4.0 Performance and Efficiency/Economy

4.1 To what extent is the Redress Process achieving its objectives and contributing to the overall objectives of the Disability Benefits Program?

4.1.1 Program governance

The evaluation finds that governance of the Redress Process is challenging as there is not one specific area or division or even Department that is responsible for Redress. VAC, the BPA and the VRAB all have important roles to play in the process.

VAC Centralized Operations has a vital role to play in making the initial decision on the Disability Benefits First Application as well as the decision on a Departmental Review, should the Veteran choose to go that avenue for redress.

The BPA is uniquely positioned. The division exists within VAC and the Chief Pensions Advocate reports to VAC’s Deputy Minister, yet BPA lawyers are tasked with representing Veterans who do not agree with a VAC decision. Key informant interviews suggested that one of the first steps that BPA staff must take is to explain the relationship between the BPA and VAC and establish trust with the client who has come forward for help.

The VRAB, however, is independent from VAC and has the role of hearing and deciding on Reviews, Appeals and Reconsiderations. Ultimately, there is not one specific area or division responsible for the full redress process.

Additionally, the Office of the Veterans Ombud (OVO) plays a role in ensuring that Veterans and their families are treated fairly and have access to the programs and services that contribute to their well-being, and in raising systemic issues. However, the OVO does not have authority to review any departmental decisions that can be reviewed or appealed to VRAB, such as Disability Benefits^{Footnote 8}.

4.1.2 Review of current departmental guidance on redress

The Department outlines how to review or appeal a decision on its departmental website. The evaluation team finds that the information contained on the departmental website relating to the Redress process is current, informative and good reference information outlining steps for clients who are not satisfied with a Disability Benefits decision.

The VRAB website and the Veterans Ombud website are also both informative.

4.1.3 Performance Information

In October 2020, VAC developed a revised Performance Information Profile (PIP) for the Disability Benefits program with updated indicators and performance targets. This document outlines the Program outputs and outcomes and identifies a number of indicators that will be used to measure those outcomes. The PIP also establishes targets indicating the level of performance that the Program plans to achieve within a specified time period.

The current PIP does not identify any specific indicators related to Departmental Review decisions and therefore the evaluation team was unable to assess the relevance of the indicators specific to DR decisions.

One of the ultimate outcomes of the program is that Veterans are satisfied with the services they receive. The evaluation team looked at the 2020 VAC National Survey and noted that 80% of individuals are satisfied with the quality of the VAC programs and services they receive. The target for this outcome is 85% satisfied by March 31, 2023.

The VRAB provides some performance information in their Departmental Plan.

Two service standards related to Redress are published online.

For BPA, there is a service standard for a case to be ready for hearing within 21 weeks 75% of time after initial contact with BPA. In 2019-2020, this target was met 54% of time, which is lower than the previous 4-year range (63 to 69%).

There is a service standard at VRAB to schedule a hearing, conduct the hearing and issue a decision within 16 weeks. In 2019-2020, this target was met in 95% of Review cases and 48% of Appeal cases. In 2020-2021, this target was met in 88% of Review cases and 66% of Appeal cases, as in-person Review Hearings were suspended for a period of time due to the pandemic, during which time VRAB focused more on Appeals.

4.1.3.1 Client Surveys

BPA Client Satisfaction Survey

BPA uses a client questionnaire as a tool for clients to contribute feedback on the quality of services they receive from the Bureau. Pre-pandemic, questionnaires were given, in person, to each client after their Review hearing. Appeal hearing clients received their questionnaires by mail. Clients were asked to complete the questionnaire and return it by mail to BPA. Client surveys ceased during the Covid-19 pandemic.

Generally, clients were very satisfied with the staff and service that the Bureau provides. One of the areas identified for improvement at the Appeal level was the amount of time to have a case heard.

