Part-Time Soldiers with Full-Time Injuries: A Systemic Review of Canada’s Primary Reserve Force and Operational Stress Injuries

May 2016

Since 2002, the Office has been tracking the issue of operational stress injuries and the adequacy of the health care provided to members of the Canadian Armed Forces.

Progress report on the status of recommendations

August 2024

•  3 Recommendations Made
•  3 Recommendations Accepted
•  2 Recommendations Partially Implemented
•  1 Recommendation Not Implemented

Progress report definitions

Recommendation 1

It is recommended that the Department of National Defence and the Canadian Armed Forces improve the clarity and administration of Reservists’ entitlement and eligibility for health care, periodic health assessments and future Reserve employment by:

1.1 Completing the revision of Queen’s Regulations and Orders, Chapter 34 – “Medical Services,” that has been under review since 2009, to clearly identify all entitlements to care for all Reservists

1.2 Incorporating the requirement for Reservists to undergo routine periodic health assessments (or to have their medical readiness determined) into the revised Queen’s Regulations and Orders Chapter 34 – “Medical Services” (along with associated policies and directives). Once this requirement is codified, ensure that the appropriate resources are in place to guarantee Reserve medical readiness

1.3 Confirming in Canadian Forces Military Personnel Instruction 20/04 that Reservists whose Medical Employment Limitations so allow may be eligible to obtain new employment despite the existence of a temporary medical category

Recommendation 1 Status:  1 Not Implemented

Progress has been slow on the implementation of this recommendation. The Chief of Military Personnel (CMP) has reviewed and started updating policies related to Reservists' entitlement and eligibility for health care, periodic health assessments, and their future employment. CMP advised that they started to engage key players to develop a health regulatory framework for the Canadian Forces Health Services (CFHS) that will replace Queen’s Regulation & Orders (QR&Os) Chapters 34 – Medical Services, and Chapter 35 – Dental Services in mid-April 2023. CMP has advised that the policy will cover all foundational elements of the CAF health system and its mandate, including its responsibility to provide health services to members in different classes of service and in different circumstances. The drafting of directives, orders and instructions for the repeal of the QR&O Chapters 34 and 35 has begun and will include establishing an entitlement for Reserve Force members to the assessment of their medical fitness for military duties. CMP anticipates completing these drafting instructions by March 2026.

CMP also adopted a phased approach to review and amend Canadian Forces Military Personnel Instructions (CFMPI) 20/04 – Administrative Policy of Class A, Class B, and Class C Reserve Service. CMP reports that this will clarify ambiguous language and update the eligibility criteria in paragraph 2.6 of CFMPI 20/04. On September 10, 2024, CANFORGEN 134/24 - AMENDMENTS TO CF MIL PERS INSTR 20 04 CLASS A B C RESERVE SVC was released highlighting some of the changes to CFMPI 20/04. 

We will continue to monitor progress on this recommendation as the CMP continues work to improve clarity and administration of Reservists’ entitlement and eligibility for health care, periodic health assessments and future Reserve employment.

Recommendation 2

It is recommended that the Department of National Defence and the Canadian Armed Forces take measurable steps to improve the knowledge and awareness of the entitlements available to all Reservists, especially those who may be ill and injured, by:

2.1 Making any relevant documents, policies, procedures and forms easily accessible on the internet and on the Defence Information Network, and ensuring this information remains current

2.2 Committing the resources required for the development and implementation of a communications plan. This would include activities, products, timelines and metrics to reach and inform Reservists

2.3 Ensuring that training on entitlement to health care (currently provided by the Field Ambulance Medical Link Teams) is effective and mandatorily provided to Reserve units

2.4 Ensuring that Reserve units have the appropriate number of training days to provide mandatory training to their members, and that such training is completed

Recommendation 2 Status:  Partially Implemented

Since our last progress report in 2022, the CMP reviewed and updated the DND/CAF Frequently Asked Questions (FAQs) about Reserve Force Compensation (RFC). The October 2022 update contains information to help Reserve Force members navigate topics on eligibility, impacts to Reserve pay and benefits, and the RFC application process in general. However, the CAF still needs to produce an updated communications plan that outlines its strategy for communicating with Reservists. The CAF also needs to demonstrate that they are taking an effective and measurable approach to training and supporting Reserve units on entitlements to health care. 

