PAR T C -Decision u nder Appeal Th e d ecisio n u n der appeal is th e Ministry of Soci a l De " m in i stry'')'s rec onsiderat io n d ecisi on d ated Jul y 8 , M onthly Nutrition a l Supplement (MNS) a s the appellant did Employmen t and As sistance for Persons wit h Disa Sched ul e C, s ection 7. The m i nistry was sa tisf ied that t he appe l la n t is be ing of health on a ccount o f a s ev e re medical c ond iti on that s h e dis played two o f t he require d symptoms se malnutrition an d signific ant d e teriora tion o f a vital or th e inform ation provid ed b y the a ppel la nt's ph y si c i a the appellant r equir es additional nu triti onal items r eg u lar dietary i n t a ke f o r the purp o se of al leviat ing one or r e sult of a chroni c , progre ssive deteri o rati o n of health as Sch e dule C, se c tion ? (a) of the EAPWDR; and th fa il u r e to obtain th e ad di tiona l nutri tiona l i tems w req uired by Section 67(1.1 )( d) o f the EAPW DR. PAR T D -Re levant Legis la tion Employ ment and Ass i stance for Perso n s wit h Disa bilities Employ ment and A ssis t ance f or Perso n s wit h D i s abiliti 7 EMT 003(10/06/01) r v el opmen t and Socia l In no vat ion (the 2014 w hi c h deni ed the a ppell ant's request for a no t mee t the requi remen ts of the biliti e s R egu l ati on (EA PWDR) sec ti on 6 7(1) and treat ed f or a c hr onic, p ro g ress ive deteriora tion as re q u ired by EAPWDR section 67(1. 1) (a ) and t o u t i n EAPWDR sec tion 67 (1. 1 ) (b) , name ly ga n. Howe ver, the ministry was no t sat isfi ed that n es tablis hes that: th a t are p a rt o f a cal o ric sup ple men ta t ion to a mor e of t h e sym pto m s th a t a r e a direc t re q uired by S e ction 6 7(1.1 ) ( c ) a nd at ould r e su l t in imminent d an ger to h er lif e as Reg ulation (EAPWDR) s e ct ion 67 (1) e s Re gul a tion (EAP W DR) Sched u l e C section
PART E -Summary of Facts At reconsideration, the documents that were before the ministry included the following: 1) Request for Reconsideration dated June 30, 2014 (AFR) in which the appellant states that she has been diagnosed with pernicious anemia which by definition is the inability to absorb vitamin B12 (though not calories) and renal failure disposes her to anemia so she requires a high caloric diet to prevent malnutrition. 2) The MNS application completed by the appellant's physician on February 14, 2014 indicating diagnoses of renal insufficiency, sarcoidosis and pernicious anemia (vitamin B12 deficiency). The physician states that the appellant has declining renal function and malnutrition. The physician reports that as a direct result of the chronic, progressive deterioration of health the appellant displays the following symptoms: malnutrition and significant deterioration of a vital organ (decreased renal function). The physician reports that the appellant requires vitamin B12 to alleviate fatigue and muscle wasting and it will prevent imminent danger to the appellant's life by decreasing risk of falls and malnutrition. The physician reports that the appellant requires nutritional items of a diet that is low in fat and low in sodium, high plant based protein (such as legumes) to prevent deterioration of renal function. The physician indicates that the appellant does not have a medical condition that results in the inability to absorb sufficient calories to satisfy daily requirements through a regular dietary intake. The physician also reports that the nutritional items will prevent imminent danger to the appellant's life by preventing renal failure and chronic renal deficiency requiring dialysis. The physician indicates that the appellant is 168.5 cm and weighs 67.8 kg. 3) Letter from a physician dated February 13, 2014 indicating that the appellant has chronic vitamin B12 deficiency, chronic renal insufficiency and high cholesterol. The letter indicates that the appellant requires daily supplement of vitamin B12, a diet low in fat and sodium and high in plant-based proteins such as legumes in order to prevent deterioration of her condition. 