Case Stories

Displaying 1 - 10 of 54

Daily Medication Coverage Approved

A Veteran contacted our Office after exhausting all review and appeal options when his request for low-dose daily medication to treat Erectile Dysfunction was denied by VAC. The on-demand higher-dose alternatives that VAC approves as a standard benefit had previously caused side effects for the Veteran.  

Medical records supporting the daily low-dose prescription had been submitted with a disability benefit claim but were not available to staff reviewing the medication coverage request due to privacy and confidentiality safeguards that restrict access to VAC systems.

Delayed Benefits Paid
An 80+ year-old surviving spouse contacted our office for help after waiting almost two years for VAC to pay Disability Pension survivor benefits that had been awarded to her by the Veterans Review and Appeal Board.

Reimbursement Approved for Glucose Monitoring Device
A Veteran living with type 2 diabetes contacted us after Veterans Affairs Canada (VAC) denied their request for a Continuous Glucose Monitor (CGM), which was prescribed by their doctor for severe nighttime hypoglycemia, or low blood sugar. A CGM is a wearable device that tracks blood sugar every few minutes on a constant basis. The Veteran needed a CGM because hypoglycemia, or low blood sugar level, can be life-threatening, particularly at night.

Caregiver Recognition Benefit - confusion resolved for palliative Veteran and spouse 
A palliative Veteran and their spouse contacted the Office of the Veterans Ombud (OVO) after Veterans Affairs Canada (VAC) said the Veteran wasn’t eligible for the Caregiver Recognition Benefit (CRB) because they were receiving a Disability Pension (DP). 

Physiotherapy for tinnitus finally approved
VAC refused to cover physiotherapy treatment for a Veteran suffering from service-related pulsatile tinnitus - which is tinnitus with a rhythmic, pulsing or whooshing sound that aligns with one’s heartbeat. It is often caused by issues with blood vessels in the head and neck. 

Featured Case: Diminished Earning Capacity Decision Corrected After Our Review
A Veteran came to us after VAC (Veterans Affairs Canada) denied their request for Diminished Earning Capacity (DEC). The DEC designation was backdated to March 25, 2019, which meant the Veteran was now eligible for the Career Impact Allowance Supplement.

Survivor Receives Benefits After Error Corrected
After a Veteran’s passing, their surviving spouse struggled to access survivor benefits due to an error in recognizing their marital status. With the OVO’s help, VAC (Veterans Affairs Canada) corrected the mistake, and the surviving spouse finally received (after roughly 31 months) the support they were owed.

Delayed Decision: Deceased Veteran’s Daughter Finally Receives Compensation
An elderly Veteran passed away before he could elect a lump sum payment option for a recently approved benefit, and his estate was unfairly denied the funds. After the Office of the Veterans Ombud identified a process error, VAC (Veterans Affairs Canada) reached out to the family and issued the remaining balance of the Pain and Suffering Compensation lump sum.

Coverage Confusion: Veteran Reimbursed After Unfair Denial of Hearing Treatment
A Veteran was initially denied coverage for noise sensitivity treatment related to their service-connected tinnitus, despite expert medical evidence. After the OVO's intervention, VAC (Veterans Affairs Canada) reviewed the case, clarified its policy, and reimbursed the Veteran for the previously denied treatment, resolving the issue over a year later.

Pricey Prescription: Quick Action Granted Veteran Access to Much Needed Medication
A Veteran with an autoimmune disorder was denied coverage for a new medication not included in VAC's (Veterans Affairs Canada) standard formulary, despite suffering severe side effects from the previous treatment. After the OVO's intervention, VAC’s Exceptional Benefits Unit quickly approved the medication, granting the Veteran retroactive coverage within a week, ensuring timely access to the necessary treatment.
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