Once an ill or injured member is medically stabilized and a permanent medical category is assigned, which may include MELs, an administrative review is conducted by the Director Military Career Administration (DMCA) staff. 14 The purpose of this review is to assess the effects of any MELs on future employability and suitability for continued service in accordance with the U of S policy and to provide the member with the opportunity to comment on the career recommendation prior to a final decision. 15
For severely injured or ill CF personnel who have been assigned permanent MELs, the CFHS will assess whether the individual has complex transition needs before DMCA conducts an administrative review. The criteria used to determine transition complexity include severity of the injury or illness, psychosocial factors, health care requirements and functional limitations resulting from the injury or illness.
Essentially, personnel will fit into one of three categories of suitability for continued service, each with a different career outcome.
- Personnel who still meet U of S standards – They will be retained in their current occupation if they meet the bona fide occupational requirements (BFORs) 16 of that occupation; otherwise, they will be transferred to an occupation for which they meet the BFORs.
- Personnel who do not meet U of S standards but who are employable in the CF in some capacity on a full-time basis – Subject to service requirements, personnel may be retained on a temporary, transitional basis in the CF for up to three years. 17 Upon departure, they may receive a range of career-transition and vocational-rehabilitation services through the CF and VAC. Alternately, if there is no service requirement or if they do not wish to be retained for additional CF service, they will be medically released with six months notice, declared eligible for the Service Income Security Insurance Plan (SISIP) income replacement and vocational rehabilitation, and transferred immediately to VAC care and support.
- Personnel who are severely injured or ill, have complex transition needs, do not meet U of S standards and are not employable in the Regular Force or Primary Reserve – When transition complexity is determined by the CFHS, an interdisciplinary team, led by the IPSC Services Manager, will develop an integrated transition plan with the member, which will feature individualized goals and projected timelines to achieve them. These timelines will be used to determine the duration of the transition support and guide the release authority in setting the release date. The transition duration will be up to three years.
The CF’s primary goal is to retain their highly skilled and experienced ill or injured CF personnel and ultimately return them to their previous employment. With that in mind, the CF have established a methodology to determine the acceptable medical boundaries of U of S.
The principle of U of S has been and will remain the cornerstone of all administrative reviews conducted to assess the effects of MELs on a member’s suitability for continued service.
Historically, the most difficult administrative reviews have concerned cases where a member suffers from a chronic condition that results in little disability, if any at all, but that can occasionally lead to medical crises in sudden and unpredictable ways. In these situations, the potential risk to the health and safety of the member should a medical crisis occur, and the effects of his or her potential performance failure on the operational mission or on the health and safety of others must be evaluated while taking into account the CF’s desire to retain personnel that are not only trained, but also productive.
The approach of the CF in applying U of S to such cases is to estimate as accurately as possible the medical risk involved. This is done by combining an estimate of the probability of an event occurring with the likely severity of the outcome and of the nature and urgency of medical care that would be required. The CFHS then communicates this medical risk to DMCA as a MEL detailing the percentage risk of an acute exacerbation occurring and its likely consequences. As part of the administrative review process, DMCA analyzes these risk-based MELs using the CF medical risk matrix 18 tool, which is a standardized grid that establishes the relationship between the probability of crises occurring and their severity. This tool assists DMCA in determining whether or not the overall risk is acceptable to the CF, and whether, therefore, a retention or release decision would be appropriate. 19
For example, some cases of kidney stones may have a 20 to 50 percent likelihood of recurrence over a 10-year period, a relatively high likelihood of occurrence. With a window of medical treatment of 72 hours and only moderate disability of the patient during an attack, the overall risk to the member and the likelihood of immediate performance failure are assessed as low enough for the CF to accept. Therefore, a member with such a condition would in all likelihood be retained without any employment limitations or career restrictions.
For those CF personnel who do not meet the requirements of U of S and will be medically released within either six months or three years, the CF will support a seamless transition to civilian life through SISIP and VAC programs.
All medically released CF personnel are entitled to a number of transition assistance services provided by the CF, SISIP and VAC. The vocational rehabilitation benefits of SISIP are available six months prior to release, and financial support is available at release. Most VAC benefits are only available after the effective date of release. However, VAC will become involved with the CF Case Manager while the member is still serving in order to ensure that VAC benefits and support services are in place when the client departs so that transition can be as seamless as possible. Several benefits and services are described below:
Ill and injured CF Regular and Primary Reserve Force personnel with MELs leading to medical release are eligible for a range of educational upgrading support services through the CF and the SISIP Vocational Rehabilitation Program (VRP) prior to departure. At the point of release, there is a coordinated transition from a CF education upgrade program to SISIP VRP, with an entitlement to financial and vocational support. This continues for 24 months after release. A CF member who meets the SISIP definition of totally disabled at 24 months post-release continues to receive long-term disability support to age 65. At release, that member may also communicate with VAC to request other support services in preparation for transition to civilian life.