Some of the highlights of the 2018-2019 Client Questionnaire results include:

• 97% of clients at Appeal and 99% of clients at Review responded very satisfied or satisfied with courtesy of BPA employees
• 90% of clients at Appeal and 99% of clients at Review responded very satisfied or satisfied with Advocate’s ability to effectively communicate
• 79% of clients at Appeal and 96% of clients at Review responded very satisfied or satisfied with time to respond to requests for information
• 68% of clients at Appeal and 92% of clients at Review responded very satisfied or satisfied with amount of time to have a case heard

VRAB Exit Survey

VRAB administers a Review Hearing Exit Survey, which provides valuable insight on clients’ experience. The feedback is generally very positive. Some of the highlights for the 2019-2020 fiscal year include:

• 98.7% agree Board Members clearly explained how the hearing would proceed
• 96.3% agree Board Members gave my representative and me the opportunity to fully explain my case
• 96.1% agree Board Members listened to what I had to say
• 94.6% agree Board Members made efforts to put me at ease
• 98.1% agree Board Members treated me with respect
• 92.9% agree the hearing was conducted in a fair manner

4.1.4 Collaboration and Trend Analysis

Policy, Program, BPA, and VRAB collaboration

Key informant interviews with multiple areas involved in the redress process have indicated that, over time, there have been different iterations of working groups or consultative committees between respective areas to discuss issues regarding redress. Currently, BPA and VRAB have a regular monthly meeting to discuss issues of mutual concern which involves the Chair and Deputy Chair of VRAB, BPA’s Chief Pensions Advocate, and BPA’s Senior Director for Legal Operations. In addition to regular senior management meetings, there are regular operations meetings with VRAB/BPA/COD to discuss issues, changes and trends. 

However, opportunity exists to renew and strengthen information sharing and collaboration among relevant parties. There is currently no formalized approach to communication and information sharing that encompasses the Service Delivery Branch, the Strategic Policy and Commemoration Branch, BPA and VRAB.

The evaluation team was not able to obtain any formal meeting minutes or records of actions taken as a result of the existing meetings. During interviews with key informants, the evaluation team was made aware of the importance of collaboration and how implementation of a policy or process change on the program side without collaboration can have significant impacts on the entire redress process. For example, a change in direction surrounding fractional entitlement^{Footnote 9} resulted in an unanticipated high volume of requests to BPA for VRAB Reviews coming forward that impacted their operations.

Trend Analysis

The Department does not currently have a formal process in place to review and analyze decision making trends at the First Application, Departmental Review, VRAB Review, VRAB Appeal and Judicial Review levels. Further, although VRAB previously captured decision reasons, this process was discontinued in May 2019 after a review identified that the report was no longer providing meaningful, accurate information. VRAB plans  to further expand its data collection in GCcase as this system begins to be used for redress in 2022-23, including tracking decision reasons.

Analysis of trends and decision reasons could provide insight to support changes or improvements earlier in the adjudication and/or redress process. For example, further analysis could be completed on:

• decisions for conditions most commonly brought forward for redress (e.g., Tinnitus, Hearing Loss and Post-Traumatic Stress Disorder make up 44% of all decisions made at the Departmental Review level)
• conditions or types of claims for which decisions are most commonly amended in redress, and why
• conditions or types of claims which have higher favourability rates in redress than in first application, and why.

Understanding the reasons that decisions are amended in redress could provide opportunity for changes to be made earlier in the process and could reduce the administrative burden on both Veterans and Departmental and VRAB employees.

Delays in receiving approval for Disability Benefits impact the Veteran’s gateway to other benefits and services such as Treatment Benefits. Key informant interviews suggest that Veterans see the whole process (initial decision to redress completion) as one complete turnaround time. In reality, there are many factors that impact the overall redress turnaround time such as:

• Length of time that passes between First Application decision and when the applicant decides to apply for redress^{Footnote 10};
• Length of time to gain/acquire supporting documentation, including medical documentation;
• Turnaround times for the BPA to have the case ready for a hearing;
• Turnaround times for Departmental Review decision making; and
• Turnaround times for a VRAB hearing to be scheduled and held.

To demonstrate from a Veteran perspective, consider the following example from the random sample of files used in the evaluation:

• First Application submitted September 17^th, 2015
• First Application decision November 30^th, 2016 (unfavourable)
• Departmental Review Decision October 31^st, 2019 (favourable due to error in fact or law)

Overall, the evaluation team finds that for efficiency and effectiveness, there is significant need to establish a formal approach to information sharing between VAC (including both the Service Delivery Branch and Strategic Policy and Commemoration Branch), the BPA and the VRAB to share information on trends, policy changes, process challenges and other issues of mutual concern.