This information gap about health care entitlements for Reservists remains unaddressed and our office continues to receive complaints, we have taken the initiative to offer information based on current policies. We develop and maintain various education products that help fill the gap in easily accessible information for reservists that are ill and injured. These products include:

• The Military Benefits Browser: A tool that provides easily accessible information related to benefits and services for military members who are ill, injured, or transitioning out of the Canadian Armed Forces, their families, as well as families of the deceased.

• Reservists: Access to PSHCP: Contains a list of frequently asked questions on eligibility and coverage related to the Public Service Health Care Plan. 

• Compensation options for ill and injured Reservists: Contains guidelines to help Reserve Force members navigate different scenarios where they may be eligible for compensation.

• Health care for Reservists: Contains guidance on policy, entitlements, service attribution, processes, and other benefits, programs and social services for Reserve Force members.

• Mental Health Supports for Primary Reserve Force members participating in domestic operations: Contains information to help Primary Reserve Force members navigate mental health support before, during, and after participating in domestic operations.

• Health care for Canadian Rangers: Contains guidance for Canadian Rangers on their eligibility for health care entitlements and the steps required when accessing those entitlements. Information presented in this education product is also available in five main languages: Denesuline, Ojibway, Ojicree, Inuktitut, and Montagnais.

Recommendation 3

It is recommended that the Department of National Defence and the Canadian Armed Forces strengthen the responsibility and capacity to follow-up with Reservists by:

3.1 Establishing a consistent and meaningful approach to contacting Reservists who are on non-effective strength; especially those with a deployment history, and document the efforts made to reach them, even if unsuccessful

3.2 Establishing an oversight mechanism to ensure the consistent completion of post-deployment follow-up activities at the unit level, and reiterating the responsibilities of the chain of command in this regard

3.3 Flagging to the chain of command when a Reservist is non-effective strength and cannot be reached

3.4 Ensuring that the Field Ambulance Medical Link Teams are properly resourced to effectively deliver their mandate

3.5 Taking the necessary steps to fill all established mental health positions, and reviewing the mental health staffing requirements for the 2016 paradigm

Recommendation 3 Status:  Partially Implemented

In our previous follow-up in 2022, the Canadian Forces Health Services Group (CFHS) informed us that Field Ambulance Medical Link Teams (FAMLTs) no longer existed within the Canadian Armed Forces. The CAF established FAMLTs in 2011 to build on the successes of a previous initiative – the Reserve Medical Link Team (RMLT). The RMLT consisted of several full-time, centralized Class “B” positions that allowed Reservists to focus exclusively on delivering their mandate.However, our investigation found that FAMLTs were decentralized and consisted of members on part-time Class “A” service (generally working one evening per week and one weekend per month). This made FAMLTs less effective than RMLTs. CFHS also informed us that FAMLT tasks would be offered by CFHS Reserve Field Ambulances, which are still funded as a Class “A” activity. No information was provided by CFHS on how Reserve Field Ambulances can build on the successes of the former full-time Class “B” Reserve Medical Link Team, on a part-time basis.

We also found that no steps have been taken by the CAF to track communication with Reservists or monitor their wellbeing. The Chief of Reserves (C Res) provided no information on if they will develop an oversight mechanism to ensure the consistent completion of post-deployment follow-up activities at the unit level. They also provided no information on how the CAF plans to adopt a meaningful approach towards establishing consistent contact with Reservists who are on non-effective strength. As these elements remain outstanding, we will continue monitoring progress on this recommendation in parallel with recommendation 1 of our 2024 Hidden Battles report.