Rehabilitation Program Plan

Issuing Authority: Director General, Policy

Effective Date: May 18, 2012
This policy replaces the following policy VPPM 5: 3.1.3 Rehabilitation Program Plan.

Purpose
This policy provides guidance on the development of a Rehabilitation Program Plan for a client in the Veterans
Affairs Canada Rehabilitation Program including plans designed to address Medical, Psycho-Social and Vocational
Rehabilitation needs and Vocational Assistance needs.

Policy
General

1. The Canadian Forces Members and Veterans Re-establishment and Compensation Act (CFMVRCA) sets out
requirements for assessment of need and development and implementation of a Rehabilitation Program, or
Vocational Assistance Plan for each client type (Rehabilitation Need veteran, Medically Released veteran,
spouse/common-law partner or survivor) who is determined to be eligible under the program. The intent of
the Act in requiring a needs based approach is to provide for an individualized response to identified
rehabilitation or Vocational Assistance needs in the form of a Rehabilitation Program Plan that authorizes
specific benefits and services.
2. The Case Manager will lead the assessment and Rehabilitation Program planning process with the
consultation and support of members of the Client Service team, and subject matter experts as necessary.
The Case Manager Assessment will serve as the basic assessment tool for completion of rehabilitation needs
and may be supplemented as needed by specialized assessments by service providers requested by the
Case Manager.
3. The Rehabilitation Program will use the existing VAC Case Plan format and practice guidelines. In addition,
CFMVRC legislation and regulatory requirements give guidance on the development of a Rehabilitation
Program Plan for rehabilitation clients including the duration, evaluation, completion, suspension and the
cancellation of a Rehabilitation Program plan.
4. To ensure a coordinated response to the rehabilitation needs of the medically releasing client, the VAC Case
Manager will work in partnership with the DND Nurse Case Manager and the Service Income Security
Insurance Plan Long Term Disability (SISIP LTD) Vocational Rehabilitation Counsellor as outlined in the
Program Arrangement (TD 2006-02) between VAC, the Department of National Defence (DND) and SISIP
Financial Services, in the development of the plan.

Assessment

5. The purpose of assessment in the Rehabilitation Program is to identify re-establishment barriers, and
consider realistic and achievable rehabilitation goals for each eligible client and clearly specify the barriers
that must be addressed in order to achieve those goals. Rehabilitation Program Plans are then built in an
attempt to address identified barriers and goals. This requires a holistic approach to assessment that goes
beyond evaluation of the health problem to also consider the barriers to re-establishment that the health
problem poses.
6. To ensure a holistic approach, section 10(1) of the CFMVRCArequires that for applications approved under
section 8, Rehabilitation Need, or 9, Medical Release, the Case Manager must assess the:
a. medical rehabilitation needs;
b. psycho-social rehabilitation needs and;
c. vocational rehabilitation needs
7. The Case Manager may structure the assessment of needs and Rehabilitation Program Plan into phases that
best respond to the client’s readiness to engage in services. For example, for a veteran just diagnosed with
severe Post Traumatic Stress Disorder (PTSD), it may be appropriate to focus the assessment and
Rehabilitation Program Plan on addressing the PTSD symptoms before engaging the client in vocational
rehabilitation assessment/planning. It is expected that subsequent assessments and Rehabilitation Program
Plans will evolve over time as the focus of work with the client shifts from medical rehabilitation to
psycho-social rehabilitation and vocational rehabilitation services to achieve the long term goal of successful
re-establishment.

