This guide explains the steps Veterans Affairs Canada (VAC) takes after you apply for Disability Benefits.
1. Claim Preparation VAC ensures your application includes all information required to make a decision. They order your service health records and may contact you for further information. When VAC has the required information, your application is placed into a queue for decision-makers.
2. The Entitlement Decision - Is your disability related to service? VAC reviews your application and service health records to confirm that your condition is service-related. To be entitled to disability benefits, the diagnosed condition must be chronic or permanent. If VAC determines you are eligible, your application advances to the assessment stage.
3. The Assessment Decision - What is the extent and impact of your disability? At this stage, VAC determines the amount of compensation you may be entitled to by assessing the level of impairment caused by your condition, and how it impacts your quality of life.
4. Notification VAC sends you a decision letter explaining the entitlement and assessment decisions.
If a link to service is not established, VAC sends you a decision letter regarding the entitlement; in this case there is no assessment decision. If you are entitled to compensation, the letter explains the amount and when you should start receiving it.
Disagree with the Decision?
The Bureau of Pensions Advocates or Royal Canadian Legion Service Officers can help guide you through a VAC departmental review, VRAB review or appeal hearing. You can find more information on this here.
When to Contact the Office of the Veterans Ombud
Are the reasons for your decision unclear? Do you have questions? The Office of the Veterans Ombud can provide information and help you navigate the VAC system.
Telephone (toll-free): 1-877-330-4343
Fax (toll-free): 1-888-566-7582
TTY: 1-833-902-9399
Mail: Office of the Veterans Ombud, P.O. Box 66 Charlottetown, PE C1A 7K2
Email: info@ombudsman-veterans.gc.ca or submit an online inquiry form.
GOOD TO KNOW
You have a right to get a decision in writing. If you do not receive a decision letter, request one from VAC.
The decision letter should explain:
- the evidence and supporting documents that were used in making the decision
- your right to appeal
Disability assessment ratings can range from 0% to 100%. There are some conditions, such as bruxism, that are assessed at 0%. These conditions may be eligible for treatment benefits but not compensation.
Your maximum financial compensation cannot exceed the rate for 100%, but your disability assessment can exceed 100%. While you will not be eligible for financial compensation beyond the maximum, you may still be eligible for treatment benefits, so you should still apply for all service-related conditions that do not have an approved disability benefit.
The length of time it takes to receive a decision can depend on a variety of factors such as:
- the complexity of your claim – the decision-maker may need to consult with a VAC medical professional
- whether your application includes all required documents
- the length of time it takes to access your service health records
Some applications are processed on a priority basis due to advanced age (over age 80) or medical risk, which simply means they are moved to the front of the line.
How VAC makes Disability Benefit Decisions
Veterans Affairs Canada (VAC) has an adjudication process for making Disability Benefit decisions. This is what happens when you first apply for VAC Disability Benefits.
Background
What are Veterans Affairs Canada (VAC) disability benefits?
Disability benefits may provide compensation to Canadian Armed Forces (CAF) members or Veterans and current or former Royal Canadian Mounted Police (RCMP) members for chronic or permanent disabilities resulting from service-related injuries or diseases. Eligibility for a Disability benefit provides access to VAC Treatment Benefits for that condition.
The two main disability benefits are Disability Pensions and Pain and Suffering Compensation. Both may provide tax-free monthly payments for life and the amount is determined by the severity of the disability and how it impacts your quality of life. Pain and Suffering Compensation can be paid as a one-time lump-sum payment.
Who is eligible to receive disability benefits?
The Disability Pension is available to eligible Canadian Armed Forces Veterans of World War II, the Korean War, and applications for an approved service-related injury or disease made before April 1, 2006. Current or former RCMP members can also apply for the Disability Pension.
Pain and Suffering Compensation is available to CAF members or Veterans with an approved service-related injury or disease for applications made on or after April 1, 2006.
Veterans may be eligible under either the Insurance Principle or Compensation Principle
The Insurance Principle provides coverage for all disabilities that had their onset during Wartime or Special Duty Service even if there is no causal link to service.
Wartime service includes service in the World Wars and Korean War, while Special Duty Service refers to service in areas or operations designated as special duty by the National Defence Minister due to elevated risk.
The Compensation Principle covers all other disabilities caused or aggravated by service.
Three Types of Eligible Conditions (Primary, Consequential, and Bracketed)
Primary condition – Is a condition that was either directly caused or aggravated by service or first occurred during Wartime or Special Duty Service.
Primary conditions can have associated consequential and bracketed conditions that may entitle you to more compensation, treatment benefits, or both.
Consequential condition – These are caused by a separate condition, or its treatment, in another part of your body area or system. For example, a gastric condition caused by medication for an approved service-related back condition would be considered a consequential condition.
These conditions can be caused by either another primary condition, or a different consequential condition. They require a separate application with supporting medical evidence for their own entitlement and assessment decisions.
Bracketed condition – Occurs in the same body area or system as a primary or consequential condition. For example, a Veteran has an approved service-related torn knee ligament that causes arthritis. The arthritis would be “bracketed” to the torn knee ligament condition. Conditions are grouped or “bracketed” together when determining the level of disability assessment.
The Four Stages of the VAC Adjudication Process
Stage 1. Claim Preparation
1.1 Once VAC receives your application, a Disability Services Assistant reviews it to ensure it includes all required information. They will also order your service health records and, if necessary, may contact you.
