This is an Instructional Resource form KPG for Our Clients and for their Medical and Dental Professionals:

Veterans Affairs Canada Assessments: Page 2 - 14

• Psychiatric Conditions  (Page 13 and mentioned throughout)
• Medical Conditions Consequential to Mental Health Page 3 -14
• Exceptional Incapacity Assessments for 98% combined pain and suffering – Page 15
• Appeals with the VAC Pension Office – Page 15

Treatment Programs Page 16 - 30

• Our KPG Clinic Treatment Mandate Page 16
• Where the Member is in their Journey Page 16-17
• Treatment Modalities/Programs to choose from Page 18 -27
• Physical Treatment Modalities Explained Page 28
• Concluding Thoughts Page 31

We thank you for your service, and we are here to serve you!

(If you would like a pdf copy of this resource please email us at admin@kelownapsychologists.com)

Kelowna Psychologists Group & Kelowna Professional Group (our multidisciplinary team)
provide in person and remote service, with direct billing, for assessment and treatment. No referral is necessary and you simple call or email for first contact. 

 

(While we have grown to be the go-to for these services, we also provide services through other third providers and direct bill to a broad clientele)

 

Who we can see: Our Team Members primarily reside in B.C. and Ontario, providing in person service in Kelowna and Nelson, and Creston, and secure video remote services to the rest of B.C. Our registered psychologist in Ontario provides secure remote video services for residents of Ontario. We can also practice across jurisdictional boundaries and offer remote services to residence of areas of Canada facing shortages of registered psychologists, including the Yukon, Northwest Territories, and Nunavut, and the provinces of Ontario, New Brunswick, and P.E.I. We require special permission for other provinces, and based on demand we can apply for registration with provinces that share an interjurisdictional agreement with B.C. Reach out to our office via email or telephone for more information.

 

We are always accepting new referrals, and we recommend our multidisciplinary team as a first step in connecting with our clinic, and to access our Registered Psychologists with swift in-house referrals to meet your needs.

 

This can be shared as a guide for those engaged with other professionals, and we accept consults with psychologists/physicians. We are happy if this helps in your healing journey.

 

Where you fit in our service delivery:

 

1. Medically Discharged or Retired Veterans of the RCMP or Canadian Military with no formal psychological diagnosis and lingering symptoms from your career: We can begin with an assessment for a new psychological condition without a referral, and we bill directly to Veterans Affairs Canada (VAC) at no charge to you. Our psychologists have significant experienced in VAC assessments, and our senior psychologist with thirty years of experience, Dr. Heather McEachern, can provide this service in combination with a multidisciplinary team member or consult in-house with your chosen assessing psychologist at KPG (with your consent) for psychological assessments and appeals. We always make room to serve our active members and veterans. Many of our psychologists and clinicians are well versed in these services. You can be long retired and circle back to assess lingering symptoms. We assess for all psychological and psychiatric entitled conditions and explain the process as well as providing the paperwork.
2. Veterans with an approved psychological/psychiatric condition: If you are a retired or medically discharged member of the RCMP or Canadian Military and have Veterans Affairs Canada (VAC) coverage for an already assessed psychological condition, we can provide immediate treatment and/or we can begin with a review of your current percentages compared to your current condition severity and when beneficial a psychologist at KPG can re-assess to provide up to date percentages that reflect your current disability for your claimed condition.  If we detect mental health diagnoses related to service that were not diagnosed, we can proceed with new condition assessment. We direct bill for treatment and assessment, with no charge to you.
3. If you are still serving and fully operational or on a medical leave but not discharged: We treat and can also assess for a new psychological condition for members of the RCMP and in many cases, there is opportunity for civilian assessments for Canadian Military as well. After assessment for treatment, based on our findings we can recommend new condition assessments or re-assessment for approved conditions. We direct bill the RCMP for members, couples, and family sessions where the member is present. We also provide services through your insurance for separate sessions with spouses and dependent children. See “Treatment Options” below.
4. If you are experiencing physical/medical conditions that may be consequential to your mental health this section is for you (if you are physically healthy move to the next section or peruse this for future consideration, and duly note that treatment for your mental health and your physical health is best combined with collaboration between psychologists, mental health clinicians, and your medical care team ): These diagnoses must be made by a medical doctor. Our psychologists are limited to the relationship of your approved psychological condition to the physical condition diagnosed by your physician. Medical doctors must diagnose and complete the VAC medical questionnaire for the permanent physical condition disability, and we reasonably offer our opinion on the evidence-based findings of the physical consequences of your case specifics and your already approved psychological condition (s ). There is significant evidence-based research connecting a variety of chronic physical diagnoses and disease processes to conditions like PTSD, Generalized Anxiety Disorder and/or Major Depressive Disorder.

