in the MIR complaining about it, it must be resolved. She said she is going to forward my information to a doctor in Ottawa, and I can go in and speak with him about it.

 

[combatpostie]

I've received a favorable decision from VAC, 5/5 PTSD, for service on Tours, I've been sent to the VAC OSI clinic in Ottawa for assessment for the % I will be awarded under the new vet charter.  Its at HQ in Charlottetown since 12 Jan, I understand the 16 weeks delay. Does anyone have any info on % to expect, I've run through the VAC chart, its a bit confusing. Any thoughts are appreciate. Cheers!

 

[Cdnleaf]

Any thoughts are appreciate. Cheers!

My thoughts are stay focused on recovery and don't get caught up in the below or %s.  As you can appreciate, every case is unique and based upon a myriad of factors; including the quality of the submission concerning your reassessment.  I generally keep my expectations low and have been pleasantly surprised at times.  Support from my DVA Case Manager has been outstanding, which I'm fortunate and is the main thing at this time.  All the best.

 

[392]

I've received a favorable decision from VAC, 5/5 PTSD, for service on Tours, I've been sent to the VAC OSI clinic in Ottawa for assessment for the % I will be awarded under the new vet charter.  Its at HQ in Charlottetown since 12 Jan, I understand the 16 weeks delay. Does anyone have any info on % to expect, I've run through the VAC chart, its a bit confusing. Any thoughts are appreciate. Cheers!

From what I have seen and heard lately, for PTSD claims, they initally give 10% across the board until "the condition stabilizes" and a 6 month recheck has been done. I have not heard anyone disclose if further % were given after the 6 month checkup or if it does / doesn't stabilize.


Note that this has been my experience with it, and may or may not reflect what you may see.  :2c:

 

[combatpostie]

Thanks for the feedback, I tend to hear the same on the 10%.  I'm already retired and employed, with weekly sessions...so that helps for the "stabilize" part of the claim. But VAC never ceases to amaze me.  I'm with you on the not expecting much from them and being happy with the outcome.  Again, thanks for the feedback. Cheers!

 

[Cdnleaf]

^ Anytime, I'm in that 16 month waiting process now after receiving the initial 10%.  It will be interesting to see what happens and I'm keeping things in perspective/grounded.  It's an odd predicament to be in so I can relate to your post.

 

[combatpostie]

That's what I don't understand, I have friends in similar circumstances (still serving though) that got the 10% upfront and waiting for final outcome (after they stabilize). As for my case, no 10%, decision in Oct 2012 (favorable 5/5) and then assessment by VAC (contracted med from OSI clinic) for % in Nov 2012 (sent to case worker in Mtl) and that report sent to HQ 12 Jan 2013.  Every step, they reserve the right to add 16 weeks from then.  I'm awaiting a call from district for the definition of "stabilized". We'll see!

 

[maniac]

I saw the VAC Ombudsman last week (one of the investigators in Ottawa),  they say they have a list of pro-bono lawyers that will take on the VRAB in federal court if you have exhausted all of your appeals and do, in fact, have a legitimate case.

It is true,  the Ontario Trial Lawyers Association has given up that service for almost 2 yr now.

 

[blackberet17]

That's what I don't understand, I have friends in similar circumstances (still serving though) that got the 10% upfront and waiting for final outcome (after they stabilize). As for my case, no 10%, decision in Oct 2012 (favorable 5/5) and then assessment by VAC (contracted med from OSI clinic) for % in Nov 2012 (sent to case worker in Mtl) and that report sent to HQ 12 Jan 2013.  Every step, they reserve the right to add 16 weeks from then.  I'm awaiting a call from district for the definition of "stabilized". We'll see!

VAC's definition of "medical stability", from the Web site:

Medical Stability: For pension/award purposes, an entitled disability is considered to be medically stabilized when it is unlikely to change substantially in the next 12 months, with or without medical treatment. Over time there may be some change, however, no further recovery is anticipated. When the prognosis is for early improvement, as after remedial surgery, the Department will determine when the condition is considered to be stabilized for assessment purposes.

PTSD and other psychological conditions, along with COPD and other respiratory/cardiovascular conditions, are the most complicated ones to assess. I say complicated, but not difficult, simply because of the ways the tables are organized.

Assessing a psychological condition requires going through four tables, contained in Chapter 21 of the 2006 Edition of the Veterans Affairs Canada Table of Disabilities. (https://www.veterans.gc.ca/eng/services/disability-benefits/benefits-determined/table-of-disabilities/ch-21-2006). Table 21.2 is the biggest one, with three columns. The instructions tell you how the condition is assessed by each table.

Have a read through those, and if you have questions, pm me. The 10% is an initial assessment, with a further assessment once the medical evidence indicates the condition has stabilized.

As for a percentage to expect, each case is different, and it all depends on the information you and/or your psychologist provide for assessment purposes. I've seen cases in the 70%, and others in the 15-20%.

 

[combatpostie]

An update on my claim (PTSD) phone VAC yesterday, I'm at the 14 week timeframe (second time around) initial claim dated 12 March 2012.  Favorable decision Oct 2012 (5/5), seen VAC doc Nov 2012, Case worker mails the full package sent to Charlottetown 12 Jan 2013.  They advise me yesterday all is done and they are in the "writing the letter stage" this would involve all the details of what % was granted for QOL etc... So! do you think they will make the 16 week mark?