P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e M i n i s t r y o f S o c i a l r e c o n s i d e r a t i o n d e c i s i o n d a t e d A u g u s t 2 7 , 2 0 1 4 i n w n o t e l i g i b l e f o r M o n t h l y N u t r i t i o n a l S u p p l e m e n t s ( M N n u t r i t i o n a l i t e m s p u r s u a n t t o s e c t i o n 6 7 ( 1 . 1 ) , a n d S c A s s i s t a n c e f o r P e r s o n s w i t h D i s a b i l i t i e s R e g u l a t i o n 1 . A m e d i c a l p r a c t i t i o n e r h a s n o t c o n f i r m e d t h a t t h e a s a d i r e c t r e s u l t o f a c h r o n i c , p r o g r e s s i v e d e t e r i o r a c o n d i t i o n a s r e q u i r e d b y s u b s e c t i o n 6 7 ( 1 . 1 ) ( b ) o f t h 2 . A m e d i c a l p r a c t i t i o n e r h a s n o t c o n f i r m e d t h a t t h e s u p p l e m e n t t o a l l e v i a t e a s y m p t o m o f a c h r o n i c , p r o o b t a i n t h e i t e m s w i l l r e s u l t i n i m m i n e n t d a n g e r t o h e o f t h e E A P W D R . 3 . T h e M i n i s t r y w a s n o t s a t i s f i e d t h a t t h e A p p e l l a n t r c a l o r i c s u p p l e m e n t a t i o n t o a r e g u l a r d i e t a r y i n t a k e a E A P W D R . I n a d d i t i o n , a m e d i c a l p r a c t i t i o n e r h a s n i t e m s t o a l l e v i a t e a s y m p t o m o f a c h r o n i c , p r o g r e s s i t h e i t e m s w i l l r e s u l t i n i m m i n e n t d a n g e r t o h e r l i f e a s E A P W D R P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b S c h e d u l e C s e c t i o n 7D e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ( M i n i s t r y ) h i c h t h e M i n i s t r y d e t e r m i n e d t h a t t h e A p p e l l a n t i s S ) , s p e c i f i c a l l y v i t a m i n s a n d m i n e r a l s a n d h e d u l e C s e c t i o n 7 o f t h e E m p l o y m e n t a n d ( E A P W D R ) f o r t h e f o l l o w i n g r e a s o n s : A p p e l l a n t d i s p l a y s t w o o r m o r e l i s t e d s y m p t o m s t i o n o f h e a l t h o n a c c o u n t o f a s e v e r e m e d i c a l e E A P W D R . A p p e l l a n t r e q u i r e s a v i t a m i n o r m i n e r a l g r e s s i v e d e t e r i o r a t i o n o f h e a l t h a n d t h a t f a i l u r e t o r l i f e a s r e q u i r e d b y s u b s e c t i o n s 6 7 ( 1 . 1 ) ( c ) a n d ( d ) e q u i r e s a d d i t i o n a l n u t r i t i o n a l i t e m s a s p a r t o f a s s e t o u t i n S c h e d u l e C s e c t i o n 7 o f t h e o t c o n f i r m e d t h a t t h e A p p e l l a n t r e q u i r e s n u t r i t i o n a l v e d e t e r i o r a t i o n o f h e a l t h a n d t h a t f a i l u r e t o o b t a i n r e q u i r e d b y s u b s e c t i o n s 6 7 ( 1 . 1 ) ( c ) a n d ( d ) o f t h e i l i t i e s R e g u l a t i o n ( E A P W D R ) s e c t i o n 6 7 , a n d
PART E -Summarv of Facts The evidence before the Ministry at the time of the reconsideration consisted of: 1) The Appellant's Request for Reconsideration dated July 23, 2014 with a note dated July 15 th requesting a time extension for the reconsideration because the Appellant was being referred to "Internal Medicine for a better diagnosis for treating her symptoms and a more detailed explanation of what she needs in terms of supplements." 2) A letter from the Ministry to the Appellant dated July 21, 2014 asking her to sign and date her Request for Reconsideration so that her request for a time extension can be processed. 3) An Application for a Monthly Nutritional Supplement completed by the Appellant's physician on April 22, 2014 who stated the following: a) Under the heading Diagnosis (severe medical conditions), the physician indicated: o Diabetic Gastroparesis: delayed gastric emptying resulting in nausea and vomiting; o Irritable bowel syndrome: causing nausea and constipation and diarrhea; o Hiatus hernia: Gastroesophagal reflux; • Chronic pain syndrome: nausea and vomiting. b) In response to the question of whether the Appellant is being treated for a chronic, progressive deterioration of health due to her severe medical conditions, the physician indicated: • Diabetes Type I: insulin dependent lifelong; • Chronic pain syndrome: medications. c) In response to the question of whether the Appellant displays two or more of the legislated symptoms under section 67 (1.1) of the EAPWDR as a direct result of a chronic, progressive deterioration of health, the physician noted: • Underweight status: yes -Body Mass Index (BMI) 22; • Significant deterioration of a vital organ: pancreas. d) The Appellant's height is recorded as 170 cm, and weight is 65 kg. e) Under the heading Vitamin or Mineral Supplementation, when asked to specify the vitamin or mineral supplements required and expected duration of need, the physician wrote: • "vege greens and phyto berries"; • gluten free diet, kidney care diet. f) When asked to describe how this item will alleviate the specific symptoms identified, the physician wrote: "provide nutrients for daily living because patient does not tolerate solid food well." g) When asked to describe how this item or items will prevent imminent danger to the applicant's life the physician wrote: "If patient cannot eat well she will need supplements that are conducive to her health issues to keep her functioning on a daily basis." h) Under the heading Nutritional Items, in specifying additional nutritional items required, the physician indicated "vege greens and phytoberries. Protein smoothies or shakes. This is due to diabetes complications which she will have life long." i) In response to the question of whether the Appellant has a medical condition that results in the inability to absorb sufficient calories to satisfy daily requirements through a regular dietary intake the ohvsician wrote: "Insulin deoendent -diabetic aastrooaresis results in decreased
