PART C – Decision under Appeal
The decision under appeal is the Ministry of Social Development and Social Innovation (the
“ministry”) reconsideration decision of August 12, 2015, which denied the appellant’s request for a
Monthly Nutritional Supplement (MNS) for vitamins/minerals and additional nutritional items on the
basis that the appellant did not meet the criteria set out in section 67(1.1) c and d of the Employment
and Assistance for Persons With Disabilities Regulation (“EAPWDR”) and Schedule C, section 7(a).
In particular, the ministry determined that the information provided did not demonstrate that the
appellant’s medical practitioner had described how the specified items would alleviate a specific
symptom set out in EAPWDR section 67(1.1)(b), as is required by EAPWDR section 67(1.1)(c), or
that the failure to obtain the specified items would result in imminent danger to the appellant’s life as
required by EAPWDR section 67(1.1)(d). In addition, the ministry determined that there was
insufficient evidence to establish that the additional nutritional items were required as part of a caloric
supplementation to a regular dietary intake as required by EAPWDR Schedule C section 7(a).
PART D – Relevant Legislation
EAPWDR, section 67 and Schedule C section 7
PART E – Summary of Facts
The information before the ministry at the time of reconsideration included the following:
Submission from the appellant’s advocate dated July 28, 2015 (the “Reconsideration
Submission”)
The appellant’s Request for Reconsideration dated July 20, 2015
Medical information provided by the appellant’s family physician dated July 16, 2015 stating
that the appellant’s medical condition of Cauda Equina Syndrome (CES) has resulted in motor
strength loss, sensory numbness, muscle atrophy, fecal incontinence, post flatulence
incontinence, and sphincter dysfunction. The physician indicates that the appellant has the
following other conditions: urinary function and bladder management, cervical fusion C5-C6-
C7, upper extremity neurological difficulties, need for exercise and rehabilitation, previous low
back injury with herniated discs, previous mood disorder, impotence, socially withdrawn and
sexual function impacts. The physician indicates that the appellant requires vitamins and
minerals and/or caloric supplements to his regular diet to alleviate the symptoms of significant
muscle mass loss, significant neurological degeneration, and significant deterioration of a vital
organ (the “Physician’s Form”)
Application for Monthly Nutritional Supplement dated April 1, 2015 in which the appellant’s
physician diagnoses the appellant with Cauda Equina neuromuscular condition, providing the
description of anal sphincter continence bowel routine/erectile dysfunction that influences
colonic/ anal genitourinary system. The physician indicates that the appellant requires vitamin
B12 and a variety of other vitamins/minerals, noting that the appellant self administers. The
physician indicates that the appellant has adapted to a pelvic neurological condition and has
found a balanced requirement of high fibre/natural foods and vitamins that allow maintenance
of health and chronic neuromuscular dysfunction which is an ongoing condition (the “MNS
Application”).
Letter from a medical specialist to the appellant’s family physician dated February 2, 2015
indicating that the appellant has a congenitally narrow spinal canal, is a good candidate for two
level anterior cervical discectomy, partial vertebrectomy and fusion instrumentation from C5 to
C7
Letter from a medical specialist to the appellant’s family physician dated January 26, 2015
indicating that he appellant has decreased strength in his elbow extension and finger
extension, walks with a normal gait, degenerative changes in his cervical spine, C7 cervical
radiculopathy on the left side and that he will be put on the list for surgical intervention as he is
quite disabled
Medscape Reference regarding Cauda Equina and Conus Medullaris Syndromes
Additional information provided
The appellant’s Notice of Appeal dated August 21, 2015 indicates that the appellant does not agree
that the ministry understands how his medical condition requires provision for MNS.
At the hearing the appellant provided oral evidence regarding the appellant’s spinal cord injury and
the impact of his medical condition to his digestive system because and details of the consequent
medical symptoms including loss of bowel function and bladder control, inability to absorb nutrients,
functional limitations, social isolation, and sexual dysfunction. At the hearing the appellant also
presented to the panel 12 containers of assorted vitamins / supplements for the panel to observe
stating the cost of approx. $170.00 per month.
Admissibility of New Information
The panel has admitted the appellant’s oral testimony and information in his Notice of Appeal as it is
evidence in support of information and records that were before the ministry at the time of
reconsideration, in accordance with section 22(4) of the Employment and Assistance Act. In
particular, the new information substantiates information about the appellant’s medical condition and
request for vitamins and nutritional supplements available at reconsideration.
The ministry relied on the reconsideration decision.
