[ PART C-Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (Ministry) reconsideration decision dated October 10, 2014 in which the Ministry determined that the Appellant is not eligible for the Monthly Nutritional Supplement (MNS) of nutritional items and vitamin/minerals pursuant to section 67(1.1 ), and Schedule C section 7 of the Employment and Assistance for Persons with Disabilities Regulation (EAPWDR). The Ministry found that a medical practitioner has not confirmed that failure to obtain the requested items will result in imminent danger to the Appellant's life as required by subsection 67(1.1 )(d) of the EAPWDR. Further, the Ministry was not satisfied that the Appellant requires nutritional items to alleviate a symptom pursuant to subsection 67(1.1 )(c), or as part of a caloric supplementation to a regular dietary intake as set out in Schedule C section 7 of the EAPWDR. PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Regulation -section 67, and Schedule C section 7
P A R T E S u m m a r y o f F a c t s T h e e v i d e n c e b e f o r e t h e M i n i s t r y a t t h e t i m e o f t h e r e 1 ) T h e A p p e l l a n t ' s R e q u e s t f o r R e c o n s i d e r a t i o n d a t e q u e s t i o n n a i r e ( t h e q u e s t i o n n a i r e ) c o m p l e t e d b y t h e A c o n t a i n e d t h e f o l l o w i n g i n f o r m a t i o n : • Q u e s t i o n 1 , t h e p h y s i c i a n w r o t e " y e s " i n r e s p o f r o m c h r o n i c d i a r r h e a c a u s i n g m a l a b s o r p t i o n l o s s , s u s c e p t i b i l i t y t o f r e q u e n t i n f e c t i o n s a n d l r h e u m a t o i d a r t h r i t i s ? " • Q u e s t i o n 2 , t h e p h y s i c i a n w r o t e " y e s " i n r e s p o d a i l y i n t a k e o f v i t a m i n s a n d m i n e r a l s i n c l u d i n g 2 0 0 0 I U , c a l c i u m a n d f i s h o i l t o p r e v e n t o r a l l e r a t e o f f u r t h e r d e t e r i o r a t i o n d u e t o c h r o n i c d i a s u s c e p t i b i l i t y t o f r e q u e n t i n f e c t i o n s a n d l i v e r d r h e u m a t o i d a r t h r i t i s ? " • Q u e s t i o n 3 , t h e p h y s i c i a n w r o t e " y e s " i n r e s p o c o n d i t i o n a t a s t a g e w h e r e v i t a m i n a n d m i n e r a a l l e v i a t e f u r t h e r h e a l t h d e t e r i o r a t i o n o r r e d u c e i m m i n e n t ( c r o s s e d o u t ) e v e n t u a l ( i n s e r t e d ) d a 2 ) A l e t t e r f r o m t h e M i n i s t r y t o t h e A p p e l l a n t d a t e d S e s u m m a r y , d e n y i n g h e r r e q u e s t f o r M N S . I n i t s d e c i s i o i s f o r S u p e r B c o m p l e x , m i l k t h i s t l e , a r t i c h o k e , f i s h o i l p o w d e r " w a s r e q u e s t e d a n d t h e A p p e l l a n t ' s p h y s i c i a n 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 . 3 ) A n A p p l i c a t i o n f o r M N S s i g n e d b y t h e A p p e l l a n t o n p h y s i c i a n w h o p r o v i d e d t h e f o l l o w i n g i n f o r m a t i o n : • U n d e r t h e h e a d i n g " D i a g n o s i s ( s e v e r e m e d i c a B a n d C , r h e u m a t o i d a r t h r i t i s , a n d o s t e o a rt h r i t i t r e a t m e n t , f o l l o w e d b y ( a s p e c i a l i s t ) , R h e u m , g • I n r e s p o n s e t o t h e q u e s t i o n o f w h e t h e r t h e A p 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 d u e t o h e r s i n d i c a t e d t h e A p p e l l a n t i s b e i n g t r e a t e d w i t h m a r t h r i t i s w h i c h a f f e c t s h e r h a n d s a n d f e e t . H e r • I n r e s p o n s e t o t h e q u e s t i o n o f w h e t h e r t h e A p p s y m p t o m s u n d e r s u b s e c t i o n 6 7 ( 1 . 1 ) ( b ) o f t h e 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 , t h e p h y s i c i a c o m m e n t : " w e i g h t c h a n g e s w i t h p r e d n i s o n e a l 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 . T h e p h y s i c i a n w r a n d h a v i n g ( p o s s i b l y r e l a t e d ) v i s i o n c h a n g e s . " • 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 a r e l e f t b l a n • U n d e r t h e h e a d i n g " V i t a m i n o r M i n e r a l S u p p l e m m i n e r a l s u p p l e m e n t s r e q u i r e d a n d e x p e c t e d d u [ c o n s i d e r a t i o n c o n s i s t e d o f : d S e p t e m b e r 3 0 , 2 0 1 4 w i t h a n a t t a c h e d p p e l l a n t ' s p h y s i c i a n o n S e p t e m b e r 3 0 , 2 0 1 4 t h a t n s e t o t h e q u e s t i o n : " D o e s y o u r p a t i e n t s u f f e r ( c r o s s e d o u t , " w e i g h t o k " i n s e r t e d ) , m u s c l e m a s s i v e r d a m a g e a s a r e s u l t o f H e p a t i t i s B a n d C a n d n s e t o t h e q u e s t i o n : " D o e s y o u r p a t i e n t r e q u i r e h i g h p o t e n c y V i t a m i n B c o m p l e x , V i t a m i n 0 3 v i a t e f u r t h e r h e a l t h d e t e r i o r a t i o n o r r e d u c e t h e r r h e a c a u s i n g m a l a b s o r p t i o n , m u s c l e m a s s l o s s , a m a g e a s a r e s u l t o f H e p a t i t i s B a n d C a n d n s e t o t h e q u e s t i o n : " I s y o u r p a t i e n t ' s m e d i c a l l s u p p l e m e n t a t i o n i s r e q u i r e d t o p r e v e n t