Canada Pension Plan (CPP) disability

Decision

[1] The Claimant is entitled to a Canada Pension Plan (CPP) disability pension to be paid as of January 2019.

Overview

[2] The Claimant stopped working in September 2018 following a diagnosis of breast cancer and a subsequent double mastectomy. This was her second bout of cancer. The first she had when she was 27 years old. The Minister received the Claimant’s application for the disability pension on January 10, 2019. The Minister denied the application initially and on reconsideration. The Claimant appealed the reconsideration decision to the Social Security Tribunal.

[3] To qualify for a CPP disability pension, the Claimant must meet the requirements that are set out in the CPP. More specifically, the Claimant must be found disabled as defined in the CPP on or before the end of the minimum qualifying period (MQP). The calculation of the MQP is based on the Claimant’s contributions to the CPP. I find the Claimant’s MQP to be December 31, 2020. Because the MQP is in the future, I have limited my consideration of entitlement up to the date of the hearing, November 13, 2020.

Issue(s)

[4] Did the Claimant’s breast cancer result in the Claimant having a severe disability, meaning incapable regularly of pursuing any substantially gainful occupation by November 13, 2020?

[5] If so, was the Claimant’s disability also long continued and of indefinite duration by November 13, 2020?

Analysis

[6] Disability is defined as a physical or mental disability that is severe and prolonged^{Footnote 1}. A person is considered to have a severe disability if incapable regularly of pursuing any substantially gainful occupation. A disability is prolonged if it is likely to be long continued and of indefinite duration or is likely to result in death. A person must prove on a balance of probabilities their disability meets both parts of the test, which means if the Claimant meets only one part, the Claimant does not qualify for disability benefits.

Severe disability

Do the Claimant’s functional limitations result in her being incapable regularly of pursuing any substantially gainful occupations?

[7] I have determined the Claimant has a severe disability. The minister set out that while the Claimant has some functional limitations she should not be precluded from any and all substantially gainful occupations. However, I have come to a difference conclusion. Below I will set out the medical information, testimony and law that has assisted me in arriving at this conclusion.

[8] I must assess the severe part of the test in a real world context^{Footnote 2}. This means that when deciding whether a person’s disability is severe, I must keep in mind factors such as age, level of education, language proficiency, and past work and life experience.

[9] The Claimant stopped working because she had a double mastectomy followed by breast reconstruction and chemotherapy.^{Footnote 3} She detailed that following her surgery and treatment she now felt lethargic, nauseous and was extremely tired. She lacked energy and was regularly short on breath.^{Footnote 4}

[10] In a January 28, 2019 medical report, Dr. Kulkarni, oncologist, set out that the Claimant had a bilateral mastectomy. As a result, the Claimant was fatigued and experience pain.^{Footnote 5}

[11] I asked the Claimant about her experience with fatigue and pain.

[12] She has to use a brace on her arm and as a result has very limited mobility with her left arm.

[13] She told me that on the right side, she got a couple bad infections and as a result, she had nerve damage. She now has discomfort. She experiences a dull constant pain. She has trouble doing everyday tasks such as opening a jar or turning her hand in a certain way are painful activities.

[14] The Claimant told me that raking leafs is painful. She did that and then had to rest for two days because of the residual pain she had under her right arm.

[15] She told me that she cannot walk as far as she used to walk.

[16] Her fatigue is constant. Even though she cannot sleep at night. She told me that going up the stairs and she has a pain in the middle of her chest. She has a constant tired feeling. If she goes for a walk, she is limited for the next couple of days in doing any activities. She gets an implant into her abdomen once monthly and the implant causes her to be out of commission for four days at a time.

[17] An October 18, 2019 progress note detailed the Claimant was experiencing significant fatigue and depression.^{Footnote 6}

[18] The Claimant set out that she has both good and bad days. She needs to stop and take her time with tasks. She set out that she is in a very sad and depressed state.^{Footnote 7} Because of her depression, she felt stressed and had a hard time concentrating. She had poor sleep and worried a great deal.

[19] The Claimant’s chart notes from 2018 to 2020 detail consistent complaints about anxiety and depression. She was having a difficult time with sleep and coping with her cancer diagnosis.^{Footnote 8}

[20] In a letter dated June 22, 2020 Dr. Kulkarni noted the Claimant continued to struggle with anxiety and depression related to her cancer diagnosis.^{Footnote 9}

[21] During the oral hearing, I asked the Claimant to explain to me how her psychological wellbeing has been impacted by cancer. She told me that she has not had the expected outcome for treatment. She has a difficult time coping. She is prescribed anti-depressants and anti-anxieties medication. She is also on sleep medication.

[22] She told me that she is in a dark place and finds it hard to get out of bed in the morning. She cannot get mental relaxation.

[23] She told me that she is in constant anxiety. She is in a constant state of worry. Every time something is wrong or does not feel right, she is extremely bothered.

[24] The Claimant told me that her interpersonal relationships have been impacted. She has become reclusive and no longer socializes with friends. She has friends that try to check in on her but she cannot deal with that or talk about it.

[25] She told me that her anxiety causes her a great deal of grief and she no longer feels like the person she was.

[26] She told me that she is constantly tired. She feels tired all the time and finds it hard to function because of that. She told me that she goes into a really dark place. She lacks interest in engaging with the world. She does not like to talk to anybody. She used to be very active with family and friends. She now has no desire to be social or even leave her house.

[27] Aside from her anxiety and depression, the Claimant also has significant challenges with concentration

[28] The Claimant told me that she has trouble concentrating. She suffers from memory loss. She finds herself closing herself off at home and that is not the kind of person she was. She loses sight of tasks and cannot focus on being able to do things. She is easily distracted. She told em that it is almost like a brain fog. She may finish a task but cannot remember doing it.

[29] She told me that it is the same thing with her kid. She needs to write everything down to make sure she does things properly. When her child had an infection, she had trouble remembering to give her medication or overdose her medication because of her concentration and memory issues.

[30] She is obsessive and compulsive about things. She needs to check things multiple times to confirm she has completed tasks.

[31] I found the Claimant to be honest and truthful. I had no problem assigning significant weight to her testimony.

[32] Both the medical evidence and testimony evidenced a severe disability. The Claimant is depressed an anxious constantly. She is withdrawn and unable to cope with day-to-day activities required to function in a workplace. She is lethargic and fatigued. Her concentration is poor. She is obsessive about some tasks and forgets to do other things.

[33] In essence, she is ill equipped to function in any sort of remunerative employment. The facts as I take them are that she can barely cope let alone look for and maintain gainful employment. As a result, I find she has a severe disability.

Prolonged disability

[34] Dr. Kulkarni thought the Claimant would improve in her condition in 6-12 months post surgery.^{Footnote 10} However, that time has well passed and the Claimant continues to suffer from anxiety, depression, fatigue, pain, and a lack of concentration. She continues to take medication and treatment for these conditions. There is no further indication of improvement. As such, I accept the disability is now prolonged.

[35] The Claimant had a severe and prolonged disability in September 2018, when she stopped working because of cancer. Payments start four months after the date of disability, as of January 2019^{Footnote 11}.

[36] The appeal is allowed.