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Sylvain Chartrand CD

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2012 - Permanent Impairment Allowance (PIA) and PIA Supplement

Permanent Impairment Allowance (PIA) and PIA Supplement
Issuing Authority: Director General, Policy
Effective Date: May 18, 2012

This policy replaces the following VPPM 5 policy: 7.1.1 - Permanent Impairment Allowance (PIA) and PIA Supplement.

    Purpose
    Policy
    General
    Application
    Eligibility
    Ineligibility
    Amounts Payable
    Date Payable
    Definition in Regulation
    Definition in Policy
    Overlapping Medical Conditions
    Assessment of Grade Level
    Reassessment of a Grade Level
    Extent of Impairment
    Supplement Eligibility
    Supplement Amounts Payable
    Supplement Date Payable
    Supplement Duration of Payment
    Suspension
    Cancellation
    Death of the Veteran/Applicant
    Review of Decisions
    References

Purpose

This policy provides guidance for the administration of the Permanent Impairment Allowance (PIA) and the PIA supplement.
Policy
General

    The PIA was developed to recognize that severe permanent impairment may lead to economic loss with respect to employment potential and career advancement opportunities, and to compensate Canadian Forces (CF) Veterans for these losses.
    For the purposes of this policy, the increase to the PIA legislated by subsection 38(3) of the Enhanced New Veterans Charter Act, which came into force October 3, 2011, will be described as the "PIA supplement."
    The PIA and the PIA supplement are taxable, monthly allowances payable for life or until such time as the Veteran no longer meets the eligibility requirements for payment.  The amount of PIA payable is based on the extent of the Veteran's permanent and severe impairment and the payment of the PIA supplement is based on whether the Veteran is totally and permanently incapacitated to the extent that prevents the Veteran from performing any occupation that would be considered to be suitable gainful employment.

Application

    Given the eligibility requirements of PIA and the PIA supplement, Veterans Affairs Canada (VAC) may already have all the medical records and other necessary information to make a decision on the Veteran’s VAC file. It is important that the Veteran’s personal information be protected and that the Veteran provide informed consent for the Department to use their information, particularly when this information is held on the VAC file for other purposes, such as the determination of eligibility for other VAC benefits.
    An application for the PIA or the PIA supplement is a process rather than the submission of a single form.
    A complete application for PIA, an increase in the grade level due to a reassessment, and the PIA supplement must be made in writing by the Veteran or the Veteran’s legal representative and shall include,
        a complete and signed VAC approved application form(s), which contains a declaration attesting to the truth of the information provided.  Letters may be acceptable in lieu of an application form if they are accompanied by a signed affidavit or declaration attesting to the truth of the information provided;
        medical reports or other records which document the health problem(s) creating  the permanent and severe impairment or the total and permanent incapacity, as the case may be; and
        at the request of the Minister, other information that is necessary to determine                   eligibility and calculate the amount payable.
    The Veteran is considered to have made an application for the PIA and the PIA supplement when all of the application requirements identified above are met to the satisfaction of the Department.

Eligibility

    PIA is payable to a Veteran who:
        has one or more physical or mental health problems that are creating a permanent and severe impairment, and
        the Veteran has, in respect of each of those health problems,
            had an application for rehabilitation services approved; and
            received a disability award or a disability pension, or would have received an award or pension but has not as the sum of the Veteran’s assessments and deemed assessments exceeds 100%, or has not received a disability award as the disability has not yet stabilized.
    The phrase "has had an application for rehabilitation services approved" will include those cases where the Veteran has already completed a rehabilitation plan.  It will also include those cases where it is determined, based on assessment, that the client is totally and permanently incapacitated.

Ineligibility

    A Veteran who has received or is receiving an exceptional incapacity allowance under the Pension Act is not eligible to be paid a PIA. (See Exceptional Incapacity Allowance.)

Amounts Payable

    The PIA payable is commensurable with the Veteran’s assessed grade level with Grade 1 being paid at the maximum amount and Grade 3 the minimum amount as set out in items 1 and 2, Column 2, Schedule 2 of the, Canadian Forces Members and Veterans Re-establishment and Compensation Act (CFMVRCA).  Grade 2 is payable at a rate that is midway between Grade 1 and 3.  Rates are indexed annually; payments are made monthly.