 

As part of best practices in keeping with the Health Professions Act in Canada, we consult and collaborate with physicians (with member permission) to assist in a multidisciplinary evaluation that ensures accurate connection of the diagnosis to your work and your approved psychological condition, and appropriate treatment plans. We are well informed about the necessary documentation for an application that is likely to successfully meet VAC standards, capturing the diagnosis, severity, and an accurate direct connection to your work history or an accurate indirect connection from your work history to your approved mental health condition to the consequential physical diagnosis.

 

Item 4, physical conditions consequential to mental health, is a labyrinth worthy of explanation, which is a long read.  If you suffer with any of these potentially entitled conditions, it is worth the read. If you are healthy physically, skip ahead to treatment choices.

 

VAC Table of Disabilities as Sourced Online at the VAC Government of Canada Website:

Table of Contents

 

There are a number of conditions listed as chapters, including details of how to complete the Quality of Life (Chapter 2) component to the submission. Note you are to speak only about the impact of the specific condition, no other injuries. Chapter 7 Exceptional Incapacity Allowance can be applied for when a member reaches 97.5% total disability or more, and our psychologists can offer an expert opinion for members they are treating. This document is offered to the nurse assigned by VAC to complete the assessment, with an opinion regarding how the mental health influences the determination.

 

Chapter 8 speaks to workplace injuries of permanent visual impairment, Chapter 9 is hearing loss or impairment, and Chapter 10 is nose, throat and sinus impairment. These can be primarily direct injuries from work, although we can offer expert opinions on the broad mental health impact on immune system function and impact of physical health. We have a documented case of permanent vision loss resulting from shingles-related eye damage in an individual younger than the typical age group affected by shingles. The treating psychologist’s expert opinion supported a connection between this outcome and a pre-existing diagnosis of PTSD, compounded by extreme occupational stress, during a successful appeal process of a denied injury.  Our psychologists are available to consult on unique physical presentations with mental health as a queried factor and offer opinions on physical consequential conditions after mental health conditions are approved.  These are assessed on a case by case basis.

 

Here are the Chapters for which with our expert opinion offerings of explanations of etiology not found in the VAC chapters but sourced elsewhere by our leadership team. We tend to the VAC criteria in detail, then offer the etiology we have researched to explain the connection when it fits with our assessed findings. The following are brief summaries of VAC chapters for entitled physical health disability benefits for individuals who served or are serving in the Canadian Military and/or the RCMP. You can find the chapters on the Government of Canada website, and you should rely on the original source for the most accurate understanding of these summarized chapters.

 

Chapter 11 Dental and Oral Impairment:

There are established mental health contributions. Bruxism resulting in damage to teeth and jaw pain is a common presentation consequential to PTSD and other anxiety conditions, and we have offered psychological opinions on these presentations in members with already assessed mental health, after evaluation and on a case-by-case basis.

 

Chapter 12 Cardiorespiratory Impairment:

Mental health is proven to have significant cardiorespiratory consequences due to chronic stress, sympathetic nervous system activation, neurochemical imbalances, and increased inflammation. These mental health conditions can lead to a wide range of heart and lung disorders, including hypertension, heart disease, stroke, and respiratory issues like asthma and COPD. Comprehensive treatment addressing both mental health and physical symptoms is essential for mitigating these risks and improving overall health outcomes. We have offered psychological opinions on these presentations in members with already assessed mental health, on a case-by-case basis.

