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 D 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 N o v e m b e r 1 9 , 2 0 1 4 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 ( M N S ) f o r a d d i t i o n a S e c t i o n 7 o f S c h e d u l e C o f t h e E m p l o y m e n t a n d A s s ( E A P W D R ) . T h e m i n i s t r y f o u n d t h a t t h e e v i d e n c e p r ( p h y s i c i a n ) d o e s n o t c o n f i r m t h a t : • d u e t o a s e v e r e m e d i c a l c o n d i t i o n w h i c h r e s u h e a l t h , t h e a p p e l l a n t d i s p l a y s t w o o f t h e s y m p • t h e a p p e l l a n t r 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 r e g u l a r d i e t a r y i n t a k e f o r t h e p u r p o s e s o f a l l e v [ s e c t i o n 6 7 ( 1 . 1 ) ( c ) ] , o r ; • 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 q u e s t w o u l d r e s u [ s e c t i o n 6 7 ( 1 . 1 ) ( d ) ] . 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 i ( 2 ) , a n d s e c t i o n 7 o f S c h e d u l e C . EAA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # I 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 ' s ( m i n i s t r y ) w h i c h h e l d 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 a l 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 ) a n d 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 o v i d e d b y t h e a p p e l l a n t ' s m e d i c a l p r a c t i t i o n e r l t e d i n 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 t i o n o f t o m s s e t o u t i n s e c t i o n 6 7 ( 1 . 1 ) ( b ) ; 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 a t i o n t o a i a t i n g a s y m p t o m r e f e r r e d i n s e c t i o n 6 7 ( 1 . 1 ) ( b ) l t 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 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 ( 1 ) a n d
P A R T E S u m m a ry 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 r e c o n 1 . A p p l i c a t i o n f o r M N S s i g n e d a n d d a t e d ( O c t o b c o m p l e t e d i n t h e p h y s i c i a n ' s h a n d w r i t i n g , w h b r e a s t c a n c e r , d i a b e t e s 2 , o s t e o a rt h r i t i s a n d l 2 . 3 p a g e t y p e d l e t t e r ( h e a r o n r e f e r r e d t o a s t h e 2 0 1 4 w h i c h l i s t s 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 T h e l e t t e r i s s i g n 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 " I h a v e r e v i e w e d t h e a b o v e s t a t e m e n t " . T h e c o s t e o a rt h r i t i s / o s t e o p o r o s i s , l u p u s , d i a b e t e s 2 , i r r i t a b l e b o w e l s y n d r o m e . U n d e r t h e s e c t i o n t a u t h o r o f t h e l e t t e r w r o t e , " F a i l u r e t o o b t a i n a r e s u l t i n i m m i n e n t d a n g e r t o l i f e . " ; 3 . S u r g i c a l P a t h o l o g y R e p o r t o f t h e r i g h t b r e a s t w a c c e s s i o n d a t e o f A u g u s t 2 1 , 2 0 1 4 a n d s t a t e s 4 . S u r g i c a l P a t h o l o g y R e p o r t o f t h e r i g h t b r e a s t w a c c e s s i o n d a t e o f A u g u s t 9 , 2 0 1 3 , a n d s t a t e s 5 . 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 s i g n e d a n d d a t e • s h e h a s b r e a s t c a n c e r a n d w i l l b e t r e a t • t h e h o s p i t a l a n d h e a l t h n u r s e a d v i s e d h m e r e l y e a t s t w i c e p e r d a y d u e t o o n l y $ • s h e r e c e i v e s $ 3 5 f o r v i t a m i n / m i n e r a l s u • s h e g o e s t o t h e f o o d b a n k b u t t h e f o o d g r o w i n g o n i t ; a n d • s h e t r i e s t o p u r c h a s e E n s u r e w h e n i t i s i n p a i n s o a l l s h e c a n d o i s d r i n k a n E n I n t h e N o t i c e o f A p p e a l , s i g n e d a n d d a t e d N o v e m b e r • s h e b e l i e v e s s h e m e e t s t h e c r i t e r i a