Canada Pension Plan (CPP) disability

Reasons and decision

Persons in attendance

L. A. (Appellant)

Introduction

[1] The Appellant’s application for a Canada Pension Plan (“CPP”) disability pension was date stamped by the Respondent on March 24, 2015. The Respondent denied the application initially and upon reconsideration. The Appellant appealed the reconsideration decision to the Social Security Tribunal (“Tribunal”).

[2] This appeal was heard by Teleconference for the following reasons:

1. There are gaps in the information in the file and/or a need for clarification.
2. This method of proceeding respects the requirement under the Social Security Tribunal Regulations to proceed as informally and quickly as circumstances, fairness and natural justice permit.

The law

[3] Paragraph 44(1)(b) of the CPP sets out the eligibility requirements for the CPP disability pension. To qualify for the disability pension, an applicant must:

1. a) be under 65 years of age;
2. b) not be in receipt of the CPP retirement pension;
3. c) be disabled; and
4. d) have made valid contributions to the CPP for not less than the minimum qualifying period (“MQP”).

[4] The calculation of the MQP is important because a person must establish a severe and prolonged disability on or before the end of the MQP.

Issue

[6] There was no issue regarding the MQP because the parties agree and the Tribunal finds that the MQP date is December 31, 2017. In this case, as the MQP date is in the future, the Tribunal must decide if it is more likely than not that the Appellant had a severe and prolonged disability on or before the date of the hearing.

Evidence

[7] The Appellant is 32 years old and lives with her husband and three children in X, Ontario. She completed a three-year Early Childhood Education program at Algonquin College. Her most recent employment was as a primary triage clerk with the Royal Canadian Mounted Police. This involved long hours at a computer. He last day of work was February 9, 2012; this is also the date she claims she could no longer work due to her medical conditions.

[8] In her application materials for CPP disability benefits, the Appellant identified her medical conditions as stress, anxiety, possible post-traumatic stress disorder (“PTSD”), depression, inability to sleep, migraines, and multiple head trauma. She indicated that she was lucky to get 2-3 hours of sleep due to anxiety related to her youngest child’s medical condition. Her daily migraines left her unable to function and she was having frequent panic attacks due to her high stress and anxiety. While she used to enjoy reading and writing, she had difficulty concentrating and remembering anything she had read. She used to participate in a choir but was now too exhausted and has lost interest.

[9] At the hearing, the Appellant repeated these symptoms and added that she had symptoms of irritable bowel syndrome. However, the tests suggest that this is actually a result of anxiety and stress. Similarly, her legs sometimes give out and she cannot really walk. Her doctor says that her body is trying to get rid of the stress that it is accumulating.

History

[10] On January 11, 2011, the Appellant fell down the stairs at work and hit her head. She blacked out and does not remember the fall. Dr. Atack (Neurology) later affirmed a diagnosis of cerebral concussion resulting in post-traumatic (post-concussion) syndrome characterized by headache and symptoms of positional vertigo. The Appellant described mild confusion and the onset of problems with memory, concentration and focus at this time. She returned to part-time work after three weeks and then resumed full-time work by the beginning of May, 2011.

[11] On January 5, 2012, the Appellant was in a motor vehicle accident. She saw Rob Karas (Physiotherapist) on January 19, 2012 with complaints of neck and right-sided back pain. Mr. Karas diagnosed a thoracolumbar sprain/strain and a Whiplash Associated Disorder (“WAD II”). At the hearing, the Appellant said that she hit her head again in that accident. She was off work for about three weeks and still had migraines and problems with focus. About a week after returning to work, she received a call that her son H. A. was very ill. He ended up being hospitalized for one-and-a-half months and was diagnosed with a rare form of epilepsy. In addition to frequent seizures (25-100 per day), H. A. has an increased risk of death at night. The Appellant stopped working on February 9, 2012 due to intense migraines, stress and anxiety. She has not worked since.

[12] Dr. Atack initially saw the Appellant in consultation on February 21, 2012. He provided a detailed description of the fall in January of 2011 but did not mention H. A.’s condition or the accident that took place in January of 2012. He noted that the Appellant’s initial symptoms of positional vertigo and imbalance resolved over a few months; headaches were almost constant at first but still occurred on an almost daily basis a year later and lasted from 2 hours to an entire day. There was also nausea, insomnia and difficulty maintaining sleep. He attributed the insomnia to the post-concussion syndrome.