Vocational Assessment

8. For clients who have established eligibility under section 8(1) of the CFMVRCA Rehabilitation Need,
vocational rehabilitation needs will be assessed by referral to a Vocational Rehabilitation Services Provider
approved by VAC, who will conduct an Initial Vocational Assessment (IVA), and develop an Individualized
Vocational Rehabilitation Program Plan (IVRP). While the Vocational Rehabilitation Services Provider will
recommend vocational rehabilitation services based on their assessments, authority to proceed with any
recommendations remains with VAC. Case Managers should involve the VAC Regional Rehabilitation Officers
in evaluating the recommendations of the IVA or the IVRP prepared by the contracted provider.
9. For clients who have established eligibility under section 9(1) of the CFMVRCA Medical Release and medical
or psycho-social rehabilitation needs have been identified , an assessment of vocational assistance needs is
required. This assessment is completed by the SISIP Vocational Rehabilitation Program counsellor. If this
assessment determines there is a vocational assistance need the SISIP counsellor will develop with the
 client a vocational assistance plan.
10. In most cases, the SISIP counsellor will be able to develop and approve funding for the vocational services
required by the medically releasing client within the policy capacity of the SISIP Vocational Rehabilitation
Program (VRP). In exceptional circumstances where the client needs vocational services that go beyond the
policy limits of the SISIP VRP, the SISIP counsellor may request additional support for the vocational
services plan through the VAC Case Manager prior to finalizing the vocational services plan. In these
circumstances VAC must be in agreement that the plan is reasonable and appropriate to the client’s
particular circumstances and be able to approve the services under its legislative and policy guidelines.
11. Section 13(1) of the CFMVRCA requires that for applications approved under section 11(1), Spouses and
Common-law Partners and section 12, Survivors, VAC must assess:
a. vocational assistance needs, and
b. if vocational assistance needs are identified, the Case Manager will assess the client’s:
i. medical rehabilitation needs
ii. psycho-social rehabilitation needs, and/or
iii. vocational rehabilitation needs,
to ensure they do not pose barriers to engaging in a Vocational Assistance Rehabilitation Program Plan.

Focus of a Rehabilitation Program Plan

12. Assessing rehabilitation needs goes beyond the identification of health problems. Assessing the
rehabilitation needs of the client means developing an accurate biopsycho-social description of the client’s
situation; setting realistic and achievable rehabilitation goals with the client and identifying the functional
and environmental barriers associated with the health problem(s) that are preventing the client from
achieving their rehabilitation goals. Having identified the barriers, medical, psycho-social and vocational
rehabilitation interventions will be designed to address the barriers. These rehabilitation interventions form
the basis of the rehabilitation services and benefits provided through the Rehabilitation Program Plan.
13. Section 10(3) of the legislation states that: “the only physical and mental health problems that may be
addressed in the Rehabilitation Program Plan are
a. in the case of a veteran who was released on medical grounds, the physical or mental health problem
for which the veteran was released; or
b. in any other case, a physical or mental health problem resulting primarily from service in the
Canadian Forces that is creating a barrier to re-establishment in civilian life.”
The intent of section 10(3) of the CFMVRCA is to define the scope of VAC’s Rehabilitation Program
responsibilities.
14. A veteran may have rehabilitation needs that do not fall within the mandate of the rehabilitation program
because the rehabilitation needs are not related to health problems as stated in legislation Section 10(3)(a)
and (b) of the CFMVRCA, which are the basis of eligibility for the rehabilitation program. At the same time, a
practical and holistic approach to Rehabilitation Program Plan may require us to include in our plan services
that address barriers to re-establishment that result from health problems that are unrelated to the reasons
for eligibility for the Rehabilitation Program. Guidance on what should be included and excluded follows with
examples to illustrate our policy approach.
15. Needs may still be addressed via VACs case management service, even if not attributable to the
Rehabilitation Program. For example, the case manager may broker or advocate for the client to obtain
required services or benefits, which may not be available from VAC.

Rehabilitation Needs That Fall Outside VAC’s Mandate

16. The policy intent of the New Veteran’s Charter is to facilitate re-establishment of veterans in civilian life by
addressing barriers caused by health problems primarily resulting from service or health problems which
lead to a career ending medical release. While Veterans may continue to sustain injuries and diseases post
release that result in rehabilitation needs, these needs are not within the mandate of the Rehabilitation
Program. In many instances the rehabilitation application/eligibility process will screen out these situations.
(Example: A veteran who voluntarily released and successfully re-established for 10 years incurs serious
head injuries from a fall while hiking in the mountains - this veteran would not meet the Rehabilitation Need
test condition of “health problem primarily resulting from service”.)
17. Clients may be engaged in a Rehabilitation Program Plan when new health problems/rehabilitation needs
emerge. In these circumstances, where the focus of the Rehabilitation Program Plan must change and other
organizations have clear mandates to respond, VAC will not assume responsibility to address the new
rehabilitation needs, other than take on a coordination role.
a. Case Example 1: A veteran is eligible for the Rehabilitation Program due to major depressive
disorder and has begun his Rehabilitation Program Plan with medications and psychological
treatment. Two months into the Rehabilitation Program Plan the Veteran has a stroke which results in
left side paralysis and cognitive impairments. In this situation, while VAC would remain involved from
a case management perspective, the new physical and psychological rehabilitation services required
by this veteran would be the responsibility of provincial health care system and not the VAC
Rehabilitation Program.
b. Case Example 2: A veteran who voluntarily released has lumbar disc disease pensioned at 10%.
While he experiences some persistent pain, he is re-established in a second career as a computer
programmer and manages his daily activities well. Thus, he has no rehabilitation needs. He
subsequently is in a serious motor vehicle accident resulting in brain and spinal cord injuries and
substantial rehabilitation needs. Since these new rehabilitation needs are not resulting from military
service or the basis of a medical release the responsibility for the veteran’s rehabilitation needs rests
with the provincial health system and any automobile insurance coverage available, and not the VAC
Rehabilitation Program.