cal ori c in tak e as makes her vom it a lo t and if (il leg ilb le ) . " j ) When asked t o des cr ib e ho w the nutr itiona l it sy m pto ms (i n pa rag rap h (b) of section 67(1 . 1 regula r d i e t, the phys ici an stated: "A mo r e li quid hers elf. P rot ein s ha k e s as n ot a ble to tolerate s k ) When aske d to des cribe ho w th e nutri tion al items w App ella nt's li fe t he phys ic ian w r ote: "Lo w pro 4 ) A letter to th e Appellant fro m the M inis try dated July 3, 201 D eci sion S u mma r y d at ed M ay 1, 201 4, denyi ng the A 5) Th e M inist ry note d t he fo llo wing in its rec onsi derati • The Appell ant is a P erson with Di sab ili tie s in • N o new i nformation w as received by Au gu st e x te ns i on; • The App ellant may qu a li f y for a mont hly di et supplem pursuant to sectio n 8 o f Sched ule C o f the EA The M inistry re l ied on the r econs ider ation d ecision at t inf ormat ion e x cept to i ndi c ate t hat th e no r m al BMI rang At th e hea r in g, th e App ellant ad ded t hat s he d i d not fo r s ubmitting a ddition al i nfor m ation; tha t she ha d trie w ho had wo rk e d with her a lo t call e d in si ck; and that intern al medic ine s pe c ialist. These tests ar e on going and g as tric em pty i ng s tudy. The A ppe ll ant also s t ated that all owance as she "ne ede d to figure out ho w. " The Pa n el finds t hat the a bove st at e me nts r elat e to the and to the Appe lla nt's attem pts t o ob t a in further in fo needs. The Panel admits t hem p ursuant to sect ion as evi d ence in support of in for m ation and records tha decision being appealed was made. The Panel makes the following finding of fa ct: A medical practitioner has confirmed that as a direct result of the chronic, progressive deterioration of health, t he Appellant displays one of the symp toms significant deterioration of a vital organ pancreas. not vomit ing then ver y nauseous ma kes ems wi ll alle viate one o r more of the l eg i slate d )) and p r o vide calor i c supplem entation t o a d ie t o f cal oric intak e ( s ic) nee ds to no urish oli d protei n." i ll pr ev ent imm inen t d ang er t o the tein can l ead to serio us he al t h proble ms." 4 and a Mont hly Nutriti onal Supple ment pp ellant 's appl ication for M N S. on d ecis ion: re ceip t o f di sabi lity assist ance; 27, 20 14 f urth er to t he Appellant's request fo r an ent of $3 5 fo r a person who has diab etes PWDR. h e he aring and did not sub mit any furt her e f o r t he Appe l la nt's he ig ht is 18.5 -2 5. know t h e Min is t ry h ad app r ove d a tim e extension d to obtain i nformation bu t th e nurse p racti t i o ner s he is c u r rentl y u nde rgoing test s with an s he has not yet r ec eiv ed t he result s o f a s he ha d not y e t appl ied fo r a diab etic di e t Mini stry 's earlier inform ation reg arding BM I, rmatio n ab out h er symp tom s and n ut rition al 22 (4)(b ) o f the Emp l oy ment a nd Assis tance Act t were befo r e the Ministry at the time the listed in p aragr a ph (b) o f section 67(1.1 ):
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e i n t h i s a p p e a l i s w h e t h e r t h e M i n i s t r y ' s d e M N S , s p e c i f i c a l l y v i t a m i n s a n d m i n e r a l s a n d n u t r i t i o S c h e d u l e C s e c t i o n 7 o f t h e E A P W D R w a s r e a s o n a r e a s o n a b l e i n t e r p r e t a t i o n o f t h e a p p l i c a b l e e n a c t m e T h e r e l e v a n t s e c t i o n s o f t h e l e g i s l a t i o n a r e a s f o l l o w E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D N u t r i t i o n a l s u p p l e m e n t 6 7 ( 1 ) T h e m i n i s t e r m a y p r o v i d e a n u t r i t i o n a l s u p p l e n u t r i t i o n a l s u p p l e m e n t ] o f S c h e d u l e C t o o r f o r a p e d i s a b i l i t y a s s i s t a n c e u n d e r ( a ) s e c t i o n 2 [ m o n t h l y s u p p o r t a l l o w a n c e ] , 4 [ m o n t h a n d b o a r d ] o r 9 [ p e o p l e i n e m e r g e n c y s h e l t e r s a n d ( b ) s e c t i o n 8 [ p e o p l e r e c e i v i n g s p e c i a l c a r e ] o f S c h e d r u g t r e a t m e n t c e n t r e i f t h e m i n i s t e r i s s a t i s f i e d t h a t ( c ) b a s e d o n t h e i n f o r m a t i o n c o n t a i n e d i n t h e f o r m r s e t o u t i n s u b s e c t i o n ( 1 . 1 ) ( a ) t o ( d ) a r e m e t i n r e s p e ( d ) t h e p e r s o n i s n o t r e c e i v i n g a s u p p l e m e n t u n d e r s S c h e d u l e C , ( e ) t h e p e r s o n i s n o t r e c e i v i n g a s u p p l e m e n t u n d e r s ( f ) t h e p e r s o n c o m p l i e s w i t h a n y r e q u i r e m e n t o f t h e ( g ) t h e p e r s o n ' s f a m i l y u n i t d o e s n o t h a v e a n y r e s o u i t e m s f o r w h i c h t h e s u p p l e m e n t m a y b e p r o v i d e d . ( 1 . 