[13] On October 2, 2012, Dr. Atack noted an overall improvement in the headaches after the Appellant started taking Topamax, although she had recently suffered a prolonged 11-day bout. He reported even more stress than before, as H. A. had a very serious seizure problem and had been admitted to hospital on numerous occasions. On October 20, 2012, the Appellant attended Emergency due to sharp pain in the left temple that had started two days before. The Emergency record described reduced sleep and increased stress at home as she had a young child who suffered daily seizures.

[14] On May 25, 2013, Dr. Carson (Family Physician) remained optimistic for an improvement but had not seen a great of progress to date. Dr. Carson described quite severe migraine headaches; Topamax medication had slightly decreased the intensity but not the frequency. The Appellant was uncomfortable taking Amitriptyline because of its sedative effect and her need to attend to her son’s poorly controlled epilepsy. Dr. Carson noted a morale problem (sad, withdrawn, decreased motivation) due to H. A.’s lack of response to medication and the Appellant’s own health. Cipralex was trialed but it caused an enormous exacerbation of her migraines. Dr. Carson recommended some cognitive behavioural therapy (“CBT”); the Appellant was concerned about the cost but agreed to try it out. The Appellant confirmed that this referral was to Dr. Corinne Easy (Psychologist), who she continues to see today.

[15] Dr. Carson did not make a psychiatric referral as the Appellant’s condition seemed more amenable to CBT and there was a shortage of psychiatrists. Dr. Carson noted that H. A.’s condition continued to be a source of great stress: he still had frequent seizure activity and significant behavioural problems related to medication, and the Appellant often had to get up two or three times in the night to check on him. The Appellant lived in X at this time but was moving to X in order to be closer to medical care for H. A. Dr. Carson found it difficult to imagine that the Appellant could return to work before August or September, although the Appellant would love to do so: she did not think the Appellant could focus or concentrate.

[16] After a delay attributable to his own illness, Dr. Atack saw the Appellant again on June 12, 2013. She still had headaches and insomnia; she also admitted to a fair amount of ongoing stress, largely concerning the health of H. A. His overall impression was unchanged.

[17] On November 13, 2014, Dr. Carson provided diagnoses of significant ongoing headaches and migraines, as well as adjustment disorder with mixed anxiety and depression. The possibility of PTSD was also raised, related to the ongoing and repeated stress and trauma of dealing with H. A.’s uncontrolled epilepsy. There were periods when his nighttime seizures disturbed everyone’s sleep. The Appellant was experiencing panic attacks and significant symptoms of general anxiety; she also had difficulty with concentration and memory. In addition to her disturbed sleep, she had attended hundreds of appointments and tried many medications for her son. Dr. Carson described her as anxious, sad, intermittently tearful, irritable and sometimes overwhelmed with the prospect of caring for a very high need child while continuing to parent her other two children.

[18] Dr. Carson wrote that the Appellant’s days were regularly upset by unplanned medical crises: Dr. Carson described this as both severe and prolonged and found it difficult to imagine her working in any regular occupation. Dr. Carson also noted that the underlying factors for the extent and duration of her disability were mainly related to H. A.’s medical condition; Dr. Carson did not think there was some other factor involved. Dr. Carson did not think it was realistic for her to return to any kind of part-time or full-time work in the foreseeable future. Her situation was described as extremely difficult and stressful: while she would dearly love to return to work, it was unrealistic that she would be able to do so in the next few years given the progress of investigation and treatment for H. A. Dr. Carson noted that her application for medical retirement was recently accepted.

[19] The Appellant’s December 5, 2014 Questionnaire listed a number of functional limitations including standing longer than 15 minutes, intolerance of loud noises, frequent dizziness, memory issues, inability to concentrate for 5 minutes, lack of sleep (2-3 hours of broken sleep per night), possible irritable bowel syndrome (IBS), and being too fatigued to do much household maintenance.

[20] Dr. Carson provided a Medical Report on January 27, 2015 with diagnoses of headaches/migraines that intensified following head injuries in 2011 and 2012 and extreme stress related to the H. A.’s severe seizure disorder that required close observation. Dr. Carson said that she had little sleep and did not want to use any medication that caused somnolence as she was intensely vigilant with H. A. The physical exam was normal but she had problems with focus, concentration and memory because of extreme stress and fatigue. CBT had been very helpful for anxiety but medication had been of little benefit. She was described as being a strong and resilient woman who would love to go to work, but H. A.’s prognosis was very uncertain and her progress was linked to his. She was unable to leave H. A. and was unable to work but Dr. Carson hoped that, dependent on H. A.’s progress, one day she would.