f o r M N S ; • h e r d o c t o r s p e c i f i e d " f a i l u r e t o o b t a i n a c a l o r i c i m m i n e n t d a n g e r t o l i f e " ; a n d • i m m i n e n t d a n g e r m e a n s " a b l e t o h a p p e n s o o n A t t h e h e a r i n g t h e a p p e l l a n t r e l i e d o n t h e i n fo r m a t i o n a n d s t a t e d t h i s l e t t e r o u t l i n e s i n d e t a i l t h a t : • s h e h a s b o n e l o s s d u e t o o s t e o p o r o s i s ; n e u r o s p e c i f i e s t h a t c e r t a i n f o o d s w i l l h e l p r e d u c e p a i m m i n e n t d a n g e r t o l i f e ; f a i l u r e t o o b t a i n a c a l o r e s u l t i n i m m i n e n t d a n g e r t o l i f e ; c e r t a i n f o o d s s y s t e m , a n d t h e p h y s i c i a n h a s e s t a b l i s h e d m u S h e a l s o a d d e d t h a t : • h e r p h y s i c i a n p r o v i d e d a l l t h e i n f o r m a t i o n h e c • s h e c a n n o t e x e r c i s e d u e t o p a i n b u t w o u l d l i k e • s h e h a s a p p l i e d f o r M N S b e c a u s e f o o d p r i c e a c a l o r i e s ; • l e s s n u t r i t i o n a l f o o d i s e a s i e r t o a f f o r d b u t w i l l EAA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # I s i d e r a t i o n c o n s i s t s o f : e r 9 , 2 0 1 4 ) b y t h e a p p e l l a n t ' s p h y s i c i a n b u t n o t i c h l i s t s 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 s a s u p u s ; l e t t e r ) w i t h a h a n d w r i t t e n d a t e a s N o v e m b e r 6 , o n d i t i o n s a n d d i e t a r y n e e d s f o r e a c h c o n d i t i o n . n a n d i n t h e p h y s i c i a n ' s h a n d w r i t i n g i t i s w r i t t e n , o n d i t i o n s a r e l i s t e d a s b r e a s t c a n c e r , m a l n u t r i t i o n , c h r o n i c g a s t r i t i s a n d h a t d e s c r i b e s t h e a p p e l l a n t ' s b r e a s t c a n c e r t h e c a l o r i c s u p p l e m e n t t o r e g u l a r d i e t a r y i n t a k e w i l l i t h a p r o c e d u r e d a t e o f A u g u s t 2 0 , 2 0 1 4 , a n " n e g a t i v e f o r d y s p l a s i a o r m a l i g n a n c y " . i t h a p r o c e d u r e d a t e o f A u g u s t 9 , 2 0 1 3 , a n i n f i l t r a t i v e d u c t a l a d e n o c a r c i n o m a ; d N o v e m b e r 6 , 2 0 1 4 w h i c h s t a t e s t h a t : e d f o r y e a r s t o c o m e ; e r t o e a t 5 -6 t i m e s p e r d a y b u t s o m e t i m e s s h e 3 5 e x t r a p e r m o n t h ; p p l e m e n t ; t h e r e i s n o t n u t r i t i o n a l , e x p i r e d o r h a s m o l d o n s a l e a s t h e r e a r e d a y s w h e n s h e i s t i r e d a n d s u r e . 2 4 , 2 0 1 4 , t h e a p p e l l a n t s t a t e s : s u p p l e m e n t t o r e g u l a r d i e t a r y i n t a k e w i l l r e s u l t i n o r i m p e n d i n g " . p r o v i d e d i n t h e l e t t e r d a t e d N o v e m b e r 6 , 2 0 1 4 , l o g i c a l d e g e n e r a t i o n d u e t o l u p u s ; t h e p h y s i c i a n i n a n d p r o g r e s s i o n o f d e t e r i o r a t i o n o f h e a l t h a n d r i c s u p p l e m e n t t o r e g u l a r d i e t a r y i n t a k e w i l l h e l p r e p l a c e a n d r e p a i r t i s s u e s a n d t h e i m m u n e s c l e m a s s a n d b o n e l o s s . o u l d b u t t h e m i n i s t r y i s b e i n g v e r y p a r t i c u l a r ; t o ; r e v e r y h i g h a n d s h e c a n n o t g e t h e r h e a l t h y n o t h e l p h e r f i g h t e a c h o f t h e p r o g r e s s i v e