Addressing Rehabilitation Needs Resulting From Other Health Problems

 18. Section 10(5)(b) of the legislation requires that; “In developing a Rehabilitation Program Plan or a
vocational assistance plan the Minister shall be guided by current research in the fields of rehabilitation and
vocational assistance.” Current research suggests that best practices in rehabilitation and vocational
assistance require a holistic approach in assessing the needs of the client.
19. A holistic approach recognizes that health problems commonly interact with one another and may prevent
successful rehabilitation if not addressed in the Rehabilitation Program Plan. Thus, while the health
problems identified in CFMVRCA section 10(3)(a) and (b) must be the main focus of a VAC Rehabilitation
Program Plan, it may be necessary to also address rehabilitation barriers/needs resulting from other health
problems.
20. The following criteria should apply to the barriers resulting from health problems other than CFMVRCA
section 10(3) (a) or (b) above:
a. the barrier created by the health problems if not addressed will exacerbate the health problem that is
the focus of the Rehabilitation Program Plan ( eg. need to treat depression as part of a Rehabilitation
Program Plan to address chronic pain where musculo-skeletal injuries were the basis of rehabilitation
eligibility), or
b. the barrier created by the health problems if not addressed will significantly limit the capacity of the
client to participate in the Rehabilitation Program Plan (eg. marital conflict and financial management
problems are causing daily difficulties and would undermine client’s ability to focus on a vocational
training program) and,
c. the rehabilitation services needed are not otherwise available; see paragraph 21 below.
In these situations, the Rehabilitation Program Plan may include services to address barriers caused by these other
health problems.
d. Case Example 3: the rehabilitation goal for a client is to improve sitting and standing tolerances to
the level required to return to the client’s employment field. The health problem that is the basis of
the approval of the Rehabilitation Program Plan is Lumbar Disc Disease. A health problem that does
not result primarily from service, an impaired knee joint, is aggravating the restoration of sitting and
standing tolerance and needs to be addressed in conjunction with the back problem. Rehabilitation
services to strengthen the torso, reduce the atrophy in the injured leg, supply a knee brace and
provide cognitive behavioural intervention for pain management will be provided through the
Rehabilitation Program.
e. Case Example 4: the initial rehabilitation goal is for a veteran with service related PTSD are to
reduce the frequency and severity of PTSD symptoms and improve sleep. The veteran has persistent
pain resulting from musculo-skeletal injuries from a motorcycle accident which happened post
release. The pain is contributing to his PTSD symptoms and sleep disturbance. The Rehabilitation
Program Plan will therefore include a pain management component
Note: any services provided to address barriers associated with these other health problems are limited to the time
required to achieve the rehabilitation objectives and do not represent a commitment to provide ongoing health
services for the problem beyond the time frame of the Rehabilitation Program Plan.
21. Section 16 of the legislation provides that VAC may refuse to provide rehabilitation or vocational assistance
services to the extent that they are available to the person as an insured service under a provincial health
care system, a provincial or federal workers’ compensation plan or any other plan prescribed. Many medical
rehabilitation services are provided by provincial health care systems at no cost. However, where these
services are available but cannot be provided in a timely manner to appropriately address the rehabilitation
objectives of the Rehabilitation Program Plan the rehabilitation services may be paid for by the VAC
Rehabilitation Program. (Example: many provincially run pain management clinics have wait lists of a few
years.)