PART F – Reasons for Panel Decision
The issue on this appeal is whether the ministry’s decision to deny the appellant funding for a MNS
for vitamins/minerals and additional nutritional items on the basis that the appellant did not meet the
criteria set out in section 67(1.1) c and d and Schedule C, section 7(a) of the EAPWDR was
reasonable. In particular, was the reconsideration decision in which the ministry determined that the
information provided did not demonstrate that the appellant’s medical practitioner had described how
the specified items would alleviate a specific symptom set out in EAPWDR section 67(1.1)(b), that the
failure to obtain the specified items would result in imminent danger to the appellant’s life and that
there was insufficient evidence to establish that the requested additional nutritional items were
required as part of a caloric supplementation to a regular dietary intake was reasonable.
The relevant legislation is as follows:
EAPWDR - 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;
(d) failure to obtain the items referred to in paragraph (c) will result in imminent danger to the person’s life.
(B.C. Reg. 68/2010)
(2) In order to determine or confirm the need or continuing need of a person for whom a supplement is provided
under subsection (1), the minister may at any time require that the person obtain an opinion from a medical
practitioner or nurse practitioner other than the practitioner referred to in subsection (1) (c). (B.C. Reg. 68/2010)
EAPWDR Schedule C, Health Supplement - MNS
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.C. Reg. 68/2010)
(b) Repealed (B.C. Reg. 68/2010)
(c) for vitamins and minerals, up to $40 each month. (B.C. Reg. 68/2010)
*******
In the Submission and at the hearing the appellant and the advocate provided considerable
information regarding the appellant’s medical condition indicating that in their view a lack of
understanding of the appellant’s medical condition contributed to the reconsideration decision
denying the appellant’s MNS request. However, the reconsideration decision confirms that the
ministry determined that EAPWDR section 67(1.1)(b) was met and that the medical information
confirmed that the appellant displayed at least two of the symptoms set out in EAPWDR section
67(1.1)(b), namely significant muscle mass loss and significant neurological degeneration.
Accordingly the panel’s jurisdiction is limited to determining whether the reconsideration decision was
reasonable with respect to EAPWDR sections 67(1.1)(c), (d) and Schedule C, section 7(a).
Vitamin Mineral Supplementation
The appellant’s position is that the MNS Application, Physician’s Form and Medscape Reference
confirm that the appellant has a neurological medical condition and that the information provided
satisfies the legislative criteria of EAPWDR section 67(1.1)(c) as the physician states that the
appellant requires vitamins of Coenzyme Q-10, Acidophilus and Digestive Enzymes to alleviate
significant muscle mass loss, significant neurological degeneration and significant deterioration of a
vital organ. The appellant’s position is that the legislative criteria of EAPWDR section 67(1.1)(d) is
met as the Physician’s Form states that the appellant requires vitamins and minerals and/or caloric
supplementation to his regular diet to prevent imminent danger to the appellant’s life.
The ministry’s position is that the information provided is not sufficient to meet the legislative criteria
because although the physician states that the specified vitamins and minerals are required to
alleviate the symptoms of significant muscle mass loss, significant neurological degeneration and
significant deterioration of a vital organ the physician has not provided any information to describe
how the vitamins or minerals will alleviate the symptoms. The ministry notes that the specified items
are not vitamins and minerals in the same manner as other vitamins such as Vitamin B12, Ferrous
Gluconate or Vitamin C and are better classified as aids to digestion. The ministry also states that
the physician has not provided any information to confirm how failure to obtain vitamin/mineral
supplements will result in imminent danger to life.
Panel Decision:
In the MNS Application, the physician indicates “Patient self administers Vit B12 and variety of other
vitamin/minerals”. Where asked to describe how the item will alleviate the specific symptoms
identified and prevent imminent danger to the appellant’s life the physician states “see next page”.
Under “Additional Comments” the physician indicates that the appellant has adapted to a pelvic
neurological condition and has found a balanced requirement of high fibre natural foods and vitamins
that allow for maintenance of health and chronic neuromuscular condition that is an ongoing
condition. In the Physician’s Form the physician provides additional information on the impacts of
the appellant’s medical condition, specified the required vitamins or minerals of Coenzyme Q-10,
Acidophilus and Digestive Enzymes to alleviate significant muscle mass loss, significant neurological
degeneration and significant deterioration of a vital organ.
The ministry argues that the prescribed items of Coenzyme Q-10, Acidophilus and Digestive
Enzymes are not true vitamins and the panel notes that the physician has not provided any further
medical information confirming whether the recommended items are vitamins or minerals. The
Merriam Webster dictionary defines Coenzyme Q-10 as a “thermostable nonprotein compound that
forms the active portion of an enzyme system after combination with an apoenzyme” and
www.medicinenet.com describes it as a compound that may be used for proper functioning of an
enzyme. Acidophilus is defined as a bacteria and rather than a vitamin or mineral and Digestive
Enzymes are defined as compounds used to assist digestion. The panel notes that the physician
includes these items under a list of vitamins and minerals but it would be helpful to have further
information from the physician confirming whether these items are in fact vitamins or minerals.