Summary of :

• Hypertension: Elevated blood pressure, headaches, dizziness, chest pain, and shortness of breath.
• Coronary Artery Disease (CAD): Chest pain, shortness of breath, fatigue, and pain in the arms, neck, or jaw.
• Heart Failure: Shortness of breath, fatigue, swelling in the legs, and rapid or irregular heartbeats.
• Myocardial Infarction (Heart Attack): Chest pain, shortness of breath, nausea, and pain radiating to the arms, neck, or jaw.
• Arrhythmias: Palpitations, dizziness, shortness of breath, and chest discomfort.
• Stroke: Sudden weakness, confusion, vision problems, and difficulty walking.
• Chronic Obstructive Pulmonary Disease (COPD): Chronic cough, shortness of breath, wheezing, and fatigue.
• Asthma: Shortness of breath, wheezing, coughing, and chest tightness.
• Panic Disorder with Cardiorespiratory Symptoms: Rapid heartbeat, shortness of breath, chest pain, and dizziness.
• Pulmonary Embolism: Sudden shortness of breath, chest pain, coughing up blood, and rapid heart rate.

Seek medical assistance and we are pleased to collaborate with your physician of care.

 

Chapter 13 Hypertension and Vascular Impairment:

Individuals with PTSD, GAD, and/or MDD are at increased risk for a variety of hypertension and vascular impairment conditions (as listed in Chapter 13) due to the chronic activation of stress pathways, including the sympathetic nervous system and Hypothalamic-Pituitary-Adrenal (HPA) axis.

It refers to a complex network of interactions between three key glands:

1. Hypothalamus – located in the brain, it controls many bodily functions including the release of hormones.
2. Pituitary gland – also in the brain, it acts as the "master gland," regulating other glands and releasing hormones like ACTH (adrenocorticotropic hormone).
3. Adrenal glands – located on top of the kidneys, they release stress hormones such as cortisol and adrenaline.

The HPA axis plays a central role in the body’s stress response, regulating mood, immune function, energy levels, and more. Dysregulation of this system is commonly linked to conditions such as PTSD, depression, anxiety, and chronic fatigue.

These psychiatric conditions can accelerate the development of cardiovascular diseases like hypertension, atherosclerosis, and coronary artery disease, while also contributing to more acute events like stroke and DVT/PE.

• DVT stands for Deep Vein Thrombosis – a condition where a blood clot forms in a deep vein, usually in the legs. It can cause pain, swelling, and in serious cases, lead to complications like a pulmonary embolism.
• PE stands for Pulmonary Embolism – this occurs when a blood clot (often from a DVT) travels to the lungs and blocks a pulmonary artery, which can be life-threatening if not treated quickly.

Managing these risks often requires addressing both the mental health conditions and their cardiovascular consequences.

Summary of Possible Diagnoses and Symptoms in Hypertension and Vasculature Impairments Due to PTSD, GAD, and MDD:

• Hypertension: High blood pressure, often asymptomatic, with possible headaches, dizziness, and chest pain.
• White Coat Hypertension: Elevated blood pressure only in medical settings due to anxiety.
• Post-Traumatic Stress Disorder (PTSD)-Induced Hypertension: Chronic high blood pressure, headaches, and chest pain.
• Atherosclerosis: Plaque buildup in arteries, leading to chest pain, fatigue, and pain in the legs.
• Coronary Artery Disease (CAD): Chest pain, shortness of breath, fatigue, and heart attack symptoms.
• Peripheral Arterial Disease (PAD): Leg pain, numbness, and delayed wound healing.
• Stroke: Sudden weakness, confusion, vision problems, and trouble walking.
• Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE): Leg swelling, pain, chest pain, shortness of breath, and coughing up blood.
• Hypertensive Heart Disease: Shortness of breath, fatigue, swelling, and chest pain.
• Autonomic Dysfunction (Dysautonomia): Dizziness, rapid heart rate, sweating abnormalities, and gastrointestinal issues.

We have offered psychological opinions on these presentations in members with already assessed mental health, on a case-by-case basis.

 

Chapter 14 Gastrointestinal Impairment:

 

Gastrointestinal (GI) disorders have an increased incident rate among individuals with PTSD, GAD, and MDD, compared to those without these chronic conditions. The chronic stress, neurochemical imbalances, and alterations in autonomic function associated with these mental health conditions contribute to a range of GI symptoms, from irritable bowel syndrome and acid reflux to more serious conditions like peptic ulcers and inflammatory bowel disease. The interaction between the gut and brain (the brain-gut axis) plays a central role in this relationship, and managing these conditions often requires addressing both the mental health disorder and the gastrointestinal symptoms simultaneously.