4.2 Are there opportunities to improve efficiencies and effectiveness with the redress process?

4.2.1 Quality assurance within the Redress Process

When a new employee is hired to work as a decision maker within the Centralized Operations Division, they receive extensive training on the Disability Benefits Program and related processes to support them in their role as decision maker. In addition, they have access to senior decision maker “coaches” to support them throughout the process.

New decision makers start with files of certain conditions that are less complicated. As experience is gained, training is provided on additional condition types depending on organizational need. Throughout this initial training period, all files that are assigned to new decision makers are quality reviewed before receiving final approval.

The evaluation team found that upon completion of the initial training period, new decision makers are assigned files on their own and are no longer required to have their decisions reviewed for quality assurance purposes. It is, however, important to note that the decision makers still have access to the senior decision maker “coaches” beyond their initial training period.

In 2020, VAC engaged a contractor to support the development of a Quality Assurance / Quality Control framework for the Department’s Disability Benefits Program. The framework was completed in January 2021 and is anticipated to be implemented in fiscal year 2022-2023. This quality assurance framework encompasses quality control activities to support First Application decisions only.

Observation: There is a significant opportunity to improve effectiveness and efficiency of redress by COD establishing a Quality Assurance/Quality Control framework which encompasses Departmental Review decisions.

4.2.2 File Review of Departmental Review applications

The evaluation team completed a file review on a random sample of favourable Departmental Review decisions. In total, the decisions for 371 Disability Benefits applicants were analyzed for the time period of April 1, 2015, to March 31, 2020.

A summary^{Footnote 11} of the results shows that:

• 153 (41%) decisions were originally unfavourable as the decision maker did not have sufficient documentation with the file to establish a link between the condition and the applicant’s military service.
• 43 (12%) decisions were originally unfavourable because the information submitted with the application did not include a medical diagnosis.
• 233 (63%) decisions were amended based on the review of additional evidence submitted.

In the following instances, the file review found that information was available and/or errors were made:

• 66 (18%) decisions were amended based on a review of available evidence already on file.
• 84 (23%) decisions were amended based on an administrative error in the initial decision.

In considering the results of the file review above it is reasonable to draw the conclusion that a broader reaching Quality Assurance framework would support more effective decision making earlier in the process.

4.2.3 Information and Data Systems

Currently, the redress process involves the use of multiple systems to capture information and decisions. The Client Service Delivery Network (CSDN) is the main system of record for VAC where applications and decisions involving redress are captured and recorded.

The VRAB currently has its own client management system, the VRAB Scheduling App. This system allows the Board to track intake and prepare the statement of case for any hearings. However, upon completion of the statement of case^{Footnote 12}, it must be uploaded to the CSDN for the BPA to be able to access the information for hearings. Statements of case and decisions made by the board are sent to the Veteran via the secure My VAC Account^{Footnote 13}.

The BPA currently does not have an electronic client management system. Prior to the Covid pandemic, BPA processes were heavily paper based. Key informant interviews revealed that implementing a suitable client management system has been an ongoing challenge at BPA.

Initial work has been completed and future plans include integration of the redress process including functionality for BPA and VRAB in the Department’s GCcase^{Footnote 14} system.

4.2.4 Published Service Standards

VAC

The turnaround time for processing a first application Disability Benefit decision is a decision within 16 weeks, 80% of the time. As of 2019-20, this standard is being met 23% of the time.

VAC does not have a published service standard for Departmental Review decisions.

The evaluation found that VAC only publishes one service standard with respect to the Redress process on its external website; it is specific to the work of the BPA (for a case to be ready for hearing in 21 weeks 75% of the time).

VRAB

VRAB publishes and reports on a service standard to schedule a hearing, conduct the hearing and issue a decision within 16 weeks.

