Canada Pension Plan (CPP) disability

Decision

[1] The appeal is dismissed.

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

Overview

[3] The Appellant is 59 years old. He worked as the owner and operator of a pharmacy. He was forced to resign his license in September 2014 due to criminal charges of fraud. He went to jail in August 2015. He hasn’t worked since that time.

[4] The Appellant was diagnosed with opioid dependence and major depression.

[5] The Appellant applied for a CPP disability pension on October 6, 2021. The Minister of Employment and Social Development (Minister) refused his application. The Appellant appealed the Minister’s decision to the Social Security Tribunal’s General Division.

[6] The Appellant says he has conditions that are severe and prolonged. He says his medical conditions have deteriorated and aren’t stable. He feels degraded and alienated, and that he has lost everything he worked for. He asked for empathy in relation to his claim for CPP.

[7] The Minister says the Appellant hasn’t provided medical documentation to prove he had a severe and prolonged disability as of December 31, 2015, and continuously since that time. It argues the Appellant would have continued to work, if not for his criminal conviction, incarceration, and the revocation of his pharmacist license.

What the Appellant must prove

[8] For the Appellant to succeed, he must prove he had a disability that was severe and prolonged by December 31, 2015. This date is based on his contributions to the CPP.^{Footnote 1}

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

[10] A disability is severe if it makes an appellant incapable regularly of pursuing any substantially gainful occupation.^{Footnote 2}

[11] This means I have to look at all of the Appellant’s medical conditions together to see what effect they have on his ability to work. I also have to look at his background (including his age, level of education, and past work and life experience). This is so I can get a realistic or “real world” picture of whether his disability is severe. If the Appellant is able to regularly do some kind of work that he could earn a living from, then he 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 3}

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

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

Reasons for my decision

[15] I find that the Appellant hasn’t proven he had a severe and prolonged disability. While he has submitted medical evidence, it doesn’t show he had a severe and prolonged condition as of December 31, 2015.

Was the Appellant’s disability severe?

[16] The Appellant’s disability wasn’t severe. I reached this finding by considering several factors. I explain these factors below.

The Appellant’s functional limitations didn’t affect his ability to work

[17] The Appellant has opioid dependence that is in remission and major depressive disorder.

[18] However, I can’t focus on the Appellant’s diagnoses.^{Footnote 4} Instead, I must focus on whether he had functional limitations that got in the way of him earning a living.^{Footnote 5} When I do this, I have to look at all of the Appellant’s medical conditions (not just the main one) and think about how they affected his ability to work.^{Footnote 6}

[19] I find that the Appellant didn’t have evidence of functional limitations that affected his ability to work.

What the Appellant says about his functional limitations

[20] The Appellant says that his medical conditions resulted in functional limitations that affect his ability to work. He provided the following examples:

• The stress of his criminal trial and media publicity made it difficult to work.
• He lost his confidence and ability to focus while he was in jail.
• He ruminates on his past mistakes and losses and feels pity and sadness for himself.
• He has lost interest in his personal hygiene.
• He has trouble sleeping and has a lack of energy.
• His condition deteriorated after 2020, and he has panic attacks.

What the medical evidence says about the Appellant’s functional limitations

[21] The Appellant must provide some medical evidence^{Footnote 7} that outlines any physical or mental disability, and that includes the following:

• nature, extent, and prognosis for the disability
• findings upon which the diagnosis and prognosis were made
• limitations resulting from the disability; and
• any other pertinent information, which can include recommendations for treatment.

[22] The medical evidence must establish the disability affected the Appellant’s ability to work by December 31, 2015, and continuously since that time.^{Footnote 8}

[23] The medical evidence doesn’t support that the Appellant’s disability was severe as of December 2015 and continuously since that time.

[24] The Appellant has been diagnosed with several medical conditions including hypertension, hypercholesterolemia, severe obstructive sleep apnea, obesity, and osteoarthritis of the right knee.

[25] There is no medical evidence that the Appellant had these conditions prior to December 31, 2015. Therefore, I can’t consider them when I make a decision.

[26] The Appellant’s family doctor, Dr. Akinsete, has provided some reports to support the appeal.

[27] Dr. Akinsete started treating the Appellant in January 2019, several years after December 2015. He didn’t have firsthand knowledge of the Appellant’s medical condition at the relevant time. He hasn’t provided dates and references to prior medical records to support his statements.

[28] For example, the report dated April 3, 2022, summarized Dr. Akinsete’s treatment of the Applicant.^{Footnote 9} It mentions depression, anxiety, panic attacks, hypertension, hypercholesterolemia, severe obstructive sleep apnea, obesity, and osteoarthritis of the right knee.

[29] No dates were provided by Dr. Akinsete regarding the onset of the conditions. No testing or records were provided to demonstrate when the conditions arose. The Appellant appeared to be seeking treatment one to two times per year.

[30] Dr. Akinsete wrote a letter dated May 12, 2022, saying the Appellant wasn’t able to work from 2012 to 2015 due to severe depression.^{Footnote 10} No further information was given to support the statement. This is important because Dr. Akinsete wasn’t treating the Appellant during that time so there has to be some evidence that he is basing his statements on.^{Footnote 11}

[31] Additionally, the Appellant confirmed worked from 2012 until he was forced to retire his pharmacy license in September 2014, making Dr. Akinsete’s statement unreliable.