VAC Transition Interview (TI)
VAC staff will provide a TI to all Regular Force personnel upon departure, all medically releasing Reserve Force personnel, and any CF member having completed an operational deployment during his or her career. The TI is an opportunity to provide CF personnel and their families with information on VAC benefits, programs, and services, to identify potential transition issues, and to facilitate access to VAC support.
Transition Assistance Program (TAP)
Administered by JPSU, the TAP is an information portal on transition that includes job search tools, résumé writing resources and key transition links.
Cadet Organizations Administration and Training Service (COATS) and Canadian Rangers.
The COATS organization and the Canadian Rangers offer medically unfit CF personnel who no longer meet CF minimum operational standards, but satisfy the COATS/Rangers minimum medical requirements and enrolment criteria, an opportunity to continue to serve the CF in uniform, in a part-time or a full-time capacity.
Vocational Rehabilitation Program for Serving Members (VRPSM)
This program permits eligible CF personnel, who have been notified of an impending medical release, to commence their participation in vocational rehabilitation while on duty for up to six months prior to departure, subject to the approval of their Commanding Officer.
SISIP Long Term Disability (LTD) and SISIP Vocational Rehabilitation Program (SISIP VRP)
SISIP LTD provides replacement-income protection to qualifying members who are medically released. 20 LTD benefits are equal to 75 percent of a member’s CF salary upon departure, minus income derived from all other sources, and they are payable for two years following release. Financial benefits may be extended if the qualifying member satisfies the SISIP definition of total disability. The SISIP VRP provides vocational rehabilitation training benefits to all SISIP LTD participants with up to $25,000 for tuition and related books. The member receives supporting allowances during the two years following release, and longer still, should he or she be determined to be totally disabled. Additionally, the SISIP VRP provides résumé preparation, job search training and targeted job leads to maximize the member’s opportunities for a return to the work force and effective re-establishment in the civilian world.
Priority Appointment in the Public Service
Recent amendments to the Public Service Employment Regulations allow for the priority appointment of certain medically released CF personnel to positions in any department of the Federal Public Service governed by the Public Service Employment Act. This priority can be activated any time within five years of the member’s release, and it gives the member two years of eligibility for priority appointment. Priority is also provided to surviving spouses or common-law partners of CF personnel whose death is attributable to service.
The New Veterans Charter
The New Veterans Charter is a comprehensive set of programs designed to provide CF personnel and their families with an opportunity for a successful transition to an independent and productive civilian life. It enables CF veterans to enjoy the best health possible, have the optimal chance for a quality job and, when necessary, receive earnings loss support to protect their standard of living. The Charter offers a single point of entry to a comprehensive suite of services and programs including one-on-one case management, a rehabilitation program, financial benefits, group health insurance, career transition services, the lump-sum Disability Award as well as other allowances and support to families. 21
Scenarios involving ill and injured personnel
Major Gagnon, a CF Regular Force member, learns while at home in Canada that he has been diagnosed with a treatable form of cancer. Married with two young children, he lives in a rural community just outside a major urban centre.
Major Gagnon is treated for his illness in a civilian health care facility; he has all the same been referred to the base surgeon (B Surg) and has been assigned a temporary medical category and a CF case manager. A Casualty Report has been issued to notify all potential players involved in his current and future support. An AO has also been assigned to him.
Major Gagnon manifested symptoms of depression, so he was referred to a mental health provider. A Health Services link nurse and the base chaplain have added their services to Major Gagnon’s provision of care. On the basis of the Major’s service record, his CO has ordered a summary investigation into the illness. Even though Major Gagnon’s illness may not appear at face value to be attributable to military service, a review of his personnel and medical files has led to the identification of potential occupational exposure to situations that could be linked to his condition.
The CO has asked the Director Military Careers (D Mil C) to post Major Gagnon to the JPSU for the remainder of his recovery and provide support and guidance during the rehabilitation and reintegration phases. The IPSC Director Military Family Support Liaison Officer (DMFS LO) has contacted Major Gagnon’s family to ensure that appropriate support is provided to his wife and children during this stressful period, particularly during the recovery stage when the future may appear uncertain. Owing to the distance that Major Gagnon must travel for his many hospital visits, the IPSC has requested funding assistance for medical and family travel.