o r t h e r a t e o f f u r t h e r d e t e r i o r a t i o n a n d p r e v e n t n g e r t o l i f e ? " p t e m b e r 1 5 , 2 0 1 4 , w i t h a t t a c h e d d e c i s i o n n s u m m a r y , t h e M i n i s t r y n o t e d t h a t t h e r e q u e s t , V i t a m i n 0 3 a n d c a l c i u m . I n a d d i t i o n , " G r e e n s h a s p r o v i d e d n o i n f o r m a t i o n r e g a r d i n g t h e J u l y 1 1 , 2 0 1 4 a n d c o m p l e t e d b y t h e A p p e l l a n t ' s l c o n d i t i o n s ) " , t h e p h y s i c i a n i n d i c a t e d : H e p a t i t i s s , w i t h t h e c o m m e n t : " E l e v a t e d l i v e r e n z y m e s o n e n e r a l i z e d j o i n t i n v o l v e m e n t " . p e l l a n t i s b e i n g t r e a t e d f o r a c h r o n i c , e v e r e m e d i c a l c o n d i t i o n s , t h e p h y s i c i a n e t h o t r e x a t e a n d p l a q u e n i l f o r h e r r h e u m a t o i d l i v e r e n z y m e s a r e b e i n g m o n i t o r e d r e g u l a r l y . e l l a n t d i s p l a y s t w o o r m o r e o f t h e l e g i s l a t e d E A P W D R 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 , n n o t e d : a ) S i g n i f i c a n t w e i g h t l o s s w i t h t h e e r n a t i n g w i t h w e i g h t l o s s " ; a n d b ) S i g n i f i c a n t o t e : " r e q u i r e s p l a q u e n i l f o r r h e u m a t o i d a r t h r i t i s k . e n t a t i o n " , w h e n a s k e d t o s p e c i f y t h e v i t a m i n o r r a t i o n o f n e e d , t h e p h y s i c i a n i n d i c a t e d : S u p e r B
c o m p l e x a n d f i s h o i l d a i l y ; m i l k t h i s t l e d a i l y f o r a r t i c h o k e ; a n d c a l c i u m -1 2 0 0 m g d a i l y . • W h e n a s k e d t o d e s c r i b e h o w t h e a b o v e i t e m s t h e p h y s i c i a n w r o t e : " V i t a m i n s f o r b o n e h e a l t h o s t e o p o r o s i s ; m i l k t h i s t l e , a r t i c h o k e f o r l i v e r s u • W h e n a s k e d t o d e s c r i b e h o w t h e a b o v e s p e c a p p l i c a n t ' s l i f e t h e p h y s i c i a n w r o t e : " I t i s m o d e p r e d n i s o n e a t t i m e s . V i t a m i n s / s u p p l e m e n t s o • U n d e r t h e h e a d i n g " N u t r i t i o n a l I t e m s " , i n s p e c p h y s i c i a n i n d i c a t e d " G r e e n s p o w d e r " d a i l y . • I n r e s p o n s e t o t h e q u e s t i o n o f w h e t h e r t h e A p 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 c a l o r i e s t o s a t i s f y i n t a k e t h e p h y s i c i a n w r o t e : " N o " . • W h e n a s k e d t o 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 s y m p t o m s ( i n s u b s e c t i o n 6 7 ( 1 . 1 ) ( b ) o f t h e E A P t h e r e g u l a r d i e t , t h e p h y s i c i a n s t a t e d : " G r e e n s p a t i e n t t o d o s w i m m i n g / e x e r c i s e w h i c h s u p p o • W h e n a s k e d t o 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 A p p e l l a n t ' s l i f e t h e p h y s i c i a n w r o t e : " A s a b o v e 4 ) A l e t t e r t o t h e A p p e l l a n t ' s p h y s i c i a n f r o m a s p e c i a l a t t a c h e d l a b o r a t o r y r e s u l t s i n w h i c h t h e s p e c i a l i s t i n d p o s s i b l y a m i l d e r f o r m o f l u p u s l i k e s y n d r o m e i s a s y m r e t u r n i n g . H e r t e s t r e s u l t s f o r D N A , E N A , a n d C C P w T h e s p e c i a l i s t r e p o r t e d t h a t t h e A p p e l l a n t h a s b e e n w H y d r o x y c h l o r o q u i n e a n d M e t h o t r e x a t e t h r e e m o n t h s a b o u t h e r v i s i o n . S h e h a s r e m a i n e d w e l l e v e r s i n c e , t a r t h r o p a t h y t h a t i s n o t r e v e a l e d o n p h y s i c a l e x a m i n a t e l e v a t i o n o f l i v e r f u n c t i o n i n k e e p i n g w i t h h e r p a s t h i s T h e s p e c i a l i s t r e c o m m e n d s a n e w t r i a l o f H y d r o x y c h l f o l l o w u p . 5 ) T h e M i n i s t r y n o t e d t h e f o l l o w i n g i n i t s r e c o n s i d e r a t • T h e A p p e l l a n t i s a P e r s o n w i t h D i s a b i l i t i e s i n r • U p o n r e v i e w , t h e A p p e l l a n t ' s r e q u e s t f o r M N S E A P W D R s e c t i o n 6 7 ( 1 . 1 ) : T h e M i n i s t r y f o u n d 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 n E A P W D R s u b s e c t i o n 6 7 ( 1 . 1 ) ( a ) . I n a d d i t i o n , t m o r e o f t h e l e g i s l a t e d s y m p t o m s a s s e t o u t i n i m m u n e s u p p r e s s i o n a n d s i g n i f i c a n t d e t e r i o r a A d d i t i o n a l s u b m i s s i o n s S u b s e q u e n t t o t h e r e c o n s i d e r a t i o n d e c i s i o n , t h e A p p e 2 0 1 4 i n w h i c h s h e s t a t e d t h a t s h e w a s p r e v i o u s l y i n r i s d e t e r i o r a t i n . T h e A e l l a n t b r o u h t a n a d v o c a t e l i v e r p r o t e c t i o n ; V i t a m i n D 3 -2 0 0 0 I U d a i l y ; w i l l a l l e v i a t e t h e s p e c i f i c s y m p t o m s i d e n t i f i e d , g i v e n b o n e l o s s o n p r e d n i s o n e a n d p p o r t o n m e t h o t r e x a t e " . i f i e d i t e m s w i l l p r e v e n t i m m i n e n t d a n g e r t o t h e r a t e l y s e v e r e a n d r e q u i r e s m e