Veterans Affairs Canada

The disability benefits program provides financial compensation in recognition for the impact a service-related injury or disease can have on a member/Veteran’s life. The amount a member/Veteran receives depends on the degree to which the condition is service-related and the severity of the condition, including its impact on the quality of their life.

Individuals who apply for a disability benefit may be required to undergo a medical examination by a qualified medical practitioner and/or testing to establish a medical diagnoses and health status.

When a medical examination and/or testing is requested by Veterans Affairs Canada (VAC), both the specific testing and/or the examination requirements, in addition to the reporting expectations, will be expressed in the letter to the health professional providing the report. This is to prevent billing of unnecessary services.

To qualify for VAC disability benefits, a person must be one of the following:

• Canadian Armed Forces (CAF) member;
• Canadian Veteran;
• A current or former member of the Royal Canadian Mounted Police (RCMP);
• Second World War or Korean War Veteran (includes Merchant Navy); or
• Certain civilians who served in the Second World War.

They may be eligible to receive either:

1. Pain and Suffering Compensation – a life-time monthly payment, or, if the member/Veteran elects, a one-time lump sum payment.
2. Disability Pension – a life-time monthly payment.

The application that needs to be submitted to VAC has several sections including:

• Personal information (e.g., name, address, marital status, dependants, etc.)
• Service information
• Health condition details (including a diagnosis and a description of how the service-related condition has impacted the applicant’s quality of life)
• Applicant statement (i.e., how the condition is related to or aggravated by service)

The following items are either required, or may be required in addition to the signed disability benefits application form:

• Service Health Records are obtained by VAC through CAF or RCMP
• Third-party consent form
• Medical questionnaire(s)

Please note that the relevant medical questionnaire will be sent to the applicant by VAC for their healthcare professional to complete and sign. The medical questionnaire is the only component of the application that a chiropractor would need to complete and sign.

VAC will provide the patient a third-party consent form to complete which allows a chiropractor or healthcare professional to release the patient’s personal information to VAC. This form is not required for chiropractors to complete and submit the medical questionnaire. The information collected will only be used in support of the administration of VAC benefits or services.

The purpose of this form is for VAC to obtain information from third parties on behalf of the member/Veteran. For chiropractors, it would apply if the submitted medical questionnaire is missing information (e.g., diagnosis or signature). VAC will either contact the member/Veteran to ask them to get the missing information or to obtain their consent (if we don’t already have a signed consent form) to contact the healthcare professional.

If a patient has questions about the consent form or would like more information, they should see the Privacy Notice on their application form or direct their questions to VAC.

Click here for a copy of the third-party consent form.

Medical questionnaires are forms for qualified healthcare providers to complete. For the purposes of Disability Benefits applications and reassessments, VAC Medical Questionnaire forms have been developed to complement the Table of Disabilities (TOD). Health care providers complete only the medical questionnaire sections relevant to the claimed/entitled condition(s).

The medical questionnaires are a tool VAC uses to confirm the patient’s medical diagnosis and determine the extent of the disability.

• If the patient is a serving CAF member, their service health records will usually have the medical information VAC requires. A medical questionnaire is not needed for serving CAF applicants.
• If the patient is a Veteran or RCMP member (current or former), VAC will send the relevant medical questionnaire(s) directly to the patient to be completed by a recognized health professional (e.g., doctor, chiropractor).

Chiropractors can complete medical questionnaires for the following MSK conditions:

• PEN6220 – Shoulder and Acromioclavicular Joint Conditions
• PEN6221 – Knee Conditions
• PEN6222 – Foot and Toe Conditions
• PEN6223 – Hip Conditions
• PEN6224 – Ankle Conditions
• PEN6225 – Wrist Joint Conditions
• PEN6226 – Elbow Joint Conditions
• PEN6227 – Thumb/Finger Conditions
• PEN6232 – Lower Limb Function
• PEN6233 – Upper Limb Function
• PEN6235 – Thoracolumbar Spine Conditions
• PEN6236 – Cervical Spine Conditions
• PEN6237 – Coccyx, Pelvis and Sacroiliac Joint Conditions

Click here to obtain VAC Medical Questionnaire forms.

The determination of VAC’s disability benefits assessment requires very specific medical information which is not typically captured in a treating clinician’s clinical notes. VAC has developed Medical Questionnaires designed to guide the clinician in the provision of medical information required to determine an accurate disability assessment. The Medical Questionnaire you are provided with should be reflective of the VAC table of disabilities for which the condition is being assessed.

At the recommendation of VAC, diagnoses should be captured in more general terms versus specificity. For example, in a member/Veteran presenting with a suspected disc herniation in the cervical spine, it is VAC best practices to indicate a diagnosis of Cervical Disc Disease or Osteoarthritis of the Cervical Spine versus a Left C5-6-disc herniation.

Click here for a copy of the VAC’s Table of Disabilities and Musculoskeletal Criteria that VAC decision makers use to assess MSK impairments.

Once the medical questionnaire is completed, either the healthcare professional or the applicant can mail it back to VAC. As of February 2023, for healthcare professionals, mailing the completed medical questionnaire is the only method of submission to the Department.

Instructions for the healthcare provider on how to complete the questionnaire and how they can return it to VAC will be included in the package.

VAC will reimburse chiropractors at a rate in accordance with the provincially recommended fee for each completed medical questionnaire form including the corresponding assessment in support of a disability benefit application or reassessment. For example, you may consider rates comparable to completing an MVA assessment with corresponding forms within your province.

Medical fees associated with examination and/or testing which has not been requested by the Department, or which is in excess of the services requested, will not be reimbursed as billed.

If the healthcare professional is submitting the medical questionnaire to VAC through mail, they can also include their invoice at that time. However, some patients may wish to submit the medical questionnaire on their own. If this is the case, the invoice can be sent to VAC separately.

It is important to note that VAC will only pay invoices for reports that have been requested (i.e., medical questionnaires that were requested by VAC to be completed).

VAC will review the application to ensure all the required information has been provided. If so, the application is placed in a queue for assignment to a decision maker.

The decision maker will then decide whether the injury/illness is related to service based on all the information in the application. Sometimes, the decision maker identifies missing information. If that happens, the patient will be notified, and their application will be placed on hold until the missing information is received. For all claims, VAC will review a patient’s service health records to confirm a link between their service and the claim.

The patient will receive a decision letter once their application has been reviewed by a decision maker. If the patient has a service-related disability, the letter will outline the entitlement and assessment the patient will receive.

If the decision is unfavourable, the letter will provide reasoning, list the evidence that was used to make the decision, and provide information on how to contact the Department if the patient has any questions. The letter will also explain the review and appeal process.

VAC’s service standards tell members/Veterans how long they can expect for VAC to make a decision under normal circumstances. VAC’s service standard for disability benefits applications is 16 weeks for first applications and reassessments, 80% of the time. A complete application is required to begin calculating the processing time [i.e., complete and signed application form, complete and signed medical questionnaire(s)]. In addition, there are several factors that can impact the processing time of an application, such as the complexity of the condition.