[21] On May 13, 2015, Dr. Easy reported symptoms of insomnia, autonomic nervous system reactivity, chronic panic attacks, generalized anxiety, emotion dysregulation due to life stressors, burnout, fatigue and hypervigilance. Sessions (including CBT) were ongoing due to H. A.’s ongoing life-threatening illness. Dr. Easy said the Appellant was working in therapy to slow the progression of her anxiety in the face of chronic traumatic stressors: the anxiety had moved beyond a diagnosis of adjustment disorder. The DSM-V diagnoses were panic disorder and generalized anxiety disorder. She was unable to work part-time or full-time due to chronic traumatic stress and insomnia. A return to work was also not possible if the current treatment program were to continue. No return to work had been discussed, although Dr. Easy said that this would be discussed once H. A. achieved medical stability.

[22] In her letter of July 23, 2015, the Appellant described her ongoing lack of response to medication and affirmed that H. A.’s illness was still the main source of her high stress and severe anxiety. H. A. was having 25-100 seizures per day, with many of those occurring in his sleep. Despite her efforts to lower her stress and anxiety, she still suffered at least two panic attacks per day and was physically, mentally and emotionally exhausted. Even though she was under financial strain, her doctors told her that it would be several years before a return to work was even a possibility.

[23] Also on July 23, 2015, Dr. Easy provided a history of the Appellant’s psychological treatment, noting that she first presented with anxiety and adjustment difficulties. While the original diagnosis was adjustment disorder, she now met the criteria for generalized anxiety disorder and panic disorder. Symptoms were described as being severe and including insomnia, hypervigilance, chronic fear of H. A.’s death, anxiety, despair, anhedonia, depressed mood, autonomic nervous system reactivity, intrusive thoughts, avoidance and panic attacks. These symptoms were described as being severe and prolonged, with a prognosis of “poor”, and had worsened as H. A.’s condition worsened. The treatment goal was to try and slow the progression of the anxiety and mood symptoms, as her recovery was contingent on H. A.’s medical stability.

[24] Dr. Easy said that the Appellant was simply unable to work due to chronic unavoidable chronic stressors. Living with the fear of H. A.’s death and the chronic life-threatening medical emergencies had also resulted in symptoms of traumatic stress. While she had made every attempt to prevent and treat her condition, the chronic nature of her traumatic stressors makes her disability long-term. Dr. Easy noted that there was no medication sufficient to ameliorate the fear of H. A.’s death and the hypervigilance associated with monitoring his safety and seizure activity: medication was simply a palliative intervention at this time.

[25] In an October 8, 2015 telephone call, the Appellant indicated that she had tried volunteering at a local school and remained interested in a return to work if she were able in the future. It was reported that she has 4 years of long-term disability benefits remaining with a private insurer, at which time the insurer will find her a job at the same salary she made with the RCMP. She was still the main caregiver although her husband helped when he could. The children also went to their grandparents when extra support was needed and she received assistance worth up to $3,000 from the Community Care Access Centre. At the hearing, the Appellant said that the “volunteering” was limited to going on a field trip (usually with H. A.’s class) once every few months.

[26] Dr. Easy provided a further letter on November 26, 2015. The Appellant was now experiencing recurrent intrusion symptoms, having flashbacks to when H. A. was in the intensive care unit, as well as nightmares and insomnia secondary to this fear, avoidance, derealisation, and numbing. Dr. Easy wrote that she was now experiencing the full range of trauma symptoms and met the full criteria for the DSM-5 diagnosis of post-traumatic stress disorder with panic attacks: she was totally disabled from employment and had been medically unstable since the beginning of her treatment in 2013.

[27] On November 30, 2015, the Appellant indicated that friends came by daily to help; her husband, parents and in-laws also help when they are able. She also received some limited funds for ‘respite care’. She said that she now had to write down everything word for word when she needed to remember something. Her migraines were worse, her concentration was not very good, and she was having 3-10 anxiety (panic) attacks every day. In these attacks lasting 15-20 minutes, her heart races and she sometimes blacks out. Her legs, arms and body all shake and she cannot grip. Although she knows it will subside, her mind races and she cannot focus. She feels like she will vomit but usually does not. There are no obvious triggers. Sometimes, she needs to be picked up, if she is away from home.