I APPEAL# diseases she has; • when she cannot cook or eat due to her medical conditions, she relies on nutrition shakes; • her cancer is in remission but she continues to take medication and must eat 5-6 meals per day in the hope it will not come back; • a caloric supplement is not only to gain weight, rather it can be to lose or maintain weight too; • she appreciates that the government pays for her medication but it does not cover the cost of her cancer medication, which is provided to her by the cancer clinic (the appellant showed a bottle of medication she takes as part of her cancer treatment. It contained 20mg tablets of Tamoxifen that is to be taken once daily); • when asked why question #2 of the application for MNS did not list cancer as a cause of her chronic progressive deterioration of health yet it was discussed throughout the documentation provided as a cause of her symptoms, the appellant stated it was an oversight; • when asked how diabetes inhibits absorption of nutrients, the appellant stated that high sugar levels affect the functioning of other organs that absorb nutrients; • when asked to explain her neurological degeneration the appellant stated that when her lupus and/or arthritis flares up, it causes pain and limited movement due to the nerve damage; • when asked who prepared the 3-page letter dated November 6, 2014 the appellant stated that she discussed her medical conditions in detail with her physician in his office, then went home and typed the letter. Later she brought the letter back to her physician for review; • when asked, the appellant could not provide evidence supporting that the diabetes and cancer clinic advised her to eat 5-6 meals per day; Admissibility of New Information The ministry did not object to the admission of the new information. The panel finds that the bottle of Tamoxifen provides information on part of her cancer treatment plan. The panel admits this additional inf o rmation as being in support of information and records that were before the ministry at the time of reconsideration, in accordance with Section 22(4)(b) of the Employment and Assistance Act. At the hearing the ministry relied on its reconsideration decision and added that: • the appellant already receives $40 supplement for vitamins and minerals and $35 dietary allowance f o r her diabetic needs; • if she were to provide medical confirmation of her breast cancer, the appellant could qualify for an additional dietary supplement; • bone loss does not qualify for MNS; • though the application for MNS was completed in the appellant's handwriting, this was not a factor f o r the denial; and • in order to determine that muscle mass loss and neurological degeneration occurred, they must be measurable in both degree and over a period of time, thereby showing a progression in the deterioration of the appellant's health. EAAT 003(10/06/01)
PART F -Reaso n s for Panel Decisi o n The issue on appeal i s whether the m i nistry' s dec ision a Monthly Nut ritiona l Supplement (MNS) because she failed to meet the legislat the EAPWDR was rea s onably supported by the evidence o applicable enactme n t i n the cir cumstances of the appellant. reason able in determining that the evide nc e provided by the appe (ph ys ician) does not confi rm t ha t d ue to a seve re medical condition which caused chronic, prog re ssive deterioration of h ea l th the a pp e llant displays two of the sympto (1.1 )(b), the addition al nutrition a l items are part of a caloric supplementation to a re intake f o r the purpose of a lleviati n g a symptom r eferred to obtain the items requested woul d res ul t in imminent danger to her lif The relevant legislation is as f o ll ow s: EA PW DR N u t ritio nal s u pp l e m e nt 67 (1) The m ini st er may pro vid e a nu tr i tional su nutr i t ion a l suppleme nt] of Schedule C t o o r receives disabi l i t y assista n c e under (a) se c tio n 2 [monthly s upport recei ving ro om a nd board] o r houses] of Sch e dul e A, o r (b) s ect i on 8 [peop l e receivi ng fac il it y is a n al coh ol or drug treatme if the mini st er is satis fie d that (c) based on the i nfo rmation con th e req ui rem ent s set o ut in su p erson with d isabil itie s, ( d) the