Veterans Ombudsman Success Stories

I was reading through this an was not sure if it has already been posted in the past , but since some were writing - or given their opinion about how they would like to see a change in the mandate - or some not sure about the help they would get from contacting the OVO , I found these stories interesting.

Although not 100% successful in our approach with the Department, we do obtain very good results in many of our mediations.

Significant Increase in Disability Assessment
A Veteran contacted the Office of the Veterans Ombudsman because he was unsatisfied with the initial (interim) assessment of 28 percent that he had received for several major injuries sustained as a result of an IED explosion. The Office contacted Veterans Affairs Canada’s Head Office Senior Medical Advisor and through discussion was able to have the injuries evaluated holistically (as opposed to each in isolation). This resulted was an increase in the assessment from 28 percent to 72 percent.

Veteran’s Vocational Rehabilitation Plan Gets a Second Look
A Veteran contacted the Office of the Veterans Ombudsman because he was feeling unsure about the career path Veterans Affairs Canada had selected for him and was worried that the Department was on the verge of closing out his Vocational Rehabilitation Plan. This Veteran had served as an air traffic controller and a trucker in the Canadian Forces. The Department’s vocational service provider had sent the Veteran to a custom broker training program, but the Veteran did not feel that this was a suitable gainful employment career path for him. The Veteran claimed that all that was required to become a custom broker was some studying and successful completion of a written exam at a cost of $500. Our Office contacted the Department to address the Veteran’s concerns and through discussion, the Department agreed to keep the Veteran’s Vocational Rehabilitation Plan open so that other, more suitable occupational goals could be explored.

Home Gym Equipment Approved
A Veteran pensioned at 100 percent had been waiting for a year for approval of home gym equipment to help alleviate the pain to his condition caused by excessive car travel. This Veteran is required to do a six hour return trip three times a week to the nearest town to get physiotherapy treatment. The Veteran had submitted to Veterans Affairs Canada a prescription from his doctor and a written recommendation from his physiotherapist for the home gym equipment, but it had not been approved by his Case Manager. By intervention of the Office of the Veterans Ombudsman, the home gym equipment was approved and the Area Director of the Region was to investigate the situation.

Permanent Impairment Allowance Approved
A Veteran applied to the Rehabilitation Program and at the same time submitted an application for the Permanent Impairment Allowance (PIA). The PIA application was declined because the Rehabilitation Program request had not yet been approved – a requirement of PIA application. When the Rehabilitation Program was approved, the PIA was not considered. The Veteran contacted the Office of the Veterans Ombudsman seeking help to get his PIA application approved. By intervention of the Office, this Veteran will receive all the PIA benefits for which he is eligible.

An Outstanding Ambulance Bill is Paid
A Veteran contacted the Office of the Veterans Ombudsman because he had an outstanding ambulance bill that had been sent to a collection agency. The Veteran had submitted the bill to Veterans Affairs Canada for payment, but the Department denied payment due to insufficient information. Our Office intervened with the collection agency and asked them to put it on hold while we investigated the issue. After proving to the Department that the ambulance service was incurred as a direct result of the Veteran’s pensioned condition, it agreed to pay the ambulance bill. We then updated the collection agency and confirmed that payment would be issued.

Red tape in the way of a Veteran getting needed chiropractic treatments
A Veteran contacted the Office of the Veterans Ombudsman about his difficulties in obtaining approval for additional chiropractic treatments, beyond and above the number of treatments allowed by the Department. Every year, for the past eleven years, the Veteran requested approval for additional treatments, which were needed to maintain his present mobility, and prevent his condition from deteriorating. One year he would get approval from the Department, and the next year, his request would be declined. After discussion with the Department, we were successful in resolving the issue in favor of the Veteran.

Medication reimbursed but not the medical procedure
A Veteran asked for our assistance in obtaining reimbursement for a medical procedure. On two previous occasions, the Department had reimbursed the Veteran for the cost of the medication as well as the cost of the injection that was done by his doctor. The last time the Veteran requested reimbursement, the Department agreed to reimburse the Veteran for the cost of the medication but did not authorize the reimbursement of the medical procedure. The Office of the Veterans Ombudsman intervened on behalf of the Veteran, and, as a result, the Department has since agreed to cover the cost of the injections.