Current Situation

[28] H. A. had 288 partial or full days in the hospital last year and the Appellant says that his condition is worsening: unfortunately, he does not seem to be growing out of the seizures. He has attended school since the 2013-2014 school year; although he is now 8 years old, he is developmentally about 2-3 years old. He missed 98 days of school last year, not including days where he had to leave early. She said that he is not medically stable.

[29] On a typical day, the Appellant is up at 6:00 a.m. and gets breakfast for H. A. He will do a bit of tidying and gets the children (including H. A.) to school at 9:00 a.m. She is often there until 9:30 or 10:00 a.m. She then goes home and tries to rest her brain but is typically called back to school by 12:00 or 1:00 p.m. because of H. A.’s condition. All of the children are home by 3:35 p.m.; she might help with homework and will try to cook dinner so that they can eat by 6:00 p.m. or shortly after. She will give H. A. a bath at 7:00 p.m. and try to calm him down in order to sleep; she reads to him and he generally is asleep by 7:30 or 8:00 p.m. The Appellant’s husband works 5-6 days per week: he leaves at 6:00 a.m. and gets back sometime between 6:00 and 10:00 p.m. at night. If he is at home, she might try to get some groceries. She tries to take an hour for herself each evening by reading a book or taking a bath. Although she goes to bed at 9:00 p.m., it usually takes an hour or two to fall asleep. Dr. Easy recommended that she get out once per week but it does not happen that often: perhaps once every few months.

[30] At the hearing, the Appellant said that she had a monitor to observe H. A. at night. The monitor wakes her up 15-20 times per night and she has to check that he is still breathing. As he loses urinary control during seizures, she has to replace his sheets 3-4 times per night. Eventually, she will bring H. A. into her bed, although the sheets usually have to be changed there once as well after he has a seizure.

[31] The Appellant said that she is supposed to do the housework but her husband and other children also help around the house. She tries to do the cooking but her husband will do this if he gets home early. The neighbours do the snow removal and her husband cuts the grass on his day off. She does some quick grocery shopping once or twice per week but does a major “re- stocking” shopping trip with her husband once per month.

[32] The Appellant said that she cannot even focus on watching television and that her memory loss has increased. She cannot remember what she did the day before and has to write everything down. She described a marked reduction in concentration over the past four months; she thinks her brain is beginning to shut down from everything. Her migraines are out of control and she estimated that she now had between 6-15 panic attacks per day. Her current medications are Cymbalta, Ativan (on an emergency basis only) and Amitriptyline. She restricts the Amitriptyline to once per week when her husband is home because it really knocks her out and she sleeps for 14-16 hours.

[33] The Appellant’s experience is that her symptoms actually get worse when H. A. is not in distress. He received a VNS implant earlier this year that provided a 2-3 week improvement, but she found that her functioning still “shut down”. This implant takes up to two years to become effective. However, the change thus far has been limited, as H. A. still has 25-100 seizures per day. It will not fix or stabilize H. A.’s condition. The Appellant has been told that it would likely take years for everything to calm down even if his condition stabilized. Dr. Easy has advised her to look at today rather than look down the road. The Appellant has not been back to work since 2012. She has not applied for any jobs or done any retraining or upgrading.

[34] Dr. Easy is the Appellant’s primary caregiver. Although she would like to attend more, she only sees Dr. Easy monthly as she has to pay for these visits. She is calmer after appointments, but it wears off quickly. She does not think Dr. Easy’s prognosis has changed in the past year. She sees Dr. Carson every 1-3 months but this is largely confined now to “family doctor” matters such as prescription renewals. She said both of her doctors are surprised at how resilient she had actually been. The Appellant has not seen or been referred to any other specialists in the past couple of years, nor are there any upcoming procedures or consultations.

Submissions

[35] The Appellant submitted that she qualifies for a disability pension because:

1. She cannot return to work any time soon because of her physical, emotional and mental health issues;
2. She has provided sufficient proof of a severe and prolonged disability, supported by reports from her doctor and specialists;
3. She is not the only person who cares for H. A. although, as she is his mother, she does her best to be there for him as he could die if she did not take action; and
4. Her conditions are actually intensified when she has a break from caregiving.