t h o t r e x a t e a n d f f s e t s i d e e f f e c t s . " i f y i n g 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 r e q u i r e d , t h e p e l l a n t h a s a m e d i c a l c o n d i t i o n t h a t r e s u l t s i n t h e d a i l y r e q u i r e m e n t s t h r o u g h a r e g u l a r d i e t a r y m s w i l l a l l e v i a t e o n e o r m o r e o f t h e l e g i s l a t e d W D R ) a n d p r o v i d e c a l o r i c s u p p l e m e n t a t i o n t o p o w d e r d a i l y h e l p s i m p r o v e e n e r g y a n d a l l o w s r t s j o i n t s / m a i n t a i n s s t r e n g t h " . m s w i l l p r e v e n t i m m i n e n t d a n g e r t o t h e " . i s t i n r h e u m a t o l o g y d a t e d J u l y 7 , 2 0 1 4 w i t h i c a t e d t h e A p p e l l a n t ' s r h e u m a t o i d a r t h r i t i s o r p t o m a t i c a l t h o u g h s h e f e e l s s o m e j o i n t s t i f f n e s s e r e n e g a t i v e a n d h e r r h e u m a t o i d f a c t o r i s 1 5 . e l l f o r s o m e t i m e , a n d d i s c o n t i n u e d b o t h a g o d u e t o s o m e s k i n l e s i o n s a n d c o n c e r n s h o u g h h e r c u r r e n t s y m p t o m s m a y b e d u e t o i o n . T h e A p p e l l a n t c o n t i n u e s t o h a v e m i l d t o r y o f H e p a t i t i s C a n d p o s s i b l y m i l d f a t t y l i v e r . o r o q u i n e a n d o b s e r v a t i o n w i t h a t h r e e m o n t h i o n d e c i s i o n : e c e i p t o f d i s a b i l i t y a s s i s t a n c e . m e e t s s o m e o f t h e e l i g i b i l i t y c r i t i e r i a i n t h a t t h e A p p e l l a n t i s b e i n g t r e a t e d f o r a c h r o n i c , t o f h e r s e v e r e m e d i c a l c o n d i t i o n s a s r e q u i r e d b y h e M i n i s t r y a c c e p t e d t h a t s h e d i s p l a y s t w o o r s u b s e c t i o n 6 7 ( 1 . 1 ) ( b ) : m o d e r a t t o s e v e r e t i o n o f a v i t a l o r g a n ( h e r l i v e r ) . l l a n t f i l e d a N o t i c e o f A p p e a l d a t e d O c t o b e r 2 0 , e c e i p t o f " m e d i c a l b e n e f i t s " a n d h e r h e a l t h s t a t u s t o t h e h e a r i n h e r d a u h t e r a n d v e r b a l !
consente d to the advocate's participation. The Appe disability a ssistance and MNS. The Ministry stopp e d all Appellant receive d compensation for a motor veh icle three or four months, en a b li n g he r to b uy vi t amins a n The Appell ant explained that the Min istry re-opened her file in June 2014 a ass istance. However, they req u ired a new applic a ti on stated that her h e alt h s t a t u s has not ch a n g ed b etw e en the two MNS a fluctua tions an d deter i oration of health. She sta te d that she no longer has access to supplemen ts due to her finances and lower soci o-econo The p a nel admits the Appellant's st a tements pursuant to section 22(4) Assistance A c t (EAA) as testimony in supp ort of the information and records that were Ministry at the time the d e ci sion being app ea l ed was made. corroborate the Appellant's hea lth status a nd M N S hi At the hea r i n g , the Ap pellant su bm i tted se ver a l n ew document 1 ) A lett er from her phys ic i an with attached "Co n s ul ta Nov ember 2 6, 2 0 1 4, and t wo pages of labora tory t e st r O cto ber 20 14: • In the l etter, th e p hy si c ia n stated that the App ella osteopor o sis, osteoa rthritis, rheum at oid arthriti 201 3 , a nd a ne g ative M IBI colonoscopy in 2012 would benefit fro m a high pro te i n, highl y nut rit ious re c omme nded for he r oste oporosis. T he physi App ellant i s taking Meth otrexate, and sh e pr es sele nium and oth er esse ntial mi n erals . The p hys compromi sed d ue to her hepatit is an d a lso du e • In th e Co n s ultatio n Reques t, u n d er " Per t inent B and C ( name of special i st) Ost eoart hrit is QA Asthma po s itive T/M 2013 . Nega t i v e MIBI co lonos • The laboratory test results indicate fluctuations over time for a large number o· measures ( n o ne are h ighlighted), an d the notat i on "white blood normal" i 2) An undated three p age submission f rom th e Appellant describing exerci therapies, laborato ry test s, vitamins and minerals, and specific foo explained tha t she copied t he i nformation from a book she 3) T w o Go v ernment of Canada health info rmation print outs containing general Hepa titis Band Hepatit i s C. The Ministry had no objection to a d m i tt in g t hes e d ocuments physician's letter, the laboratory test results, and the Appellant's three page submiss section 22(4)(b) of the EAA as submissions in support of the informatio the Ministry at the time the decision being appealed was made. in these documents substantiates the A ellant's medical conditions that were descri [ llant explain ed that she previousl y r eceived of the se benefits in F ebruary 2 014 w hen t he accident. This settlemen t s upported h er f or d other supplements. n d reinsta ed her d isab i lity for MNS wh ich wa s re f u sed. T h e A p pellant pplications except for constant vitamin s and mic status. (b) of the Employment and b efo re the T he panel finds that t he s tatements story w hich t he Mi nistry had information on. s as foll ows : I tion Request" f or a d e rm a tologis t dated e sul ts with a