Gastrointestinal Impairments at Risk with chronic PTSD, GAD, and MDD:

• Irritable Bowel Syndrome (IBS): Abdominal pain, bloating, and alternating diarrhea/constipation.
• Gastroesophageal Reflux Disease (GERD): Heartburn, chest pain, and acid regurgitation.
• Peptic Ulcer Disease (PUD): Burning abdominal pain, nausea, and possible vomiting of blood.
• Functional Dyspepsia: Upper abdominal discomfort, bloating, nausea, and early fullness after eating.
• Chronic Constipation: Infrequent bowel movements, straining, and abdominal discomfort.
• Stress-Induced Diarrhea: Loose stools, urgency, abdominal cramps.
• Inflammatory Bowel Disease (IBD): Abdominal pain, diarrhea with blood/mucus, fatigue, weight loss.
• Functional Abdominal Pain Syndrome (FAPS): Chronic, stress-triggered abdominal pain without identifiable pathology.
• Gastroparesis: Nausea, vomiting, fullness after eating, and weight loss.
• Celiac Disease: Diarrhea, abdominal bloating, fatigue, and skin rashes (worsened by stress).

We have offered psychological opinions on these presentations in members with already assessed mental health, on a case-by-case basis.

 

Chapter 15 Endocrine and Metabolic Impairment:

Individuals with PTSD, GAD, and MDD are at an increased risk for a variety of endocrine and metabolic impairment conditions due to the chronic stress response and dysregulation of various physiological systems. The impact on hormones like cortisol, insulin, thyroid hormones, and sex hormones can contribute to a range of symptoms, including weight gain or loss, fatigue, changes in appetite, and metabolic issues like insulin resistance and type 2 diabetes. The pathophysiological mechanisms underlying these disorders often involve chronic activation of the Hypothalamic-Pituitary-Adrenal (HPA) axis, sympathetic nervous system, and inflammatory pathways, all of which can affect metabolic and endocrine functions.

Mechanisms Involved

1.  HPA axis is a critical part of the body’s neuroendocrine system that helps regulate:

• Stress response
• Mood and emotions
• Immune function
• Energy metabolism
• Digestion
• Sleep-wake cycles

Here’s how it works:

1. Hypothalamus (in the brain) detects stress and signals the pituitary gland.
2. Pituitary gland releases ACTH (Adrenocorticotropic Hormone).
3. Adrenal glands (on the kidneys) respond by releasing cortisol and other stress hormones.

Overactivation or dysregulation of the HPA axis—often due to chronic stress or trauma—can lead to issues like PTSD, anxiety, depression, and various physical health conditions.

Common Endocrine and Metabolic Condition Impairments Associated with Chronic PTSD, GAD and/or MDD:

• Cortisol Dysregulation (Hypocortisolism/Hypercortisolism)
• Thyroid Dysfunction (Hypothyroidism/Hyperthyroidism)
• Insulin Resistance/Type 2 Diabetes
• Obesity
• Adrenal Insufficiency (Addison's Disease)
• Osteoporosis and Bone Density Loss
• Sex Hormone Imbalance (Low Testosterone, Low Estrogen)
• Growth Hormone Deficiency

We have offered psychological opinions on these presentations in members with already assessed mental health, on a case-by-case basis.

 

Chapter 16 Urinary, Sexual, Reproductive, and Breast Impairment:

PTSD, GAD, and MDD can have significant and lasting effects on the urinary, sexual, and reproductive systems, as well as breast health, due to complex interactions involving hormonal imbalances, chronic sympathetic nervous system activation, and sustained psychological stress. A combined, multidisciplinary approach to diagnosis and treatment—integrating both physical and mental health—is essential for improving outcomes.

