Canada Pension Plan (CPP) disability

Decision

[1] The appeal is dismissed.

[2] The Claimant, S. M., isn’t eligible for a Canada Pension Plan (CPP) disability pension. This decision explains why I am dismissing the appeal.

Overview

[3] The Claimant is currently a 54-year old woman, who was 46 years-old at the time of her MQP, and 47 at the time of her pro-rated MQP. She has anxiety, ADD, bouts of depression and alcohol dependency. She was working from February 2013 until March 2014 in light clerical work for a property management company. She was fired for poor performance. She went on Ontario Works (OW) in 2013, then return to work. After being fired from the last company, she went back on OW and has remained on since 2015. She has also worked part-time as a house cleaner since then, and continues to work as a house cleaner. She is claiming that she cannot work because of ADD, anxiety (GAD) and alcohol dependency. She has had the services of counselling and a psychiatrist over 10 years, but has been non-compliant with medications and treatment.

[4] The Claimant applied for a CPP disability pension on November 27, 2018. The Minister of Employment and Social Development (Minister) refused her application. The Claimant appealed the Minister’s decision to the Social Security Tribunal’s General Division.

[5] The Claimant says her alcohol abuse is continuous and present and negatively impacts all her other symptoms. She has been under the care of psychiatrist Dr. Gangdev for 10 years, and tried numerous medications without any benefit.

[6] The Minister says the information supports she has treatable and manageable mental health conditions and there are no significant psychosis or severe mental health conditions.

What the Claimant must prove

[7] For the Claimant to succeed, she must prove she had a disability that was severe and prolonged by December 31, 2013. This date is based on her contributions to the CPP.^{Footnote 1}

[8] The Claimant had CPP contributions in 2014 that were below the minimum amount the CPP accepts. These contributions let the Claimant qualify for a pension if she became disabled between January 2014 and September 30, 2014.^{Footnote 2}

[9] The Canada Pension Plan defines “severe” and “prolonged.”

[10] A disability is severe if it makes a claimant incapable regularly of pursuing any substantially gainful occupation.^{Footnote 3}

[11] This means I have to look at all of the Claimant’s medical conditions together to see what effect they have on her ability to work. I also have to look at her background (including her age, level of education, and past work and life experience). This is so I can get a realistic or “real world” picture of whether her disability is severe. If the Claimant is able to regularly do some kind of work that she could earn a living from, then she isn’t entitled to a disability pension.

[12] A disability is prolonged if it is likely to be long continued and of indefinite duration, or is likely to result in death.^{Footnote 4}

[13] This means the Claimant’s disability can’t have an expected recovery date. The disability must be expected to keep the Claimant out of the workforce for a long time.

[14] The Claimant has to prove she has a severe and prolonged disability. She has to prove this on a balance of probabilities. This means that she has to show that it is more likely than not she is disabled.

Reasons for my decision

[15] I find that the Claimant hasn’t proven she had a severe and prolonged disability by December 31, 2013 or by September 30, 2014.

What the evidence says about the Claimant’s conditions

[16] The Claimant must provide medical evidence that shows that her functional limitations affected her ability to work by December 31, 2013 or by September 30, 2014.^{Footnote 5}

[17] The Claimant has provided little medical information at the time of both MQP’s. Dr. Anne Marie Monforton has been her family physician for over 20 years. She endorses the Claimant had anxiety, depression and ADD in 2019^{Footnote 6} . However, her clinical notes from March 2014 to December 2014 indicated anxiety due to job loss. She was not on any medications for anxiety or depression by November 2014^{Footnote 7} . At that time, for her anxiety, the doctor re-referred the Claimant to psychiatrist, Dr. Gangdev, whom she had seen previously in January 2013, two years earlier.

[18] The Claimant is putting weight on Dr. Gangdev as her treating psychiatrist for 10 years. As such, I have put weight on the information from Dr. Gangdev. His information reveals non-compliance with medications, therapy and appointments.

[19] It is misleading to state he has been her treating psychiatrist for 10 years. She saw him intermittently since her initial assessment in November 2011, and she never followed up with appointments.^{Footnote 8} After the initial assessment, she saw him once in January 2013, over a year later, then once in December 2014, two years later. He indicated he saw her intermittently and she missed numerous appointments. He noted she had not been compliant with recommended treatment. .

[20] Dr. Gangdev’s notes show in January 2013^{Footnote 9} , she had fluctuating mood and anxiety possibly related to PMS, a common condition of anxiety caused by menstruation and lasts during the menstruation cycle. There were no abnormalities on her mental status. He recommended Seroquel and psychosocial interventions. She did not attend with Dr. Gangdev again until December 2014, post MQP’s and almost two years later, when he diagnosed anxiety disorder, alcohol in remission and to rule out ADD. Like Dr. Monforton, Dr. Gangdev also noted she was not on any medications.