1 ) I n o r d e r f o r a p e r s o n w i t h d i s a b i l i t i e s t o r e c e i v e m i n i s t e r m u s t r e c e i v e a r e q u e s t , i n t h e f o r m s p e c i f i e p r a c t i t i o n e r o r n u r s e p r a c t i t i o n e r , i n w h i c h t h e p r a c t i t ( a ) t h e p e r s o n w i t h d i s a b i l i t i e s t o w h o m t h e r e q u e s t c h r o n i c , p r o g r e s s i v e d e t e r i o r a t i o n o f h e a l t h o n a c c o u ( b ) a s a d i r e c t r e s u l t o f t h e c h r o n i c , p r o g r e s s i v e d e t e m o r e o f t h e f o l l o w i n g s y m p t o m s : ( i ) m a l n u t r i t i o n ; ( i i ) u n d e r w e i g h t s t a t u s ; ( i i i ) s i g n i f i c a n t w e i g h t l o s s ; ( i v ) s i g n i f i c a n t m u s c l e m a s s l o s s ; ( v ) s i g n i f i c a n t n e u r o l o g i c a l d e g e n e r a t i o n ; ( v i ) s i g n i f i c a n t d e t e r i o r a t i o n o f a v i t a l o r g a n ; ( v i i ) m o d e r a t e t o s e v e r e i m m u n e s u p p r e s s i o n ; ( c ) f o r t h e p u r p o s e o f a l l e v i a t i n g a s y m p t o m r e f e r r e d m o r e o f t h e i t e m s s e t o u t i n s e c t i o n 7 o f S c h e d u l e C ( d ) f a i l u r e t o o b t a i n t h e i t e m s r e f e r r e d t o i n p a r a g r a p l i f e .t e r m i n a t i o n t h a t t h e A p p e l l a n t i s n o t e l i g i b l e f o r n a l i t e m s , p u r s u a n t t o s e c t i o n s 6 7 ( 1 . 1 ) a n d b l y s u p p o r t e d b y t h e e v i d e n c e , o r w a s a n t i n t h e c i r c u m s t a n c e s o f t h e A p p e l l a n t . s : i s a b i l i t i e s R e g u l a t i o n m e n t i n a c c o r d a n c e w i t h s e c t i o n 7 [ m o n t h l y r s o n w i t h d i s a b i l i t i e s i n a f a m i l y u n i t w h o r e c e i v e s l y s h e l t e r a l l o w a n c e ] , 6 [ p e o p l e r e c e i v i n g r o o m t r a n s i t i o n h o u s e s ] o f S c h e d u l e A , o r d u l e A , i f t h e s p e c i a l c a r e f a c i l i t y i s a n a l c o h o l o r e q u i r e d u n d e r s u b s e c t i o n ( 1 . 1 ) , t h e r e q u i r e m e n t s c t o f t h e p e r s o n w i t h d i s a b i l i t i e s , e c t i o n 2 ( 3 ) [ g e n e r a l h e a l t h s u p p l e m e n t ] o f u b s e c t i o n ( 3 ) o r s e c t i o n 6 6 [ d i e t s u p p l e m e n t s ] . m i n i s t e r u n d e r s u b s e c t i o n ( 2 ) , a n d r c e s a v a i l a b l e t o p a y t h e c o s t o f o r t o o b t a i n t h e a n u t r i t i o n a l s u p p l e m e n t u n d e r t h i s s e c t i o n , t h e d b y t h e m i n i s t e r , c o m p l e t e d b y a m e d i c a l i o n e r h a s c o n f i r m e d a l l o f t h e f o l l o w i n g : r e l a t e s i s b e i n g t r e a t e d b y t h e p r a c t i t i o n e r f o r a n t o f a s e v e r e m e d i c a l c o n d i t i o n ; r i o r a t i o n o f h e a l t h , t h e p e r s o n d i s p l a y s t w o o r t o i n p a r a g r a p h ( b ) , t h e p e r s o n r e q u i r e s o n e o r a n d s p e c i f i e d i n t h e r e q u e s t ; h ( c ) w i l l r e s u l t i n i m m i n e n t d a n g e r t o t h e p e r s o n ' s
(2) In order to determine or confirm the need or continuing need of a person for whom a supplement is provided under subsection (1) , the minister may at any time require that the person obtain an opinion from a medical practitioner or nurse practitioner other than the practitioner referred to in subsection (1) (c). Schedule C Monthly nutritional supplement 7 The amount of a nutritional supplement that may be provided under section 67 [nutritional supplement] of this regulation is the sum of the amounts for those of the following items specified as required in the request under section 67 (1) (c): (a) for additional nutritional items that are part of a caloric supplementation to a regular dietary intake, up to $165 each month; (b) Repealed. [B.C. Reg. 68/2010, s. 3 (b).] (c) for vitamins and minerals, up to $40 each month. Appellant's position The Appellant's position, as stated in her Notice of Appeal dated September 6, 2014, is that she requires meal replacements and supplements to be able to minimally function daily due to chronic, debilitating nausea and vomiting which make her very ill. At the hearing, she added: "I get pretty much no nutrition because I can't keep solid food down. Sometimes I can keep a smoothie down and as long as I have something in my stomach I can get nutrition." She argued that she does meet the legislative criteria of "two or more of the following symptoms" because both the Ministry in its reconsideration decision and her doctor on the MNS application form indicated that she has other symptoms including nausea, vomiting, constipation, and slow gastric emptying. She is not sure how the Ministry can say that she has only one symptom when diabetes is an auto immune disease that falls under "moderate to severe immune suppression" per clause (vii) of EAPWDR subsection 67(1. 1 )(b). The Appellant argued that she also has malnutrition per clause (i) of subsection 1. 1 (b) because she will be malnourished if she can't keep food down and absorb nutrition into her body. With regard to Schedule C of the EAPWDR, while the Ministry stated that there is no evidence that she requires more food (caloric supplementation) than would be required to meet her regular dietary intake, her doctor said that she does require a more liquid caloric intake including protein shakes. She cannot tolerate solid protein and low protein leads to serious health issues. The Appellant further argued that her doctor did state the items specifically needed for Schedule C of the EAPWDR indicating that she requires vitamins and minerals as well as "vege greens and phyto berries". She submitted that she is eligible for 3 out of the 9 options for a diet supplement under Schedule C section 8, including $35 for diabetes and allowances for specific diets including gluten free. In her Notice of Appeal, she affirmed that she cannot eat gluten and requires a kidney (care) diet as prescribed by her doctor.
