Canada Pension Plan (CPP) disability

Decision

[1] The Claimant applied for a Canada Pension Plan (CPP) disability pension on May 7, 2018. The Minister refused the application. The Claimant appealed to the General Division of the Social Security Tribunal.

[2] I have decided that the Claimant is eligible for CPP disability pension payments as of June 2017. This written decision explains why I am allowing the appeal.

Overview

[3] The Claimant last worked as a call centre representative from November 2010 until February 2017. She reported that she could no longer work as of that time because of COPD, acute respiratory distress syndrome (ARDS), depression, post-traumatic stress disorder, and anxiety.   

[4] The Minister has submitted that although the Claimant’s family doctor is supportive of her application, the medical evidence shows that her lung condition is stable with treatment. There have also been no adjustments to her medications for mental health, and she no longer requires follow-up with any mental health professional.

The issues in this appeal

[5] A Claimant is entitled to a CPP disability pension if they meet all of these conditions:

• They must have contributed to the CPP within a time frame called the minimum qualifying period.^{Footnote 1}
• They must have a disability that is both ‘severe’ and prolonged’, as CPP law defines these terms.
• They must have become disabled on or before the end of the minimum qualifying period.^{Footnote 2}

[6] The Claimant’s minimum qualifying period ended on December 31, 2019. I have to decide if she was disabled on or before that date. It is the Claimant’s responsibility to prove that this is more likely than not.^{Footnote 3}

What I have to decide

[7] First, I have to decide if the Claimant’s disability was severe by December 31, 2019. Canada Pension law says that ‘severe’ means that a Claimant cannot regularly work in any ‘substantially gainful’ job because of their disability.^{Footnote 4}

[8] If so, I have to decide if the Claimant’s disability was also prolonged by December 31, 2019. ‘Prolonged’ means that it is ‘long continued and of indefinite duration.’  In other words, it will likely go on for a long time and there is no end in sight.^{Footnote 5}

Analysis

Is the Claimant’s disability severe?

[9] I found the Claimant to be credible. Her testimony was straightforward in answering questions about her health and work history. I have put equal weight on the Claimant’s credible testimony and on the evidence contained in the hearing file.

[10] The Claimant has been diagnosed with COPD, post-traumatic stress symptoms, major depression, acute respiratory distress syndrome, and asthma. I must assess the impact of all of these conditions taken together.^{Footnote 6}

Depression and post-traumatic stress disorder 

[11] Dr. Caissie, psychologist, reported that the Claimant suffered from symptoms of post-traumatic stress disorder related to past traumatic experiences. She felt that the Claimant’s prognosis for an eventual return to work was poor. The Claimant attended 6 sessions with Dr. Caissie because that is all that coverage was approved for. She could not afford more sessions because of the cost. The Claimant has not been referred to a psychiatrist because there are so few where she lives and the wait times to see one are so long. I do not fault the Claimant for not being referred to a psychiatrist.

[12] In April 2018, the Claimant’s family doctor, Dr. Robichaud, reported that the Claimant’s depression improved slightly. She attended bi-weekly to monthly counseling sessions and group therapy for about 2 years leading up to September 2019. In September 2019, Ms. Leger, the Claimant’s treating mental health nurse, closed her file.  She reportedly did so because the Claimant’s symptoms improved. According to the Claimant, however, her file was closed because the counseling was not helpful. Ms. Leger could not offer her anything else apart from encouraging her to apply what she had learned at home. The Claimant continues to look for group therapy sessions through the mental health association that could help her.

[13] In December 2019, the Claimant was taking Seroquel, Mirtazapine, and Citalopram medications for her mental health conditions.

COPD, asthma, and acute respiratory distress syndrome

[14] In 2010, the Claimant spent 65 days in a hospital intensive care unit because of septic shock from a lung infection. She continued to need home oxygen therapy upon discharge, but she did not return home to her abusive husband.  Instead, she went to live with her son.  

[15] The Claimant has had daily coughing/choking fits since her septic shock in 2010. The coughing is productive, so she has to spit. The fits also make her dizzy, cause increased stress/anxiety, and drain her energy. It is like a cycle where one symptom aggravates another.

[16] Between 2011 and 2019, the Claimant consulted with Dr. Brideau, respirologist. He has tried her on multiple medications, but the symptoms continue. He has described that the Claimant’s condition is stable. The Claimant submitted that while it might not be worse than in 2010, it is not manageable unless she does nothing and goes nowhere. In December 2019, she was taking Omnaris and Symbicort inhalers. She is currently using Breo.