pers on is n o t receiving a supplem supplement] of Sche du le C, (e) the pers on is no t receivin g s upplement s ], (f) the person complies with any requirement of the minister under subsection (2), a n d (g) the person's family unit does not have any resources available to pay the cost of or t o obtain the items for wh i c h (1.1) In order for a person with disabilities to receive a nutritional supplement under this section, the mi ni ster m u st receive a reques t, in the f practitioner or nurse practitioner, in which the practitioner h (a) the person with disabili ties 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 EAAT 003(10/06/01) I APPEAL# w hich he ld t ha t the appellant is not eligible for ive c riteria set out i n r wa s a r easonable appli c atio n o f the In particular, w as the ministry llant's medical practitioner ms listed i n sec t i on 67 g ular dietary i n section 67 (1.1 )(b), or that failure to e? pplemen t in accord a nce with secti o n 7 [ mont h l y f or a pers on wi th dis a bil itie s in a family unit who allow ance], 4 [monthly shelt er allo w ance], 6 [peo ple 9 [people i n em er gency shelters and transition spec i a l car e] of Sch edu le A, if the s p ecia l care nt centre, tained in th e fo rm r eq u ired under subse c tion ( 1. 1 ) , bsectio n ( 1 . 1 ) ( a ) to ( d) are met in res pect of the ent u nd e r s ec tion 2 (3) [gener al heal th a su p ple ment under subsection (3) o r section 6 6 [ d i et the supplement may be provided. orm specified by the minister, completed by a medical a s confirmed all of the following: to whom the request relates is being treated by the
displays two or more o f t he following symptoms: (i) ma l nutri tion; (i i) underwei ght statu (ii i) significant weight loss; (iv) signi f i cant muscle mas (v) sign ificant neur ological (vi) significant d et eri orat (vii) mod erate to severe immune supp (c) for the p urpose o f a l l eviatin requ ires one or more of the items s in the request; (d) failu re to o bt ain t h e items referre dan ger to the per s o n's li f e . (2) In order to deter mi n e or confi rm the ne ed su ppl e me n t i s p rovid e d u nder subs ection (1 p er s on o btain an o pin ion f ro m a m e di ca l pr pr actition er r e f er red to i n subs ection ( 1 ) (c). Schedule C M ont h ly n utrit ional sup pl e men t 7 T h e amou nt of a nut ritio nal su ppleme nt th at m ay supplem e nt] of thi s regu lati on i s th e sum o f t h a s requi red in the re ques t und e r sec tio n 6 7 ( 1) (a ) for addi tion al nutr itio nal item regular diet ary intake, up to $165 (b) Repea l e d. [B .C. R eg. 68/ 2010, (c) for v it a mins and min era l s , T he Ministry's Positio n : Th e ministry's p o si t i on is that the appe llant already receiv and $35 fo r a dietary allowance for her diabetes. The ministry argues that in o MNS the appellant must meet all four cr it er ia listed in the additional nutritional items be for additional caloric intake to Schedule C of the EAPWDR. T he mini str y argues th ap pellant d is pla ys two of th e s y m ptoms listed s e ction n u t r it i ona l ite m s wi ll result in imminent danger to li fe, and that the re The a ppellant's ph y sician states t h at breast cancer puts legislation [section 67 (1.1) (d) of the EAPWDR] requires that a failure to obtain the nutritional items requeste d will result in imminent danger to the appellan physician. Furthermore, muscle mass loss is substantiated by the appellant's physician however the level of significance has not been established as the physician has not provided evidence to confirm how much muscle mass was lost and/or over how long a period and neurological degeneration due to muscle spasms/weakness has not been explained. EAAT 003(10/06/01) ! APPEAL # s; s loss; degener at ion ; io n of a vital organ; r e s si on; g a s ymptom referred