Ministry's position The Ministry 's positi on is that the Appellant's reques nutritional items, do e s not meet all of the criteria in the EAPWDR eligible f or th e it e ms specified by her p hysicia n. The with Disab ilities in re ci p i e nt of disab ility assistance in a and her application for MNS wa s in th e form specified by the Mi medical pra ctitioner purs u ant to section 67(1.1) . The Ministry was also satisfie practi tione r is treati ng the Appellant for a chronic, pro severe medical conditi ons pursuant to subsection 67(1.1 )(a): Dia sy n d r o m e, hia t us hernia, and chronic pain syndr ome. th e following criteria were met: EAPWDR subse cti on 67(1 .1 )(b): the person displays two or more (of the listed) sym W i th rega rd to the sym pto m s l i s te d in subsection 67 from the Appel lant's phys ici a n indicates that a s a di deteri ora ti on of he alt h , t he A pp ellan t d isp lays only o deteriorati o n of a vit al or gan ( pa n creas) . Although t he under weight statu s with a BMI of 22 , t he Ministry argued of ( h e r) a ge and is not repre sen t ative of under w e i ght st r econsiderati on decisio n tha t t h ere is no inf or m ati o n mu s cle mass . EAPWD R su bsect ion 6 7(1.1 ) (c ): nutritional it e m s r eq p aragraph ( b l V itamin/mineral supplementatio n The Mi n i str y arg u ed t hat t he Appe l l ant 's ph ysician did n required and that the items he identified under vitamin berries", and s p e cifi c di e t s) are no t a vitamin or mine c onsidered under the criteria for th o se items. The Ministry argued that in any event, the crite needing vitamins and minerals for the pu rpose of alleviating the l met. In particular, the Ministry was not satisfied that the physician's com daily living because patient does not tolerate solid food well vitamin/mineral supplement would alleviate the symptom of significant (panc rea s ). Nutri tional items The Ministry argued that the physician's request for "vege greens and phyla berrie s mooth i es or sha kes" due to lifelong complications of dia items will allev iate the identifie d symptom (significant deterioration of the pancreas). also argued that the physician's prescription for a liquid protein diet did not address the alleviation this symptom. t for MNS, spec i f i c all y vi t a mins and minerals, and and the Appellant is th erefore not Ministr y not e d that the Appe l lan t is a Per son c cordance w i t h s ection 67 (1) o f the EAPWDR n i s try and it w a s c o m pleted by a d that a medica l g ressiv e deterioratio n of health on acc o unt of betic ga s troparesis, irritable bowe l However, the Ministry was not satisfied that p toms (1.1 )(b), the M ini s t r y ar g ue d t hat the informatio n rect r es ul t o f her ch roni c, prog ressive ne o f t h e symptoms o n t h e li st: (vi) signi f i cant p hy s i c i an a lso i n di cated tha t th e A p pellant has that "th is is wit hin n orma l lim its for a fe m ale a t us." Th e Ministry f urt her noted in i t s to sug gest sign i ficant weight l oss or los s of u i r ed to a l levia te a sy m pt o m de s cribed in ot specif y whi ch vit amins/mineral s wer e s a n d m in erals ("vege gr ee ns a nd phyto ral, but rathe r ad ditiona l nutrit ional i te m s to b e rion of egislated s ymptoms had not been ment "provide nutrients for " adequately describes how a deterioration of a vital organ s, protein be tes does not add ress h o w the s e nutritional The Ministry of
E A P W D R s u b s e c t i o n 6 7 ( 1 . 1 ) ( d ) : I m m i n e n t d a n g e r t i t e m s V i t a m i n / m i n e r a l s u p p l e m e n t a t i o n T h e M i n i s t r y a r g u e d t h a t s p e c i f i c v i t a m i n s / m i n e r a l s a n d i n a n y e v e n t , h i s c o m m e n t " I f p a t i e n t c a n n o t e a c o n d u c i v e t o h e r h e a l t h i s s u e s t o k e e p h e r f u n c t i o n i t o o b t a i n t h e v i t a m i n / m i n e r a l s u p p l e m e n t w i l l r e s u l t r e q u i r e d b y s e c t i o n 6 7 ( 1 . 