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 r e c o n s i d e r a t i o n d m i n i s t r y d e n i e d t h e a p p e l l a n t ' s r e q u e s t f o r a m o n t h n u t r i t i o n a l i t e m s a n d v i t a m i n s / m i n e r a l s . I n i t s d e c i s i m e e t t h e q u a l i f y i n g c r i t e r i a s e t o u t i n E m p l o y m e n t a 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 S c h e d u l e 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 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 E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # e c i s i o n d a t e d O c t o b e r 2 1 , 2 0 1 4 i n w h i c h t h e 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 l o n , t h e m i n i s t r y d e t e r m i n e d t h e a p p e l l a n t d i d n o t 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 l i t i e s C s e c t i o n 7 . i l i t i e s R e g u l a t i o n , s e c t i o n 6 7 ( 1 ) i l i t i e s R e g u l a t i o n , S c h e d u l e C s e c t i o n 7
I APPEAL# PART E -Summary of Facts The information before the ministry at the time of reconsideration included the following: • An Application for Monthly Nutritional Supplement dated June 23, 2014, in the name of the appellant completed by her physician. The physician lists PTSD and insomnia as her diagnoses and writes she is going through counseling, seeing a sleep specialist, and that she feels she would benefit from vitamins and minerals. The physician indicates she displays significant neurological degeneration as a symptom. The physician writes that vitamins and minerals will prevent further deterioration in her psychological well being, should improve her sleep and alleviate some symptoms of PTSD. • An updated Application for Monthly Nutritional Supplement dated October 7, 2014, in the name of the appellant completed by her physician. The physician used the same application that he completed on June 23; however, he provided additional information about the appellant's condition. He added the appellant displays malnutrition as an additional symptom of her condition. He notes that the malnutrition results in her losing weight, constipation, and deformed fingernails. The physician added in the Nutritional Items section that the appellant needs Boost, to maintain weight and that she needs to eat a higher fiber diet. He wrote that the vitamins would help with constipation. In response to the question of how will the nutritional items prevent imminent danger to the appellant's life, the physician wrote, they will prevent further weight loss and malnutrition. • A request for reconsideration application form dated October 7, 2014. The appellant writes she has been told by several doctors to take vitamins, however, on her current disability assistance she cannot afford to buy enough food or vitamins. She writes she has an irritable bowel and her fingernails grow under if she doesn't eat fresh meats and vegetables. In her notice of appeal dated October 29, 2014 the appellant writes she doesn't have enough money for proper food and vitamins and, as a result, she has been losing weight. She gets constipated when she doesn't eat properly, her nails grow under, and her life is in danger without proper nutrition. The appellant was not in attendance at the hearing. After confirming she had been notified of the hearing location, date, and time, the hearing proceeded under section 86(b) of the Employment and Assistance Regulation. At the hearing the ministry reviewed the reasons for denial in the reconsideration decision and told the panel that although the physician had added malnutrition as a second symptom to the revised version of the application form, the physician failed to provide sufficient supporting detail for the ministry to consider it. The physician writes that the appellant has experienced weight loss, constipation, and deformed fingernails as a result of the malnutrition. The ministry stated in order for it to consider malnutrition as a symptom it requires more specific details about the applicant's weight, BMI, and rate of weight loss, in order to determine the severity of the her condition. The ministry added that the physician details that the appellant requires a high fiber diet to alleviate her symptoms, however, he does not explain the connection of how the vitamins/mineral supplement will assist with her constipation and weight loss. The ministry told the panel that there are other diet allowances available to applicants, including funding for those requiring a high-fiber diet, however, the person would need to apply for this funding and it would be considered. The ministry suggested that the appellant's needs might be met by a different ministry option. EAAT 003(10/06/01)
T h e m i n i s t r y c o n c l u d e d t h a t t h e a p p e l l a n t d i d n o t p r e s u l t o f h e r c h r o n i c c o n d i t i o n , s h e d i s p l a y s t w o o r ( 1 . 1 ) ( b ) . F u r t h e r m o r e , t h e m i n i s t r y t o l d t h e p a n e l t h 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 i n i m E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # r o v i d e s u f f i c i e n t i n f o r m a t i o n t o e s t a b l i s h t h a t a s a m o r e o n t h e s y m p t o m s a s l i s t e d i n E A P W D R 6 7 a t t h e a p p e l l a n t h a s n o t p r o v i d e d e v i d e n c e t h a t m i n e n t d a n g e r t o h e r l i f e .