d ate r ange f rom Oct obe r 20 13 t o n t' s d iagno s es i nclud e H e p a t i t i s B and C, s , poss ibl e PH TB, asth ma, a pbsiti ve T/ M in . T he phys i ci a n s t a te d that th e Ap pel lant d iet, and Vi t a min D and c alcium a r e c ia n re co mmen d s f ol ic a c i d f or w h en the crib ed a general mu lt ivitamin that c ontai n s ician reporte d th at the App e llan t is i mmu n o to the dru g s t hat t reat h er rhey �atoid arthritis. C linic a l I nform at ion", the ph ys i � i � n wro te : "Hep and RA (name of specialist ) poss ible PH TB copy 2 012 (name o f s pecia l'st) ok ." s wri tt en o n the irst pag e . ses, comp ementary ds for arthritis. Th Appellant saw at an arthritis sup port society . infer ation on i nto evi dence. The pa ne admi ts the 1 0n pursuant to n and records that were before The panel finds that � he information e d i n the -----"
R e q u e s t f o r R e c o n s i d e r a t i o n ( H e p a t i t i s B a n d C a n d a l s o d e s c r i b e v i t a m i n s a n d n u t r i t i o n a l i t e m s t h a t t h e A a p p l i c a t i o n a n d q u e s t i o n n a i r e t h a t t h e M i n i s t r y h a d a W i t h r e g a r d t o t h e G o v e r n m e n t o f C a n a d a h e a l t h i n f o c o n t a i n g e n e r a l i n f o r m a t i o n o n l y r e g a r d i n g H e p a t i t i s A p p e l l a n t ' s h e a l t h o r r e f e r e n c e a n y v i t a m i n s a n d m i n t h a t t h e s e d o c u m e n t s a r e c o n s i s t e n t w i t h t h e h e a l t h i r e c o n s i d e r a t i o n a n d a d m i t s t h e m u n d e r s e c t i o n 2 2 ( 4 ) l i t t l e w e i g h t d u e t o t h e i r g e n e r a l i z e d c o n t e n t a n d l a c k A t t h e h e a r i n g , t h e M i n i s t r y r e l i e d o n i t s r e c o n s i d e r a t i i n f o r m a t i o n . I n r e s p o n s e t o a q u e s t i o n f r o m t h e A p p e l i s t o f s u p p o r t i n g d o c u m e n t s t h a t w o u l d b e c o n s i d e r e d e c i s i o n o n t h e b a s i s o f t h e i n f o r m a t i o n i n t h e A p p l i c a s u b m i s s i o n s p r o v i d e d b y t h e c l i e n t . I n r e s p o n s e t o a q u e s t i o n f r o m t h e p a n e l , t h e M i n i s t r y p r e v i o u s a p p l i c a t i o n s f o r M N S . W h e n i t r e i n s t a t e d t h a p p l i c a t i o n f o r M N S w a s r e q u i r e d i n o r d e r t o p r o v i d e n u t r i t i o n a l r e q u i r e m e n t s . I n r e s p o n s e t o a n o t h e r q u e s t i o n f r o m t h e p a n e l , t h e M s u b s e c t i o n 6 7 ( 1 . 1 ) ( d ) c o n t a i n s t w o p a r t s : " w i l l r e s u l t i H o w e v e r , i n f i n d i n g t h a t t h e c r i t e r i a s e t o u t i n c l a u s e ( f o c u s e d o n t h e w o r d " i m m i n e n t " w h i c h i m p l i e s a n i m m t h a t t h e r e w a s e v i d e n c e o f i m m e d i a t e d a n g e r t o t h e A p r e s c r i b e d v i t a m i n s a n d n u t r i t i o n a l i t e m s . T h e P a n e l m a k e s t h e f o l l o w i n g f i n d i n g o f f a c t : A m e d i c a l p r a c t i t i o n e r h a s p r e s c r i b e d v i t a m i n s a n d m n u t r i t i o n a l s u p p l e m e n t s ( f i s h o i l , m i l k t h i s t l e a n d a r t i c h o f f s e t t h e s i d e e f f e c t s o f m e d i c a t i o n s . T h e m e d i c a l p i m p r o v e e n e r g y a n d f a c i l i t a t e p a r t i c i p a t i o n i n e x e r c i s e A r t h r i t i s ) . T h e l e t t e r a n d A p p e l l a h t ' s s u b m i s s i o n p p e l l a n t ' s p h y s i c i a n r e c o m m e n d s p e r t h e M N S t t h e t i m e o f t h e r e c o n s i d e r a t i o n . r m a t i o n , t h e p a n e l n o t e s t h a t t h • e s e d o c u m e n t s B a n d C , a n d d o n o t s p e c i f i c a l l y a d d r e s s t h e e r a l s o r n u t r i t i o n a l s u p p l e m e n t s . T h e p a n e l f i n d s n f o r m a t i o n t h a t w a s b e f o r e t h e r � i n i s t r y a t ( b ) o f t h e E A A . H o w e v e r , t h e p , m e l g i v e s t h e m o f i n fo r m a t i o n r e g a r d i n g n u t r i t i o 1 a l s u p p l e m e n t s . o n d e c i s i o n a n d d i d n o t s u b m i t c n y f u r t h e r l l a n t , t h e M i n i s t ry s t a t e d t h a t i t d :> e s n o t h a v e a d s u f f i c i e n t f o r M N S e l i g i b i l i t y . I m a k e s i t s t i o n f o r M N S a n d a n y a d d i t i o n a d o c u m e n t s o r s t a t e d t h a t i t d o e s n o t r e f e r b a < k t o a n y e A p p e l l a n t ' s d i s a b i l i t y a s s i s t a n c e , a n e w c u r r e n t i n f o r m a t i o n r e g a r d i n g t h e A p p e l l a n t ' s i n i s t r y c o n s i d e r e d w h e t h e r E A P W D R n " a n d " i m m i n e n t d a n g e r t o t h e � e r s o n ' s l i f e " . d ) w e r e n o t m e t , t h e M i n i s t r y c o h f i r m e d t h a t i t e d i a t e e v e n t a n d t h e M i n i s t r y \I\ a s n o t s a t i s f i e d p p e l l a n t ' s l i f e i f s h e d i d n o t r e c e i v e t h e i n e r a l s ( V i t a m i n s B , D 3 , a n d c a l c i u m ) , a n d o k e ) f o r b o n e h e a l t h a n d l i v e r s J p p o r t , a n d t o r a c t i t i o n e r a l s o p r e s c r i b e d " G r e e n s p o w d e r " t o .