4) Letter from the ministry to the appellant dated June 14, 2014 advising the appellant that she did not meet the eligibility requirements for the MNS. 5) MNS Decision Summary from the ministry Health Assistance Branch dated June 14, 2014 In her Notice of Appeal dated July 28, 2014, the appellant states that her "bronchiectas has become a life or death matter and that a plant based diet will help to liquefy her mucus which creates actually a grave infection". Admissibility of New Information At the hearing, the appellant provided oral testimony regarding her condition. She states that she requested the MNS because her renal failure is serious. She stated that her physician advised her to eat lots of fruit and vegetables and legumes. She states that the MNS is vital because if her kidneys fail then she will require dialysis and then she may die and that due to her pernicious anemia she does not absorb vitamins. The appellant confirmed that she is not on dialysis now. She reports that she does take daily vitamins but needs more meals. EMT 003(10/06/01)
The min is try did n o t o b jec t to the n e w inform ation a The p anel h as admitted t h e n ew documentati o n and oral i n form a tion and r eco rd s tha t we re b efor e t h e min istry wit h s ection 2 2(4) of the Emp l oy m ent and Assistanc a p pel lant's Notice of Appeal and her ora l test i mo n y prov previ o u s l y diag nos ed heal t h con d itions a nd requ irem The mi nist ry rel ied on t he reconsid e rat ion d ec i sio n Ba sed o n the e v ide n ce, t h e pan el's findi ng s of f acts the a p pe l lan t is a Person wit h Di s abilities in r e ceipt the appe llant has been diag nosed with c hronic r EAA T003(10/0 6/01) nd d oc umen t ation. testimon y in to eviden ce a s it is i n s u pport of at the time of r e c onside r ation, i n acc o rdanc e e A ct. In part i c ular, the informatio n i n the ides furth e r inform ati on regardi ng h er ents fo r M NS. . ar e as fol lows: of d isab i lity assis ta nc e ; an d e na l insuffic i enc y, sarcoidosis an d anemia.
PART F -Reasons for Panel Decision The issue to be decided is whether the ministry's reconsideration decision denying the appellant's MNS application on the basis that she did not meet the requirements for the MNS as set out in Section 67(1.1)(c) and (d) and Schedule C, Section 7 of the EAPWDR was reasonably supported by the evidence, or whether the reconsideration decision was a reasonable application of the legislation in the appellant's circumstances. The relevant sections of the EAPWDR are as follows: Nutritional supplement 67 (1) The minister may provide a nutritional supplement in accordance with section 7 [monthly nutritional supplement] of Schedule C to or for a person with disabilities in a family unit who receives disability assistance under (a) section 2 [monthly support allowance], 4 [monthly shelter allowance], 6 [people receiving room and board] or 9 [people in emergency shelters and transition houses] of Schedule A, or (b) section 8 [people receiving special care] of Schedule A, if the special care facility is an alcohol or drug treatment center, if the minister is satisfied that (c) based on the information contained in the form required under subsection (1.1), the requirements set out in subsection (1.1) (a) to (d) are met in respect of the person with disabilities, ( d) the person is not receiving a supplement under section 2 (3) [general health supplement] of Schedule C, (e) the person is not receiving a supplement under subsection (3) or section 66 [diet supplements], (f) the person complies with any requirement of the minister under subsection (2), and (g) the person's family unit does not have any resources available to pay the cost of or to obtain the items for which the supplement may be provided. (1.1) In order for a person with disabilities to receive a nutritional supplement under this section, the minister must receive a request, in the form specified by the minister, completed by a medical practitioner or nurse practitioner, in which the practitioner has confirmed all of the following: (a) the person with disabilities to whom the request relates is being treated by the practitioner for a chronic, progressive deterioration of health on account of a severe medical condition; (b) as a direct result of the chronic, progressive deterioration of health, the person displays two or more of the following symptoms: (i) malnutrition; (ii) underweight status; (iii sianificant weiaht loss: EAAT003(10/06/01)