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 d e c i s i o n u n d e r a p p e a l i s t h e r e a s o n a b l e n e s s o a p p l i c a t i o n 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 i n c 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 ' s a p p l i c a t i o n l e g i s l 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 a p p e l l a n t d i d s y m p t o m s , t h a t t h e 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 d i e t a r y i n t a k e , n o r d i d s h e p r o v i d e e v i d e n c e d e m o n a l l e v i a t e a s y m p t o m o r t h a t f a i l u r e t o r e c e i v e t h e s u T h e a p p l i c a b l e l e g i s l a t i o n i s t h e E A P W D R s e c t i o n 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 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 r s o n w i t h d i s 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 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 t r a n s i t i o n h o u ( 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 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 e 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 c t o f t h e p ( 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 e ( 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 u ( 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 m ( 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 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 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 d b y t h e m 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 i o n e r h a s c o n f i r m e d a ( 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 r 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 t o f a s e ( 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 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 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 a n d s p 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 ( 2 ) I n o r d e r t o d e t e r m i n e o r c o n f i r m t h e n e e d o r c o n t p r o v i d e d u n d e r s u b s e c t i o n ( 1 ) , t h e m i n i s t e r m a y a t a m e d i c a l 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 o t h e r t h a n t ( 3 ) 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 m e n t h e s u p p l e m e n t i s p r o v i d e d t o o r f o r a r e c i p i e n t o f d i s d i s a b i l i t y a s s i s t a n c e i f ( a ) t h e r e c i p i e n t o r d e p e n d e n t c h i l d i s n o t r e c e i v i n g a 2 ( 3 ) o f S c h e d u l e C , a n d ( b ) a m e d i c a l 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 c o n f i r a c u t e s h o r t t e r m 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 o w h i l e r e c o v e r i n g f r o m ( i ) s u r g e r y , ( i i ) a s e v e r e i n j u r y , i i i a s e r i o u s d i s e a s e o r E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # I f t h e m i n i s t r y ' s d e c i s i o n t o d e n y t h e a p p e l l a n t ' s l u d i n g n u t r i t i o n a l i t e m s a n d v i t a m i n s / m i n e r a l s . T h e d i d n o t m e e t t h e c r i t e r i a s e t o u t i n t h e a p p l i c a b l e n o t m e e t t h e c r i t e r i a o f h a v i n g t w o o r m o 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 s t r a t i n g t h e r e q u e s t e d M N S a r e r e q u i r e d t o p p l e m e n t p o s e s a n i m m i n e n t t h r e a t t o h e r l i f e . 6 7 a n d 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 : 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 n u t r i t i o n a l 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 d i s a b i l i t y a s s i s t a n c e 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 a n d b o a r d ] s e s ] o f S c h e d u l e A , o r 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 d r u g 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 s e t o u t i n e r s o n w i t h d i s a b i l i t i e s , 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 S c h e d u l e C , 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 ] , 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 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 i t e m s f o r 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 m i n i s t e r 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 p r a c t i t i o n e r o r n u r s e l l o f t h e f o l l o w i n g : 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 c h r o n i c , 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 m o r e o f t h e 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 m o r e o f 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 l i f e . i n u i n g n e e d o f a p e r s o n f o r w h o m a s u p p l e m e n t i s n y t i m e r e q u i r e t h a t t h e p e r s o n o b t a i n a n o p i n i o n f r o m a h e p r a c t i t i o n e r r e f e r r e d t o i n s u b s e c t i o n ( 1 ) ( c ) . t f o r a p e r i o d o f 3 c a l e n d a r m o n t h s t o o r f o r a f a m i l y u n i t i f a b i l i t y a s s i s t a n c e o r a d e p e n d e n t c h i l d o f a r e c i p i e n t o f s u p p l e m e n t u n d e r s u b s e c t i o n ( 1 ) o f t h i s s e c t i o n o r s e c t i o n m s i n w r i t i n g t h a t t h e r e c i p i e n t o r d e p e n d e n t c h i l d h a s a n a r e g u l a r d i e t a r y i n t a k e t o p r e v e n t c r i t i c a l w e i g h t l o s s
