Veterans Well-being Regulations (SOR/2006-50)

Critical Injury Benefit

48.1 An application for a critical injury benefit shall include medical reports or other records that document the member’s or veteran’s injury or disease, the diagnosis and the nature and duration of treatment received.

48.2 The presumptions set out in section 50 apply with any necessary modifications to applications for a critical injury benefit.

48.3 For the purpose of subsection 44.1(2) of the Act, the Minister shall consider whether the member or the veteran

• (a) sustained an amputation at or above the wrist or ankle;

• (b) sustained legal blindness in both eyes — meaning that their best corrected visual acuity is less than or equal to 6/60 or they have less than 20 degrees of visual field remaining — for a minimum of 84 consecutive days;

• (c) sustained quadriplegia, paraplegia, hemiplegia or complete paralysis of a limb for a minimum of 84 consecutive days;

• (d) sustained total loss of urinary or bowel function for a minimum of 84 consecutive days;

• (e) required the assistance of at least one person to perform at least three activities of daily living for a minimum of 112 consecutive days;

• (f) was admitted to an intensive care unit for a minimum of five consecutive days;

• (g) was admitted to a hospital for acute or rehabilitative inpatient care for a minimum of 84 consecutive days; or

• (h) was admitted to a hospital for acute or rehabilitative inpatient care for less than 84 consecutive days during which the member or the veteran received complex treatments.

48.4 For the purpose of subsection 44.1(1) of the Act, a sudden and single incident is a one-time event — including motor vehicle accidents, falls, explosions, gunshot wounds, electrocution, and exposure to chemical agents — in which the member is abruptly exposed to external factors.

Pain and Suffering Compensation

49 An application for pain and suffering compensation shall include

• (a) medical reports or other records that document the member’s or veteran’s injury or disease, diagnosis, disability and increase in the extent of the disability; and

• (b) in the case of an application by a survivor or a dependent child,

  • (i) a copy of the death certificate of the member or veteran, and

  • (ii) medical reports or other records that document the cause of death of the member or veteran.

50 For the purposes of subsection 45(1) of the Act, a member or veteran is presumed, in the absence of evidence to the contrary, to have established that an injury or disease is a service-related injury or disease, or a non-service-related injury or disease that was aggravated by service, if it is demonstrated that the injury or disease or its aggravation was incurred in the course of

• (a) any physical training or sports activity in which the member or veteran was participating that was authorized or organized by a military authority, or performed in the interests of the service although not authorized or organized by a military authority;

• (b) any activity incidental to or directly connected with an activity described in paragraph (a), including the transportation of the member or veteran by any means between the place at which the member or veteran normally performed duties and the place of the activity;

• (c) the transportation of the member or veteran, in the course of duties, in a military vessel, vehicle or aircraft or by any means of transportation authorized by a military authority, or any act done or action taken by any person that was incidental to or directly connected with that transportation;

• (d) the transportation of the member or veteran while on authorized leave by any means authorized by a military authority, other than public transportation, between the place at which the member or veteran normally performed duties and the place at which the member or veteran was to take leave or a place at which public transportation was available;

• (e) service in an area in which the prevalence of the disease that was contracted by the member or veteran, or that aggravated an existing injury or disease of the member or veteran, constituted a health hazard to persons in that area;

• (f) any military operation, training or administration, as a result of either a specific order or an established military custom or practice, whether or not a failure to perform the act that resulted in the injury or disease or its aggravation would have resulted in disciplinary action against the member or veteran; or

• (g) the performance by the member or veteran of any duties that exposed the member or veteran to an environmental hazard that might reasonably have caused the injury or disease or its aggravation.

51 Subject to section 52, if an application for pain and suffering compensation is in respect of a disability or disabling condition of a member or veteran that was not obvious at the time they became a member of the forces and was not recorded on their medical examination prior to enrolment, the member or veteran is presumed to have been in the medical condition found on their enrolment medical examination unless there is

• (a) recorded evidence that the disability or disabling condition was diagnosed within three months after enrolment; or

• (b) medical evidence that establishes beyond a reasonable doubt that the disability or disabling condition existed prior to enrolment.

52 Information given by a member or veteran at the time of enrolment with respect to a disability or disabling condition is not evidence that the disability or disabling condition existed prior to their enrolment unless there is corroborating evidence that establishes beyond a reasonable doubt that the disability or disabling condition existed prior to the time they became a member of the forces.