1.2 A Benefits Program Officer gathers any remaining required information and determines if your claim is complex and should instead be assigned to a Disability Adjudicator. Complex claims may require consultation with a VAC health professional when more advanced medical knowledge is needed to make the decision.
- The Service Standard Start Date (SSSD), or the date the “clock starts ticking”, is the date VAC received all required information.
- You can find your SSSD in your My VAC Account under the “Track your applications” section, which will show a status message similar to “Your application has been prepared as of…” or “all your supporting documentation was received on…” which is the SSSD. The Wait Time Tool online can give you the latest on average wait times.
Stage 2. Entitlement Decision
2.1 After claim preparation, the decision-maker determines whether you are entitled to benefits. First, they confirm the diagnosis for your claimed condition by reviewing any available medical reports and medical questionnaire(s).
2.2 Once a diagnosis is confirmed, the decision-maker determines whether your condition is caused or aggravated by service or by another service-related condition by reviewing your application, service health records, and guidance documents for decision makers such as the Entitlement Eligibility Guidelines.
2.3 The decision-maker then determines your level of entitlement, which is expressed in fifths (full entitlement is five-fifths while partial entitlement is four-fifths):
- Full entitlement means your condition was caused by service or had its onset during Wartime or Special Duty service, or it is a consequence of a condition related to service without other contributing factors.
- Partial entitlement means your condition was aggravated, rather than caused, by service or is in part a consequence of a condition related to service.
- The level of entitlement, full or partial, for consequential conditions is determined by the extent to which the consequential condition was caused by an approved service-related condition.
2.4 A favourable entitlement decision will grant you access to treatment benefits. It may also entitle you to compensation.
- The amount depends on the outcome of the Stage 3: Assessment Decision. In situations where you are not entitled to disability benefits, there is no assessment and your claim proceeds to Stage 4: Notification.
Stage 3. Assessment Decision
3.1 When entitlement is established, an assessment then determines the level of compensation you may receive. The decision-maker assesses the level of impairment caused by the entitled condition(s) by using the application and the Table of Disabilities, which measures the impact of a condition on your quality of life, from independence, recreation and community activities, to personal relationships.
3.2 The Table of Disabilities includes Medical Impairment Ratings and Quality of Life Ratings. Decision makers combine these ratings to determine your Disability Assessment. This assessment is given as a percentage, from 0% to 100%, which determines the amount of compensation you may be entitled to.
- In cases where you have already reached a 100% disability assessment, VAC will still make a decision for any new conditions. While no additional payments can be made once your total disability assessment exceeds 100%, you may be eligible for additional treatment benefits.
3.3 Once a Disability Assessment is established, no additional calculations are needed when you have full entitlement. When you have partial entitlement, the decision-maker then calculates four-fifths of the Disability Assessment.
The examples below show how Pain and Suffering Compensation (PSC) amounts for hearing loss are calculated, for both full and partial entitlement, using the rates from 2023:
Sample PSC Calculation: Full Entitlement for Hearing Loss.
- A Veteran applies for hearing loss and VAC determines there is full entitlement for the condition. The Veteran’s medical impairment rating for their hearing loss is assessed at 25 and the quality of life rating is determined as 2. These two ratings are combined for a total disability assessment of 27% (25+2).
- With the 27% disability assessment, the Veteran would receive monthly Pain and Suffering Compensation of $324.25 (which could alternatively be paid in a lump sum of $105,500.47).
Sample PSC Calculation: Partial Entitlement for Hearing Loss.
- A Veteran applies for hearing loss and VAC determines there is partial entitlement for the condition. The Veteran’s medical impairment rating for their hearing loss is assessed at 25. The quality of life rating is determined as 2. These two ratings are combined for a total disability assessment of 27% (25+2).
- Because the Veteran has partial entitlement, the level of compensation they would receive is determined by calculating four-fifths of the disability assessment. This would be 22% (4/5 x 27% = 21.6 rounded to the nearest whole number).
- With this disability assessment of 22%, as of 2023, the Veteran would receive monthly Pain and Suffering Compensation of $259.40 (which could alternatively be paid in a lump sum of $84,400.38).
Stage 4. Notification
4.1 You will be notified of the outcome through a decision letter, which will also be available in My VAC Account. This letter explains the decision and lists the evidence used by the decision-maker.
4.2 When the decision is favourable a Payment Officer reviews the details of the decision and authorizes payments, if applicable. While Pain and Suffering Compensation is provided in monthly payments by default, your decision letter will also explain the process for requesting to cash-out the full amount of Pain and Suffering Compensation as a lump sum.
More information on how a disability benefit application is reviewed can be found here.
What if I disagree with the decision?
You have options for requesting a VAC departmental review or VRAB review and appeal hearings. The Bureau of Pensions Advocates and the Royal Canadian Legion can help guide you through these processes.
More information on these processes can be found here.
When to Contact the Veterans Ombud
Are the reasons for your decision unclear? Do you have questions? The Office of the Veterans Ombud can provide information and help you navigate the VAC system.
Telephone (toll-free): 1-877-330-4343
TTY (toll-free): 1-833-902-9399
Mail: Office of the Veterans Ombud, P.O. Box 66 Charlottetown, PE C1A 7K2
Email: info@ombudsman-veterans.gc.ca or submit an online inquiry form.