I APPEAL# (iv) side effects of medical treatment. 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. Arguments of the Parties The argument of the appellant is that she requires a vitamin/mineral supplement and extra money to buy nutritious food in order for her to maintain her physical and mental health. The appellant argues that without these items her health is in imminent danger. The position of the ministry is that the appellant did not provide sufficient information to establish that, as a result of her chronic condition, she displays two or more on the symptoms as listed in EAPWDR 67 (1.1) (b) or that the requested additional nutritional items are part of a caloric supplementation to a regular dietary intake. Furthermore, the ministry holds that the appellant has not provided evidence the requested items are required to alleviate a symptom or that failure to obtain the requested items will result in imminent danger to her life. Panel Decision and Reasons The applicant applied for both a vitamin/mineral supplement (multivitamin, calcium, and magnesium supplement) and Nutritional Items (Boost and a high-fiber diet). As these two requests have different criteria, I will deal with them separately. Both requests are subject to a person meeting the criteria set out in EAPWDR 67 (1) and (1.1) . The ministry has found that the appellant has met the criteria of EAPWDR 67(1) as well as EAPWDR 67(1.1 )(a) so the panel will not address these. The panel will review the reasonableness of the ministry's decision to find the appellant failed to meet the three criteria EAPWDR 67(1.1)(b), (c), and (d) and EAPWDR Schedule C section 7. Two or more symptoms The EAPWDR 67(1.1) (b) requires: as a direct result of the chronic, progressive deterioration of health, the person displays two or more of the following symptoms. Malnutrition, underweight status, significant weight loss, significant muscle mass loss, significant neurological degeneration, significant deterioration of a vital organ, moderate to severe immune suppression. First the panel considered the reasonableness of the ministry's determination that the appellant has not met EAPWDR 67(1.1) (b). The ministry writes in the reconsideration decision the although the appellant's application lists both malnutrition and significant neurological loss as symptoms, the physician has not provided details about how, or how severely, the appellant is impacted by the malnutrition. The physician has not provided her height and weight, her BMI, her underweight status, information on how much weight was lost, and over what period of time she has lost weight. The panel considered the lack of detail regarding the physician's indication that the appellant has suffered weight loss as a result of her condition. The panel noted that the ministry application form has a section for the physician to include the applicant's height and weight explicitly for the calculation of BMI, however, on this application the section was left bla.nk. The physician does write that the a ellant re uires Boost and a hi h fiber diet however no further detail of her wei ht loss was EAAT 003(10/06/01)
prov ided . The p a n el c o ncl udes tha t without the det thoroug hly assess the i m pact of this sy mpto m. T h e find that th e appellant has not me t the c riteri a of dis chr on ic c o ndition. V it amin/mine ral Supp lem ent s The M inistry fou nd t hat the ap pellan t did no t mee t t Supp leme n t f o r vit a mi ns /mi neral s in the EAPWDR 67 c. for the purp ose of all ev iatin g a symptom r eferred to in para o r more of t h e ite ms set out in secti on 7 of Sche d. failure t o o btain th e it ems re f e r re d to in paragraph ( pe r son's li f e . The panel c onsidered th e r easonablenes s of th e m met EAPWDR 6 7 (1.1 ) ( c) ; for t he purpose of allev iatin per son r equires on e or mor e of the items s e t out in re quest . Th e eviden ce regar ding the allev i a ti on of sympto r econ side ration con siste d of the physic ian's s t a t e m 1. Should impr o v e s leep 2. Alleviate some sym ptoms of PTSD 3 . Pr eve nt fur t h er de ter i orat io n in her p sycho l o The pan el considered the wording of th e legislation se t out in secti on 7 of S che d ule C f o r "the purpose of (b )." T he panel finds that the p h y sic ian is clear tha t sym ptoms related to her cond i tion, as su mm arized pr ovided any ev id e nce on how the m in istr y d etermined T he p anel finds that ther e is n o c onfl i cting o r oppo sing will have o n t h e app ellant. T he pan el f i nd s tha t the min vita m ins/mineral s wou ld not a ll eviate her sympt oms T h e p anel consi der ed the reaso n ab leness of th e mi m et the criteria that failure to ob t ai n the re q u es ted i the a pplicatio n form i n the sec tion a s king, "Ho w will appellant's life" the physician writes the vitamins/m iner psychological well being. The physician does not elaborate on the possi psychological condition nor the rate at which is deteriorating. Without this information the ministry coul d not determine if the appellant is under the threat of imminent danger to her life. The panel finds the ministry was reasonable to determine the appellant had not established that failure to obtain the vitamins/minerals will result in i mm i nent d ange r t o her life. Nutritional Items The Mini stry found that the appellant did not meet the following criteria for Monthly Nutri Su pplement for vitamins/minerals in the EAPWDR 67(1.1 ): 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; d . failure to obtain the items referred to in paragraph (c) will result in imminent danger to the p e r s o n ' s l i f e . EAAT 003(10/06/01) I APPEA L # ai ls of h er wei g ht loss th e mini stry coul d not p a n el finds that th e min is t r y wa s rea sonabl e t o playing tw o or more sy m ptoms a s a resul t of h er he following c rite ri a for Month l y N u tr i tional (1 . 