I APPEAL# PART C -Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation ("Ministry") October 2, 2014 reconsideration decision denying the Appellant a monthly nutritional supplement for nutritional items because, based on the information provided, it was not satisfied that a medical practitioner confirmed that the Appellant met the requirements in section 67(1.1) and Schedule C section 7 of the Employment and Assistance for Persons with Disabilities Regulation, and specifically that: • The Appellant requires additional nutritional items that are part of a caloric supplementation to a regular dietary intake; and, • Failure to obtain the items required would result in imminent danger to her life. The Ministry did approve the Appellant's request for a monthly nutritional supplement for vitamin and mineral supplements. PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Regulation (EAPWDR) Section 67(1.1) and Schedule C Section 7. EAAT003(10/06/01)
,.. I APPF.A-t i£ I PART E -Summary of Facts For its reconsideration decision, the Ministry had the following evidence: 1. Information from its records that the Appellant receives disability assistance as a Person with Disabilities ("PWD") designation, as well as, a $40 diet supplement for high protein. 2. Applicant's Application for a monthly nutritional supplement for nutritional items submitted on the Ministry form and completed by her doctor in July 2014 with the following information: • Diagnoses: hypoglycemia ("low blood sugar"), osteoporosis, epilepsy and several severe neurological disorders. • Regarding treatment for a chronic progressive deterioration of health: Appellant has a very complex medical diagnosis with several severe illnesses. It is especially important that she eats enough protein. She has very weak muscles and multiple neurological abnormalities. • As a direct result of the chronic, progressive deterioration of health the Appellant displays the following symptoms: significant muscle mass loss and significant neurological degeneration. • Height 160cm_and weight 60kg. • Nutritional items to alleviate one or more of the identified symptoms, are medically essential and will provide caloric supplementation to a regular dietary intake and are required to prevent imminent danger to the Appellant's life: regulate protein intake; regular supplements. • As to whether the Appellant has a medical condition that results in the inability to absorb sufficient calories to satisfy daily requirements through a regular dietary intake: "No". • Description of how nutritional items required will alleviate one or more of the specified symptoms: "N/A" [not applicable). • How nutritional items requested will prevent imminent danger to the Appellant's life: prevent worsening of already frail neurological and orthopedic problems. 3. Appellant's October 3, 2014 request for reconsideration and letter dated October 2, 2014 stating: • Severe muscle loss has occurred since 2001-2010 and will continue to occur due to myasthenia gravis, a neuromuscular auto immune disease which is chronic, possibly progressive and leads to a deterioration of health. • Her doctor indicated: multiple medical co-morbidities -epilepsy, Myelomeningoceles, Spina Bifida Diastermatomyelia, Arnold Chiarl Malformation, Asthma, Thyroid dysfunction and Mentere's disease. • She has multiple symptoms as a direct result of chronic, progressive conditions daily experiences weakness, fatigue, chronic pain, nausea, memory loss and retention, muscle weakness, double vision, difficulty chewing and swallowing at times (must be mindful). • She has struggled daily to maintain weight; has had to eat a lot of carbohydrates as these are less expensive, but not always good for her health; being a normal weight does not equal being nutritionally healthy; has attempted to eat as healthy as she can by making her own soups, etc. • She is asking for the monthly nutritional supplement to help cover the cost of her nutritional needs to prevent further deterioration and to maintain her health; that is, $165 due to the autoimmune and neurological implications of this disease she needs to enrich her diet by eating more fruits and vegetables, quality protein and not possible on her current PWD income; and, $40 for extra vitamins/minerals. • She referred to an attached brochure describing nutrition and myasthenia gravis. 4. Letter dated September 22, 2014 from the same doctor stating that: • The Appellant has been her patient since 2009. EAAT003(10/06/01)
