To recognize the obligation of all Canadians and the Government of Canada, Veterans Affairs Canada (VAC) provides various benefits under a legislative framework consisting of related specific Acts approved by Parliament. Disability benefits are adjudicated mainly under the Pension Act (PA), the Canadian Forces Members and Veterans Re-establishment and Compensation Act (CFMVRCA), commonly known as the New Veterans Charter (NVC), and the Veterans Review and Appeal Board (VRAB) Act. Here, we will use the two following acronyms, PA and NVC, when describing the process that pertains to claimants submitting an initial claim for disability benefits under these two Acts.
Both Acts (PA & NVC) are meant to be liberally construed and interpreted in recognition of the debt owed to Veterans in service to Canada. Whether adjudication is made by Departmental adjudicators or by members of the Veterans Review and Appeal Board, the proceedings are meant to be expeditious and informal, based on a non-adversarial process where claimants can be represented, and where a “Benefit of the doubt” clause prevails.
Under this “Benefit of the doubt” clause, disability claims are adjudicated favourably if evidence of a disability is clear, relevant and deemed credible, and if the disability is related to service, or is the result of a non-service related injury or disease that was aggravated by service. If a disability claim is disallowed, a reason is provided to the claimant and he/she can appeal the decision through various levels of appeal.
Under the PA, Veterans, Canadian Forces (CF) members, Royal Canadian Mounted Police (RCMP) members and dependants are compensated for death and disability with a monthly pension. Under the NVC, CF members, Veterans and dependants are compensated with a lump sum for the non-economic impacts of service related disability or death.
Disability is defined in both the PA and the NVC as "the loss or the lessening of the power to will and to do any normal mental or physical act.”
The following applicant may qualify for disability benefits under the PA if he/she has a medical disability that is related to or aggravated by service:
- A War Service Veteran or a Merchant Navy Veteran of the First or Second World War or the Korean War;
- A CF Veteran;
- A civilian who served in close support of the Armed Forces during wartime (WW II);
- A still serving or former member of the RCMP; and
- A survivor (spouse or dependant in some instances)
The following applicant may apply for disability benefits under the NVC, if he/she has a medical disability that is related to or aggravated by service and is applying for benefits after 1 April 2006:
- A CF member or Veteran who served after 1 April, 1947 other than the Korean War; and
- A survivor (some conditions apply).
The above listings do not include all potential claimants as eligibility criteria for various groups are very complex. It is always best to refer claimants to a Command Service Officer who will be best able to determine eligibility under either the PA or the NVC. The Departmental adjudicator will eventually determine under which Act (PA or NVC) a decision will be rendered.
Every application for disability benefits must first be made to the Minister who will consider an application without delay. An applicant can get assistance in submitting a disability claim from either a VAC employee or a Legion Service Officer. Normally, first contact with VAC is made through the National Client Contact Network (NCCN) at 1-866-522-2122 (English) or 1-866-522-2022 (French) or a Legion Service Officer. Applicants can also call Dominion Command Toll Free at 1-877-534-4666, or a Provincial Command Service Officer.
The adjudicative framework consists of the determination of both Entitlement and Assessment.
Entitlement for a disability benefit under both the PA and the NVC will be adjudicated under either the compensation or the insurance principle. When considering entitlement, the adjudicator determines whether or not there is a disability, the service relationship of the disability, and to the extent of the cause and effect factors. If a disability is fully related to service, adjudicators will grant full entitlement (5/5). Partial entitlement can also be granted in fifths (1/5, 2/5, 3/5, 4/5) if service factors played a partial role in the aggravation of a disability.
VAC has published very comprehensive Entitlement Eligibility Guidelines (EEGs) which describe various diseases and disorders, including comments on diagnoses, anatomical and physiological factors, clinical features and other considerations such as the relationship to other disorders. These EEGs are based on credible and peer-reviewed medical research and literature. The EEGs also identify who can provide a diagnosis. These EEGs are published on the VAC website.
An entitlement decision based on the EEGs will be framed under the compensation principle if a disability (or death) arose out of or was directly connected with military service. If disability developed (or occurred) during military service, the cause and effects (etiology) factors are very important. A disability diagnosed after release can be service connected if cause and effect factors during service resulted in disability. The compensation principle is the basic adjudicative test for peacetime CF and RCMP members.
An entitlement decision based on the EEGs will be framed under the insurance principle if a disability (or death) is attributable to or incurred during military service. Coverage is deemed to be 24 hours a day, 7 days a week, regardless of cause and effect factors. A disability diagnosed after service can be service connected if the onset was during service or service factors caused the disability. The insurance principle is the basic adjudicative test for Veterans of WWII, the Korean War, and Special Duty Area/Operations (SDA/SDO) personnel.
Assessment reflects the extent of the disability, expressed on a scale of 0% to 100% based on the VAC Table of Disabilities and the medical information provided. The Table of Disabilities is the instrument used by VAC to assess the degree of medical impairment caused by an entitled disability. A disability assessment is established based on a medical impairment rating in conjunction with quality of life indicators which assess the impact of the medical impairment on the individual’s quality of life. VAC’s Table of Disabilities is for the guidance of both the Department and the VRAB. The Table of Disabilities (TOD), which was introduced on 1 April, 2006, is available on the VAC website. The new TOD applies to all individuals being assessed for a disability after that date. This includes individuals assessed under the Pension Act (PA) (WW II and Korea) and those assessed under the New Veterans Charter (NVC).
An initial assessment can be re-evaluated if a condition has worsened. In those cases, a medical examination will be scheduled by VAC, normally two to three years following the initial assessment. Prior to two years, a claimant must provide medical evidence that his/her condition has worsened.
Under the PA, tax exempt disability benefits are paid monthly. The basic rates are legislated and are adjusted yearly based on the Consumer Price Index or the pay rates of an unskilled member of the Public Service Labour Groups. Under the NVC, tax exempt disability benefits are paid in a lump sum. The basic rates are legislated and are adjusted yearly based on the Consumer Price Index.
Under the Pension Act (PA), a disability pension is deemed payable from the later of:
- The date on which the application was first made. For Legion purposes, an application is deemed to have been made when the RCL Claim Form is faxed to Adjudicative Services at VAC; and
- A date 3 years prior to the date of which an award decision was made.
Under the New Veterans Charter (NVC), the effective date is the date of decision.
A favourable entitlement decision under the PA is a gateway to the various Health Services and other ancillary benefits. Under the NVC, a favourable decision is not necessarily a gateway to other programs and services though it may lead to treatment benefits if need is linked to disability. As the eligibility criteria grid is very complex, it is best for Branch Service Officers to make appropriate referrals to Command Service Officers.