In addition, as the physician does not provide any information to indicate how the specified vitamins
will alleviate the noted symptoms or how the specified vitamins will prevent imminent danger to the
appellant’s health, the panel finds that the ministry was reasonable in determining that the criteria for
a request for vitamins/minerals was not met.
Nutritional Items
The appellant’s position is that the information provided by the physician demonstrates that impacts
of motor strength loss, sensory numbness, muscle atrophy, fecal incontinence, post flatulence
incontinence and sphincter dysfunction impact the appellant’s ability to ingest nutrients in the body
and that certain food styles help to mitigate that issue. The appellant’s position is that the Physician’s
Form states that the appellant requires vitamins and minerals and/or caloric supplementation to his
regular diet to prevent imminent danger to the appellant’s life.
The ministry’s position is that the information provided does not establish that the appellant requires
additional nutritional items that are part of a caloric supplementation to a regular dietary intake for the
purpose of alleviating a symptoms referred to in EAPWDR section 67(1.1)(b) and that failure to obtain
the requested items would result in imminent danger to the appellant’s life.
The reconsideration decision notes that the physician indicates that the appellant has found a
balanced requirement of high fibre/natural foods and vitamins that allows maintenance of health and
chronic neuromuscular dysfunction but that the physician does not speak to the need for nutritional
items to provide caloric supplementation to the appellant’s regular dietary intake. The
reconsideration decision notes that the physician did not, on the Physician’s Form indicate that any of
the other items noted, such as fresh pineapple cores, steel-cut oats or fresh vine ripened fruits are
required as caloric supplements to the appellant’s regular dietary intake.
The ministry notes that the physician did not confirm that the appellant is displaying a symptom set
out in the EAPWDR section 67.1(b) that would indicate a need for caloric supplementation, such as
malnutrition, underweight status, significant weight loss, or significant muscle mass loss (in the sense
of muscle mass reduction, or wasting). The ministry’s position is that the appellant’s height and
weight recorded in the application indicate that the appellant’s BMI is within the overweight range.
The ministry’s position is that the information provided does not describe a medical condition that
results in the inability to absorb sufficient calories to satisfy daily requirement through a regular
dietary intake, a description of how the nutritional items required will alleviate one or more symptoms
specified and provide caloric supplementation to the regular diet, or a description of how the
nutritional items requires will prevent imminent danger to the appellant’s life.
Panel Decision:
In the MNS Application, the physician has not specified the additional nutritional items that the
appellant requires. Where asked to describe the appellant’s medical condition resulting in the
inability to absorb sufficient calories to satisfy daily requirements through a regular dietary intake the
physician indicates “see below”. Where asked to describe how the nutritional items required will
alleviate one or more of the symptoms specified in question 3 of the MNS Application the physician
indicates “see below”. Where asked to describe how the nutritional items requested will prevent
imminent danger to the appellant’s life, the physician indicates “see below”. Under Additional
Comments the physician indicates that the appellant has adapted to a pelvic neurological condition
and has found a balanced requirement of high fibre natural foods and vitamins that allow for
maintenance of health and chronic neuromuscular condition that is an ongoing condition. In the
Physician’s Form the physician provides additional information on the impacts of the appellant’s
medical condition indicating that the appellant has found certain food styles help to mitigate the
various impacts that his medical conditions cause. The physician also indicates the vitamins and
minerals that the appellant requires. However, the physician has not provided any information
indicating the specified nutritional items that the appellant requires that are part of a caloric
supplementation to a regular dietary intake as required or provided any information to describe how
the nutritional items will alleviate the appellant’s symptoms of significant muscle mass loss or
significant neurological degeneration as required by EAPWDR section 67(1.1) (c) and Schedule C,
section 7(a).
The panel finds that the physician has not provided information describing that the appellant has a
medical condition that results in the inability to absorb sufficient calories to satisfy daily requirement
through a regular dietary intake, a description of how the nutritional items required will alleviate one or
more symptoms specified and provide caloric supplementation to the regular diet, or a description of
how the nutritional items requires will prevent imminent danger to the appellant’s life.
Although the physician states that the nutritional items are required to prevent imminent danger to the
appellant’s health, the physician has not identified what those nutritional items are and how those
items will prevent imminent danger to the appellant’s health. Accordingly, the panel finds that the
ministry was reasonable in determining that the information provided did not meet the legislative
criteria for the MNS of nutritional items.
Conclusion
Having reviewed and considered all of the evidence and the relevant legislation, the panel finds that
the ministry’s reconsideration decision finding the appellant ineligible for MNS as the legislative
criteria of EAPWDR section 67(1.1)(c), (d) and Schedule C, section 7(a) was not met was a
reasonable application of the legislation in the circumstances of the appellant. The panel therefore
confirms the ministry’s decision.
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