Considerations

The Department has made a significant investment to reduce the Disability Benefit application inventory to help meet the service standard. More than 300 new employees have been hired to reduce the inventory by 2022. As of March 31, 2021, the total number of pending Disability Benefit applications is approximately 6,900 fewer than it was as of March 31, 2020.

Similar to VAC, the BPA has hired temporary resources in an effort to achieve its service standards. The service standard for the BPA is to have a case ready for a hearing within 21 weeks, 75% of the time, after a client’s initial contact with the bureau. As of 2019-20, this target was being met 54% of the time. This was lower than the previous 4 years, which ranged between 63% and 69%.

These additional resources at VAC and BPA have had an impact on workload at VRAB, where additional funding was not received.

Overall, the evaluation team finds that there is an important need for VAC to proceed with the implementation of a quality assurance / quality control program to ensure efficient and effective decision making and the best possible outcomes for Veterans and to regularly evaluate its quality assurance/control program and expand it to include the redress process.

4.2.5 Operating Costs and Level of Effort

The Redress process is a highly involved process which includes the effort of three distinct areas: VAC Centralized Operations, BPA and VRAB.

For fiscal year 2019-20, VRAB had planned human resource and operational spending of approximately $10.7M with 83 full-time equivalent employees. BPA had planned spending of $12.6M with 127 employees. For BPA, this represents a one-year boost in budget based on extra resources reallocated to the Bureau from within VAC for that one year. BPA’s normal annual A-base funding is approximately $9.5M.

The portion of the Department’s costs associated with the Departmental Review process is not tracked or separated from the larger Disability Benefits Program expenditures.

As a result of Recommendation 1 (modifying the Disability Benefits Program Information Profile to include performance indicators related to redress), it is anticipated that more detailed reporting on the costs and resources dedicated to redress in particular will be necessary. This will facilitate further analysis of expenditures related to redress in the future.

4.2.6 Opportunities for Standardization

When a client first reaches out to BPA, the BPA advocacy officer and lawyer will review the case and provide the client with advice on how to proceed. This may include a recommendation to proceed with a Departmental Review application or to go straight to a VRAB Review hearing. This advice may also include a recommendation not to proceed with any application if it is felt that nothing will be gained by proceeding. This is referred to as being “counselled out”.

Through interviews with BPA employees, the evaluation team attempted to understand the rationale behind recommending a Departmental Review case, a VRAB Review case and “counselling out^{Footnote 15}” a client. Some of the factors identified included:

• Disability Benefit application inventory, which impacts Departmental Review turnaround times
• Nature of the information or evidence required for a successful outcome
• Likelihood of success
• Disability Benefit Applicant preference
• Regional and/or lawyer preference
• Language of the case (fewer resources at VAC to process French cases)

Interviews with BPA employees and a review of operational data show a wide regional difference in the proportion of cases being referred to Departmental Reviews compared to VRAB Reviews. For instance, in fiscal year 2019-20, 80% of cases that went forward for redress in the Western Region, went through the Departmental Review process first. Similarly, the Ontario and Atlantic regions saw approximately 70% of cases follow this path. However, in the Quebec region, less than 40% of cases are directed to the departmental Review process with the majority being directed to VRAB. This variance may be partly explained by language (lawyers report delays in French cases).

The evaluation team was informed through the interviews that the current high disability benefit application inventory impacts the advice provided by BPA lawyers to their redress clients. For instance, part of the information provided to the redress client by BPA may be that they can have a VRAB Review hearing in less than half the time compared to a DR decision.

4.3 Are there any unintended impacts (positive or negative) of the redress process?

4.3.1 Impacts of the COVID-19 Pandemic

The global outbreak of COVID-19 triggered a series of changes to the redress process for Disability Benefits. Of note, the shift to a virtual work environment and virtual delivery of services. This virtual shift included significant upgrades to redress operations, including moving the Departmental Review process from an outdated paper-based system to digital administration and delivery.

The abrupt shift to a virtual work environment put Departmental Reviews on hold for five months, from mid-March to September 2020, while processes were developed to send Department Review applications electronically from BPA to COD, as opposed to via paper. This shift was particularly challenging for the BPA given their reliance on paper-based processes and files and the continued need to respect solicitor client privilege while trying to adapt to digital. However, each area has been able to successfully pivot and continue providing the service to applicants. At the same time, key informants indicated that the pause on Departmental Reviews allowed BPA and VRAB to focus on Appeal hearings and tackle the existing inventory of cases.