Principles and Factors in the Development of the Rehabilitation Program Plan

22. Following the assessment of the rehabilitation or vocational assistance needs, the Case Manager in
collaboration with the client and as required in consultation with the Client Service Team members, will
develop a Rehabilitation Program Plan to address the needs identified in the assessment. In developing the
Rehabilitation Program Plan and determining services to be provided Canadian Forces Members and
Veterans Re-establishment and Compensation Regulations (CFMVRCR) Part 8 and 9 identify principles and
factors that shall be considered.
23. In developing a Rehabilitation Program Plan, staff shall consider the following factors:
a. the client’s potential for improvement in physical, psychological and social functioning, employability
and quality of life;
b. the availability of local resources;
c. the motivation, interest and aptitudes of the client;
d. the cost of the plan; and
e. the duration of the plan.
24. In developing the Rehabilitation Program Plan, staff shall consider the following principles:
a. services be focussed on addressing individual client needs
b. services will involve family members to the extent required to facilitate the rehabilitation
c. services will be provided as soon as possible;
d. services be focussed on building on previous education, skills, training and experience of the client.

Approval of Rehabilitation Services and Benefits

25. All Rehabilitation Program Plans, will be pre-approved by the Client Services Team Manager (CSTM). The
effective date is always the eligibility date.
26. In approving medical and psycho-social services in the Rehabilitation Program Plan the frequency and cost
limits of the NPS Benefit Grids are to be used as a guide by the CSTM.
a. Frequency limits: The CSTM is the approval authority for any recommended medical or psycho-social
 rehabilitation benefit or service that exceeds the frequency limits of the Benefit Grids.
b. Cost Limits: The CSTM is the approval authority for any recommended medical or psycho social
rehabilitation benefit or service that exceeds the cost limits to a maximum of 20% of the Benefit
Grids. The CSTM, in consultation with the National Manager, Re-establishment and Compensation
Programs, NOD, is the approval authority for cost limits exceeding 20% of the Benefit Grids.

Duration of a Rehabilitation Program Plan

27. While a health problem may last a lifetime, a Rehabilitation Program Plan is focussed on restoring function
and is time limited because it is addressing those aspects of functioning that have the highest potential for
improvement within a predicted time frame that are directly going to impact the outcome of the clients
Rehabilitation Program Plan. Setting time lines is an important factor of Rehabilitation Program Plan as it
enhances the focus and motivation of clients and supports accountability. The time frames are informed
from the assessments and recommendations provided to VAC by the medical, psycho social and vocational
expertise consulted on the case.
28. The duration of a Rehabilitation Program Plan is determined collaboratively between the client and the case
manager and is established when the plan is developed. The concept for planning in a rehabilitation context
is based on knowledge of setting the overall program outcome first and then identify the steps required to
ensure you get there. Thorough assessment are key to accurate estimation of the time required to meet the
objectives of a Rehabilitation Program Plan. Where it is difficult to identify time lines with confidence, health
professionals and other members of the Client Services Team should be consulted to determine if additional
specialized assessments are required.
29. Rehabilitation Program clients will progress at different rates and may have delays due to deterioration of
health, re-injury, or when additional health issues arise. There is therefore, no fixed time prescribed in
legislation for a Rehabilitation Program Plan.The duration will vary depending on individual circumstances
and may be adjusted as needed upon review of progress in the case.

Evaluation of a Rehabilitation Program Plan

30. The Rehabilitation Program Plan will be monitored and evaluated regularly by the Case Manager.
Rehabilitation Program Plan evaluation will involve the client and the relevant members of the Client
Services Team.
31. For purposes of evaluating a Rehabilitation Program Plan VAC may require a medical examination or
assessment by a person specified by VAC. Based on the information gathered in the evaluation, a
Rehabilitation Program Plan may be modified and its duration changed.

Completion of a Rehabilitation Program Plan

32. From the outset, a Rehabilitation Program Plan anticipates a completion date. Case Managers should
discuss a completion date with the client as the Rehabilitation Program Plan nears completion. While setting
the completion date will usually be a joint decision of the Case Manager and the client, VAC has the
independent authority to set the date of completion if needed.
33. The following are general guidelines for determining when a Rehabilitation Program Plan should be
completed.
a. when an evaluation by the CM and client indicates that the client has met or substantially met the
goals of the Plan, or
b. when there is evidence that further intervention will not be effective in achieving the goals
c. when a client’s health problem(s) deteriorates to the point where participation in the Rehabilitation
Program Plan is no longer possible.
34. When completion of a Rehabilitation Program Plan is due to inability to meet the Rehabilitation Program
Plan goals or because of deterioration in the clients health condition consideration should be given to
whether the client meets the criteria for Total and Permanent Incapacity.