[ PART F -Reasons for Panel Decision The issue in this appeal is whether the Ministry's determination that the Appellant is not eligible for the MNS of nutritional items and vitamin/minerals pursuant to section 67(1.1 ), and Schedule C section 7 of the EAPWDR was reasonably supported by the evidence, or was a reasonable application of the applicable enactment in the circumstances of the Appellant. The relevant sections of the legislation are as follows: Employment and Assistance for Persons with Disabilities Regulation 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 centre 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) significant weight loss; (iv) significant muscle mass loss; (v) significant neurological degeneration; (vi) significant deterioration of a vital organ; (vii) moderate to severe immune suppression; (c) for the purpose of alleviating a symptom referred to in paragraph (b), the person requires one or more of the items set out in section 7 of Schedule C and specified in the request; I (d) failure to obtain the items referred to in paragraph (c) will result in imminent danger to the person's life. I
(2) In order to determine or confirm the n eed or co n tinuing ne is pr o v ided u nder subsection (1), the mini ster may at opinion from a medical practi tione r or nurse practiti oner subsection (1) (c). Sch e d u le C Monthly nutri ti onal supplement 7 The amount of a nutritional suppl e ment that may be provide supplement] of this regulation is the sum of the amounts for thos required in the request under secti on 67 (1) (c) : (a) for additional nutrit ional it ems that are part of a caloric suppl up to $165 each m o nth; (b) Repealed. [B.C. Reg. 68/2 0 1 0 , s. 3 (b).] (c) f o r vit amin s and m i ne ra ls , up to $40 eac h mont h . Appel lant's posi tion In her Noti ce of Appea l , the Ap pellant argued that s he supp l e ments b ecau s e h er health s tatus i s dete r iorating. s u b mitted that her p hys ici an's supp or ting l etter from Se that she mee ts t h e elig i bility r equirements for vitamin and EAP W DR. A t the heari ng, t h e Appel la nt argued t h a t she n eeds nutri heal th c ondit ion s. Sh e n o longe r has a cces s to the supp ac ce ss to MNS i s a ba r rie r t o her he a lth. When the Mini was n ot full y fami li a r wi th how to prov i de documents that i t was dif fic ult to u n de rst a nd the l ogi stics of all the The Ap pella n t argu e d t h at she n eed s MNS to assis t h q u ali ty of life because sh e live s in poverty and the s tre for food, laundry and other expenses, there i s nothing lef supplements. Ministry's position The Mi nistry a rgue d that the Appellant ' s request f or MNS, specifically vitamins and rr inerals, and nutri tional items , does not meet all of the criteria in EAPWDR section 67 and the ApA there f or e not eligible for the items speci f i ed by her physi to persons in receipt of disability assist a n c e who have a severe medical condit progressive deterioration of health "with symptoms of wasting". danger to the person's life by providing essential, specified items to supplement regu ar nutritional needs. The Ministry argued that the following criteria were not met: ed o f a person for who� a s upplem ent a ny time r equire t hat the pe r sor'l o bt ain a n other than the practi tioner referre d to in I d un der section 67 [nut itional e of the followi ng ite s specified as ementation to a regu l f a r d ieta r y intake, I r e ally ne eds t h e vi tam i n and Jineral In her R equest for R e c ons;de ra t i on, s h e ptember 30, 2 014 (the q uest i + n naire) shows m ineral suppl em ents p e r secti on 67 of the I t i ous f ood i n o rder to li ve and to ma nage he r l ement s du e to her f inances l an d not h a ving str y r e inst ated h er disab il ity t 1 s sistance, she f or her ne w MNS app li cati on. S e submitted p a p erw ork. er in maintaining a min imu m bala n ce a nd ss in cr ea ses her sym ptom s. Once she p ay s t i n he r cheque for vitamin ahd mineral ellant is cian. The Minis try noted that i MNS is provide d ion ca r sing a ch ro n ic, MNS is intended to �revent imminent
E A P W D R s u b s e c t i o n 6 7 ( 1 . 1 ) ( d ) : F a i l u r e 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 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 t h e p h y s i c i a n ' s c o m m e n t t h a t h e A p p e l l a n t ' s m e d i c a t i o n s d o e s n o t e s t a b l i s h t h a t t h s u p p l e m e n t a t i o n t o p r e v e n t i m m i n e n t d a n g e r t o h e r l i p h y s i c i a n ' s i n f o r m a t i o n i n t h e q u e s t i o n n a i r e d o e s n o t t h e p h y s i c i a n c r o s s e d o u t t h e w o r d " i m m i n e n t " a n d r e t h a t t h e A p p e l l a n t ' s m e d i c a l c o n d i t i o n i s a t a s t a g e w h r e q u i r e d t o p r e v e n t i m m i n e n t d a n g e r t o l i f e : T h e M i n i m e a n " e v e n t u a l " b e c a u s e " I m m i n e n t " d e n o t e s i m m e d l i k e l y t o o c c u r v e r y s o o n . N u t r i t i o n a l i t e m s W i t h r e g a r d t o t h e " G r e e n s p o w d e r " s p e c i f i e d b y t h e A t h e p h y s i c i a n ' s c o m m e n t : " h e l p s i m p r o v e e n e r g y a n d s u p p o r t s j o i n t s / m a i n t a i n s s t r e n g t h " d o e s n o t c o n f i r m 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 M i n i s t r y s u b s e q u e n t i n f o r m a t i o n i n t h e q u e s t i o n n a i r e r e f e r s o n a d d r e s s a n e e d f o r n u t r i t i o n a l i t e m s . 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 s w e l l a s 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 n 7 m 6 7 ( 1 . 