(iv) significant m usc le mass l oss; (v) signific a nt ne u rol ogical deg eneration; (vi) significant deterioration of a vital organ; (vi i) modera t e to severe i mmune suppression; (c) f or the purpo s e of alleviatin g a sy mpto m referred to in paragraph (b), the person requir es one or more of the it em s set out in section 7 of Sched u le C and specified in the requ e s t; (d) f a ilure to o btain the items referre d to in p aragraph (c) will re s ult i n imminent da n g er to the person' s life. (B.C. Reg. 68/2010) ( 2) In order to determine or confirm the need or continuing ne ed of a p erson fo r whom a suppleme nt is pro vided unde r subsection (1), the min ist e r m ay at any time re quire that t he p ers on ob tain a n opinion fr om a med i cal pra c titioner or nu rse practitio ner oth e r than the prac titioner ref erred to in sub section (1 ) (c). ( B. C. Reg. 68/ 2 010). .. S chedu l e C Monthly nutr it ion al su pplement 7 The amou nt of a nutrition al suppl ement t h at may be p rovi ded u nder sec t i on 67 [ n utrition al supp l e men t ] of thi s r egulati on i s th e sum of t he a m ounts for thos e o f th e foll ow i n g items spe cif i ed as req ui r ed in the re ques t u nder sec tio n 6 7 ( 1 ) (c ): (a) f or a dd itio na l nut ri t io na l items that are pa r t of a caloric supp lemen t ation t o a regu l ar die tary intake, up to $165 eac h mo nth; (B. C . Re g. 68/ 2010) ( b) R epealed ( B.C. Re g. 6 8/2010) ( c) for vitamins a nd min erals, up to $40 each m ont h. (B.C . Reg . 6 8/ 2010) Section 67(1. 1 )(c ) of the EAPWDR requires that a request for supplements must specify in the re q ue st that the person requires one or more of the items set out in Schedule C, section 7(a) namely additional nutritional items that are part of a caloric supplementation to a regular dietary intake. Section 67(1. 1 )(d) requires that the medical practit ioner confirm that failure to obtain the nutritiona l items that ar e part of a caloric supplementation to a regular dietar y intake will result in imminent danger to the person's life. T he appel lan t 's position is that she has a serious health condition with renal failure and pernicious anemia resulting in an inability to absorb vitamins and minerals. The appellant's position is that al though she receives a vitamin and minera l supplement she n eed s t h e MN S for nutritional items too. T he appellant's po s itio n is that she is no lo nger in i m minent d a nger due to bronchiectas is as n o t ed in her Notice of Appeal as medicatio ns have relieved that situation but that without the MNS she could hav e renal failure, dialys is, an d death. The ministry notes that it had approved the appellant's request for vitamin and mineral suoolementation in March 2014. The ministry's oosition is that althouah the annel l ant's physician EMT 003(10/06/01)
indicated th at t he a ppellan t requires a d ie t low in f at d i et to pr e v e nt m a lnutrition d ue to pernicious anemia represents a spec ific dietary pla n rather than caloric supplement T he ministry's position is that alth o ugh th e physi cian high caloric diet to prevent malnutrition, there is no inf vitam in B 12 results in an ina bility to absorb sufficie th e appellant has a medical condition that results in the inabi dai ly r equ i rements through a regula r dietary i n t a ke the physician write n ote s that the ph ys i c i an d i d not confirm that the appellant displays symptoms of sign ificant weight loss or significant musc le mass l o caloric supp lem entation is required to a regular dieta appell ant's recorded height and weight indi cate a BMI of 23.9, which 18.5 to 24.9. T he m i n istry's po sition is that although th e p hysic ia wo ul d b e beneficial t o the appel lant 's h ea lth , the re med i c a l pr ac titioner s to c onf ir m that fai l u r e to obt a in s u pp lementa ti on to a reg u lar di e tary int ake wi ll resu r equir ed by t he legisla tion. The m i n i st ry notes that the use of the r efers to i m mediacy such that the d anger to the app P anel De cision S ectio n 67(1 . 