,.. • T h e d o c t o r ' s m o t i v a t i o n a n d s u p p o r t f o r t h m e d i c a l h i s t o r y i n c l u d i n g m u l t i p l e m e d i c a l c o n d i t i o n s i n c l u d i n g E p i l e p s y , M y e l o m e n i n C h i a r i M a l f o r m a t i o n ; a l s o h a s s i g n i f i c a n t s A s t h m a , T h y r o i d D y s f u n c t i o n a n d s i g n i f i c a • T h e A p p e l l a n t l i v e s w i t h g r e a t d i s a b i l i t y d u m u s c u l o s k e l e t a l w e a k n e s s ; h a s m u s c u l a r b i l a t e r a l c r u t c h e s , b i l a t e r a l c u s t o m m a d e s h a d o v e r 3 0 s u r g e r i e s o n o n e k n e e o n l y a y e a r ; h a s s i g n i f i c a n t m u s c l e w e a k n e s s d u M y a s t h e n i a G r a v i s s u p e r i m p o s e d o n t h i s p i n j u r y . • T h e A p p e l l a n t l i v e s o n a d i s a b i l i t y g r a n t a n h e r f o o d i n t a k e ; s h e c a n n o t a f f o r d t o p a y f a c h r o n i c i r o n d e f i c i e n c y f o r w h i c h s h e n e e t h e s e s u p p l e m e n t s i n c l u d i n g V i t a m i n D a n n e u r o p a t h y a s w e l l a s e p i l e p s y c o n t r o l l e d I n h e r 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 7 , 2 0 1 4 , t s h e s t r u g g l e s e a c h a n d e v e r y d a y j u s t t o t r y a n d a n d d i s o r d e r s j u s t t o f i n d o u t s h e i s n o t e l i g i b l e f o s m a l l p a r a m e t e r o f d i s e a s e s s e t o u t b y t h e g o v e r a s o n e s s e t o u t i n t h e g u i d e l i n e s . T h e A p p e l l a n t t o t a l l y w i t h o u t m e r i t b e c a u s e f r o m o n e d a y t o t h e t h a t s h e c o u l d s t a r t l o s i n g w e i g h t i f h e r i l l n e s s h a s A t t h e h e a r i n g , t h e A p p e l l a n t s u b m i t t e d a m e d i c a c o n d i t i o n s a n d t h e s p e c i a l i s t s w h o t r e a t h e r . S h e w h i c h s h e s t a t e d s h e s t r u g g l e s e a c h a n d e v e r y d a n d d o c t o r i n t h e d o c u m e n t s i n t h e r e c o n s i d e r a t i o a n d S e p t e m b e r 2 0 1 4 i n f o r m a t i o n f r o m h e r d o c t o r s a i d t h a t t h e d o c t o r c a n o n l y d e s c r i b e h e r c o n d i t i o i n f o r m a t i o n ; h o w e v e r , i f s h e h a s a f l a r e u p h e r w e J u l y . T h e A p p e l l a n t a l s o d e s c r i b e d t h e v a r i o u s w a t a k e c a r e o f h e r n u t r i t i o n a l n e e d s . S h e s a i d s h e n s h e c a n n o t a ff o r d t h e c o s t s o f s u c h n u t r i t i o n . T h e P a n e l f i n d s t h a t t h e i n f o r m a t i o n i n t h e A p p e l l a s u m m a ry a n d t h e A p p e l l a n t ' s t e s t i m o n y a t t h e h e e v i d e n c e t h e M i n i s t r y h a d a t r e c o n s i d e r a t i o n . T h e s e c t i o n 2 2 ( 4 ) o f t h e E m p l o y m e n t a n d A s s i s t a n c e 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 v i e w e d t h e c r i t e r i a i r e a f f i r m e d 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 . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # e A p p e l l a n t b e c a u s e t h e A p p e l l a n t h a s a s i g n i f i c a n t c o m o r b i d i t i e s ; h a s s e v e r a l v e r y s e v e r e n e u r o l o g i c g o c e l e s , S p i n a B i f i d a , D i a s t e m a t o m y e l i a a n d A r n o l d y s t e m i c d i s e a s e i n c l u d i n g M y a s t e n i a G r a v i s , n t M e n i e r ' s D i s e a s e . e t o h e r m u l t i p l e d i s e a s e s ; b a t t l e s w i t h w a s t i n g , e s p e c i a l l y o f t h e l e g m u s c l e a n d h a s t o u s e h o e s w i t h h i g h l i ft s a n d a n a n k l e f o o t o r t h o s i s ; h a s n d i s d u e t o h a v e a n o t h e r a n k l e s u r g e r y l a t e r t h i s e t o t h e d e t e r i o r a t i o n o f h e r m u s c l e s a n d t h e r