1 ) , 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 c r i t e r i a i n s u o b t a i n t h e r e q u e s t e d i t e m s ( t h e s p e c i f i e d v i t a m i n s a 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 l i f e . T h e M i n i 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 i m m e d i a c y a n d m e a n s t h e t h r e a t e n e d l o s s o f l i f e i s m t h e A p p e l l a n t d o e s n o t r e c e i v e t h e s u p p l e m e n t s t h a t h M i n i s t r y c o n f i r m e d t h a t i t f o c u s e d o n t h e i m m e d i a c y o t h a t t h e p r o p e r a p p r o a c h t o s t a t u t o r y i n t e r p r e t a t i o n i s h a r m o n y w i t h t h e o b j e c t i v e o f t h e l e g i s l a t i o n . T h e d i c s o o n t o h a p p e n " , w h i l e t h e p u r p o s e o f s e c t i o n 6 7 ( 1 . 1 ) e x c e p t i o n a l c i r c u m s t a n c e s w h e r e t h e r e i s a n i m m e d i a w i l l c l e a r l y r e s u l t i n l i f e t h r e a t e n i n g c o n s e q u e n c e s . T h i n i n t e r p r e t i n g t h e w o r d " i m m i n e n t " t o d e n o t e a d e g r e e o b j e c t i v e t o p r o v i d e t h e s u p p l e m e n t i n c a s e s w h e r e t h t h r e a t t o l i f 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 h a e r t o l i f e t " v i t a m i n s / s u p p l e m e n t s o f f s e t s i d e e f f e c t s " o f e A p p e l l a n t r e q u i r e s v i t a m i n / m i r 1 e r a l f 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 � h I a t t h e c o n f i r m t h e " i m m i n e n t d a n g e r " d r i t e r i a b e c a u s e p l a c e d i t w i t h t h e w o r d " e v e n t u a � " w h e n a f f i r m i n g e r e v i t a m i n a n d m i n e r a l s u p p l e r e n t a t i o n i s s t r y a r g u e d t h a t t h e w o r d " i m m i n e n t " d o e s n o t i a c y a n d m e a n s t h a t t h e t h r e a t e , e d l o s s o f l i f e i s p p e l l a n t ' s p h y s i c i a n , t h e M i n i s t r Y a r g u e d t h a t a l l o w s p a t i e n t t o d o s w i m m i n g / E x e r c i s e w h i c h t h a t f a i l u r e t o o b t a i n t h i s i t e m w i j l r e s u l t i n f u r t h e r s u b m i t t e d t h a t t h e p h y s i c i a n ' s l y t o v i t a m i n s a n d m i n e r a l s a n d d o e s n o 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 , 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 1 e c t i o n 6 7 ( 1 . 1 ) u s t b e s a t i s f i e d . W i t h r e g a r d t f s e c t i o n b s e c t i o n 6 7 ( 1 . 1 ) ( d ) w e r e n o t m e : f a i l u r e t o d m i n e r a l s , a n d " G r e e n s p o w d e r " ) w i l l r e s u l t i n t h a t i m m i n e n t d a n g e r " d e n o t e s a d e g r e e o f o r e l i k e l y t h a n n o t g o i n g t o o c c L . r v e r y s o o n " i f e r p h y s i c i a n s p e c i f i e d . A t t h e t e a r i n g , t h e f a n y d a n g e r t o t h e A p p e l l a n t . 1 h e p a n e l n o t e s t o r e a d t h e w o r d s i n t h e i r o r d i n � r y s e n s e i n t i o n a r y d e f i n i t i o n o f " i m m i n e n t " i ' " i m p e n d i n g / o f t h e E A P W D R i s t o p r o v i d e M N S o n l y i n t e n e e d f o r t h e s u p p l e m e n t ; f a i i L r e t o p r o v i d e i t 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 l a s r e a s o n a b l e o f i m m e d i a c y i n s u p p o r t o f t h e l e g i s l a t i v e e a p p l i c a n t r e q u i r e s i t t o p r e v e r t a s e r i o u s
W i t h r e g a r d t o t h e M i n i s t r y ' s f i n d i n g t h a t t h e r e w a s n o l i f e i f 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 n a l i t e m s w e r e M N S a p p l i c a t i o n w a s t h a t s p e c i f i c v i t a m i n s a n d m i n e a r t i c h o k e a r e r e q u i r e d t o o f f s e t t h e s i d e e f f e c t s o f t h e " G r e e n s p o w d e r " h e l p s i m p r o v e e n e r g y a n d a l l o w s t s u p p o r t h e r j o i n t s a n d m a i n t a i n s t r e n g t h . 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 w e i g h 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 i f s h e d i d n o t W i t h r e g a r d t o t h e M i n i s t r y ' s a r g u m e n t t h a t t h e p h y s i c n o t c o n f i r m t h a t f a i l u r e t 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 p a n e l n o t e s t h a t t h e p h y s i c i a n a f f i r m e d o n l y ( b y a n s w p r e v e n t " e v e n t u a l " d a n g e r t o l i f e . T h e p h y s i c i a n d i d n w i l l r e s u l t i f t h e A p p e l l a n t d o e s n o t o b t a i n t h e s p e c i f i e 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 i n f o r m a t i o n i n t h e q u e t o o b t a i n t h e s p e c i f i e d 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 6 7 ( 1 . 1 ) ( d ) . W i t h r e g a r d t o t h e n e w i n f o r m a t i o n p r o v i d e d b y t h e A g r e a t e r w e i g h t t o t h e N o v e m b e r 2 0 1 4 l e t t e r f r o m t h e 6 7 ( 1 . 1 ) r e q u i r e s t h e e l i g i b i l i t y c r i t e r i a f o r M N S ( i n c l u d t o b e 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 . W h i l e t h e s u b m i s s i o n p r o v i d e b a c k g r o u n d i n f o r m a t i o n o n h e r m r e q u e s t e d , t h e y d o n o t c o n t a i n a n y c o m m e n t s f r o m t h d a n g e r t o h e r l i f e t h a t w i l l r e s u l t f r o m f a i l i n g t o o b t a i n T h e p a n e l f i n d s t h a t t h e p h y s i c i a n ' s N o v e m b e r 2 0 1 4 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 n a l i t e m s w i l l r e s u l t l e t t e r , t h e p h y s i c i a n l i s t s v i t a m i n s a n d m i n e r a l s u p p l e v a r i o u s m e d i c a l c o n d i t i o n s a n d f o r t h e A p p e l l a n t t o t a T h e p h y s i c i a n p r o v i d e d n o i n f o r m a t i o n r e g a r d i n g a n y t a k i n g t h e 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 . G i v e n t h e r e c o n s i d e r a t i o n , a n d t h e n e w i n f o r m a t i o n f r o m t h e p h 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 " i m m i n e n t d a n g e r " c r w e r e n o t m e t . E A P W D R S c h e d u l e C s e c t i o n 7 a n d s e c t i o n 6 7 1 . 