Veterans Ombud finds sex-based bias in VAC adjudication processes

In 2018, Veterans Affairs Canada (VAC) implemented a new process to streamline male-specific erectile dysfunction claims that are related to a psychiatric condition. As part of our work to identify barriers experienced by women Veterans, we launched an investigation to determine whether Veterans have equitable access to fair and timely decisions for sexual dysfunction disability benefits regardless of their sex or gender.

Key Findings: 

• Our investigation highlights sex-based biases found in VAC adjudication processes. 
• VAC streamlines applications for male Veterans with erectile dysfunction consequential to a primary condition. There is no equivalent process for female Veterans with sexual dysfunction.
• There is clear consideration in the VAC medical questionnaires for male sexual dysfunction, but not for female sexual dysfunctions. 
• The VAC Table of Disabilities, used to determine compensation amounts for impairments, includes two impairment ratings for male sexual dysfunctions and only one for female sexual dysfunctions. 
• VAC is more likely to adjudicate female sexual dysfunctions as “decreased libido,”, but does not provide adjudicators with a clear definition or guidance for decision-making.
• We found serious limitations in the availability of accurate VAC client data. These limitations made it impossible for us to measure the full impact of the systemic sex-based biases we uncovered. 

Recommendations:

The OVO recommendations to the Minister of Veterans Affairs and Associate Minister of National Defence are: 
 

1. Eliminate the sex-based bias in the VAC adjudication of sexual dysfunction claims consequential to a psychiatric condition. One way would be to use the same approach to decision-making for both male and female claims.
2. Update the PEN 68e Medical Questionnaire to equitably capture sexual dysfunctions affecting all clients.
3. Update the Table of Disabilities to include impairment ratings for all sexual dysfunctions listed in contemporary diagnostic manuals to standardize the adjudication process for all clients.
4. Provide clearer guidance for adjudicating female sexual dysfunction claims consequential to a psychiatric condition by defining decreased libido in the psychiatric Entitlement Eligibility Guidelines.
5. Refine the granularity of the data collection system in order to fully capture the nature of sexual dysfunction claims, including for decreased libido, in the diverse VAC client population.