Major Gagnon has completed his medical treatment and his program of care now shifts to the rehabilitation phase. A case conference has determined that he needs home modifications and some special services. The case conference, supported by the subsequent report of the occupational therapist, will also determine how these services are to be provided: either by the CFHS if they are covered by the Canadian Forces Spectrum of Care or by the IPSC if they are covered by a mobility aids Compensation and Benefits Instruction (CBI).
The Director of Medical Policy (D Med Pol) assigns permanent MELs to Major Gagnon as recommended by the attending medical officer. In consultation with the CF case manager, D Med Pol determines that he has complex transition needs. This information is sent to the DMCA, who initiates the administrative review process. Since Major Gagnon’s MELs breach U of S, DMCA determines that he will be medically released from the CF. An interdisciplinary team led by the IPSC services manager, and which includes representatives from SISIP and VAC, along with the CF case manager, develops an integrated transition plan with Major Gagnon, one that features individualized transition goals and projected timelines to achieve them.
These projected timelines are taken into consideration by DMCA in its determination of the medical release date. The IPSC staff and the CF case manager remain in touch with Major Gagnon throughout the transition period so as to ensure that he and his family are provided the support they need to successfully transition to civilian life.
Major Gagnon’s transition support plan includes vocational rehabilitation, which starts with the CF Education Reimbursement Program and is completed through the SISIP VRP.
As the medical release date approaches, the base release section and the base personnel selection officer (PSO) engage with Major Gagnon. The IPSC services section contacts Major Gagnon to ensure that he is aware of the TAP and the priority entitlement to employment in the federal public service. Additionally, SISIP FS will help him develop a résumé so that he can access both of these programs, and they will also provide targeted job leads.
Post release, Major Gagnon will be supported by VAC in accordance with the NVC.
Corporal Able, a member of the Primary Reserve, has sustained serious injuries in theatre. He is single, and his family lives three provinces away from his parent unit.
Following initial treatment at the Role 3 hospital in theatre, the unit releases a Casualty Report (CasRep) message to notify all players involved in the present and future support of Corporal Able, including medical services, the IPSC, and VAC. Initially, the CFHS take the lead in providing medical treatment and determining the appropriate time for other service providers to participate. The parent unit CO assigns an AO to Corporal Able. His parents are notified that he has been injured and is to be repatriated to Canada. The family is flown to the airport where they are joined by the CRT about two hours before Corporal Able’s arrival. The CRT plans and executes the aeromedical evacuation and the patient transfer over to the civilian medical facility in Ottawa, where Corporal Able will receive acute care.
The IPSC CF case manager team leader gives a status report to the service providers, informing them of when it will be appropriate for each to make their initial contacts. A CMT is convened to advise all service partners of Corporal Able’s progress and to plan for the continued provision of support services. The CMT will reconvene at various times during Corporal Able’s recovery and rehabilitation.
The IPSC asks the MFRC to address family concerns and provide support to the parents by offering them access to counselling and travel assistance.
Throughout recovery and rehabilitation, three IPSCs are supporting Corporal Able and his parents – the IPSC at Kingston, where Corporal Able’s unit is located, the IPSC in Edmonton, the city where his parents reside, and the one in Ottawa where he is being treated owing to the nature of his injuries.
Because of the treatment and rehabilitation required by Corporal Able, DCSM 2 extends his Class C contract after receiving a request to this effect from his parent unit.
When the CFHS define Corporal Able’s MELs, the CF case manager works with the AO to ensure that the information is relayed to Corporal Able’s CO. The B Surg and CO decide that Corporal Able should be posted to the IPSC Support Platoon in Ottawa, which provides the same administrative support and supervision as the member’s chain of command, including the staffing of further contract extensions. As a result, the parent unit disengages their AO.
The B Surg provides a prescription for RTW by completing a CF 2018. The IPSC RTW coordinator liaises with his civilian employer in the development of his RTW program.
The IPSC calls upon a peer support coordinator from the OSISS program to bring Corporal Able and his family in touch with their peer and family support networks, should they wish to do so.
The RTW Coordinator and the unit become more involved in Corporal Able’s progress during this stage. The IPSC Support Platoon updates the unit CO on Corporal Able’s progress so as to prepare for his return to duty in the Primary Reserve or for his civilian employment when he has fully recovered. In this example, Corporal Able recovers completely from his injury and returns to his position in the Primary Reserve.