Mechanisms Involved

1. HPA Axis Dysregulation

• Chronic stress leads to dysregulation of the Hypothalamic-Pituitary-Adrenal (HPA) axis, resulting in abnormal cortisol levels.
• Cortisol and other stress hormones can suppress reproductive hormone production, such as testosterone, estrogen, and progesterone, disrupting normal reproductive function.
• This hormonal imbalance can lead to infertility, menstrual irregularities, and sexual dysfunction.

2. Sympathetic Nervous System Overactivation

• PTSD and anxiety disorders often result in prolonged activation of the sympathetic (“fight or flight”) nervous system.
• This sustained state contributes to urinary urgency, frequency, and incontinence, as the bladder becomes hypersensitive to stress signals.
• Sexual arousal and function are impaired when the body remains in a heightened state of alert, reducing blood flow and interfering with normal physiological responses.

3. Neurochemical Imbalances

• Depression and anxiety alter levels of key neurotransmitters like serotonin, dopamine, and norepinephrine, which play vital roles in libido, arousal, orgasm, and mood regulation.
• Low serotonin and dopamine levels can lead to low libido, anorgasmia, and erectile dysfunction, often compounded by medication side effects (e.g., SSRIs effective in treating the mental health conditions in combination with psychotherapy).

4. Endocrine Disruption

• Long-term psychological distress can affect the hypothalamic-pituitary-gonadal (HPG) axis, impairing the secretion of sex hormones.
• In females, this may cause amenorrhea (absence of menstruation) or polycystic ovary syndrome (PCOS). In males, it can result in low testosterone levels, decreased sperm count, and reduced sexual performance.

5. Immune and Inflammatory Pathways

• Chronic stress and depression increase systemic inflammation, which may contribute to conditions like interstitial cystitis, pelvic pain syndromes, and breast tissue sensitivity or fibrocystic changes.
• Stress-induced hormonal imbalances can also elevate prolactin, potentially contributing to breast pain (mastalgia) and increasing breast cancer risk in some individuals.

This interconnectedness underscores the importance of integrating psychological care with medical evaluation and treatment, especially for Veterans and RCMP members whose service-related mental health conditions may manifest with significant physical consequences.

Summary of Possible Diagnoses and Symptoms in Urinary, Sexual, Reproductive, and Breast Impairments Due to PTSD, GAD, and MDD:

• Urinary Impairments:
  • Urinary Incontinence: Leakage with exertion or sudden urges.
  • Frequent Urination/Nocturia: Increased need to urinate during the day and night.
  • Interstitial Cystitis: Pelvic pain, frequent urination, and painful intercourse.
• Sexual Impairments:
  • Sexual Dysfunction: Erectile dysfunction, low libido, and anorgasmia.
  • Premature Ejaculation: Early ejaculation with minimal control.
  • Dyspareunia: Painful intercourse and vaginal dryness.
• Reproductive Impairments:
  • Menstrual Irregularities: Amenorrhea, dysmenorrhea, and menorrhagia.
  • Infertility: Difficulty conceiving due to hormonal disruption.
  • Polycystic Ovary Syndrome (PCOS): Irregular periods, excess hair, and acne.
• Breast Impairments:
  • Breast Pain (Mastalgia): Aching or tightness in breast tissue.
  • Fibrocystic Breast Changes: Lumps, cysts, and breast density changes.
  • Increased Breast Cancer Risk: Exacerbated by stress-induced hormonal imbalances.

We have offered psychological opinions on these presentations in members with already assessed mental health, on a case-by-case basis.

 

Chapter 17 Musculoskeletal Impairment:

Conditions with neurologic involvement that are rated within this chapter include:

• brain injury or disease resulting only in upper or lower limb effects but not both
• spinal cord injury or disease (including central spinal stenosis, but excluding spinal cord injury or disease which affects the function of both the upper and lower limbs)
• nerve root compression lesions of the spine
• complex regional pain syndromes Type 1 and Type 2
• compartment syndrome
• thoracic outlet syndrome
• peripheral neurological conditions affecting the limbs which are not rated from Table 20.5 contained within Chapter 20, Neurological Impairment.

A rating is not given from this chapter for the conditions listed below. Each bullet indicates the appropriate chapter to be used.