Date Payable

    The PIA and an increase in the grade level due to a reassessment, begins to be payable on the later of:
        the day on which the application for the allowance was made (see the Application section of this policy); and
        the day that is one year prior to the day on which the application for the allowance is approved, i.e. one year prior to the decision date.
    The effective date cannot pre-date the later of the decisions by which the Veteran has an application for rehabilitation services approved and has been granted a disability benefit for the health problem(s) that are causing the permanent and severe impairment.
    The effective date of PIA cannot predate October 3, 2011 (i.e. the implementation date of the Enhanced New Veterans Charter Act) unless the eligibility criteria in effect prior to this date are met.
    Where eligibility for PIA is granted based on the criteria set out in the Permanent Impairment Allowance Eligibility section of this policy, the effective date of the award of PIA cannot pre-date October 3, 2011 when the legislative amendments, which expanded the former criteria, came into force.

Definition in Regulation

    As per section 40 of the Canadian Forces Members and Veterans Re-establishment and Compensation Regulations, a permanent and severe impairment is:
        an amputation at or above the elbow or the knee;
        the amputation of more than one upper or lower limb at any level;
        a total and permanent loss of the use of a limb;
        a total and permanent loss of vision, hearing or speech;
        a permanent and severe psychiatric condition;
        a permanent requirement for physical assistance of another person for most activities of daily living; or
        a permanent requirement for supervision.

Definition in Policy

    For the purposes of this policy the following definitions apply:
    “Permanent” means that the impairment or requirement is expected to persist indefinitely despite treatment or interventions.  With respect to the impairment, although the signs and symptoms may wax and wane over time; further recovery or deterioration is not anticipated.
    “Activities of daily living” (ADL) are a set of activities necessary for normal self-care:
        feeding
        washing
        dressing
        grooming/personal care
        ambulation / mobility / transfers/ foot care
        toileting
        taking medication
    “Permanent and severe impairment” is defined as any one of the following:
        An amputation, or loss by physical separation, of a limb at or above the elbow or the knee; or
        Two or more amputations of limbs at or above the ankle, or at or above the wrist; or
        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 essentially useless 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; or
        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; or
        A loss of hearing of at least 300 Decibel Sum Hearing Loss (DSHL) over four frequencies in both ears; or
        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; or
        A psychiatric condition, diagnosed according to the most recent version of the Diagnostic Statistical Manual of Mental Disorders, that presents at least once per week symptoms of considerable impairment of a Veteran’s functioning in the areas of thought and cognition; emotion, behaviour and coping; activities of daily living; and/or treatment needs; or
        The Veteran is unable to perform independently tasks associated with at least four ADLs, as defined in this section and hence requires help from another person to carry out the ADLs. The level of assistance may vary from minimal to complete care. For example:
            the Veteran may be able to put on his shirt, but requires the assistance of another person to fasten buttons;
            the Veteran may be able to wash his upper body, but requires the assistance of another person to wash his back and legs;
            the Veteran may be able to eat by himself, but requires the assistance of another person to cut up all his food; or
            the Veteran may require someone to complete all personal care.
            Consideration may also be given to a client who requires an inordinate amount of time to carry out ADLs.  While this should normally be addressed through the provision of assistance with ADLs, there may be some situations where assistance is not provided, for example an individual who lives alone in a geographically remote area where physical   assistance with ADLs would not be available, or an individual who prefers to do things independently irrespective of the amount of time it takes to complete the task; or
        The Veteran requires supervision on at least a twice per week basis for at least one hour per visit, and is considered safe when left alone for longer periods of time.

Overlapping Medical Conditions

    In some situations, it will be difficult, if not impossible, to medically separate the impact of a health condition for which a disability benefit has been granted from other non-awarded health conditions. In circumstances where there is a reasonable doubt or uncertainty as to whether the permanent and severe impairment is due to the health problem for which the applicant is in receipt of a disability benefit, then the reasonable doubt or uncertainty may be resolved in the Veteran’s favour.

Assessment of Grade Level

    The PIA is payable at three grade levels, based on the extent of the permanent impairment, considering such factors as the need for institutional care, the need for supervision and assistance, the degree of the loss of use of a limb, the frequency of symptoms, the degree of psychiatric impairment and the degree of loss of earnings capacity for persons with similar impairments.
    The grade level is determined using the criteria provided in the Extent of Impairment section of this policy.

Reassessment of a Grade Level

    A Veteran may apply in writing for a reassessment of the grade level of the PIA.  (See the Application section of this policy for more information.)
    The effective date of any increase in the PIA grade level is defined in the Date Payable section of this policy.
    The effective date of any decrease in the PIA grade level will be effective the date of the next payment.

Extent of Impairment

Note: For the purposes of the following information, “frequent” means at least once per week, and persistent” means daily or almost daily.

