Parliamentary affairs

Canadian Rangers: A Systemic Investigation of the Factors That Impact Healthcare Entitlements and Related Benefits of the Rangers

Recommendation 1: We once again recommend that the Department of National Defence and the Canadian Armed Forces eliminate ambiguity and inconsistency in language in the policy framework for Reservists, with a focus on health care entitlements, as soon as possible, and no later than spring 2019.

Recommendation 2: We recommend that the Department of National Defence and the Canadian Armed Forces ensure compliance with the existing illness and injury reporting process so that Canadian Rangers are not inadvertently barred from accessing their health care entitlements and related benefits.

Recommendation 3: We recommend that the Department of National Defence and the Canadian Armed Forces ensure the delivery of health care to Canadian Rangers to which they are entitled by:

3.1 Engaging with Canadian Rangers with the view of identifying the barriers to their access to Canadian Armed Forces health care, and their health care needs within their social and cultural contexts.

3.2 Identifying and implementing a service delivery model for Canadian Armed Forces health care that is responsive to the identified needs of the Canadian Rangers.

Recommendation 4: We recommend that the Department of National Defence and the Canadian Armed Forces take concrete steps to ensure Canadian Rangers have a clear understanding of the importance of reporting injuries, and to improve their knowledge and awareness of the health care entitlements and related benefits available to them by:

4.1 Amalgamating information on Canadian Ranger health care entitlements and related benefits; distributing this information to Canadian Rangers in various languages and formats as necessary, by fall 2018.

4.2 Ensuring that this information is integrated into formal and any other relevant training offered to the Canadian Rangers, by fall 2018.

NDDN: Canadian Armed Forces Health Care and Transition Services, Recommendation 22

Response to NDDN recommendation 22

Letter to MND: Rangers Report

Letter to MND: Canadian Rangers Instructor Ratios

Response From MND: Canadian Ranger Instructor Ratios

Health care / Benefits / Canadian Rangers

Determining Service Attribution for Medically Releasing Members

Recommendaion 1: We recommend that the CAF determine whether an illness or injury is caused or aggravated by that member’s military service and that the CAF’s determination be presumed by VAC to be sufficient evidence to support an application for benefits.

NDDN: Canadian Armed Forces Health Care and Transition Services, Recommendations 11 and 19

Response to NDDN recommendation 11 and 19

Letter to MND: Determination of Attribution to Service for medically releasing members

Response from the Minister of National Defence regarding the 2016 report: Determination of Attribution to Service

Letter to MND: Follow-up to Service Attribution Letter

Response from MND: Service Attribution Follow-Up Jan 2018

Regular Force / Reserve Force / Transition

Hidden Battles: A systemic investigation into the identification of mental health needs and support for Primary Reserve members participating in domestic operations

Recommendation 1: By fall 2025 that the CAF formalize the post-deployment check-ins. This includes that Commanding Officers employ consistent and mandatory post-deployment individual check-ins following members' return from any domestic operation. The CAF must complete these check-ins on a cyclical basis (for example: at one month, three months and one year) following a domestic deployment. The aim is to provide up to date information and resources related to mental health support and facilitate access to CAF health services, if required.

Recommendation 2: By fall 2025, the CAF, in consultation with all DND/CAF authorities involved in the administration of mental health supports for Primary Reserve members participating in domestic operations, strengthen oversight of mental health screenings. This includes:

• The CAF to consistently track that Reserve Unit Commanding Officers complete pre-deployment screenings and post-deployment check-in activities. This would include enhancing data integrity and quality controls.
• CFHS to implement a formalized Lessons Learned framework for continuous improvement and this would include detailing trends in mental health requests and collecting disaggregated data.
• The CAF to enhance leadership tools using the Mental Health Continuum Model to improve leadership’s ability to guide members facing mental health challenges and through recovery.

Recommendation 3: By fall 2025, expand virtual care services to offer mental health services to locations that do not have mental health clinics and to better support Primary Reserve members during core clinic hours. This could include supporting Bases/Wings with longer wait times.

Recommendation 4: By fall 2025, ensure compliance with training on mental health supports and Reserve Force entitlements for all those involved in the administration and provision of health care.

