Annex A: APSC Policy Excerpts

33. A “Permanent and severe impairment” is evident if the Veteran has at least one of the following:

1. An amputation, or loss by physical separation, of a limb at or above the elbow or the knee;
2. Two or more amputations of limbs at or above the ankle, or at or above the wrist;
3. The permanent loss of use of a limb such as may result from a permanent paralysis of an arm or a leg to the extent that it is ineffective for any practicable purposes in carrying out activities of daily living. Consideration should also be given to severe amputations that contribute to the loss of use of a limb at any level;
4. Legal blindness which is defined by the Canadian National Institute for the Blind as worse than or equal to 20/200 with best correction in the better eye or a visual field extent of less than 20 degrees in diameter;
5. A loss of hearing of at least 300 Decibel Sum Hearing Loss (DSHL) over four frequencies in each of the two ears;
6. A loss of speech such that the Veteran’s audible communication has been reduced to a level insufficient to meet needs of everyday speech and conversation;
7. A psychiatric condition or neurocognitive disorder, diagnosed according to the most recent version of the Diagnostic Statistical Manual of Mental Disorders, for which the Veteran requires ongoing regular treatment, and which results in the Veteran suffering from severe and frequent symptoms (presenting at least once per week) which significantly interfere with functioning in the areas of thought and cognition; emotion, behaviour and coping; and/or activities of daily living;
8. A severe and permanent limitation in Mobility or Self-care (see paragraph 34 below for more information); or
9. The need for supervision at least three to four times per week for at least one hour per visit to ensure safety in performing activities of daily living.

34. A severe and permanent limitation in Mobility or Self-care is evident where the Veteran, all or substantially all of the time, has at least one of the following limitations (a-g):

Mobility

Self-Care (must demonstrate the impairment with at least two Self-care activities)

OR
Cumulative Effects of Limitations in Activities of Daily Living

1. unable to transfer or ambulate independently (i.e., requires total assistance), even with the aid of medication, therapy, or an assistive device (e.g., cane, crutches, walker, wheelchair, shower lift);
2. able to perform less than 50% of the tasks associated with transferring or ambulating without the assistance of another person (i.e., requires maximal/significant assistance; Veteran provides less than half of the effort);
3. takes an inordinate amount of time, to transfer or ambulate, even with the aid of medication, therapy, or an assistive device (e.g., cane, crutches, walker, wheelchair);
4. unable to perform any of the tasks associated with two Self-care activities independently (i.e., requires total assistance);
5. able to perform less than 50% of the tasks associated with two Self-care activities without the assistance of another person (i.e., requires maximal/significant assistance; Veteran provides less than half of the effort with each Self-care activity);
6. takes an inordinate amount of time to complete two Self-care activities even with the aid of medication, therapy or an assistive device (e.g., reachers, toilet safety rails; shower chair);
7. has an inordinate frequency in how often two Self-care activities are completed daily, causing significant interference with his or her ability to participate in normal daily activities;
8. Experiences limitations in most of the ADLs defined in paragraph 32.e, which when taken together have an equivalent impact on the person as the limitations in 35.a-g above.

APSC Grade 1 is for those with the most severe level of physical, functional and/or mental impairment. To determine that Veterans have this extent of impairment, they must meet at least one of the following criteria:

OR

OR

1. Functionally, these Veterans:
   1. require long-term hospitalizations;
   2. are institutionalized, or are approaching the need for institutionalization;
   3. require continuous physical assistance of another person with 6 of 7 ADLs as defined in paragraph 32.e.; or
   4. require daily supervision and are not considered safe when left alone.
2. Physically, these Veterans include those who have:
   1. quadriplegia;
   2. paraplegia;
   3. bilateral upper extremity amputation (at or above wrist); or
   4. bilateral lower extremity amputation (at or above the ankle).
3. Mentally, these Veterans:
   1. show obvious signs and behaviour that are influenced by delusions or hallucinations not controlled with treatment and demonstrate gross impairment in communication or judgement i.e., grossly inappropriate, incoherent or mute; or
   2. require total care and supervision in the home or an institutionalized setting.

APSC Grade 2 is for those with a lesser extent of functional, mental and/or physical impairment than those in Grade 1. To determine that Veterans have this extent of impairment, they must meet at least one of the following criteria:

OR

OR

1. Functionally, these Veterans:
   1. require the physical assistance of another person with 50% or more of the tasks associated with transferring and ambulation (Mobility); or 4 Self-care activities, as set out in paragraph 34;
   2. take an inordinate amount of time to complete transferring and ambulation (Mobility); or 4 Self-care activities, as set out in paragraph 34;
   3. have cumulative effects of limitations in most ADLs, as defined in paragraph 32.e., which when taken together have an equivalent impact on the person as A or B above; or
   4. require daily supervision and are considered safe when left alone for very short periods of time, such as 2 to 3 hours during the day, or 5 to 6 hours overnight.
2. Physically, these Veterans include those who have:
   1. a complete and permanent loss of vision;
   2. irrecoverable loss of use of an upper and lower limb;
   3. a single upper or lower limb amputation at the hip or shoulder (no viable stump); or
   4. double limb amputations, i.e., at or above the ankle for the lower extremity and at or above the wrist for the involved upper extremity (viable stump).
3. Mentally, these Veterans include those who:
   1. suffer from a psychiatric condition or neurocognitive disorder with persistent symptoms of extreme impairment of one’s ability to think clearly, respond emotionally, communicate effectively, understand reality, and/or behave appropriately;
   2. suffer from a psychiatric condition or neurocognitive disorder which requires long periods of inpatient hospital care or a combination of inpatient hospital care and outpatient care (greater than 8 weeks, cumulative, within a 6 month period); e.g., a full time day program; or
   3. require recurrent hospitalization, i.e., greater than 3 times per year, without recovery.

APSC Grade 3 is for those with a lesser extent of functional, mental and/or physical impairment than those in Grade 2. All Veterans who meet the APSC eligibility criteria will be eligible for at least Grade 3.The criteria set out below is for illustrative purposes.

OR

OR

1. Functionally, these Veterans:
   1. require the physical assistance of another person with 50% or more of the tasks associated with transferring or ambulation (Mobility); or 2 Self-Care activities, as set out in paragraph 34;
   2. take an inordinate amount of time to complete transferring or ambulation (Mobility);
      or 2 Self-care activities, as set out in paragraph 34;
   3. have an inordinate frequency in how often 2 Self-care activities are completed daily;
   4. have cumulative effects of limitations in most ADLs, as defined in paragraph 32.e, which when taken together have an equivalent impact on the person as A, B, or C above; or
   5. require supervision at least three to four times per week for at least one hour per visit to ensure safety in performing activities of daily living, and are considered safe when left alone for longer periods of time.
2. Physically, these Veterans include those who have:
   1. a total and permanent loss of hearing;
   2. a total and permanent loss of speech;
   3. a single upper extremity amputation at or above the elbow;
   4. a single lower amputation at or above the knee; or
   5. irrecoverable loss of use of a limb.
3. Mentally, these Veterans include those who have:
   1. a psychiatric condition or neurocognitive disorder for which the Veteran requires ongoing regular treatment, and which results in the Veteran suffering from severe and frequent symptoms (presenting at least once per week) which significantly interfere with functioning in the areas of thought and cognition; emotion, behaviour and coping; and/or activities of daily living.