1) of the EAP WDR m akes it c le ar that ther n utritional item s, na me ly c alor i c s u pplementat i on, and the ap pell ant's chro n ic , pr o gres sive det er i or atio n of health. p rovided by the m e dical practitio ne r d oes not esta bli as ca loric su pplem en t a t i on and t he chronic, progressive deteriora On the MN S applicat i on , the app e l lant's p h y sician r an d low in sodium an d a high pl ant ba s ed prote i n die cal o ric diet is requ i red to p r event malnutrition due to pe vitami n B12. T h e panel also notes tha t when a sk ed results in t he in ability t o absorb sufficient calories to dietary intake the physical writes: "no". Alt hou gh th e nutritional needs as recommended by her physician as she cannot absorb vitamins and minerals, the record ed height and weight indicate a BMI of 23.9, which is withi and her physician did not confirm that the appellant displays symptoms of underweight status, significant weight loss or significant muscle mass loss which wo caloric supplemen t a ti on is required to a r egular dietary intake The panel finds that the ministry reasonably concluded that the physician's recommendations represents a specific dietary plan rather than caloric supplementation to a regular dietary alleviate the symptoms of her chronic, progressive deterioration of health as required by EAPWDR section 67(1.1 )(c) and Schedule C, section 7(a). EAAT 003(1010610 1) and l ow in s o di u m an d a h igh p lant bas ed protein an d a n inability t o absorb vi ta m in B 12 , this ation to a regular diet. write s, in the RFR, that the appellant requir es a ormation to e stablish that an inab ility to abs orb nt calories. The mini s try notes tha t w hen asked if lit y to absorb suffici ent calories to satis fy s: "no". The ministry further underweig ht status, s s wh ich would b e required to demonstrate that ry inta ke. The ministry further notes t h at the is with in the normal ran ge o f n indi cates that the d ietary recommen d a tio n s w a s n o in f orma tion provided by the appel l a nt's a nut r it io n al i tem as p art of caloric lt in imm in ent dan g er to the ap pel l ant 's li fe a s wo rd immin ent in sec t ion 6 7 (1.1) ( d ) li cant's lif e is likely t o happe n soon. e m ust b e a direct link between t he r eque ste d a l leviation o f th e symp toms o f t h e However, t he panel finds that t h e ev i den ce sh t he req u i red li n k bet w een the n utrition al item s tion of hea l th. e ports t ha t the a p pellant require s a diet lo w in fa t t and that th e physici a n i ndicate s tha t a high rnicious anem i a and an inability to absorb if the a p pe ll a nt has a medical condition that sa t isf y da i ly r equ ir ements through a r egular appel lant indicate s tha t sh e requires a d ditional n th e normal rang e of 18.5 to 2 4.9 uld be r equired to demonstrate that i n t a ke to
Although the appellant indicated on the Notice of Appeal that she faced imminent danger to her life because of bronchiectasis, there was no information from a medical practitioner confirming that information. At the hearing, the appellant indicated that she was no longer in imminent danger to her life because of that condition. Although the appellant indicates that she continues to face imminent danger to her life because of her anemia resulting in inability to absorb vitamins and minerals and chronic renal failure that will lead to dialysis and death, that she is not currently on dialysis and there is no information from her medical practitioner indicating that the appellant faces an imminent danger to life if the requested items are not provided as required by Section 67(1. 1)(d) of the EAPWDR. The panel finds that the ministry's decision that the physician's information did not establish that failure to obtain the requested nutritional items would result in imminent danger to the appellant's life was reasonably supported by the evidence and was a reasonable application of the legislation in the appellant's circumstances. Based on the above, the panel finds that the ministry's decision to deny the appellant's MNS request was reasonably supported by the evidence and was a reasonable application of the legislation in the appellant's circumstances. Therefore, the panel confirms the ministry's decision. EM T003(10/06/01)
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