1 ) . T h e M i n i s t r y n o t e d t h a t h a t t h e d a n g e r t o l i f e i s l i k e l y t o h a p p e n s o o n . T h e l e g i s l a t i v e r e q u i r e m e n t w a s o r i g i n a l l y d r a f t e d f o r A I D i m m i n e n t d a n g e r t o t h e p e r s o n ' s l i f e b y p r o v i d i n g e s n u t r i t i o n a l n e e d s . N u t r i t i o n a l i t e m s T h e M i n i s t r y a r g u e d t h a t t h e p h y s i c i a n ' s c o m m e n t " d o e s n o t d e s c r i b e h o w t h e n u t r i t i o n a l i t e m s w i l l p r e v h e a r i n g , t h e M i n i s t r y a l s o a r g u e d t h a t t h i s c o m m e n t c o n d i t i o n s b u t i s a g e n e r a l i z a t i o n r e g a r d i n g h e a l t h e E A P W D R S c h e d u l e C s e c t i o n 7 : n u t r i t i o n a l i t e m s a r d i e t a ry i n t a k e T h e M i n i s t r y a r g u e d i t w a s n o t s a t i s f i e d t h a t t h e A p p a n d p r o t e i n s m o o t h i e s a n d s h a k e s a s p a r t o f a c a l o r M i n i s t r y n o t e d t h e p h y s i c i a n ' s s t a t e m e n t " i n s u l i n d e p d e c r e a s e d c a l o r i e i n t a k e a s m a k e s h e r v o m i t a l o t . . . d i e t i s r e c o m m e n d e d " t h i s c o u l d b e a c h i e v e d b y i n c l p o w d e r s i n t o a s h a k e " . T h e M i n i s t r y a l s o a r g u e d t h a l i q u i d d i e t w o u l d i n v o l v e c o n s u m i n g m o r e f o o d ( c a l o m e e t t h e A p p e l l a n t ' s r e g u l a r d i e t a r y i n t a k e . T h e M i n i s t r y f u r t h e r a r g u e d t h a t b a s e d o n a B M I o f 2 t h e A p p e l l a n t w a s d i s p l a y i n g t h e s y m p t o m s o f u n d e r w o u l d d e m o n s t r a t e t h a t s h e r e q u i r e s c a l o r i c s u p p l e m P a n e l ' s d e c i s i o n I n o r d e r f o r a r e c i p i e n t o f d i s a b i l i t y a s s i s t a n c e t o b e e m i n e r a l s a n d n u t r i t i o n a l i t e m s u n d e r s e c t i o n 6 7 o f t h e a l o n g w i t h t h e a d d i t i o n a l c r i t e r i a i n S c h e d u l e C s e c t i o T h e c r i t e r i a i n s e c t i o n 6 7 ( 1 . 1 ) t h a t t h e M i n i s t r y d e t e r m s y m p t o m s m u s t b e d i s p l a y e d ; t h e r e q u e s t f o r n u t r i t i o m i n e r a l s a n d n u t r i t i o n a l i t e m s f o r t h e o u r o o s e o f a l l e o l i f e d u e t o f a i l u r e t o o b t a i n r e q u e s t e d n u t r i t i o n a l w e r e n o t i d e n t i f i e d b y t h e A p p e l l a n t ' s p h y s i c i a n t w e l l s h e w i l l n e e d s u p p l e m e n t s t h a t a r e n g o n a d a i l y b a s i s " d o e s n o t a d d r e s s h o w f a i l u r e i n i m m i n e n t d a n g e r t o t h e A p p e l l a n t ' s l i f e a s t " i m m i n e n t " r e f e r s t o a n i m m e d i a t e s i t u a t i o n s u c h M i n i s t r y e x p l a i n e d a t t h e h e a r i n g t h a t t h i s S p a t i e n t s w i t h s y m p t o m s o f w a s t i n g , t o p r e v e n t s e n t i a l , s p e c i f i e d i t e m s t o s u p p l e m e n t r e g u l a r l o w p r o t e i n c a n l e a d t o s e r i o u s h e a l t h p r o b l e m s " e n t i m m i n e n t d a n g e r t o t h e A p p e l l a n t ' s l i f e . A t t h e i s n o t d i r e c t e d a t t h e A p p e l l a n t ' s s p e c i f i c h e a l t h f f e c t s t h a t c o u l d h a p p e n a t a f u t u r e t i m e . e p a r t o f a c a l o r i c s u p p l e m e n t a t i o n t o a r e g u l a r e l l a n t r e q u i r e s " v e g e g r e e n s a n d p h y l a b e r r i e s " , i c s u p p l e m e n t a t i o n t o h e r r e g u l a r d i e t . T h e e n d e n t d i a b e t i c g a s t r o p a r e s i s r e s u l t s i n a n d n a u s e a t e d " , b u t a r g u e d t h a t w h i l e a l i q u i d u s i o n o f r e g u l a r f r u i t s , v e g e t a b l e s a n d p r o t e i n t t h e r e i s n o e v i d e n c e t h a t t h e r e c o m m e n d e d r i c s u p p l e m e n t a t i o n ) t h a n w o u l d b e r e q u i r e d t o 2 , t h e A p p e l l a n t ' s p h y s i c i a n d i d n o t c o n f i r m t h a t w e i g h t s t a t u s o r s i g n i f i c a n t w e i g h t l o s s w h i c h e n t a t i o n o v e r a n d a b o v e h e r r e g u l a r d i e t . l i g i b l e f o r M N S , s p e c i f i c a l l y v i t a m i n s a n d E A P W D R , a l l o f t h e c r i t e r i a i n s e c t i o n 6 7 ( 1 . 1 ) , n 7 m u s t b e s a t i s f i e d . i n e d w e r e n o t m e t a r e t h a t t w o o r m o r e l i s t e d n a l i t e m s m u s t i n c l u d e s p e c i f i c v i t a m i n s a n d v i a t i n a o n e o r m o r e o f t h e A n n e l l a n t ' s s v m o t o m s ;