VIP going astray
VIP reimbursements of a surviving spouse had gone missing in recent months without explanation. The client’s September reimbursement had already been issued to her twice, and had to be combined with her missing November reimbursement and reissued again in late January. Instead of risking the reimbursement going astray for a third time, we communicated with VAC and they agreed to courier the cheque to the recipient, thus relieving the financial stress that was beginning to mount because of the delays.

It’s worth the Insulin
An 87 year old Veteran contacted the OVO indicating that he requires a specific type of insulin that is not covered through the VAC drug plan. The client submitted a Doctor’s note indicating why he needed this specific type of insulin and was still denied reimbursement. We contacted VAC on his behalf, and asked why a fixed income Veteran with B coverage would choose to pay out of pocket for a non-formulary type of insulin unless he did indeed suffer serious side-effects from the listed types? VAC has since agreed to cover the insulin for the client on an exceptional basis, and reimburse him back to July of 2007 when he was first denied.

Vindication through Perseverance
A Veteran had a TTY (teletypewriter) device installed during the early 1990s, which was required due to his pensioned condition for hearing loss. In 1996, he began writing and phoning VAC requesting they pay the monthly TTY bill. VAC denied his requests. We did a review of his file and encouraged him to appeal the initial decision. He appealed and partially won, with reimbursement back to April 2008. We encouraged him to go to a second level of appeal. In the meantime, we indicated to VAC that a total review of his file would be required to obtain a full understanding of this case. VAC, much to their credit, did review his file in its entirety which resulted in the Veteran being awarded reimbursement of monthly TTY charges back to December 1996.

Health Related Travel
This story is somewhat related to one of the hot issues that we listed last month. An 82 year old Veteran has taken the same route to his medical appointments for years because he feels that it is the safest route for him. VAC used to reimburse him based on his odometer reading.However, VAC has recently been reimbursing him based on the mileage calculated via Google Maps, which uses his home address and the address where his appointments take place to calculate the distance. Although he had written to VAC to advise that he took his route due to safety, but nothing had changed. We checked his exact route on Google Maps and could see that the shortest route would involve this Veteran merging into and out of a three lane highway. We contacted VAC, on his behalf, and advised that although the Health Related Travel (HRT) guidelines state that an online calculator can be used to determine mileage, the policy is not so strict that it specifically states that a calculator has to be used. Travel is to be by the most convenient and economical means. As such, we requested VAC review the Veteran’s letter, pointed out the safety issue for him and the related policy. VAC agreed to overturn its decision and will backdate his previous HRT claims to reflect the full mileage.

Light Therapy for Depression
A Veteran was recommended light therapy by two physicians as treatment for a pensioned condition. VAC denied the coverage as the device was not on their benefits grid. Following discussion with the Department, it was found that a fair amount of evidence was available supporting this type of therapy. This in turn resulted in VAC amending their benefits grid to include this treatment. The treatment will now be covered for this Veteran.

Restrictions on Grounds keeping under VIP
We were recently successful in a case involving the grounds maintenance portion of VIP services. The Veteran had been denied hedge and shrub trimming based on policy, which we felt was being misinterpreted to the Veteran's disadvantage. According to regulations, the maintenance that is the responsibility of the client, and would normally be performed by him aside from his health condition, should be covered. After mediation and discussion with VAC the decision was reviewed and overturned, granting this client the services he needed.

Long Term Care Expenses
In one instance, a Veteran's daughter contacted our Office because she was frustrated with delays in receiving reimbursement by VAC for her father’s long-term-care expenses. We asked VAC if it was possible to set up direct billing with the facility to ensure a smoother process for all involved. VAC agreed and arranged for the facility to directly bill VAC. In addition, they will change all existing and new residents (Veterans) of this facility to direct billing.

Veterans Independence Program
In another instance, VAC denied a request from a Veteran for social transportation costs under the Veterans Independence Program. The reason for the decline was that although he was a pensioned veteran, he did not meet the income qualification. Upon review of his VAC file, we noticed his eligibility for the War Veterans Allowance for the purposes of treatment benefits. That eligibility, for all intents and purposes, identifies him as an income qualified veteran. Upon contacting the District Office for clarification on the reason for declining the service, they reviewed their decision and granted him eligibility to the service.

http://www.ombudsman-veterans.gc.ca/eng/about-us/success-stories#ss4