1 a s y m p t o m a s 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 T h e M i n i s t r y a r g u e d t h a t t h e a d d i t i o n a l r e q u i r e m e n t i n t o t h e n u t r i t i o n a l i t e m " G r e e n s p o w d e r " , t h e M i n i s t r y n A p p e l l a n t h a s a m e d i c a l c o n d i t i o n t h a t r e s u l t s i n t h e i d a i l y r e q u i r e m e n t s t h r o u g h h e r r e g u l a r d i e t a r y i n t a k e , 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 f o u n d t h a t t h e r e i s n o i n d i c a t e t h a t t h e A p p e l l a n t i s d i s p l a y i n g s y m p t o m s o f 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 ( a s l i s t e d i n s u b s e c t i o n 6 d e m o n s t r a t e t h a t s h e n e e d s " G r e e n s o w d e r " t o a l l e v e v i d e n c e o f i m m i n e n t d a n g e r t t h e A p p e l l a n t ' s n o t o b t a i n e d , t h e p h y s i c i a n ' s i f o r m a t i o n i n t h e r a l s , a n d s u p p l e m e n t s o f f i s h o i � l , m i l k t h i s t l e a n d A p p e l l a n t ' s m e d i c a t i o n s . F u r t h r , h e A p p e l l a n t t o p a r t i c i p a t e i n e x r c i s e s t h a t n o t e d t h a t t h e p h y s i c i a n d i d n o i n d i c a t e a n y l o s s o r w a s t i n g t h a t w o u l d s u p p , r t t h e r e b e i n g r e c e i v e t h e s p e c i f i e d i t e m s . i a n ' s i n f o r m a t i o n i n t h e q u e s t i o n a i r e a l s o d o e s 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 n t ' s l i f e , t h e e r i n g " y e s " ) t h a t t h e v i t a m i n s a n ti m i n e r a l s w i l l o t e l a b o r a t e o n a n y i m m i n e n t d n g e r t o l i f e t h a t d s u p p l e m e n t 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 s t i o n n a i r e d o e s n o t s u p p o r t f i n i n g t h a t f a i l u r e n g e r t o l i f e p u r s u a n t t o E A P W D s u b s e c t i o n p p e l l a n t a t t h e h e a r i n g , t h e p a n I a s s i g n s a A p p e l l a n t ' s p h y s i c i a n b e c a u s e A P W D R s e c t i o n i n g " i m m i n e n t d a n g e r " i n s u b s e c i o n 6 7 ( 1 . 1 ) ( d ) ) l a b o r a t o r y t e s t r e s u l t s , a n d A p p � l l a n t ' s e d i c a l c o n d i t i o n s a n d t h e s u p p l e m e n t s e A p p e l l a n t ' s p h y s i c i a n r e g a r d i � g i m m i n e n t t h e v i t a m i n s a n d o t h e r i t e m s . l l e t t e r d o e s n o t c o n f i r m t h a t f a i l u e t o o b t a i n 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 . I n t h e m e n t s t h a t s h e " r e c o m m e n d s " f r t h e A p p e l l a n t ' s k e w h i l e s h e i s t a k i n g h e r a r t h r i i s m e d i c a t i o n . i m m i n e n t d a n g e r t o l i f e t h a t w i l l r e s u l t f r o m n o t e v i d e n c e t h a t t h e M i n i s t r y h a d t t h e t i m e o f t h e y s i c i a n , t h e p a n e l f i n d s t h a t t h e i n i s t r y i t e r i a i n s u b s e c t i o n 6 7 ( 1 . 1 ) ( d ) o f t h e E A P W D R c : N u t r i t i o n a l i t e m s t h a t a r e r e l!.l i r e d t o a l l e v i a t e e g u l a r d i e t a ry i n t a k e S c h e d u l e C s e c t i o n 7 w a s n o t e t . W i t h r e g a r d o t e d t h a t t h e p h y s i c i a n d i d n o t o n f i r m t h a t t h e n a b i l i t y t o a b s o r b s u ff i c i e n t c a l o i e s t o s a t i s f y a n d t h e r e f o r e n e e d s t h e i t e m f r c a l o r i c e v i d e n c e f r o m t h e A p p e l l a n t ' s h y s i c i a n t o u n d e rw e i g h t s t a t u s , s i g n i f i c a n t e i g h t l o s s , o r 7 ( 1 . 1 ) ( b ) o f t h e E A P W D R ) w h i h w o u l d i a t e o n e o f t h e s e s m t o m s o r s 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 h e r r e g u l a r d i e t a r y i n t a k e . c o m m e n t : " G r e e n s p o w d e r d a i l y h e l p s i m p r o v e e n e r g d o e s n o t c o n f i r m t h a t t h e A p p e l l a n t n e e d s n u t r i t i o n a l 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 . T h e M i n i s t r y n o t e d 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 a n d a r g u e d t h a t i t t h e r e f o r e c a n n o t b e d e t e r m i n e d t h w o u l d i n d i c a t e a n e e d f o r c a l o r i c s u p p l e m e n t a t i o n . T h p h y s i c i a n p r o v i d e d i n t h e q u e s t i o n n a i r e d o e s n o t e s t a n u t r i t i o n a l i t e m s t h a t a 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 P a n e l ' s d e c i s i o n T h e p a n e l n o t e s 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 u n 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 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 p p e l l a n t ' s r e q u e s t e x t r a c a l o r i e s b e y o n d t h o s e p r o v i d e d b y h e r r e g u l a r d 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 i n 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 r e r e q u i r e d a s p a r t o f a c o r 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 E A P W D R s u b w e r e a c c e p t e d b y t h e M i n i s t r y w e r e s i g n i f i c a n t d e t e r i i m m u n e s u p p r e s s i o n . T h e p h y s i c i a n s t a t e d i n t h e M N i m p r o v e e n e r g y a n d a l l o w s t h e A p p