Canada Pension Plan (CPP) disability

Decision

[1] The appeal is allowed.

[2] The Appellant, S. M. is eligible for a Canada Pension Plan (CPP) post‑retirement disability benefit (PRDB). Payments start as of September 2021. This decision explains why I am allowing the appeal.

Overview

[3] The Appellant is a 64-year-old former crane operator. From August 2013 to May 2021, he was employed by X. He stopped working following a diagnosis of Covid-19. In May 2020, he applied for a CPP retirement pension. He commenced receipt of this benefit in June 2020.

[4] The Appellant applied for a CPP disability pension and PRDB on April 1, 2022. 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.

[5] The Appellant says that his physical and psychological impairments result in him being unable to work in any capacity. 

[6] The Minister says that there is no evidence on file to demonstrate the presence of a severe and prolonged disability.^{Footnote 1} 

What the Appellant must prove

[7] For the Appellant to succeed, he must prove he had a disability that was severe and prolonged by the hearing date. This date is based on his contributions to the CPP.^{Footnote 2}

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

[9] A disability is severe if it makes an appellant incapable regularly of pursuing any substantially gainful occupation.^{Footnote 3}

[10] 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.

[11] 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}

[12] 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.

[13] 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.

Matters I have to consider first

The Appellant cannot qualify for a PRDB

[14] The Appellant cannot qualify for a disability benefit because he applied too late.

[15] The CPP allows for late appeals. However, when an appellant is in receipt of a retirement benefit, he or she must apply for a disability benefit within 15 months from the date the retirement benefit started.^{Footnote 5} No person may be deemed disabled more than 15 months prior to the date an application for CPP disability benefits is received.^{Footnote 6}

Reasons for my decision

[16] I find that the Appellant had a severe and prolonged disability as of May 2021. I reached this decision by considering the following issues:

• Was the Appellant’s disability severe?
• Was the Appellant’s disability prolonged?

Was the Appellant’s disability severe?

[17] The Appellant’s disability was severe. I reached this finding by considering several factors. I explain these factors below.

The Appellant’s functional limitations affect his ability to work

[18] The Appellant has:

• chronic fatigue
• chronic pain
• anxiety
• depression

[19] However, I can’t focus on the Appellant’s diagnoses.^{Footnote 7} Instead, I must focus on whether he had functional limitations that got in the way of him earning a living.^{Footnote 8} 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 9}

[20] I find that the Appellant has functional limitations that affected his ability to work.

What the Appellant says about his functional limitations

[21] The Appellant says that his medical conditions have resulted in functional limitations that affect his ability to work. He says he has the following impairments:

• Inability to remain on his feet for at least 20 minutes – He will get pain in his legs and back. He will also get dizzy. A lot of times he has lost his balance and fallen.
• Difficulty going up and down 12-15 steps – It takes him more time to go up or down this many steps. It can take him up to 15 minutes to go up a flight of stairs.
• Inability do adjust to changes – The Appellant is unable to adjust to changes. He is able to manage simple changes but anything complex is difficult.
• Difficulty figuring out what to do when stressed – Most of the time he stays alone at home and avoids people. He gets stressed out and hot tempered. He avoids stress because he is unable to cope with it.
• Difficulty doing household activities – His family has to assist him with grocery shopping, getting dressed, doing dishes, cleaning, and laundry. In addition, his wife helps him get dressed and pick his clothing.
• Poor memory – The Appellant has a difficult time remembering things and recalling things he is supposed to do.
• Socializing – The Appellant no longer socializes. The Appellant told me that he suffered a lot emotionally. He took psychiatric medications, but he found no benefit from these drugs.

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

[22] The Appellant must provide some medical evidence that supports that his functional limitations affected his ability to work by the hearing date.^{Footnote 10}

[23] The medical evidence supports what the Appellant says.

[24] On April 1, 2022, Dr. Sameera Benjamen submitted a medical report in support of the Appellant’s application for CPP disability benefits.

[25] Dr. Benjamen wrote that the Appellant was diagnosed with chronic fatigue and chronic pain. These conditions had resulted in post-covid-19 symptoms including severe fatigue, weakness, stiffness, and pain all over, especially in his back, legs, and feet.

[26] As a result of this diagnosis the Appellant was noted as having difficulty with standing, walking, daily activities, and personal care needs.^{Footnote 11}

[27] Dr. Benjamen wrote that the Appellant suffered from anxiety and depression. As a result of these conditions the Appellant felt down, had poor sleep, poor motivation, trouble coping, foggy memory, and a poor social life. Because of these conditions, the Appellant also had a difficult time concentrating.^{Footnote 12}

[28] Dr. Benjamen saw the Appellant in April 2021 and noted that the Appellant presented with general fatigue. It was noted that the Appellant was so fatigued that he had passed out.

[29] Dr. Benjamen wrote that he recommended that the Appellant stop working as of May 31, 2021.^{Footnote 13}

[30] The medical evidence supports that the Appellant’s physical and psychological conditions have been negatively impacted by his disability. He is no longer able to socialize. His concentration and ability to cope are limited. Moreover, his memory is poor. In addition to his psychological impairments, the Appellant is also impaired physically. He suffers from fatigue that impairs his ability to regularly function. He is also limited in standing and walking.

[31] Next, I will look at whether the Appellant has followed medical advice.

The Appellant has followed medical advice

[32] 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 had on the appellant’s disability.^{Footnote 15}

[33] The Appellant has followed medical advice.^{Footnote 16}

[34] The Minister doesn’t dispute this. Moreover, in my review of the file, I saw no indication that the Appellant had failed to follow medical advice. As a result, I am satisfied this is not an issue in this appeal.

[35] 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 17}

The Appellant can’t work in the real world

[36] 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

[37] 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 18}

[38] I find that the Appellant can’t work in the real world.

[39] The Appellant moved to Canada in 2006. He was born in Iraq. He does not speak any English or French. Moreover, he has always worked in physically demanding jobs, most recently as a crane operator. However, before that, he worked in an aluminum window factory and doing various forms of factory and construction work.

[40] These positions all relied on his physical ability to do the work. Because he cannot speak English or French, the Appellant is at a serious disadvantage for obtaining substantially gainful employment.

[41] Moreover, the Appellant is in his 60s. Given the extent of his disabilities, his limited work experience outside of manual labour and the degree of his physical and psychological impairments, I am satisfied on a balance of probabilities that he cannot work in any capacity.

[42] I find that the Appellant’s disability was severe as of May 2021 when he was no longer able to work following his diagnosis of Covid-19.

Was the Appellant’s disability prolonged?

[43] The Appellant’s disability was prolonged.

[44] The Appellant’s conditions began in May 2021. These conditions have continued since then, and they will more than likely continue indefinitely.^{Footnote 19}

[45] Dr. Benjamen wrote that the Appellant’s chronic pain and fatigue, along with his anxiety and depression, were likely to last for an unknown period of time or deteriorate.^{Footnote 20}

[46] Given the prognosis provided by Dr. Benjamen along with the continuity of symptoms experienced by the Appellant, I am satisfied that his condition is prolonged.

[47] I find that the Appellant’s disability was prolonged as of May 2021.

When payments start

[48] The Appellant’s disability became severe and prolonged in May 2021.

[49] There is a four‑month waiting period before payments start.^{Footnote 21} This means that payments start as of September 2021.

Conclusion

[50] I find that the Appellant is eligible for a CPP disability pension because his disability was severe and prolonged.

[51] This means the appeal is allowed.