• Impairment from spinal cord injury or disease which affects the function of both the upper and lower limbs is rated within Chapter 19, Activities of Daily Living.
• Impairment from peripheral vascular conditions is rated within Chapter 13, Hypertension and Vascular Impairment.
• Impairment from pain disorders recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and chronic pain syndrome is rated within Chapter 21, Psychiatric Impairment and Chapter 19, Activities of Daily Living. The ratings are compared and the highest selected.
• Impairment from musculoskeletal conditions that have global body effects such as rheumatoid arthritis, generalized osteoarthritis and ankylosing spondylitis is rated within Chapter 19, Activities of Daily Living.
• Thoracic outlet syndrome causing vascular impairment only is rated within Chapter 13, Hypertension and Vascular Impairment.
• Impairment from thoracoplasty due to tuberculosis is rated within Chapter 24, Tuberculosis Impairment.
• Impairment from malignant musculoskeletal conditions is rated within Chapter 18, Malignant Impairment. Follow the steps contained within the Malignant Impairment chapter.

For the neurological conditions listed, there are several ways that mental health can play a role—both in contributing to the development or persistence of symptoms, and in the overall treatment and rehabilitation process.

Here’s a breakdown of the possible mental health contributions and the role of psychological treatment for these conditions:

Possible Mental Health Contributions:

1. Chronic Stress and PTSD
   • PTSD and prolonged stress can exacerbate neurological symptoms such as chronic pain, spasticity, or sensory disturbances.
   • In some cases, stress-related inflammation may worsen nerve irritation or contribute to conditions like complex regional pain syndrome (CRPS) or thoracic outlet syndrome.
2. Somatization or Functional Overlay
   • Individuals with depression, anxiety, or trauma histories may experience an intensification of neurological symptoms (e.g., pain, numbness, weakness), even when the structural damage is mild.
   • Psychological distress can manifest physically, complicating the clinical picture and requiring integrated care.
3. Pain Perception and Processing
   • Mental health conditions affect how pain is perceived. PTSD, depression, and anxiety often lower pain thresholds and increase pain sensitivity.
   • In conditions like CRPS or nerve root compression, emotional factors can heighten pain and make it more resistant to physical treatment alone.
4. Adjustment and Disability-Related Stress
   • Experiencing a neurological condition—especially one that impairs function—can lead to grief, identity loss, social isolation, and depression.
   • Veterans may feel frustration or anger due to changes in independence and performance, especially if pain limits return to previous roles.

Psychological Treatment Contributions at our KPG Clinic (This is a specific treatment section to musculoskeletal issues with mental health; See more treatment in the final pages of this larger document):

1. Pain Management and Coping Strategies
   • Cognitive Behavioural Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help patients manage chronic pain, shift unhelpful thinking, and develop adaptive coping mechanisms.
   • These therapies are evidence-based for CRPS, neuropathic pain, and other chronic neurological pain syndromes.
2. Trauma-Informed Care
   • If PTSD or trauma is contributing to symptom exacerbation or functional overlay, trauma-focused therapies such as Accelerated Resolution Therapy (ART), EMDR, or Prolonged Exposure Therapy may significantly reduce symptom intensity.
   • Reducing trauma-related activation can help reduce autonomic arousal, muscle tension, and inflammation—indirectly improving physical symptoms.
3. Mood and Anxiety Stabilization
   • Treatment for co-occurring MDD or GAD can reduce fatigue, improve sleep, enhance pain tolerance, and restore motivation for rehabilitation.
4. Behavioural Activation and Rehabilitation Support
   • Psychologists and our multidisciplinary clinicians can support motivation, goal setting, and engagement in physiotherapy, occupational therapy, or return-to-function programs.
   • Addressing fear-avoidance behaviours (e.g., avoiding movement due to pain) can reduce deconditioning and improve outcomes.
5. Psychoeducation and Family Support
   • Helping individuals and families understand the mind-body connection can reduce stigma, increase adherence to treatment, and enhance holistic recovery.

In the VAC Context:

• Chronic pain syndromes with mental health features may warrant rating from both Chapter 21 (Psychiatric Impairment) and Chapter 19 (Activities of Daily Living).
• Our psychologists can provide an expert opinion on whether a psychological condition (e.g., PTSD, chronic pain disorder, somatoform disorder) is contributing to the neurologic symptoms and how significant