    Grade 1:  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:
        Functionally, these Veterans:
            require long-term hospitalizations; or
            are approaching the need for institutionalization or be institutionalized; or
            require daily physical assistance with all activities of daily living (ADL); or
            level of assistance required to perform ADLs has increased compared to Grade 2; or
            daily supervision and are not considered safe when left alone.
            OR
        Physically, these Veterans include those who have:
            quadriplegia; or
            paraplegia; or
            bilateral upper extremity amputation (at or above wrist); or
            bilateral lower extremity amputation (at or above the ankle).
            OR
        Mentally, these Veterans:
            show obvious signs and behaviour that are influenced by delusions or hallucinations not controlled with psychiatric care and demonstrate gross impairment in communication or judgement i.e. grossly inappropriate, incoherent or mute; or
            require total care and supervision in the home or an institutionalized setting.

    Grade 2:  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:
        Functionally, these Veterans:
            require daily physical assistance in performing 4 activities of daily living (ADL); or
            level of assistance required to perform ADLs has increased compared to Grade 3; or
            requires daily supervision and is 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.

            OR
        Physically, these Veterans include those who have:
            a complete and permanent loss of vision; or
            irrecoverable loss of use of an upper and lower limb; or
            a single upper or lower limb amputation at the hip or shoulder (no viable stump); or
            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).

            OR
        Mentally, these Veterans include those who:
            suffer from a psychiatric condition with persistent symptoms of extreme impairment of one’s ability to think clearly, respond emotionally, communicate effectively, understand reality and behave appropriately. There is overt evidence of the disease, chronic psychotic illness; or
            suffer from a psychiatric condition which require 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
            require recurrent hospitalization, i.e. greater than 3 times per year, without recovery.

    Grade 3: Lesser extent of functional, mental and/or physical impairment than those in Grade 2.  To determine that Veterans have this extent of impairment, they must meet at least one of the following criteria:
        Functionally, these Veterans:
            require physical assistance for 4 activities of daily living; or
            require supervision on at least a twice per week basis for at least one hour per visit, and is considered safe when left alone for longer periods of time.

            OR
        Physically, these Veterans include those who have:
            a total and permanent loss of hearing; or
            a total and permanent loss of speech; or
            a single upper extremity amputation at or above the elbow; or
            a single lower amputation at or above the knee; or
            irrecoverable loss of use of a limb.
            OR
        Mentally:
            these Veterans suffer from severe and frequent symptoms of moderate to extreme impairment of one’s ability to think clearly, respond emotionally, communicate effectively, understand reality and behave appropriately causing considerable distress; or
            these Veterans suffer from persistent depressive and anxiety symptoms causing persistent distress requiring chronic use (greater than 2 years) of medication and psychiatric care with no period of sustained recovery and all recreational and social activities are abandoned.

Supplement Eligibility

    The PIA supplement is payable to a Veteran who:
        is in receipt of PIA (see the Eligibility section of this policy); and
        has been determined to be “totally and permanently incapacitated” (TPI.)
    Veterans who have been approved for rehabilitation services may be determined to be “totally and permanently incapacitated” if the Veteran is incapacitated by a permanent physical or mental health problem, for which rehabilitation services were approved, that prevents the Veteran from performing any occupation that would be considered to be suitable and gainful employment.  For guidance regarding the TPI determination, see the Totally and Permanently Incapacitated policy.

Supplement Amounts Payable

    Eligible Veterans will receive a monthly permanent impairment allowance (PIA) supplement as set out in item 2.1, column 2, Schedule 2 of the CFMVRCA.  The supplement is paid in addition to the amount payable commensurate with the Veteran’s PIA grade level and is indexed annually.
    The grade level does not affect the amount of supplement payable; the supplement is a flat rate irrespective of grade level.

Supplement Date Payable

    The PIA supplement begins to be payable the later of:
        the day on which the application for the supplement was made (see the Application section of this policy); and
        the day that is one year prior to the day on which the application for the supplement is approved, i.e. one year prior to the decision date.
    The effective date cannot pre-date the later of the decisions by which the Veteran is determined to be “TPI”, and is determined to be eligible for a PIA for the physical or mental health problems that are creating a permanent and severe impairment.
    The effective date cannot predate October 3, 2011 (i.e. the implementation date of the Enhanced New Veterans Charter Act.)

Supplement Duration of Payment

    The PIA supplement will continue to be payable until such time as the Veteran is either:
        no longer eligible for the PIA; or
        no longer considered to be totally and permanently incapacitated.

