Canada Pension Plan (CPP) disability

Decision

[1] The Claimant, A. S., is eligible for a Canada Pension Plan (CPP) disability pension. Payments are to start May 2018. This decision explains why I am allowing the appeal.

Overview

[2] The Claimant last worked as a full-time hot metal operator from January 2015 until January 2018. He indicated that he could no longer work as of that time because of chronic neck/shoulder/low back pain, anxiety, and post-traumatic stress disorder (PTSD). He was in a car accident in January 2018.

[3] The Claimant applied for a CPP disability pension on November 26, 2018. The Minister of Employment and Social Development Canada (the Minister) refused his application because he had not tried lighter work and medical investigations did not show any significant pathology. The Claimant appealed to the General Division of the Social Security Tribunal.

What the Claimant must prove

[4] For the Claimant to succeed, he must prove that he has a disability that is severe on or before the date that I heard his appeal.^{Footnote 1}

[5] A disability is severe if it makes a person incapable regularly of pursuing any substantially gainful occupation. It is prolonged if it is likely to be long continued and of indefinite duration, or is likely to result in death.^{Footnote 2}

The reasons for my decision

[6] I find that the Claimant had a severe and prolonged disability of January 2018. I reached this decision by considering the following issues.

Is the Claimant’s disability severe?

The Claimant has functional limitations that affect his capacity to work

[7] My decision about whether the Claimant’s disability is severe is not based on his diagnoses. It is based on whether he has functional limitations that prevent him from working.^{Footnote 3} I have to look at his overall medical condition and think about how his health issues might affect his ability to work.^{Footnote 4}

[8] The Claimant argues that chronic pain, a neck fracture, depression, and post-traumatic stress results in an inability to walk for more than 10 minutes, sit for more than 20 minutes, sleep for more than 4 to 5 hours each night, difficulty bending, daily intrusive thoughts, nightmares, poor concentration, forgetfulness, social isolation, and a driving phobia. Since the accident, he has had to rely on his spouse to organize his daily medications, drive him to and from medical appointments, and do all of the household cooking and cleaning. The Claimant has not driven since his accident.

[9] Objective medical imaging findings and the medical evidence from Dr. Matsuda, Dr. Reis, and Dr. Sharma supports the Claimant’s argument. An MRI of the low back dated August 2018 showed degenerative disc disease and impingement of the L5 nerve roots. A CT scan of the neck dated April 2019 showed an undisplaced fracture of C4.  X-rays of the neck around the same time, showed evidence of Diffuse Idiopathic Skeletal Hyperostosis (DISH) syndrome.

[10] In November 2018, Dr. Matsuda reported that the Claimant had chronic neck pain, shoulder pain, back pain, post-traumatic stress disorder, and depression. In January 2019, she reported that his mood was not under control and he continued to have significant symptoms of depression. In March 2019, Dr. Reis, psychologist, reported that the Claimant had ongoing mood difficulties, including a lack of motivation, driving anxiety, and memory/concentration issues that were preventing him from returning to work. Dr. Sharma, psychiatrist, confirmed that the Claimant suffered from post-traumatic stress disorder and had chronic neck/back pain. He noted that the Claimant was sad most days, had no interest in activities, insomnia, nightmares, and suicidal thoughts. In October 2019, Dr. Sharma reported that because of the combination of the Claimant’s physical and psychiatric issues, he would not be able to function in his own job or any other job. He was always in chronic pain, he had not resumed driving, he had increased anxiety, and he had sleep disturbances with nightmares.

[11] The medical evidence shows that the Claimant had functional limitations that affected his ability to work by the date of the hearing.

The Claimant does not have work capacity

[12] When I am deciding if the Claimant is able to work, I have to consider more than just his medical conditions and their effect on functionality. I must also consider his age, level of education, language proficiency, and past work and life experience. These factors help me to decide if he can work in the real world.^{Footnote 5}

[13] I find that the Claimant has no capacity to work in the real world. He is 60 years old and fluent in English. He completed a diploma in aeronautical engineering in the Philippines, but he has only worked as a factory labourer in Canada. He has limited transferable skills.

[14] When I consider the combined impact of the Claimant’s age, limited transferable skills, and his numerous functional and psychological limitations, I find that he is not a good candidate for re-training or for desk-type work. He cannot sustain any posture, he has no physical endurance, he is forgetful, and he cannot concentrate.

[15] The Claimant has not attempted to return to any work since his accident. He submitted that his condition has not improved to the point that he could, despite being off work. I accept that the Claimant would return to work if he could. I do not think it is realistic to expect that any employer in a competitive job market would accommodate the Claimant’s limitations on an ongoing basis.       

The Claimant has made reasonable efforts to follow recommended treatment

[16] The Claimant has made reasonable effort to follow medical advice.^{Footnote 6} He is currently seeing his family doctor, psychiatrist, and pain specialist about every 3 months. He was seeing a psychologist as well, but he stopped treatment in August 2020 because of the out of pocket expense. He also participated in physiotherapy following his accident, but it did not provide any lasting benefit.

[17] The Claimant is currently taking Zopiclone, Pantoprazole, Escitalopram, Tylenol #3, Oxazepam, Amlodipine, Aspirin, Perindopril, Bisoprolol Fumerate, and Rosuvastatin. For exercise, he tries to walk on his treadmill for 5 to 10 minutes each day.

[18] The Claimant gets steroid injections for his low back at a pain clinic every few months. His last injections were in September 2020. The injections provide about a month of low back pain relief.  Back surgery has reportedly been discussed with the Claimant, but for now, he has been advised to keep having the steroid injections.

[19] I am mindful that the Claimant’s low back pain represents only one aspect of his overall condition. Even with a successful surgical outcome for his low back, he would still be left with chronic neck pain and several psychological conditions.

[20] Apart from the low back surgery, there has not been any other treatment recommended to the Claimant.Unfortunately, with the treatment he has had to date, there has not been any significant improvement in his functionality.

Is the Claimant`s disability prolonged?

[21] The Claimant’s disability is prolonged. His condition began in January 2018 and it continues today. Despite consulting with several specialists, participating in both conservative and invasive treatments, and taking many medications, his condition has not improved in any lasting way. Given the chronicity of his symptoms, I find little prospect that he will improve to the point that he could regularly return to any substantially gainful work.

Conclusion

[22] I am allowing this appeal. The Claimant’s disability became severe and prolonged in January 2018. There is a four-month waiting period before the disability pension is paid.^{Footnote 7} This means that payments start as of May 2018.