Refusal of Rehabilitation or Vocational Assistance Services

35. In accordance with section 16 of the CFMVRCA and section 13 of the CFMVRCR, Veterans eligible for the
Rehabilitation Program can be refused rehabilitation services or vocational assistance services when:
a. these services are available as an insured service under a provincial health care system, a provincial
or federal workers’ compensation plan or any other plan that may be prescribed, including SISIP;
b. these services have already been provided by VAC or another organization or provider;
c. other reasonable circumstances for refusal. In determining what those circumstances are, VAC may
consider the Principles and Factors prescribed in sections 8 and 9 of the CFMVRCA and CFMVRCR.
For example, rehabilitation services may be refused when: a client is not motivated to participate;
the duration or cost of the Rehabilitation Program Plan is unrealistic; or improvement would not be
expected because the client may have achieved maximum medical recovery or has a terminal health
condition.
36. Refusal applies only to specific services as described above, not usually to the entire Rehabilitation Program
Plan

Suspension of Rehabilitation and Vocational Assistance Services

37. Section 12 of the regulations provides that: “A person who is in receipt of rehabilitation services or
vocational assistance shall provide, at the request of the Minister, the following information relating to the
provision of the services or assistance:
a. attendance reports
b. evaluations, assessments and progress reports; and
c. any other information that is necessary to enable the Minister to assess continued eligibility for the
services or assistance.”
 services or assistance.”
38. In accordance with section 13 of the CFMVRCR, rehabilitation and vocational assistance services may be
suspended when the client does not provide the information the Area Counsellor (CM)/Client Service Team
Manager (CSTM) requires to assess the client’s progress toward his/her rehabilitation goals.
39. This information may be required by the AC/CSTM to determine the client’s continued eligibility for the
Rehabilitation Program, the continued appropriateness of the type of services provided, the duration of the
services, the need for additional services etc.
The types of information that the AC/CSTM may require include:
a. attendance reports
b. evaluations, assessments and progress reports; and
c. any other information that is necessary: for example, employer contact sheet when engaged in job
search, training performance reports, educational transcripts etc.
40. Suspension applies only to specific services for which the client is not providing the required information.
Suspension does not apply to the entire Rehabilitation Program Plan.
41. Suspension of rehabilitation or vocational assistance services does not effect Earnings Loss payments. A
client who has specific services suspended is still eligible to receive Earnings Loss.

Cancellation of Rehabilitation Program Plan

42. The Rehabilitation Program Plan for a client may be cancelled for any one of the following reasons:
a. the client refuses, without reasonable excuse, to undergo a medical examination or other assessment
required as part of the evaluation of a plan (Section 15(3) of the CFMVCRA)
b. the client does not participate to the extent required to meet the goals of the plan (Section 7 of the
Act and 14(1) of the regulations); or
c. the client’s eligibility for Rehabilitation Services or Vocational Assistance was based on a
misrepresentation or the concealment of a material fact; or
d. at least six months after the Rehabilitation and/or Vocational services have been suspended, as per
paragraph 36 above, the client continues to fail to provide the required information.
43. Before cancelling a Rehabilitation Program Plan, the Case Manager shall provide the client with written
notification of the reasons for the cancellation, the consequences of the cancellation, the effective date of
the cancellation and the rights of review. (Section 14(2) of the regulations)
44. Cancellation refers to cancellation of the entire Rehabilitation Program Plan and also means cancellation of
Earnings Loss Benefits.
45. When suspending or cancelling a Rehabilitation Program Plan, please refer to the Rehabilitation Business
Process on suspension and cancellation for instructions on effective dates, letters etc.

References
Canadian Forces Members and Veterans Re-establishment and Compensation Act, sections 10, 13, 14, 15, 16, 17
Canadian Forces Members and Veterans Re-establishment and Compensation Act Regulations 8, 9, 12, 13, 14