[17] I acknowledge that there has been some limited improvement in the Claimant’s condition since she stopped working. But, that is only because she has been able to limit her activity and completely control her home environment. I find that when her physical and psychological symptoms are considered in totality, they preclude her regularly from any substantially gainful work.

The Claimant’s condition has a big impact on her daily life.

[18] The measure of whether a disability is “severe” is not whether the Claimant suffers from severe impairments, but whether the disability prevents her from earning a living. So, it’s not just a question of whether the Claimant is unable to perform her regular job, but rather, unable to perform any substantially gainful work^{Footnote 7}.

[19] The Claimant lives alone in an apartment. If she wants to do anything outside, she has to really plan for it. She tries to walk outside each day, but she can only walk short distances because it makes her cough/choke. In fact, her coughing/choking seems to be triggered whenever she leaves her apartment. She only goes out when she has to.

[20] The Claimant relies on her neighbour to help wash her floors, clean her bathrooms, and carry her groceries. She pays her when she can. In a typical day, the Claimant does some basic cooking and light dusting.  She rests whenever she needs to. She might drive to the store to pick up a few groceries, talk to her daughter on the phone, or have a visitor in. She enjoys crocheting. She can’t read because she has difficulty concentrating. She naps most afternoons because she is always tired.  She does not sleep well. The Claimant also visits her son and his family a few days each week. They live 30 minutes away. She can’t play with her grandchildren the way she would like to, but she can watch a movie or play a game with them.

[21] The Claimant has learned how to better manage her anxiety and COPD/respiratory symptoms at home. She knows her limitations and spends most of the time sitting. She still has many coughing/choking fits each day, but she does not have to worry about being others around her.

The Claimant worked for as long as she could.

[22] Where there is evidence of work capacity, a Claimant must show that efforts at obtaining and maintaining employment have been unsuccessful because of their health condition^{Footnote 8}.

[23] The Claimant spent 27 years working as a full-time social services case manager. She semi-retired in 2007 because her job was extremely stressful and she was being abused physically and mentally by her husband at home. She wanted to keep working in some way and planned to go back to school in 2010. That was before she got sick.

[24] While she was still on home oxygen in 2010, the Claimant was applying for jobs. She knew she could not do a physical job, so she found desk-type work at a call centre. She weened herself off the home oxygen to be able to start working. Each day at work was a challenge. She started off working full-time hours, but it took a lot of time and energy just to prepare herself for each shift. Her coughing/choking fits were so bad that she had to end calls and take breaks because she could not keep talking. She had a hard time meeting the job requirements and she was disturbing her co-workers. That caused her anxiety to increase and she could no longer concentrate.

[25] On the days the Claimant worked, she could not do anything else at home. The more she worked, the more tired she got, and she was frequently getting colds and pneumonia.  Dr. Robichaud decreased her hours to 30 hours each week, but it didn’t help. By February 2017, she stopped working completely.  

[26] The Claimant submitted that she does not know what other type of work she could do. She tried her best to keep working doing the easiest job she could think of, even part-time, but she couldn’t.  Dr. Robichaud has advised her that she cannot return to work. I accept that the Claimant would work if she could. She has demonstrated a strong work ethic and an inability to continue working even in an alternate job.

The Claimant is not realistically employable.

[27] In order to get a ‘real world’ picture of whether the Claimant’s disability is severe, I also have to consider her background. This includes age, education, language proficiency, and past work and life experience.^{Footnote 9}

[28] The Claimant is 60 years old and fluent in English. She finished high school and some college courses in human resources. She has worked as a case manager, in customer service, and at a call centre. I find that she possesses some transferable skills. Despite those few transferable skills, I also find that the combination of her age and functional/psychological limitations renders her a poor candidate for any re-training. Again, she has shown that she was not able to keep working even part-time in a desk-type job.

[29] I conclude that the Claimant had a severe disability, as defined in CPP law, by December 31, 2019.

Is the Claimant’s disability prolonged?

[30] I find that the Claimant’s disability was also prolonged by December 31, 2019. Despite consulting with specialists and participating in treatment to the best of her ability, there has been limited improvement in her overall condition since she stopped working in 2017. Dr. Robichaud and Dr. Caissie have advised her that she cannot return to work.

Conclusion

[31] I find that the Claimant had a severe and prolonged disability in February 2017 when she stopped working. Payments start four months after the date of disability, so as of June 2017.^{Footnote 10}