VRAB also shifted to a virtual work environment and the virtual delivery of services to ensure client and staff safety during the pandemic. Review hearings moved quickly from face-to-face hearings to teleconference hearings, then eventually to videoconference hearings. Since January 2021, the process has evolved to include hearings over MS Teams, a collaboration application used by federal government Departments and agencies across Canada.

It is important to note that key informants highlighted that some Veterans and other clients have chosen to wait for a face-to-face hearing which will be reinstated once provincial and/or federal public health guidance for COVID-19 allows. Both key informants at VRAB and the BPA acknowledged the importance of face-to-face hearings, which are the client’s legislated right. Some key informants spoke to the importance of first-hand testimony in a Review hearing and how sometimes this can be the most important piece of evidence provided.

The COVID-19 pandemic also impacted the delivery of training to VAC adjudicators who perform Departmental Reviews. Previously, adjudicators travelled to VAC Head Office in Charlottetown, PEI to participate in training. Given travel restrictions during the pandemic, a virtual training strategy was adopted. It is anticipated that employee training for Departmental Reviews and other Disability Benefits decisions will continue to be delivered virtually into the future.

The evaluation team found evidence of excellent collaboration among VAC, the BPA and the VRAB as a result of the COVID-19 pandemic to ensure continued service to Veterans seeking access to redress.

4.4 Are there modifications, alternatives, or best practices regarding redress processes that are being or can be adopted by VAC or VRAB?

In carrying out the evaluation, a scan was completed of redress in other jurisdictions. The evaluation team reviewed Veterans disability benefits and redress systems in Australia, the United Kingdom, and the United States. The team also reviewed the Canada Pension Plan Disability Benefits, the Social Security Tribunal of Canada, and various Canadian Worker's Safety and Insurance Boards and Tribunals.

In completing this review, it was noted that the Australian Veterans Review Board (AVRB) was the most relevant comparison as it is also an independent tribunal that reviews decisions about Veterans’ entitlements and compensation.  Of note, the AVRB has implemented two approaches of interest:

• Australia’s Alternative Dispute Resolution (ADR): ADR is an “alternative” process which helps parties to finalize a case, without the need for a Board hearing, so the expense and time of a hearing can be avoided. The ADR process is informal, flexible and its course depends on the assessment of a Conference Registrar as to what is appropriate for a given case. In 2015, the AVRB began a pilot whereby all new applications for review in one particular state go to Alternative Dispute Resolution (ADR).
• Australia’s Online Dispute Resolution (ODR): AVRB is now trialing online dispute resolution (ODR) to increase Veterans' access to justice. The initiative provides a modern, simple, efficient, user-friendly and accessible forum for Veterans, current serving Members and their families seeking review of decisions that affect their interests. ODR lets current serving Members, Veterans and their families resolve applications when and where it is convenient for them.

At the time of this evaluation report, there was no publicly available information on results or impact of these alternatives, however it may be of benefit for VAC or VRAB to engage Australian counterparts to determine the impacts of these novel approaches.

Simplified Hearing Process

The VRAB Simplified Hearing Process was identified as a best practice.

In spring 2020, the Board developed a Simplified Hearing Process to adjudicate less complex claims to create greater access to justice and render more timely decisions.

VRAB introduced this new process in an effort to ensure decisions are made in a timely and efficient manner. The Simplified Hearing Process aims to reduce the amount of time it takes to process less complex claims and therefore create more capacity to adjudicate claims. The major change is that a formal hearing is not required to make a decision, and the resultant decision is less complex.

Examples of cases that may go to the Simplified Hearing Process include Reviews, Appeals or Reconsiderations of certain Hearing Loss cases as well as partial entitlement cases for other conditions. The evaluation team did not have any available data to analyze the results of this new process, however, it will be valuable to follow the progress of this change going forward and whether it can be expanded for other types of Reviews, Appeals or Reconsiderations.