[32] The only reliable medical evidence that can be linked to December 2015 is a letter from Dr. Schneider, psychiatrist, dated December 16, 2020.^{Footnote 12} I find this to be the most reliable evidence in the file because Dr. Schneider treated the Appellant from 2012 to 2020, when he retired.

[33] Dr. Schneider said the Appellant’s diagnosis was major depressive disorder. He said it had been in remission for a few years. He also diagnosed opioid dependence and said this condition had been in remission for seven to eight years.

[34] Dr. Schneider said the Appellant’s response to treatment had been good and his medication should continue. His condition was characterized as “stable improvement”. No recommendation for further psychiatric care was made.

[35] Dr. Schneider’s report of December 16, 2020, represents the only medical opinion of a doctor who was treating the Appellant in December 2015. It doesn’t confirm the Appellant’s status as of December 2015 specifically.

[36] Even if I were to use Dr. Schneider’s report as evidence to confirm a disability as of December 2015, there is no medical evidence to establish a continuous disability that was severe and prolonged since that time. Dr. Schneider reported that the two conditions he had diagnosed had both been in remission for a few years.

[37] Since Dr. Schneider’s retirement, the Appellant hasn’t had any psychiatric care.

[38] The Appellant told me his condition worsened since he stopped seeing Dr. Schneider. However, I can’t consider the worsening or a medical condition that occurs after December 2015 when I make a decision.

[39] The medical evidence doesn’t show that the Appellant had functional limitations that affected his ability to work on December 31, 2015.

[40] There is some medical evidence confirming opioid dependence prior to December 31, 2015.

[41] When I am deciding whether a disability is severe, I also have to consider an appellant’s personal characteristics and whether they followed medical advice.

[42] This also helps me to realistically assess an appellant’s ability to work.^{Footnote 13}

The Appellant has followed medical advice

[43] To receive a disability pension, an appellant must follow medical advice.^{Footnote 14} If an appellant doesn’t follow medical advice, then they must have a reasonable explanation for not doing so. I must also consider what effect, if any, the medical advice might have

[44] The Appellant has followed medical advice.^{Footnote 15}

[45] The Appellant sought psychiatric treatment for his conditions. He has ben taking prescribed medications for several years.

[46] I don’t see any evidence that the Appellant failed to follow medical advice.

[47] I now have to decide whether the Appellant can regularly do other types of work. To be severe, the Appellant’s functional limitations must prevent him from earning a living at any type of work, not just his usual job.^{Footnote 16}

The Appellant can work in the real world

[48] When I am deciding whether the Appellant can work, I can’t just look at his medical conditions and how they affect what he can do. I must also consider factors such as his:

• age
• level of education
• language abilities
• past work and life experience

[49] These factors help me decide whether the Appellant can work in the real world—in other words, whether it is realistic to say that he can work.^{Footnote 17}

[50] I find that the Appellant can work in the real world.

[51] On December 31, 2015, the Appellant was 51 years old. He had a graduate degree in pharmacy. He spoke English and he owned and operated a pharmacy. None of these factors created a barrier for working in the real world.

[52] The Appellant stopped working in 2014 because he was forced to resign his pharmacist license due to criminal charges. He didn’t resign because of his medical condition.

[53] The Appellant wasn’t working on December 31, 2015, because he was in jail. The reason he wasn’t working wasn’t related to his medical condition. He was in jail and unable to work until May 2016.

[54] The Appellant has significant education and experience that would allow him to work in the real world. He wasn’t close to retirement age in December 2015.

[55] I can’t consider socio-economic factors, such as the impact of a criminal record when deciding if an appellant can work in the real world.^{Footnote 18}

[56] I can’t consider empathy or compassionate grounds when I am deciding if an appellant has a severe disability.^{Footnote 19}

The Appellant didn’t try to find and keep a job

[57] If the Appellant can work in the real world, he must show that he tried to find and keep a job. He must also show his efforts weren’t successful because of his medical conditions.^{Footnote 20} Finding and keeping a job includes retraining or looking for a job he can do with his functional limitations.^{Footnote 21}

[58] The Appellant made efforts to work. But these efforts don’t show that his disability gets in the way of earning a living.

[59] The Appellant tried to have his pharmacist license re-instated after he was released from jail in 2017. The regulatory body denied his request. The Appellant hasn’t actively applied to any other jobs.

[60] The Appellant told me that if his license had been re-instated, he would have returned to working in a pharmacy, even if it was only as a technician on reduced hours.

[61] The Appellant says he looked into working for Uber as a driver. He said he doesn’t qualify because of his criminal record.

[62] Given the Appellant’s education and experience running a retail business, he could work in the real world. His only real effort to do so was to try and have his license re-instated. The refusal to re-instate his license was due to his criminal charges, not due to his medical conditions. Aside from this, he hasn’t shown that he tried to work and was unable to do so because of his medical conditions.

[63] Therefore, I can’t find that the Appellant had a severe disability by December 31, 2015.

Conclusion

[64] I find that the Appellant isn’t eligible for a CPP disability pension because his disability wasn’t severe. Because I have found that his disability wasn’t severe, I didn’t have to consider whether it was prolonged.

[65] This means the appeal is dismissed.