Suspension

    A Veteran who is in receipt of the PIA shall provide on request medical records, reports or any other information that is necessary to enable the Minister to assess continued eligibility for the PIA, the PIA supplement or the amount payable (i.e. Grade level).
    The Minister may suspend the payment of the PIA and/or the PIA supplement to a Veteran who fails to submit requested information until such information or documentation is provided.
    Before suspending the payment to a Veteran, the Minister shall provide the Veteran with written notification of the reasons for the suspension and the effective date of the suspension.
    In cases where the PIA and/or PIA supplement are suspended, the payment shall resume when the requested information or documents have been received and the effective date will be the date from which the payment was suspended.

Cancellation

    The Minister may, for the purposes of determining whether a Veteran may continue to receive the PIA and/or the PIA supplement, require the Veteran to undergo a medical examination or assessment by a person specified by the Minister. If a Veteran fails without reasonable excuse to do so, the Minister may cancel the PIA and/or the supplement.
    On cancelling the payment of the PIA and/or PIA supplement, the Minister shall provide the Veteran with written notification of the reasons for the cancellation, the effective date of the cancellation and their rights for review.
    In cases where the PIA and/or supplement is cancelled, the payment shall be discontinued effective the date of the next payment.  Where an allowance has been suspended, the cancellation will be effective from the date of the suspension.

Death of the Veteran/Applicant

    PIA and PIA supplement payments cease the first day of the month following the date of the Veteran’s death.
    In the event that a Veteran dies prior to receiving a PIA payment, and supplement if applicable, the PIA and PIA Supplement may be payable to the Veteran’s estate if:
        the Veteran had completed an application for the allowance; and
        prior to the applicant’s death the Minister had communicated a favourable decision to the Veteran.

Review of Decisions

    A Veteran who is dissatisfied with any PIA or PIA supplement decision may request a review in writing no later than 60 days after receiving notice of the decision unless circumstances beyond the control of the applicant necessitate a longer period. (See the Review Process – Part 2 – CFMVRCA policy.)

References

Enhanced New Veterans Charter Act

Canadian Forces Members and Veterans Re-establishment and Compensation Act – Sections 38, 39, 40, 83, and Schedule 2.

Pension Act

Canadian Forces Members and Veterans Re-establishment and Compensation Regulations – Sections 40 to 46, 68, and 69.

Totally and Permanently Incapacitated policy

Review Process – Part 2 – Canadian Forces Members and Veterans Re-establishment and Compensation Act

-------------------

Review Process - Part 2 - Canadian Forces Members and Veterans Re-establishment and Compensation Act

Issuing Authority: Director General, Policy
Effective Date: May 18, 2012

This policy replaces the following VPPM 5 policy: 1.1.3 Review Process – Part 2 – Canadian Forces Members and Veterans Re-establishment and Compensation Act.

    Purpose
    Policy
    Definitions
    General
    Reviews on Application — First level review decisions
    Reviews on Application — Second level review decisions
    Reviews on the Minister’s Own Motion
    Effective Date of Review Decisions
    References

Purpose

This policy outlines the review process for decisions made under Part 2 of the Canadian Forces Members and Veterans Re-establishment and Compensation Act (CFMVRCA). Part 2 of the Act provides the authority for the provision of rehabilitation services, vocational assistance and financial benefits which include Earnings Loss, Canadian Forces Income Support, the Supplementary Retirement Benefit, the Permanent Impairment Allowance and the Permanent Impairment Allowance Supplement.
Policy
Definitions

    A “review” is a re-examination of evidence or information which pertains to a previous decision.
    “New evidence” is evidence that is relevant to the applicant's case, that was not previously submitted and considered by Veterans Affairs Canada (VAC) at the time of the previous decision and that is not merely a re-statement of the information that was previously presented to VAC.
    A review “on application” means that a person submits a request to have a decision reviewed by VAC.
    A review “on the Minister’s own motion” means that a review of a decision is initiated internally by VAC staff.  “Minister” in this context includes public servants who serve within VAC.

General

    Part 2 of the Canadian Forces Members and Veterans Re-establishment and Compensation Act provides authority to render rehabilitation, vocational assistance and financial benefit decisions.
    Before an eligibility decision can be made, an application for the program or benefit must be submitted. Potential applicants should be counselled, i.e. provided information regarding eligibility requirements and program benefits, and be offered the opportunity to apply should they desire.
    All Part 2 decisions must be communicated in writing and must state the reason(s) for the decision and provide information regarding the process for exercising their rights for review and time limits for applying for a review, as described in this policy.
    Individuals who have received a Part 2 decision have the right to apply for two levels of review.  VAC may also initiate a review on the Minister’s own motion to correct any errors in fact or law.
    Decisions regarding, but not limited to eligibility, cancellation of services or benefits, the amount of financial benefits payable and services and related expenses included in a rehabilitation plan or vocational assistance plan may be reviewed.
    A review must not be conducted by the same official who made or was involved with the decision under review.  Each level of review must be conducted by an official who was not involved with the previous decision(s).
    The correction of minor typographical errors that do not affect the substance of the decision does not require a formal review process. In these cases the affected person should be provided written notification of the error identified and the correction made.