e l l a n t t o p a r t i c i p a t s u p p o r t s j o i n t s a n d m a i n t a i n s s t r e n g t h . T h e p h y s i c i a n s y m p t o m a n d t h e r e f o r e 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 R e g a r d i n g t h e s y m p t o m o f s i g n i f i c a n t w e i g h t l o s s w h t h e M i n i s t ry n o t e d t h a t t h e r e i s n o i n f o r m a t i o n f r o m t h 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 . I n t h e M N S a p p l i c a t i o t h e r e w a s w e i g h t l o s s o v e r a s p e c i f i e d p e r i o d o f t i m e t h a t t h e p h y s i c i a n ' s o n l y r e f e r e n c e t o t h e A p p e l l a n t ' s w h e t h e r t h e A p p e l l a n t h a d s i g n i f i c a n t w e i g h t l o s s . T h p r e d n i s o n e a l t e r n a t i n g w i t h w e i g h t l o s s " . T h i s i s n o t e s i g n i f i c a n t w e i g h t l o s s o v e r a s p e c i f i e d t i m e p e r i o d a n r e g u l a r d i e t . M o r e o v e r , t h e p h y s i c i a n d i d n o t e x p l a i n a d d i t i o n a l c a l o r i e s ; t h a t i s , c a l o r i c s u p p l e m e n t a t i o n t o S i m i l a r l y , t h e l a b o r a t o ry t e s t r e s u l t s d o n o t h i g h l i g h t a s u p p l e m e n t a t i o n a n d t h e p h y s i c i a n d i d n o t e x p l a i n h o 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 . W c a l o r i e s d u e t o h e r a m e d i c a l c o n d i t i o n , t h e p h y s i c i a n o f w h e t h e r t h e A p p e l l a n t h a s a m e d i c a l c o n d i t i o n t h a t 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 t h r o u g h a r e g u l a t h e " G r e e n s p o w d e r " a s a n 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 i t a s p a rt 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 h e r r e g u l a r d 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 t y s i c i a n ' s y a n d a l l o w s p a t i e n t t o d o s w i m m i n g / e x e r c i s e " 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 h e r c h r o n i c , i g h t a r e n o t r e c o r d e d i n h e r a p p i c a t i o n f o r M N S , a t t h e A p p e l l a n t h a s s y m p t o m s c f w a s t i n g w h i c h e M i n i s t r y a r g u e d t h a t t h e i n f o r T a t i o n t h e b l i s h t h a t t h e A p p e l l a n t r e q u i r e � a d d i t i o n a l a t i o n t o h e r r e g u l a r d i e t a r y i n t a k , e . d e r 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 r t o f a n d 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 ' i n d i c a t e s a 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 r e q u e s t f o r i e t . 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 I p i n d i c a t e t h a t 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 s e c t i o n 6 7 ( 1 . 1 ) ( c ) . T h e o n l y s y r h p t o m s t h a t o r a t i o n o f a v i t a l o r g a n a n d m o d i e r a t e t o s e v e r e S a p p l i c a t i o n t h a t " G r e e n s p o w < e r " h e l p s e i n e x e r c i s e s u c h a s s w i m m i n � w h i c h i n t u r n ' s r a t i o n a l e d o e s n o t a d d r e s s t h l e a l l e v i a t i o n o f a m i n e d t h a t s u b s e c t i o n 6 7 ( 1 . 1 ) ( c w a s n o t m e t . i c h w o u l d s u p p o r t a n e e d f o r a d i t i o n a l c a l o r i e s , e A p p e l l a n t ' s p h y s i c i a n s p e c i f y i g t h e n , t h e p h y s i c i a n a l s o d i d n o t i n d c a t e w h e t h e r o r h o w m u c h w e i g h t w a s l o s t . h e p a n e l n o t e s w e i g h t w a s i n r e s p o n s e t o t h e q u e s t i o n o f e p h y s i c i a n w r o t e " w e i g h t c h a n � e s w i t h 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 e x p e r i e n c e d d i s u n a b l e t o o b t a i n s u f f i c i e n t c a l o r i e s f r o m h e r h o w " G r e e n s p o w d e r " w o u l d p n b v i d e t h e a r e g u l a r d i e t a r y i n t a k e . n y m e a s u r e s t h a t i n d i c a t e a n e E � d f o r c a l o r i c w a n y o f t h e t e s t r e s u l t s p e r t a i n t o a n e e d f o r i t h r e g a r d t o a n i n a b i l i t y t o a b s c r b s u f f i c i e n t ' s e v i d e n c e w a s t o a n s w e r " N o " t o t h e q u e s t i o n r e s u l t s i n t h e 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 d i e t a r y i n t a k e . T h e p h y s i c i a n r e c o m m e n d e d b u t d i d n o t i n d i c a t e h o w t h e A p o e l l a n t w o u l d u s e i e t a r y i n t a k e .
With regard to the information in the questionnaire, and as noted by the Ministry, there were no questions or responses that addressed the need for caloric supplementation to a regL lar dietary intake. The Ministry noted that there was no evidence in any of the documentation o1 the Appellant presenting with underweight status or symptoms of wasting that would indicate a nee j for caloric supplementation. With regard to the new medical evidence (the September 2014 physician's letter), the panel finds that the information in this letter does not confirm any need for caloric supplementation. It� this letter, the physician reported that the Appellant is "immuno-compromised" due to her Hepatitis c nd the medications that treat her rheumatoid arthritis, but there is no information regarding a need for additional nutritional items as a caloric supplement. The panel therefore finds that thP Ministry reasonably determined that the criteria in Schedule C section 7 of the EAPWDR were not met. Conclusion The Panel confirms the Ministry's reconsideration decision as being reasonably supp,�rted by the evidence and a reasonable application of the applicable enactment in the circumstan<�es 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.