e d i s p o s e s h e r f o r f u r t h e r m u s c l e w a s t i n g a n d d t a k e s m u l t i p l e n u t r i t i o n a l s u p p l e m e n t s t o a u g m e n t o r a l l t h e s e s u p p l e m e n t s o n h e r c u r r e n t i n c o m e ; h a s d s t o t a k e i r o n ; d u e t o h e r o s t e o p e n i a s e v e r a l o f d C a l c i u m a r e n e c e s s a r y ; d u e t o h e r p e r i p h e r a l b y G a b a p e n t i n , T e g r e t o l , s h e r e q u i r e s F o l i c A c i d . h e A p p e l l a n t w r o t e t h a t i t s a d d e n s h e r t o k n o w t h a t s t a y a s h e a l t h y a s s h e c a n w i t h h e r v a r i o u s d i s e a s e s r t h e n u t r i t i o n s u b s i d y b e c a u s e s h e d o e s n o t h a v e a n m e n t . H e r d i s e a s e s a r e j u s t a s r e a l a n d d e b i l i t a t i n g s t a t e d t h a t t o j u d g e h e r a s n o t b e i n g u n d e r w e i g h t i s n e x t s h e d o e s n o t k n o w h o w s h e w i l l d o . S h e w r o t e a f l a r e u p . l h i s t o r y s u m m a r y w i t h a l i s t o f v a r i o u s m e d i c a l a l s o d e s c r i b e d a l l o f t h e m e d i c a l c o n d i t i o n s w i t h a y ; t h e s a m e c o n d i t i o n s d e s c r i b e d b y t h e A p p e l l a n t n r e c o r d . T h e A p p e l l a n t r e f e r r e d t o t h e J u l y 2 0 1 4 , w h o s h e s a i d s h e s e e s a b o u t o n c e a w e e k . S h e n s a n d w e i g h t a t t h e t i m e t h e d o c t o r p r o v i d e s t h a t i g h t d r o p s . S h e s t a t e d s h e h a d l o s t 2 0 1 b s . s i n c e y s s h e t r i e s t o s t a y h e a l t h y a n d h o w s h e t r i e s t o e e d s e x t r a n u t r i t i o n a s p r e v e n t a t i v e m e d i c i n e a n d n t ' s n o t i c e o f a p p e a l , i n t h e m e d i c a l h i s t o ry a r i n g i s c o n s i s t e n t w i t h a n d i n s u p p o r t o f t h e r e f o r e , t h e P a n e l a d m i t s a l l o f t h e i n f o r m a t i o n u n d e r A c t . n t h e E A P W D R f o r n u t r i t i o n a l s u p p l e m e n t s a n d
PART F Reasons for Pan el Decis ion The is su e i n t his appeal is w h et he r th e Ministr y's m ont hly nutritio n al sup pl ement f o r nutritio n al it ems requireme n t s in EAPWDR section 67 ( 1.1 ) a nd S s uppor t ed by th e evi de nc e a nd wa s a reaso n ably appli Appell ant 's cir cu m s tan ce. A pp l icab l e Le g isl a tion The f ollowing sectio n s of th e EAPWDR apply to 6 7( 1.1) In o rder for a p e rs o n w ith disabilit ies to re th e ministe r must r ecei ve a request, in the fo rm speci pr a ct it ioner or nu rse pra ct itioner, in whi c h th e practitioner ha (a) the p e r s on wit h d i sabilities t o wh om the r e qu e chronic , progressiv e d e te riora t io n of hea lth o n ac ( b) a s a dire ct result of t he chroni c , p rogressi ve d mor e of t h e following s ymptoms : (i) malnu trition; (iv) sig nific a n t mus cle mass loss ; ( v) si gni fic ant n dete r i orati on of a vital organ; ( v ii ) mod erate t o severe immune supp ( c ) f or t he purp o se of alle vi a ti ng a sympto m ref erre mo re of t h e it ems set out i n s e c tion 7 o f S ched ule (d) fai lure t o obta in the item s referre d to in p arag lif e. Sc h ed ule C Health Supplem ent s -Monthl y Nu t ritional 7 The amo u nt of a nu triti o nal suppleme n t that m a suppl e ment] of this regu l ati o n is t he sum o f th e amounts req uire d i n the r equest un der sect ion 67(1) ( c) : ( a) for addi t ional nutriti o n a l item s t h at a re part of u p to $165 ea c h month; (c) for vita mins and mine T he Parties' Positio ns The Appe ll a nt 's position i s that he r d o c to r has confirme a nd d e bilitat ing me d ical c onditions. S he needs additi conditions and she can not afford the nutritional it e The Ministry's position is that the information provided has confirmed that the Appellant requires additio n suppl e mentation to a regular dietary intake for the purpose of alleviating a symptom referred to in section 67(1.1) (b) of the EAPWDR and that failure t im min e n t danger to the A p pellan t 's life. The Panel's Findings and Conclusion The Ministry may provide a supplement f or a nutri to