[21] The Claimant stated that she started taking the Seroquel. She went on Ontario Works (OW) for the first time then. OW paid for counselling at Daya Counselling for 10 sessions. She found the counselling helpful. She did not need any medications after that, or to consult with psychiatrist Dr. Gangdev for another two years.

[22] The medical evidence shows that at the time of both MQP’s, she was not on any medications and did not need ongoing counselling other than 10 sessions before the end of both MQP’s.

The Claimant mislead her doctors about sobriety

[23] Consistently, Dr. Gangdev and Dr. Monforton note that her alcohol was in remission since January 2013 to at least October 2018.^{Footnote 10} I do note that in 2019^{Footnote 11} , Dr. Monforton began to diagnose alcohol abuse, recurrent, and that she was suffering alcohol abuse in 2019. Dr. Gangdev notes in 2019, that currently she consumes a few drinks a week.^{Footnote 12} This was well beyond both MQP’s. The medical evidence in 2013 and 2014 notes the alcohol abuse condition was in remission. Dr. Monforton’s clinical notes in November 2014, just after her pro-rated MQP, state the Claimant denied any alcohol use^{Footnote 13} .

[24] The Claimant testified that she has never stopped drinking. She has never been sober. She continues to drink daily, and has blackouts every weekend.

[25] She has only tried to quit drinking for three months, before seeing Dr. Gangdev in the summer/fall of 2011. She went to Alcoholics Anonymous (AA) meetings during that period for the only in her life.

[26] I accept that AA is not the only solution for alcohol abuse, however, because she had mislead her doctors about being sober, they were not recommending any treatment for alcohol abuse.

[27] The Claimant has testified that it is the alcohol abuse and her anxiety, along with ADD which have limited her ability to work. She stated her drinking, which began many years earlier, affected her performance at work, caused sick days, missed appointments and cancelled meetings. She had been fired from almost all of her jobs, in part due to her drinking.

[28] She stated her anxiety limits her focus, ability to meet deadlines and additional responsibilities. The anxiety affects her ability to cope day to day and use her life skills responsibly. She also noted that she would turn to alcohol to help her, then would get anxiety when not drinking.

[29] I refer to Dr. Monforton’s medical conditions questionnaire of August 2019^{Footnote 14} where she indicates alcohol abuse, recurrent for more than one year. She notes the impairments and symptoms related to this condition are increased anxiety, increased stress, decreased mood, decreased social activity and decreased functional ability in all tasks requiring attention and staying in focus.

[30] I am taking judicial notice of the effects of alcohol abuse, which are the symptoms described, above can also be the symptoms of anxiety, depression and, the lack of focus and attention, the same as the symptoms of ADD.

[31] Therefore, treating the alcohol abuse would also help treat her anxiety and ADD.

[32] Moreover, as she has testified she mislead her doctors throughout the years that she was not drinking, it is reasonable that the symptoms she was demonstrating: anxiety, depression, poor focus, and being easily overwhelmed,^{Footnote 15} were attributed to anxiety and depression by the doctors as they were under the impression her alcohol abuse was in remission.

[33] She has not attempted to resolve her alcohol abuse. She stated that she is still drinking today, and that she is not doing anything for it.

A correlation between GAD, ADD and alcohol abuse

[34] Dr. Gangdev found in 2019, well beyond her MQP’s, that it was unlikely she would find and maintain employment until her GAD and ADD are satisfactorily controlled. He found her ADD so severe to cause significant impairment at work, and that the treatment for ADD is limited because of her GAD.

[35] There is a correlation between her GAD, ADD and alcohol abuse. Treating her alcohol abuse would treat her GAD, which in turn would open the avenue for treating ADD.

[36] She had been on Vyvance for her ADD, a common medication for the condition. She stated she did feel sharper with it, but not great, and had side effects. Dr. Gangdev noted that she had not been consistent with the Vyvance or Concerta over the years.^{Footnote 16} Dr. Lefcoe took her off Vyvance in 2017. She stated she has been taking Addoral as needed since 2017, though Dr. Gangdev did not note that medication in 2019. She stated currently she is receiving counselling for her ADD through Daya Counselling. These dates are well beyond her MQP’s.

[37] The clinical notes at the time of her MQP’s show that she was not compliant. Dr. Gangdev recommended psychosocial intervention and Seroquel in January 2013, and she takes it today, finding it helps. However, when he saw her next in December 2014, Dr. Gangdev noted she was not on any medications. Clearly, she stopped the medications and resumed again at a later date.

