The 2019 Mandate Letter directed the Minister to continue to streamline the current suite of benefits with the goal of reducing overlap and administrative burden, and further improving VAC’s performance, as well as the client experience for Veterans, both as they transition to civilian life and as their needs change throughout their lives.
This priority was re-affirmed in the 2021 Mandate Letter, which included additional direction to apply GBA+ in decisions and consider public policies through an intersectional lens to address systemic inequities including: systemic racism; unconscious bias; gender-based discrimination; barriers for persons with disabilities; discrimination against LGBTQ2 communities; and inequities faced by all vulnerable populations.
To date, VAC has never audited or evaluated each program’s assessment criteria to determine: how they align with other VAC programs; or how alignment could reduce overlap and administrative burden. Additionally, VAC has not had access to sufficient intersectionality data for departmental clients to apply a fulsome GBA+ lens to determine if there are barriers to access for various sub-groups of VAC’s client base (i.e. LGBTQ+, indigenous, etc).
As part of VAC’s 2019-24 Departmental Evaluation Plan, Senior Management agreed to a cross-program evaluation of VAC programs to identify opportunities for efficiencies where assessment criteria alignments existed. Additionally, the 2019 Neutral Assessment of VAC’s evaluation function recommended that VAC should continue to explore options for specialized/cross-cutting studies and the impacts of GBA+ factors on access to VAC programming. The evaluation was conducted primarily due to risk/need and also addresses the recommendation for specialized/cross-cutting studies.
This report presents findings of the Horizontal Evaluation of Program Alignments and focuses on Canadian Armed Forces (CAF) Veterans assessed with a more significant level of disability and impairment and the programs they are likely to access.
Based on preliminary interviews with key stakeholders and a survey of program decision makers, it was determined that the evaluation would focus on alignments between VAC’s Disability Benefits Table of Disabilities (TOD) medical impairment criteria, the health-related assessment criteria of Additional Pain and Suffering Compensation Program (APSC) and the Caregiver Recognition Benefit Program (CRB). Prior to applying for the APSC and CRB the Veteran must receive a Pain and Suffering Compensation (PSCFootnote 1).
1.1 Program Overviews
Pain and Suffering Compensation (PSC)
The PSC recognizes and compensates for the non-economic effects of service-related disabilities. Determining the PSC is a two-part process:
- an entitlement decision is made based on relationship to military service;
- then an assessment (percentage) is made based on the medical impairment criteria in conjunction with quality of life indicators found in the Table of Disabilities (ToD).
The ToD is a legislated/statutory instrument used to assess the extent of a disability for the purposes of determining the amount of the PSC. Each of its 24 chapters considers the relative importance of a certain body part/system to assess the level of impairment, and the impact that impairment has on the Veteran's quality of life. When determining a PSC disability assessment percentage, the Veteran’s entitled medical impairment is assessed against the appropriate ToD worksheet.
Additional Pain and Suffering Compensation (APSC)
The APSC program came into effect on 1 April 2019. It is a tax-free monthly benefit that recognizes and compensates Veterans for the non-economic loss associated with service-related permanent and severe impairments that cause barriers to re-establishment. The amount of the compensation is based on the severity of the impairment. The impairments are classified as being grade 1, 2, or 3 (1 being the most severe).
As of March 2020, the program had 14,223 recipients with expenditures of $119.1 million. Departmental forecasts for the APSC program suggest by the 2025 fiscal year end, there will be 32,980 recipients with expenditures of $264.5 million.
Caregiver Recognition Benefit (CRB)
Established 1 April 2018, the CRBFootnote 2 is a monthly, tax-free benefit (indexed annually). It formally recognizes the contribution that informal caregiversFootnote 3 make to the health and well-being of seriously disabled Veterans with service-related physical and/or mental health condition(s) who require continuous provision of care. The benefit is paid directly to an eligible Veteran’s designated informal caregiver.
As of March 2020, the CRB program had 756 recipients with year-to-date expenditures of $9.5 million. Departmental forecasts for the CRB program suggest by the 2025 fiscal year end, there will be 1,576 recipients with expenditures of $20.8 million.
The Audit and Evaluation Directorate conducted a comprehensive evaluation of the CRB Program in 2020, the recommendations and findings of which have been considered in this evaluation.