Recommendation 5: By fall 2025, the CAF to improve the knowledge and awareness of mental health supports available to all Primary Reserve members before, during and after a domestic operation including recourse mechanisms, by:

• Making available on the internet and/or the CAF Mobile Application any relevant documents, policies, procedures, forms, and supplemental documentation related to eligibility criteria and limitations—and ensuring this information remains current.
• Committing the resources to develop and implement a communications plan that assesses and addresses gaps in all phases of the process. This includes activities, products, timelines, and metrics to reach and inform Reserve Force members and leadership (in person and virtually).

Recommendation 6: By fall 2025, the CAF completes the ongoing review of the mental health services needs of equity-deserving groups. This review must include all equity-deserving groups by:

• Engaging members from equity-deserving groups to determine their needs.
• Committing the resources required for the development of an action plan, including a communications plan.
• Given the CAF's current medical resources constraints, this review could include civilian or contractor support.

NDDN: Providing Aid to the Civil Power: Disaster Relief and the Canadian Armed Forces' Domestic Operations, Recommendation 12

NDDN: Rebuilding Trust: Transparency and Accountability in the Department of National Defence and the Canadian Armed Forces, Recommendation 14

Response to NDDN recommendation 12 due by 18 October 2024

Letter to MND: Hidden Battles report

Response from MND: Hidden Battles report

Letter to MVA: Hidden Battles report

Response from MVA: Hidden Battles report

Reserve Force / Health

Independent civilian oversight: The defence community deserves no less - A Position Paper

While the Ombudsman’s current mandate includes an express provision that the office is independent from the military chain of command and the administration of the Department of National Defence, we consistently encounter governance issues and interference with our operations. [...]

The proposed legislation gives the Ombudsman full structural and administrative independence from the Department so that it can carry out its functions unimpeded. Additional provisions protect the office from criminal or civil proceedings for actions taken in good faith in the performance of our functions and duties.

NDDN: Rebuilding Trust: Transparency and Accountability in the Department of National Defence and the Canadian Armed Forces,
Recommendation 10

Independence

On the Homefront: Assessing the Well-being of Canada's Military Families in the New Millennium

It is recommended that the CF review its current approach to provincial and territorial engagement on key issues affecting military families under provincial jurisdiction (including health, child care, education, and employment), adopting a more innovative and comprehensive approach.

It is recommended that DND/CF assist military families in accessing and maintaining continuity of healthcare and in maintaining their physical and mental well-being.

NDDN: Canadian Armed Forces Health Care and Transition Services, Recommendations 31 and 32

Response to NDDN recommendations 31 and 32

Strong, Secure, Engaged: Canada's Defence Policy
Page 29

Families

Part-Time Soldiers with Full-Time Injuries: A Systemic Review of Canada’s Primary Reserve Force and Operational Stress Injuries

Recommendation 1: Administration

It is recommended that the Department of National Defence and the Canadian Armed Forces improve the clarity and administration of Reservists’ entitlement and eligibility for health care, periodic health assessments and future Reserve employment by:

• Completing the revision of Queen’s Regulations and Orders, Chapter 34 – “Medical Services,” that has been under review since 2009, to clearly identify all entitlements to care for all Reservists.

• Incorporating the requirement for Reservists to undergo routine periodic health assessments (or to have their medical readiness determined) into the revised Queen’s Regulations and Orders Chapter 34 – “Medical Services” (along with associated policies and directives). Once this requirement is codified, ensuring that the appropriate resources are in place to guarantee Reserve medical readiness.

• Confirming in Canadian Forces Military Personnel Instruction 20/04 that Reservists whose Medical Employment Limitations so allow may be eligible to obtain new employment despite the existence of a temporary medical category.

Recommendation 2: Knowledge and Awareness

It is recommended that the Department of National Defence and the Canadian Armed Forces take measurable steps to improve the knowledge and awareness of the entitlements available to all Reservists, especially those who may be ill and injured, by:

• Making any relevant documents, policies, procedures and forms easily accessible on the internet and on the Defence Information Network, and ensuring this information remains current.

• Committing the resources required for the development and implementation of a communications plan. This would include activities, products, timelines and metrics to reach and inform Reservists.

• Ensuring that training on entitlement to health care (currently provided by the Field Ambulance Medical Link Teams) is effective and mandatorily provided to Reserve units.

• Ensuring that Reserve units have the appropriate number of training days to provide mandatory training to their members, and that such training is completed.