to in para graph (b ), the person e t out in secti on 7 of Schedule C and specifie d d to in pa ragraph (c) will result in imminent o r c o n tin ui ng need o f a p ers o n for wh om a ) , the minister m ay a t a ny time requ ire tha t the a ct itio ner or nur s e p racti tio ne r oth er t han the be provid ed under s ect i on 6 7 [nutrit io n al e am ount s f or tho se of the fo ll o w i ng item s spe cifie d (c) : s tha t are part of a calori c supp leme nta tion t o a each month; s. 3 (b) . ] up to $4 0 e ach mon th es $40 for vitamin and minerals supplement rder to be eligible for a section 67 (1. 1) (a -d) of t he EAPWDR an d tha t a regular diet as stat e d i n section 7 of at the evidence does not es t ablish tha t the 6 7 (1.1.) (b ) and that failure to obtain the q ue st is f o r ad ditional calories. her in imminent danger however the t's life and this has not been confirmed by the
I APPEAL# The Appellant's Position: The appellant's position is that her physician has provided information that establishes that she suffers from bone and muscle mass loss and neurological degeneration, and that failure to obtain a nutritional supplement will result in imminent danger to her life. The physician has also stated that her medical conditions lead to a chronic, progressive deterioration of health. Thereby she meets the legislative criteria as it is set out. She also argues that in order to fight cancer and live with her other medical conditions she needs a good healthy diet and to eat 5-6 times per day. The Panel's Decision: Section 67 (1.1) (b) of the EAPWDR states that as a direct result of the chronic, progressive deterioration of health, the person displays two or more of the listed symptoms. The evidence provided by appellant's physician establishes that the appellant has several severe medical conditions for which she is currently being treated; namely breast cancer, lupus diabetes type 2 and osteoarthritis. In the application for MNS, the physician states that the appellant displays the symptoms of malnutrition, muscle mass loss due to osteoarthritis and osteoporosis, and neurological degeneration due to lupus and osteoarthritis. In the letter under the heading 'lupus', the appellant's physician confirms that the appellant has "severe muscle weakness, muscle spasms due to significant neurological degeneration", under the heading osteoarthritis/osteoporosis "significant muscle mass loss due to poor nutrition, muscle has turned to unhealthy fat. .. " and the appellant stated she is unable to exercise which may allow her to build muscle mass. However, the physician has not provided information to allow quantitative determination of whether or not muscle mass loss and neurological degeneration are significant in extent and length of time. Furthermore, the panel finds that the physician has indicated that the muscle mass loss is due to poor nutrition, which is neither chronic nor progressive in nature, and which is not indicated on the appellant's application for MNS as a medical condition for which she is currently receiving treatment. As a result the panel finds that the ministry reasonably determined that evidence does not establish that appellant meets the requirements of section 67 (1.1) (b) of the EAPWDR. Section 67 (1.1) (c) of the EAPWDR states that for the purpose of alleviating a symptom referred to in section 67 (1.1) (b) of the EAPWDR, the appellant requires one or more of the items set out in section 7 of Schedule C. The appellant argues that her physician has determined that she requires more nutritional items to maintain her strength to fight lupus, osteoarthritis and breast cancer. He specifically mentions folic acid, grains, fruits, vegetables and fish. The ministry argues the listed items represent a specific diet rather than additional calories and that the height