Reviews on Application — First level review decisions

    A person who is dissatisfied with an original decision or a decision made on the Minister’s own motion may apply for a review of that decision.  There is no requirement to present the grounds or reason for the review.
    An application for a first level review must be in writing and be submitted no later than 60 days after receiving notice of decision. Applications submitted after 60 days may be considered if circumstances beyond the control of the applicant necessitate a longer period.
    The first level review must be based only on written submissions.
    The decision under review may be confirmed, amended or rescinded.
    The review decision must be communicated to the applicant in writing, and reasons for the decision must be provided. Applicants must be advised of their right to seek a review of this first level review decision.
    Applicants must be informed of their obligation, should they request a second level review, to provide the following information as grounds or reasons for requesting further review:
        New evidence; or
        Information regarding an error with respect to any finding of fact or the interpretation of law.

Reviews on Application — Second level review decisions

    A person who is dissatisfied with a first level review decision has a right to apply for a review of that decision. The application for review must include the grounds for review as specified in paragraph 17.
    The application for a second level review must be in writing, and must be submitted within 60 days of receiving notice of the first level review decision.
    The second level review must be based only on written submissions.
    The decision under review may be confirmed, or amended or rescinded on the basis of new evidence, or if there is an error with respect to a finding of fact or interpretation of law.
    The review decision must be communicated in writing with reasons for the decision provided.  The decision letter must specifically address the grounds for review presented by the applicant in the reasons for the decision.
    The second level of review is the final level of review on application.

Reviews on the Minister’s Own Motion

    All decisions made under Part 2 of the CFMVRA, including original, first level and second level review decisions, may be reviewed on the Minister’s own motion.
    A Minister’s own motion review may be initiated on the basis of an apparent error in fact or law. These reviews cannot be initiated on the basis of new evidence.
    VAC staff may initiate a Minister’s own motion review at any time. There are no time limits for conducting a review on the Minister’s own motion.
    The decision under review may be confirmed, or amended or rescinded if there is an error with respect to the finding of any fact or the interpretation of any law.
    Prior to amending or rescinding a decision that would result in the reduction or removal of eligibility and/or services or benefits, VAC must write to the affected person, advise of the nature of the alleged error and provide an opportunity to respond in writing.  The affected person must respond within 30 days of receiving notice of the intention to amend or rescind the decision.
    After considering the response received from the affected person, or if no response is received within 30 days, the final Minister’s own motion decision must be communicated in writing to the affected person. Reasons for the new decision, as well as information regarding rights for review, must be provided.

Effective Date of Review Decisions

    Each Part 2 program and benefit uses a unique method for determining the effective date. When a review decision amends or rescinds a previous decision, the date of the review decision is the date used to determine the effective date.
        Example: Effective date of Rehabilitation Program eligibility and Earnings Loss for a Veteran following a review of a Rehabilitation Program eligibility decision.  A Veteran applies for the Rehabilitation Program on March 15.  On March 24 the Veteran is found not eligible. The Veteran applies for a review of that decision on April 19.  On May 3 a review occurs and it is determined that the Veteran is eligible for the Rehabilitation Program.  As there is no authority to pre-date the decision date for Rehabilitation Program eligibility decisions, the effective date is the date of the review decision, May 3. The earliest date that Earnings Loss may be payable to the Veteran is also May 3.

    For further guidance on how to determine the effective date, refer to the policy for the relevant Part 2 service or benefit.

References

Canadian Forces Members and Veterans Re-establishment and Compensation Act, Sections 67.(1) and (2), 76.(1), (2) and (3), 77 and 83.

Canadian Forces Members and Veterans Re-establishment and Compensation Regulations, Sections 14.(2), 26.(2), 35.(2), 46, 68, 69, 71 and 72.(1).

Rehabilitation Services and Vocational Assistance - Eligibility

Earnings Loss Benefit - Eligibility Period

Supplementary Retirement Benefits - General

Canadian Forces Income Support - Application and Effective Date

Permanent Impairment Allowance (PIA) and PIA Supplement