NDDN: Canadian Armed Forces Health Care and Transition Services, Recommendation 23

Ill and injured / Transition / Releasing / Reserve Force

Service versus Self

Recommendation 1

By May 2024, the Canadian Armed Forces complete a review and update to DAOD 5003-6, and by May 2023, provide clarification through official supplemental documentation available on the internet. This review or provision of information should ensure:

1. Eligibility criteria and limitations, guidelines and service standards are included;
2. A Gender Based Analysis Plus analysis is completed;
3. All reference documents that inform the process for contingency cost moves for personal reasons, compassionate status and compassionate postings, and available resources, are identified and accessible; and
4. That the rationale, the resources for Canadian Armed Forces members and families, and all available recourse mechanisms are included in any decision letter.

Recommendation 2

By May 2024, the Director General Military Careers, in consultation with other stakeholders involved in the process, strengthen oversight of contingency cost moves for personal reasons, compassionate status and compassionate postings and leverage data to improve their administration from start to finish. This includes:

1. A formal tracking system for requests and decision letters which is accessible to stakeholders and contains privacy safeguards; 
2. Enhancing data integrity and quality controls;
3. Establishing a formalized Lessons Learned framework; and
4. Detailing trends in requests regularly and collecting disaggregated data.

Recommendation 3

By May 2023, Director Military Family Services develop baseline resources for families with disabilities to help them access information that is tailored to their needs, regardless of where they are posted.

NDDN: Gaps to Fill: Housing and Other Needed Supports For Canadian Armed Forces Members And Their Families, Recommendation 22

Currently Unavailable.

Regular Force / Reserve Force / Relocation

NDDN: Canadian Armed Forces Health Care and Transition Services, Recommendations 12 and 13

SECD: From Soldier to Civilian: Professionalizing the Transition, Recommendation 1

ACVA: Reforming Transition from Military to Civilian Life, Recommendation 1

Response to SECD recommendations (PDF)

Strong, Secure, Engaged: Canada's Defence Policy
Page 30

Ill and injured / Transition / Releasing / Reg Force / Reservists

SECD: From Soldier to Civilian: Professionalizing the Transition, Recommendation 2

SECD: From Soldier to Civilian: Professionalizing the Transition, Recommendation 7

Statement to the Standing Committee on National Defence (NDDN) Opening Remarks 26 February 2024

"In Fall 2023, I published a report pertaining to the identification of mental health needs and support for Reservists participating in domestic operations. Five months later, I have still not received a response from the Minister. 

Before I leave this post on July 2nd, 2024, I will release a report that will address issues relating to CAF complaint mechanisms. Will we have to wait months again for a response? Is this how you wish accountability to work?"

- Gregory A. Lick, Ombud

NDDN: Rebuilding Trust: Transparency and Accountability in the Department of National Defence and the Canadian Armed Forces,
Recommendation 13

Independence

A Systemic Review of the Compensation Options for Ill and Injured Reservists

Recommendation 1

It is recommended that the Department of National Defence and the Canadian Armed Forces improve the governance and administration of the Reserve Force Compensation process by:

1.1 Creating a functional authority who is accountable for the Reserve Force Compensation process, and who can reinforce the applicable policies and directives in place

1.2 Amending Canadian Forces Military Personnel Instructions 20/04 to provide clarity and consistency in the cessation of service due to service-related injuries and illnesses

1.3 Streamlining the Reserve Force Compensation process by:

1.3.1 Standardizing and simplifying forms; and

1.3.2 Ensuring that units forward claims directly to the Director Casualty Support Management for adjudication, within 30 days of the time the application was commenced

1.4 Creating a Defence Administrative Order and Directive to codify the Reserve Force Compensation process, including service standards or a performance measurement strategy to validate the effectiveness of the entire process

Recommendation 2

It is recommended that the Department of National Defence and the Canadian Armed Forces take concrete steps to improve the knowledge and awareness of the compensation options available to ill and injured Reservists by:

2.1 Making any relevant documents, policies, procedures and forms easily accessible on the internet and on the Defence Information Network

2.2 Committing the resources required for the development and implementation of a communications plan. This would include activities, products, timelines and metrics to reach and inform Reservists about available compensation options

2.3 Formalizing training on Reserve Force Compensation and the Government Employees Compensation Act, and defining the roles and responsibilities for all Reservists and their leadership within these processes

NDDN: Canadian Armed Forces Health Care and Transition Services, Recommendation 22

Response to NDDN recommendation 22 (PDF)

Ill and injured / Transition / Releasing / Reg Force / Reservists