a n d f a i l u r e t o o b t a i n t h e r e q u e s t e d i t e m s w i l l r e s u l t P a n e l n o t e s t h a t t h e s p e c i f i c n u t r i t i o n a l i t e m s s e t o u s u p p l e m e n t a t i o n t o a r e g u l a r d i e t a r y i n t a k e a n d t h e T h e P a n e l f u rt h e r n o t e s t h a t " c a l o r i c s u p p l e m e n t a t i o A p p e l l a n t ' s r e q u e s t f o r n u t r i t i o n a l i t e m s i s t h e r e f o r e p r o v i d e d b y h e r r e g u l a r d i e t . I n a d d i t i o n , a s t h e M i n i " i m m i n e n t d a n g e r " t o l i f e r e f e r s t o a n i m m e d i a t e s i t u l i k e l y t o h a p p e n s o o n . E A P W D R s u b s e c t i o n 6 7 / 1 . 1 ) / b ) : t h e p e r s o n d i s p l a y W h i l e t h e P a n e l n o t e s t h a t b o t h p a r t i e s a g r e e t h a t t h s i g n i f i c a n t d e t e r i o r a t i o n o f a v i t a l o r g a n ( p a n c r e a s ) , i n f o r m a t i o n a n d t h e M i n i s t r y ' s p o s i t i o n r e g a r d i n g t h e i n d i c a t e d t h a t t h e A p p e l l a n t h a s u n d e r w e i g h t s t a t u s a B M I o f 2 2 i s w i t h i n t h e n o r m a l r a n g e . T h e P a n e l p t h a t a B M ! o f 2 2 i s i n t h e m i d d l e o f t h e n o r m a l r a n g e i n f o r m a t i o n a t t h e h e a r i n g , s t a t i n g t h a t a B M I r a n g e A p p e l l a n t ' s h e i g h t . F u r t h e r , t h e P a n e l n o t e s t h a t t h e a b l e t o o b t a i n n u t r i t i o n , a l b e i t f r o m a l i q u i d p r o t e i n , g W i t h r e g a r d t o t h e A p p e l l a n t ' s a r g u m e n t t h a t h e r d o a n d v o m i t i n g , t h e E A P W D R m a k e s i t c l e a r t h a t t h e o e l i g i b i l i t y f o r M N S a r e t h e o n e s l i s t e d i n s u b s e c t i o n 1 v e r y w e l l d i s p l a y o t h e r s y m p t o m s , t h e M i n i s t r y c a n o r e g u l a t i o n a n d c o n f i r m e d b y a m e d i c a l p r a c t i t i o n e r . c l a u s e ( v i i ) , m o d e r a t e t o s e v e r e i m m u n e s u p p r e s s i o t h e M N S a p p l i c a t i o n f o r m . T h e M i n i s t r y a f f i r m e d a t t a p p l i c a t i o n , t h e c r i t e r i o n o f t w o o f m o r e s y m p t o m s c T h e P a n e l f i n d s t h a t b e c a u s e t h e p h y s i c i a n ' s i n f o r m s y m p t o m s a n d t h e p h y s i c i a n l e f t t h e r e s t o f t h e s y m p b l a n k , t h e M i n i s t r y r e a s o n a b l y d e t e r m i n e d t h a t t h e c E A P W D R s u b s e c t i o n 6 7 / 1 . 1 ) / c ) : n u t r i t i o n a l i t e m s r e q p a r a g r a p h ( b ) T h e P a n e l n o t e s t h a t t h i s s u b s e c t i o n r e f e r e n c e s " i t e m s p e c i f i e d i n t h e r e q u e s t . " S e c t i o n 7 i n t u r n r e f e r s t o " n u t r i t i o n a l i t e m s a n d s t a t e s t h a t t h e i t e m s a r e " a s r e q p u r p o s e o f a l l e v i a t i n g a s y m p t o m a s d e s c r i b e d a b o v T h e P a n e l n o t e s t h a t t h e A p p e l l a n t ' s p h y s i c i a n d i d n d i d s p e c i f y n u t r i t i o n a l i t e m s , h e m a d e n o s t a t e m e n t s p u r p o s e o f a l l e v i a t i n g t h e A p p e l l a n t ' s s y m p t o m o f s i g p a n c r e a s ) . F o r t h i s r e a s o n , t h e P a n e l f i n d s t h a t t h e i n i m m i n e n t d a n g e r t o t h e A p p e l l a n t ' s l i f e . T h e t i n S c h e d u l e C s e c t i o n 7 m u s t b e p a rt o f a c a l o r i c M i n i s t r y f o u n d t h a t t h i s c r i t e r i o n w a s a l s o n o t m e t . n " i n d i c a t e s a n e e d f o r a d d i t i o n a l c a l o r i e s . T h e a r e q u e s t f o r e x t r a c a l o r i e s b e y o n d t h o s e s t r y e x p l a i n e d i n i t s r e c o n s i d e r a t i o n d e c i s i o n , a t i o n s u c h t h a t t h e d a n g e r t o t h e A p p e l l a n t ' s l i f e i s s t w o o r m o r e ( o f t h e l i s t e d ) s y m p t o m s e A p p e l l a n t ' s p h y s i c i a n c o n f i r m e d t h a t s h e h a s t h e r e i s a d i s c r e p a n c y b e t w e e n t h e p h y s i c i a n ' s s y m p t o m o f u n d e r w e i g h t s t a t u s . T h e p h y s i c i a n d u e t o a B M ! o f 2 2 , w h i l e t h e M i n i s t r y a r g u e d t h a t l a c e s g r e a t e r w e i g h t o n t h e M i n i s t r y ' s e v i d e n c e b e c a u s e t h e M i n i s t r y p r o v i d e d a d d i t i o n a l b e t w e e n 1 8 . 