[36] The Respondent submitted that the Appellant does not qualify for a disability pension because:

1. While caring for her son requires an inordinate amount of her time, this is not a determining factor when considering eligibility for disability benefits;
2. She has been trialled on a few antidepressants but there is no indication she has undergone multiple medication trials or augmentation of her medications to help ameliorate her symptoms;
3. Although she experiences symptoms of anxiety, depression and PTSD, she has not exhausted all treatment options for conditions; and
4. Despite a reported worsening of her symptoms, there is no indication of any changes in her treatment or referrals to other specialists.

Analysis

[37] The Appellant must prove on a balance of probabilities that she had a severe and prolonged disability on or before the date of the hearing.

Severe

[38] As noted above, a person is considered to have a severe disability if she is incapable regularly of pursuing any substantially gainful occupation. The severe criterion must be assessed in a real world context (Villani v. Canada (A.G.), 2001 FCA 248). This means that when deciding whether a person’s disability is severe, the Tribunal must keep in mind factors such as age, level of education, language proficiency, and past work and life experience.

[39] The Appellant’s situation is a very difficult one. It is difficult to conceive of the stress and strain faced by a parent in such circumstances. The Tribunal accepts the opinion of her doctors that she has actually done very well and has done everything asked of her. It is clear from the evidence that the Appellant is unable to pursue regularly any substantially gainful occupation in addition to her caregiving responsibilities. However, the Tribunal is created by legislation and, as such, it has only the powers granted to it by its governing statute. The Tribunal is required to interpret and apply the provisions as they are set out in the Canada Pension Plan. The Tribunal is not a court of equity, nor can it change the law or make rulings outside of its legislatively- conferred jurisdiction.

[40] The Tribunal’s enabling legislation does not permit a claimant’s disability to be based on the disability of another person, no matter how close and dependent that person might be. As a result, the Tribunal cannot make a finding of disability on the sole basis that the Appellant’s family obligations and their current impact on her health prevent her from holding a job. Just as socio-economic factors such as labour market conditions are not relevant in a determination of whether a person is disabled within the meaning of the CPP (Canada (MHRD) v. Rice, 2002 FCA 47), a finding of disability cannot be based on one’s family obligations. A related principle is that an ability to care for a severely disabled child is indicative of retained work capacity: such an approach is supported by the reasoning of the Tribunal’s Appeal Division in T.C. v. Minister of Employment and Social Development, 2015 SSTAD 637.

[41] However, this does not mean that the Appellant cannot succeed in her appeal. While it requires creating a hypothetical situation that is not currently realistic for the Appellant, the Tribunal essentially needs to assess whether, independent from H. A.’s condition, the Appellant is suffering from medical conditions that prevent her from working. In such a scenario, would the Appellant still be severely disabled? Alternatively, using the language of the T.C. decision, do the Appellant’s current caregiving responsibilities demonstrate retained work capacity?

[42] While Dr. Easy opined on November 26, 2015 that the Appellant was totally disabled from employment and had been medically unstable since the beginning of her treatment in 2013, the Tribunal is not persuaded that this opinion sufficiently distinguishes the impact of H. A.’s ongoing medical distress from the Appellant’s actual capabilities if H. A. were medically stable. Indeed, the medical opinions up to that point had generally linked the Appellant’s condition to H. A.’s condition: this is evident in Dr. Carson’s opinions of November 13, 2014 and January 27, 2015, as well as Dr. Easy’s opinions of May 13, 2015 and July 23, 2015.

[43] While the Tribunal is not persuaded that the Appellant has been severely disabled since 2013 or some earlier date, the Tribunal accepts that there has been a continuing deterioration in the Appellant’s condition. This is supported by the Appellant’s own evidence as well as the objective medical documentation. Perhaps most importantly, the development of PTSD as well as increasingly frequent associated panic attacks suggest that the Appellant now has a serious medical condition that is independent of H. A.’s condition. The Appellant testified that her panic attacks had no specific triggers; in fact, they were just as prominent when she had some respite from her parental responsibilities. The panic attacks are currently so frequent that it is difficult to imagine how she could hold down employment, even without her reported cognitive deterioration.