1 ) : graph (b), the per son requires one du le C and s pecified in the req uest ; c ) will result in i mminent danger to the in istry's d eter mination that th e appella nt has n o t g a sy m ptom referre d t o in paragraph (b), the sectio n 7 of Sched u l e C a nd spec i fied in th e ms bef ore the minis t r y at the t ime of t h e e nt s that t he v i t a mins / min erals: gical well be i ng. t ha t ; th e pe rs on re quire s o n e or more o f the items all eviating a s ympt o m r eferr ed to in paragraph t h e vitamins/minera ls will all evi ate some in the bul let p oi n ts above. Th e p anel was no t that the phys i cian's asse ssmen t is inco r rect . eviden c e re lating to of the e ff e c t the se it e ms ist ry was unr ea s onabl e to fin d that the . nistry's determi nation that the a ppella nt has not te ms woul d result in imminent d an ger t o h er l i f e. In this item prevent imminen t danger to the als will prevent fu rthe r deterioration in her b l e outcome of her tional
And EAPWDR Schedule C section 7( a ) a. for add i tion a l nutritional i tems tha t a re part of a caloric su intake, up to $165 per month. The panel considered the reasona blen ess of the ministry's met EAPWDR 67(1.1)(c); for the purpose of al levi a person requires one or mor e of the items set out in section request. The e vidence before t he min i stry at the time of the reconsideration consisted of the phys ician's s t a tem ents regarding t he appella nt' s nu statements that: 1. The app ell ant requires Bo ost and a high-fi ber 2. This diet will prev ent fur ther weight loss and malnu 3. T his diet will h elp wi t h constipation As described previously i n this dec ision, the panel has found the mi determine the details regard in g the symptom of malnutriti min is t ry det e rm ined th at there wa s insufficient e vidence nutritiona l i te ms , Boost and h i gh f iber d iet, wo uld a lleviate ministry was reasonable to de t e rm ine the appellan t Th e p a ne l c o ns idered the rea son a bl ene s s o f the m m et EAPWD R Sch ed ule C secti on ? (a) , fo r a dd i tional suppl em entation t o a regula r diet ar y i ntake, u p to $16 rega rdin g the appe llant's malnu t riti on as discusse d the ph ysi cia n did not indic at e in t he appli cation th at her to abso rb s u f fic ient c a lories t o s at i sfy h er d aily requ mini stry wr ites t hat th e r e is no evid e nce th a t sh e requires ad maln ut rition a nd c onstipatio n , b ut rathe r, she n e eds a hi p anel fi nds th e ministr y was reasonable t o de termin sectio n ? (a) . Th e panel con side red the re asonable n e ss o f the minist m et the cri te r ia that failure to o btain the re queste d it the application form in the section asking, "How will this item prevent imminent danger to the appel lant' s life" the physician writes the vitamins/minerals will prevent further deterioration in her psychological well being. The physician does not elaborate on the possible outcome of her p sycholo gical c o ndition nor the r ate at w hich i s deteriorati could n ot determine if th e appella nt is under the t hreat the appellant's need for nutrit ional items and how they will prevent imminent danger to the appellant's life th e phys i cian respon ds th at t he items will "prevent further weight loss and malnutrition. The physician does not provide any details about the appellant's reasons for EAPWDR 67(1.1)(b), the ministry was reasonable that the appellant tha t failur e to obtain thes e nutritional items will result in imminent danger to her life. The panel finds tha t the ministry's de c i sion wa s reasonably confirms the ministry's decision. EAAT 003(10/06/01) I APPEAL# p plementat i on to a re gula r die t ary determination th at the appell ant has not ting a symptom referred t o i n para g raph (b), the 7 of Schedule C an d specified i n t he tritional needs . This incl uded the physici an's diet trition nistry was reasonable to on were no t s u ffic iently suppor ted. The to de term ine whether th e r e qu e s te d h er malnutri ti o n . The p an e l fi nds t he has n ot me t EAPWDR 6 7(1. 1) (c ). inistr y ' s deter mi natio n that t he appel lant has not nu trit ional ite ms t hat ar e pa rt o f a calo ric 5 per month. The p an e l notes t he la c k o f detai l previ ousl y in t his decisi on . The p ane l n o tes t hat t he appellant' s co nd i tio n r es u lts i n an inabili ty for irem e nts th rough a regular d ietary int a ke. The diti ona l c alori es to all e via te he r g h f iber diet as note d b y he r phy sician. The e th e a pp e ll an t has n ot m et E A PWD R S che du le C r y's d eter mina t ion that th e a ppel la nt has not e m s wou ld result in im min e n t danger to her life. I n n g. Without thi s in f o r mation the mi n i s tr y o f imminent dange r to her l i fe. Regarding how weight los s, as discussed abov e in the had not established support e d by t he evidence and theref ore
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