5 a n d 2 5 i s n o r m a l w i t h r e g a r d t o t h e p h y s i c i a n ' s e v i d e n c e w a s t h a t t h e A p p e l l a n t i s l u t e n f r e e d i e t . c t o r r e p o r t e d v a r i o u s s y m p t o m s i n c l u d i n g n a u s e a , n l y s y m p t o m s t o b e c o n s i d e r e d i n d e t e r m i n i n g . 1 ( b ) c l a u s e s ( i ) t o ( v i i ) . W h i l e t h e A p p e l l a n t m a y n l y c o n s i d e r t h e o n e s t h a t a r e l i s t e d i n t h e S i m i l a r l y , t h e s y m p t o m t h e A p p e l l a n t n o t e d f r o m n , w o u l d n e e d t o b e r e p o r t e d b y h e r p h y s i c i a n o n h e h e a r i n g t h a t i f t h i s w e r e d o n e i n a n e w o u l d b e m e t . a t i o n d i d n o t c o n f i r m a n y o f t h e o t h e r l i s t e d t o m s e c t i o n o f t h e M N S a p p l i c a t i o n ( q u e s t i o n 3 ) r i t e r i o n i n s u b s e c t i o n 6 7 ( 1 . 1 ) ( b ) i s n o t m e t . u i r e d t o a l l e v i a t e a s y m p t o m d e s c r i b e d i n s s e t o u t i n s e c t i o n 7 o f S c h e d u l e C a n d s p e c i f i e d " v i t a m i n s a n d m i n e r a l s a n d a d d i t i o n a l u i r e d " u n d e r s u b s e c t i o n 6 7 ( 1 ) ( c ) ; t h a t i s , f o r t h e e ( u n d e r t h e " t w o o r m o r e s y m p t o m s " h e a d i n g ) . o t l i s t a n y s p e c i f i c v i t a m i n s / m i n e r a l s a n d w h i l e h e i n d i c a t i n g t h a t t h e n u t r i t i o n a l i t e m s w e r e f o r t h e n i f i c a n t d e t e r i o r a t i o n o f a v i t a l o r g a n ( h e r M i n i s t r v r e a s o n a b l y d e t e r m i n e d t h a t v i t a m i n s a n d
m i n e r a l s w e r e n o t s p e c i f i e d t o a l l e v i a t e t h i s s y m p t o f o o d s u p p l e m e n t s n o t v i t a m i n s ; a n d " g l u t e n f r e e " a n t y p e s o f d i e t s t h e y a r e n o t v i t a m i n s o r m i n e r a l s . T h e P a n e l a l s o f i n d s t h a t t h e M i n i s t r y r e a s o n a b l y d e e s t a b l i s h t h a t t h e s p e c i f i e d n u t r i t i o n a l i t e m s ( " v e g e g s h a k e s " ) w e r e r e q u i r e d t o a l l e v i a t e t h e d e t e r i o r a t i o n c o m m e n t " p r o v i d e n u t r i e n t s f o r d a i l y l i v i n g b e c a u s e a d d r e s s e s t h e A p p e l l a n t ' s n e e d f o r n u t r i e n t s . T h e p t h e n u t r i t i o n a l i t e m s i n c l u d i n g a l i q u i d p r o t e i n d i e t w c r i t e r i o n i n s u b s e c t i o n ( 1 . 1 ) ( c ) i s n o t m e t f o r n u t r i t i o n E A P W D R s u b s e c t i o n 6 7 / 1 . 1 ) / d ) : I m m i n e n t d a n g e r t i t e m s T h e P a n e l f i n d s t h a t t h e M i n i s t r y r e a s o n a b l y d e t e r m d a n g e r t o t h e A p p e l l a n t ' s l i f e i f v i t a m i n s a n d m i n e r a l t h e p h y s i c i a n ' s i n f o r m a t i o n f o r t h i s c r i t e r i o n w a s t h a t f u n c t i o n i n g o n a d a i l y b a s i s " a n d " l o w p r o t e i n c a n l e n o t e d , t h e p h y s i c i a n d i d n o t i n d i c a t e a n y i m m e d i a t e w e i g h t l o s s o r w a s t i n g , a n d t h e p h y s i c i a n d i d n o t i n d c a n b e f a l l t h e A p p e l l a n t i f s h e d o e s n o t c o n s u m e m o E A P W D R . S c h e d u l e C s e c t i o n 7 . N u t r i t i o n a l i t e m s a d i e t a ry i n t a k e T h e P a n e l f i n d s t h a t t h e M i n i s t r y r e a s o n a b l y d e t e r m a d d i t i o n a l n u t r i t i o n a l i t e m s w e r e r e q u i r e d a s p a r t o f a i n t a k e . T h e i n f o r m a t i o n f r o m t h e A p p e l l a n t ' s p h y s i c i a i n d i c a t e a B M I t h a t i s w i t h i n t h e n o r m a l r a n g e . T h i s i s u p p l e m e n t h e r r e g u l a r d i e t . F u r t h e r m o r e , t h e r e i s n c o n d i t i o n t h a t c a u s e s u n d e r w e i g h t s t a t u s o r w a s t i n g c a l o r i e s t o s a t i s f y d a i l y r e q u i r e m e n t s . I n r e s p o n s e