and weight recorded in the appellant's application for MNS indicates a body mass index of 30.9, which is in the obese range. The panel finds that in the letter, the physician outlines specific nutritional items that may help either reduce pain, swelling and inflammation or aid in cell growth. This speaks to a specific diet rather than additional calories. Furthermore, the nutritional items specified are requested to alleviate pain, swelling, inflammation and to aid in cell growth but these are not the conditions that are outlined in section 67 (1.1) (b) of the EAPWDR. As a result, the panel finds that the ministry reasonably determined that evidence does not confirm that the purpose of alleviating a symptom referred to in section 67 (1.1) (b) of the EAPWDR, the appellant requires one or more of the items set out in section 7 of Schedule C pursuant to section 67 (1.1) (c) of the EAPWDR. EMT 003(10/06/01)
t o t h e a p p e l l a n t ' s l i f e . T h e a p p e l l a n t a r g u e s t h e l e t t e i m m i n e n t d a n g e r . T h e m i n i s t r y a r g u e s t h a t t h e p h y s p u t s h e r i n i m m i n e n t d a n g e r n o t t h a t a f a i l u r e t o o b t a 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 p a n e l f p h y s i c i a n s t a t e s t h a t t h e n u t r i t i o n a l i t e m s r e q u e s t e d t o o b t a i n t h e i t e m s w i l l i n c r e a s e t h e i m m i n e n t d a n g e i n i m m i n e n t d a n g e r a s s h e c u r r e n t l y d o e s n o t h a v e a d d i t i o n a l m e d i c a l r e p o r t s t o s u b s t a n t i a t e i m m i n e n t t h e a p p l i c a b l e l e g i s l a t i o n r e s t s o n t h e d e f i n i t i o n o f i m d i c t i o n a r y , r e f e r s t o s o m e t h i n g t h a t i s l i k e l y t o h a p p e f i n d s t h a t t h e e v i d e n c e d o e s n o t e s t a b l i s h t h a t i f t h e t h e a p p e l l a n t ' s l i f e w o u l d b e i m p e n d i n g . A s a r e s u l t d e t e r m i n e d t h a t t h e e v i d e n c e d o e s n o t c o n f i r m t h a t w o u l d 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 a p p e l l a n t ' s l i f C o n c l u s i o n : 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 c o n c l u d a p p e l l a n t ' s r e q u e s t d i d n o t m e e t t h e l e g i s l a t i v e c r i t e r E A P W D R t o b e e l i g i b l e f o r M N S . T h e p a n e l c o n f i r m EAA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # ! r f r o m h e r p h y s i c i a n e s t a b l i s h e s t h a t s h e i s i n i c i a n h a s e s t a b l i s h e d t h a t t h e a p p e l l a n t ' s c a n c e r i n t h e n u t r i t i o n a l i t e m s r e q u e s t e d w i l l r e s u l t i n i n d s t h a t u n d e r s e v e r a l h e a d i n g s i n t h e l e t t e r , t h e w i l l r e d u c e i m m i n e n t d a n g e r t o l i f e , o r t h a t f a i l u r e r t o l i f e b u t d i d n o t s t a t e t h a t t h e a p p e l l a n t ' s l i f e i s t h e i t e m s r e q u e s t e d , n o r d o e s h e p r o v i d e d a n g e r t o l i f e . T h e p a n e l n o t e s t h a t t h e h e a r t o f m i n e n t , a n d t h a t i m m i n e n t , a s i t i s d e f i n e d i n t h e n a t a n y m o m e n t o r i s i m p e n d i n g . T h e p a n e l n u t r i t i o n a l i t e m s a r e n o t o b t a i n e d , t h a t d a n g e r t o , t h e p a n e l f i n d s t h e m i n i s t r y r e a s o n a b l y f a i l u r e t o o b t a i n t h e n u t r i t i o n a l i t e m s r e q u e s t e d e p u r s u a n t t o s e c t i o n 6 7 ( 1 . 1 ) ( d ) o f t h e E A P W D R . e d t h a t t h e e v i d e n c e e s t a b l i s h e s t h a t t h e i a s e t o u t i n s e c t i o n 6 7 ( 1 . 1 ) { b , c a n d d ) o f t h e s t h e m i n i s t r y ' s d e c i s i o n .
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.