a regular dietary intake if a medical practitioner confirms all of the information required in EAPWDR section 67(1.1) and Schedule C section 7. In this case, the Appellant's doctor, who she sees about once a week, is the medical practitioner. That doctor completed the Appellant's nutritional EAAT 003(1 0/0 610 1) AP PFAI -JJ. : recon side r a tion d ecision deny i ng t he Appe ll a n t a beca use the infor m at ion did no t est ab lish that the c hed ule C s ectio n 7 were m e t, was reason ably ca tion of t he a p pli cabl e en actments in the t he App ellant's circumstan ces in this a ppeal. ceiv e a nutritio n al s u pp l eme nt u nder this se ct io n , fi e d by the mi nist er, c omplet ed by a me d i cal s con firmed a l l of t he follow in g: st re late s is being treate d by the p r ac titioner f o r a count of a severe med ic a l condition; et eriorat i on of healt h, the p e rson di s p lays two o r (ii ) underw e ight status ; ( ii i) signi fic ant weight lo s s; euro logical deg enerati on; (v i ) signif icant r essi on; d to in paragr aph (b), t he pe r son requires one or C an d specif ied in the requ est; r aph (c ) wi l l result i n i mmi n e n t dang e r to t he p ers o n 's Supp lem ent y be provide d und e r section 67 [ nutr itional fo r those of the foll owing it e ms s pe cifi ed as a caloric supplementation t o a re g u lar d ietary int a k e, r als, up to $40 a mont h . d t h at s he s tr ugg l es d a i l y with seve r a l sev ere o n al nut r i t i ona l s upplements t o ma n age t hose m s th at she n e eds. does not establish that a medical pract itioner a l nutritional items that are part of a caloric o obtain the requeste d it ems w i l l result in tio nal it e m that is part of a caloric su pplementation
s u p p l e m e n t a p p l i c a t i o n i n J u l y 2 0 1 4 a n d t h e n p r o l e t t e r . T h e P a n e l f i n d s t h a t t h e i n f o r m a t i o n f r o m t h e A p p 2 0 1 4 a p p l i c a t i o n , t h e d o c t o r i n d i c a t e d t w o s y m p t o w e i g h t l o s s w a s n o t o n e o f t h e m . I n a d d i t i o n , i n t n u t r i t i o n a l i t e m s r e q u i r e d w i l l a l l e v i a t e o n e o r m o r s u p p l e m e n t a t i o n t o t h e r e g u l a r d i e t , t h e d o c t o r w r s p e c i f i c a l l y a n s w e r e d " n o " t o t h e q u e s t i o n w h e t h e 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 c a l o r i e s t o s a t i s i n t a k e . T h e s a m e d o c t o r h a d t h e o p p o rt u n i t y i n S e v e n t o c h a n g e t h e i n f o r m a t i o n p r o v i d e d , b u t d i d p r o v i d e d b y t h e A p p e l l a n t ' s d o c t o r , t h e P a n e l f i n d r e q u i r e m e n t s i n E A P W D R s e c t i o n 6 7 ( 1 . 1 ) ( c ) a n d H a v i n g c o n s i d e r e d a l l o f t h e e v i d e n c e a n d t h e a p M i n i s t r y ' s r e c o n s i d e r a t i o n d e c i s i o n w a s r e a s o n a b c o n f i r m s t h a t d e c i s i o n . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # v i d e d a d d i t i o n a l i n f o r m a t i o n i n t h e S e p t e m b e r 2 0 1 4 e l l a n t ' s d o c t o r i s v e r y c l e a r a n d s p e c i f i c . I n t h e J u l y m s i n t h e A p p e l l a n t ' s a p p l i c a t i o n , b u t s i g n i f i c a n t h e s e c t i o n r e q u i r i n g a d e s c r i p t i o n o f h o w t h e e o f t h e s y m p t o m s i d e n t i f i e d a n d p r o v i d e c a l o r i c o t e " N / A " ( n o t a p p l i c a b l e ] . T h e d o c t o r a l s o 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 r e s u l t s f y 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 e p t e m b e r 2 0 1 4 t o a d d r e s s t h e s e s p e c i f i c i s s u e s a n d n o t d o s o . T h e r e f o r e , b a s e d o n t h e i n f o r m a t i o n s t h a t t h e M i n i s t r y r e a s o n a b l y d e t e r m i n e d t h a t t h e ( d ) a n d S c h e d u l e C S e c t i o n 7 ( a ) w e r e n o t m e t . p l i c a b l e l e g i s l a t i o n , t h e P a n e l f i n d s t h a t t h e l y s u p p o r t e d b y t h e e v i d e n c e . T h e r e f o r e , t h e P a n e l
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