[38] By January 2017, Dr. Gangdev indicated that she had intermittent anxiety and was not adhering to medications, so he reinforced the importance of prescribed medications.

[39] By not properly adhering to medications for her ADD, she was not able to treat her anxiety. It has already been found that treating her alcohol abuse would treat her anxiety. Dr. Gangdev indicated that not only was it important to be compliant with the medications for anxiety, but also the ADD could not be properly treated until the anxiety was managed. Both relied upon taking medications as prescribed, which the Claimant did not do.

The Claimant hasn’t followed medical advice

[40] The Claimant hasn’t followed medical advice.

[41] To receive a disability pension, a claimant must follow medical advice.^{Footnote 17} If a claimant doesn’t follow medical advice, then she must have a reasonable explanation for not doing so. I must also consider what effect, if any, the medical advice might have had on her disability.^{Footnote 18}

[42] The Claimant hasn’t followed medical advice. She didn’t give a reasonable explanation for not following the advice.

[43] In 2017 she had a psychiatric assessment with Dr. Lefcoe^{Footnote 19} . He noted her cognitive functioning was grossly intact. He diagnosed GAD and recommended cognitive behavioural therapy (CBT) for anxiety. Dr. Lefcoe was aware she was still drinking as he told her to stop drinking and contact addictions services. This would reinforce the Claimant’s testimony that she was always drinking. The Claimant stated that six months after seeing Dr. Lefcoe, she received a letter regarding CBT. She postponed treatment. Eventually she went twice at the London Health Sciences and stopped.

[44] I find she was not compliant with recommendations for CBT or for recommendations to stop drinking and contact addictions services.

[45] Dr. Monforton noted in 2018 that she has continued to have ongoing anxiety and depressed mood despite significant intervention from psychiatry and psychotherapy with CBT. She did not receive any meaningful CBT as recommended as she only took two sessions.

[46] Dr. Gangdev also noted in 2019 that her symptoms have not changed over the years, however, he reiterated that she had not been compliant or consistent with treatment recommendations.

[47] I accept Dr. Gangdev’s medical observations over that of Dr. Monforton, as requested by the Claimant. Dr. Gangdev implies her anxiety and ADD symptoms have not changed over the years due to non-compliance with medications and treatment recommendations.

[48] I also find she has not tried to treat her alcohol abuse. She had been advised to stop drinking and seek help from addiction services. Because of this, she has not properly managed her anxiety or ADD. As she has not been compliant with treatment recommendations, her symptoms have not improved.

[49] I must now consider whether following this medical advice might have affected the Claimant’s disability. I find that following the medical advice might have made a difference to the Claimant’s disability.

[50] The Claimant mislead her treating physicians, by stating she was sober for years when she was still drinking abusively, stating she is still having blackouts every weekend and drinking daily as she has always done. Dr. Lefcoe, many years after her MQP, recommended she stop drinking. It is quite reasonable that had her family physician and Dr. Gangdev been aware she was still abusing alcohol, they too would have tried to treat the condition.  According to Dr. Gangdev, she was also non-compliant with medications and treatments recommended for anxiety and ADD.

[51] Dr. Gangdev also noted in November 2015^{Footnote 20} that she had intermittent anxiety due to various stressors but was able to get through with self-management and medications. This implies that at the time she was compliant with medications for her anxiety, and with compliance, the Claimant could manage her anxiety.

[52] I agree with the Minister that the information supports both treatable and manageable mental health conditions. I also find that had she been consistently compliant, the evidence indicates she would manage her conditions.

[53] Had she addressed her alcohol condition, it is likely her anxiety would be properly managed. With proper management of her anxiety, she would be able to find the right medication to treat her ADD. Had she treated continuously with Dr. Gangdev, she may have resolved her anxiety and ADD at the time of her MQP. As she did not treat continuously for many years, her conditions became chronic and difficult to treat, as suggested by Dr. Gangdev.

[54] The Claimant didn’t follow medical advice that might have affected her disability. This means that her disability wasn’t severe.

[55] When I am deciding whether a disability is severe, I usually have to consider a claimant’s personal characteristics.

[56] This allows me to realistically assess a claimant’s ability to work.^{Footnote 21}

[57] I don’t have to do that here because the Claimant didn’t follow medical advice and didn’t give a reasonable explanation for not following the advice. This means she didn’t prove that her disability was severe by either December 31, 2013 or between January 2014 and September 30, 2014.^{Footnote 22}

Conclusion

[58] I find that the Claimant isn’t eligible for a CPP disability pension because her disability isn’t severe. Because I have found that her disability isn’t severe, I didn’t have to consider whether it is prolonged.

[59] This means the appeal is dismissed.