t o t h e M i n i s t ry ' s f i n d i n g i n t h e r e c o n s i d e A p p e l l a n t r e q u i r e s " m o r e f o o d " t h a n w o u l d n o r m a l l y A p p e l l a n t a r g u e d t h a t h e r d o c t o r s t a t e d t h a t h e r d i a b i n t a k e " d u e t o v o m i t i n g a n d n a u s e a , a n d s h e n e e d s c a n n o t t o l e r a t e s o l i d p r o t e i n . T h e M i n i s t r y n o t e d t h a r e g u l a r f o o d s b l e n d e d t o g e t h e r w h i c h t h e P a n e l f i n d s f i n d s t h a t t h e M i n i s t r y r e a s o n a b l y d e t e r m i n e d t h a t a t o n a u s e a a n d v o m i t i n g i s n o t e q u i v a l e n t t o r e q u i r i n g A p p e l l a n t ' s r e g u l a r d i e t a r y i n t a k e .m b e c a u s e " v e g e g r e e n s a n d p h y t o b e r r i e s " a r e d " k i d n e y c a r e " a r e d e s c r i b e d b y t h e p h y s i c i a n a s t e r m i n e d t h a t t h e p h y s i c i a n ' s i n f o r m a t i o n d i d n o t r e e n s a n d p h y t o b e r r i e s , p r o t e i n s m o o t h i e s o r o f t h e A p p e l l a n t ' s p a n c r e a s . T h e p h y s i c i a n ' s p a t i e n t d o e s n o t t o l e r a t e s o l i d f o o d w e l l " h y s i c i a n h a s n o t p r o v i d e d i n f o r m a t i o n a b o u t h o w o u l d b e n e f i t p a n c r e a t i c f u n c t i o n i n g . T h u s , t h e a l i t e m s . o l i f e d u e t o f a i l u r e t o o b t a i n r e q u e s t e d n u t r i t i o n a l i n e d t h a t t h e r e w a s n o e v i d e n c e o f i m m i n e n t s a n d n u t r i t i o n a l i t e m s w e r e n o t o b t a i n e d b e c a u s e s h e w i l l n e e d s u p p l e m e n t s " t o k e e p h e r a d t o s e r i o u s h e a l t h p r o b l e m s . " A s t h e M i n i s t r y l i f e t h r e a t e n i n g s y m p t o m s s u c h a s s i g n i f i c a n t i c a t e a n y i m m e d i a t e h e a l t h c o n s e q u e n c e t h a t r e p r o t e i n . r e p a r t o f a c a l o r i c s u p p l e m e n t a t i o n t o a r e g u l a r i n e d t h a t t h e r e w a s n o e v i d e n c e t o i n d i c a t e t h a t c a l o r i c s u p p l e m e n t a t i o n t o a r e g u l a r d i e t a r y n c o n f i r m s t h a t t h e A p p e l l a n t ' s h e i g h t a n d w e i g h t s n o t i n d i c a t i v e o f a n e e d f o r a d d i t i o n a l c a l o r i e s t o o e v i d e n c e t h a t t h e A p p e l l a n t h a s a m e d i c a l , r e s u l t i n g i n a n i n a b i l i t y t o a b s o r b s u f f i c i e n t r a t i o n d e c i s i o n t h a t t h e r e i s n o i n d i c a t i o n t h e b e r e q u i r e d t o m e e t h e r r e g u l a r d i e t a r y i n t a k e , t h e e t i c g a s t r o p a r e s i s " r e s u l t s i n d e c r e a s e d c a l o r i c " a m o r e l i q u i d d i e t o f c a l o r i c i n t a k e " b e c a u s e s h e t a l i q u i d p r o t e i n d i e t c o u l d b e a c h i e v e d w i t h i s a r e a s o n a b l e c o n c l u s i o n . T h e P a n e l t h e r e f o r e n e e d f o r l i q u i d p r o t e i n t o r e d u c e c a l o r i e l o s s d u e a d d i t i o n a l c a l o r i e s o v e r a n d a b o v e t h e
EAPWDR, section 8 of Schedule C: Appellant's eligibility for diet supplements The Panel notes the Appellant's submission that she qualifies for a diabetic supplement as well as supplements for specific diets, and the Ministry's instructions for applying for these supplements. The Ministry explained that it needs a prescription pad note from a physician that states the Appellant's medical condition, specifies a type of diet; and indicates the duration the diet is needed for. The Panel's jurisdiction is limited to deciding the reasonableness of the Ministry's reconsideration decision of August 2? 1h which denied MNS on the basis of the information provided as of that date. Eligibility for other supplements or MNS once she obtains new information or a note from her physician or specialist will need to be assessed via the Ministry's application processes. Conclusion The Panel confirms the Ministry's reconsideration decision as being reasonably supported by the evidence and a reasonable interpretation of the applicable enactment in the circumstances of the Appellant.
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.