[44] The Tribunal finds that a threshold had been crossed by the time of Dr. Easy’s November 26, 2015 letter. With the recurrent flashbacks, nightmares and insomnia, the Appellant now had the full range of trauma symptoms to fulfil a diagnosis of PTSD with panic attacks. This moves beyond the symptoms relating to exhaustion and hypervigilance that would generally be expected in the demanding circumstances facing the Appellant. With this letter, and the Appellant’s own evidence concerning the lack of panic triggers, the Tribunal is satisfied that a severe disability independent of H. A.’s condition has existed since November 26, 2015 and continued through the date of the hearing. While there were references to possible PTSD prior to this date, the concurrent medical opinion was still maintaining that the Appellant’s condition was linked to that of her son. The November 26, 2015 letter does not make such a link: while the repeated traumatic events clearly contributed to her current condition, Dr. Easy no longer states that the Appellant’s recovery is contingent on H. A.’s stabilization.

[45] The Tribunal has also considered whether the Appellant’s caregiving activities themselves establish work capacity. This is important because, where there is evidence of work capacity, a person must show that effort at obtaining and maintaining employment has been unsuccessful by reason of the person’s health condition (Inclima v. Canada (A.G.), 2003 FCA 117).

[46] As H. A. attends school, the Appellant’s caregiving role has diminished from what it would have been when the seizure disorder first developed. While his school attendance is irregular, this is often due to hospitalization rather than the Appellant caring for him at home. Furthermore, the Appellant has given evidence that she is frequently assisted or relieved in her duties by external respite care, her husband, her parents, her in-laws and her friends. It also appears that the Appellant’s panic symptoms are actually worse when she has some respite from observing H. A.: this suggests that she is able to function only under extreme duress. It also appears that much of her supervision of H. A. is at night when she is simply ensuring that he is still breathing or periodically changing his sheets. These simple tasks are interspersed with sleep and, while exhausting, do not equate to a realistic employment situation or to establishing real-world work capacity. As a result, the Tribunal is not persuaded that the principle in Inclima prevents the Appellant from establishing severity.

[47] Many of the Respondent’s submissions essentially suggest that the Appellant’s treatment has not been optimized. In this regard, Dr. Easy’s July 23, 2015 letter is of assistance: the Appellant had made every attempt to prevent and treat her condition and, in her particular circumstances, medication was simply a palliative intervention. The Tribunal is inclined to accord Dr. Easy’s opinions significant weight, given her specialization, the length of time she has treated the Appellant, and the Appellant’s own admission that Dr. Easy was much better positioned than Dr. Carson for the Appellant’s treatment. Accordingly, the Tribunal does not find that the Appellant has failed to mitigate her condition or that her condition is not severe enough to warrant exceptional forms of treatment.

[48] After careful consideration, the Tribunal concludes that the Appellant had a severe disability by November 26, 2015 and that it continued through the date of the hearing.

Prolonged

[49] A disability is prolonged if it is likely to be long continued and of indefinite duration or is likely to result in death. There is no evidence to suggest that the Appellant’s disability will result in her death. The Tribunal must therefore determine whether her PTSD with panic attacks is likely to be long continued and of indefinite duration.

[50] Dr. Carson and Dr. Easy have long maintained that the Appellant’s disability was prolonged. However, for the reasons mentioned above in the analysis of “severity”, the Tribunal is cautious about placing too much reliance on these assertions. They were made at the time that the Appellant’s condition was still firmly linked to H. A.’s condition. The diagnosis of full PTSD in November of 2015, however, suggests that the Appellant’s condition will in fact endure. PTSD, by its very nature, persists after the trauma that caused it. The Appellant’s associated panic attacks frequently occur when the Appellant is not dealing with H. A.’s condition.

[51] The Appellant was told that it would likely take years for everything to calm down even if H. A.’s condition stabilized. Notably, she was also told by Dr. Easy to change her focus from the future to the present. On top of this, she reports fairly significant and recent cognitive impacts. She also does not believe that Dr. Easy’s prognosis has changed since the end of 2015. While the Tribunal does not assign much weight to it, the Appellant also had some problems with focus even before H. A.’s seizure disorder emerged.

Conclusion

[53] The Tribunal finds that the Appellant had a severe and prolonged disability in November of 2015, when Dr. Easy made the diagnosis of full PTSD with panic attacks and the Appellant’s prognosis no longer appeared to be contingent on H. A.’s condition. According to section 69 of the CPP, payments start four months after the date of disability. Payments start as of March, 2016.

[54] The appeal is allowed.