53 A member or veteran who is in receipt of pain and suffering compensation shall, at the Minister’s request, provide medical reports or other records or any other information or documents that are necessary to enable the Minister to assess the member’s or veteran’s continued eligibility for the compensation or the extent of the member’s or veteran’s disability or to determine the amount of the compensation payable.

• 53.1 (1) For the purposes of section 52.1 of the Act, the Minister may suspend the payment of pain and suffering compensation to a member or veteran who fails to provide the information or documents required under section 53 until the information and documents are provided.

• (2) Before suspending the payment of pain and suffering compensation to a member or veteran, the Minister shall provide the member or the veteran with written notification of the reasons for the suspension and the effective date of the suspension.

• 53.2 (1) For the purposes of section 52.1 of the Act, the Minister may cancel the payment of pain and suffering compensation if

  • (a) the situation that gave rise to the suspension of the payment of pain and suffering compensation is not resolved within six months from the effective date of the suspension; or

  • (b) the assessment of the member’s or veteran’s eligibility for pain and suffering compensation or of the extent of their disability or the determination of the amount payable was based on a misrepresentation or the concealment of a material fact.

• (2) On cancelling the payment of pain and suffering compensation, the Minister shall provide the member or the veteran with written notification of the reasons for the cancellation, the effective date of the cancellation and the member’s or veteran’s rights of review.

53.3 For the purposes of subsection 53(1) of the Act, a member or veteran may elect to receive the pain and suffering compensation as a lump sum by notifying the Minister in writing of their election.

• 53.4 (1) The following sources are prescribed for the purposes of section 56.3 of the Act:

  • (a) amounts arising from a legal liability to pay damages for non-economic loss; and

  • (b) compensation payable in respect of non-economic loss under

    • (i) the Government Employees Compensation Act,

    • (ii) any provincial workers’ compensation legislation,

    • (iii) a compensation plan established by any other legislation of a similar nature, whether federal, provincial or of another jurisdiction other than a plan to which the member or veteran has contributed, and

    • (iv) a compensation plan of a similar nature established by the United Nations or by or under an international agreement to which Canada is a party, other than a plan to which the member or veteran has contributed.

• (2) For the purposes of section 56.3 of the Act, the amount by which the Minister may reduce the pain and suffering compensation that is payable monthly to a member or veteran is the lesser of

  • (a) the amount that is payable from the prescribed source, converted into a monthly amount in accordance with generally accepted actuarial principles if it has been paid or is payable in a lump sum or on a periodic basis other than monthly, and

  • (b) the full amount of pain and suffering compensation that is payable monthly.

• (3) For the purposes of section 56.3 of the Act, the amount by which the Minister may reduce the pain and suffering compensation that is payable as a lump sum to a member or veteran is the lesser of

  • (a) the amount that is payable from the prescribed source, converted into a lump-sum amount in accordance with generally accepted actuarial principles if it has been paid or is payable on a periodic basis, and

  • (b) the full amount of pain and suffering compensation that is payable as a lump sum.

• (4) If the pain and suffering compensation paid to a member or veteran was reduced in accordance with subsection (2) or (3) and, at the time of the member’s or veteran’s death, the total amount of the reduction exceeds the total amounts received from the prescribed source, the reduction in the pain and suffering compensation shall be redetermined in accordance with subsection (2) or (3) with the references in paragraphs (2)(a) and (3)(a) to the amount that is payable from the prescribed source being replaced with references to the total amount received by the member or veteran from the prescribed source before death.

• (5) If the redetermination under subsection (4) results in a smaller reduction of pain and suffering compensation than was previously determined under subsection (2) or (3), the difference between the two amounts is to be paid to the member’s or veteran’s survivor or dependent children in the manner set out in section 56.1 of the Act.

Additional Pain and Suffering Compensation

54 For the purposes of section 56.6 of the Act, a permanent and severe impairment is

• (a) an amputation at or above the elbow or the knee;

• (b) the amputation of more than one upper or lower limb at any level;

• (c) a total and permanent loss of the use of a limb;

• (d) a total and permanent loss of vision, hearing or speech;

• (e) a severe and permanent psychiatric condition;

• (f) a severe and permanent limitation in mobility or self-care; or

• (g) a permanent requirement for supervision.

54.1 For the purposes of subsection 56.6(4) of the Act, the assessment of the extent of the veteran’s permanent and severe impairment shall be based on any relevant factor, including

• (a) the need for institutional care;

• (b) the need for supervision and assistance;

• (c) the degree of the loss of use of a limb;

• (d) the frequency of the symptoms; and

• (e) the degree of psychiatric impairment.