Canada Pension Plan (CPP) disability

Decision

[1] The appeal is allowed.

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

Overview

[3] The Appellant is 37 years old. He last worked in a lawn care business. He has bipolar disorder. He has manic and depressive episodes. He also has post-traumatic stress disorder.

[4] The Appellant applied for a CPP disability pension on August 12, 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 he is disabled from working any job. Since 2015 he couldn’t maintain employment because of his medical conditions. He argues that he wasn’t correctly diagnosed with bipolar disorder until 2020.^{Footnote 1}

[6] The Minister says that the evidence doesn’t support a finding of disability. The psychiatric reports were dated after 2015. The Minister says that the employer questionnaire reported the Appellant’s work in 2017 to 2019 was satisfactory with no missed time for medical reasons.^{Footnote 2}

What the Appellant must prove

[7] For the Appellant to succeed, he must prove he has a disability that was severe and prolonged by December 31, 2015. This date is based on his CPP contributions.^{Footnote 3}  He must also prove that he continues to be disabled.^{Footnote 4}

[8] The Appellant had CPP contributions in 2017 that were below the minimum amount the CPP accepts. These contributions let the Appellant qualify for a pension if he became disabled between January 2017 and November 30, 2017, and he continues to be disabled.^{Footnote 5}

[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 6}

[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 7}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.

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

Reasons for my decision

[13] I find that the Appellant had a severe and prolonged disability as of September 2015. He continues to be disabled. I reached this decision by considering the following issues:

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

The Appellant’s disability was severe

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

The Appellant’s functional limitations affected his ability to work

[15] The Appellant has:

• bipolar disorder
• anxiety disorder
• major depressive disorder
• post-traumatic stress disorder (PTSD)

[16] However, I can’t focus on the Appellant’s diagnoses.^{Footnote 8} Instead, I must focus on whether he has functional limitations that got in the way of him earning a living.^{Footnote 9} 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 10}

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

What the Appellant says about his functional limitations

[18] The Appellant says that his medical conditions have resulted in functional limitations that affect his ability to work. He says:

• the cycling of his bipolar disorder isn’t predicable. He can be in a depressive episode where he struggles to get out of bed for months at a time.
• he has a poor memory and concentration of his mental health symptoms.
• he has panic attacks and anxiety.
• he has nausea, vomiting, and dizzy spells as physical symptoms from his mental health conditions.
• he has night terrors from PTSD twice per week. He has fatigue and poor decision making.
• he missed work because of chest pain from costochondritis.

[19] The Appellant’s mother and wife testified. His wife has been responsible for all the household duties since at least 2015 or 2016. His family assisted him in completing two of his most recent jobs when he couldn’t go because of his medical conditions.

[20] The Appellant’s mother explained that in 2015 he had his first episode of psychosis. She said that the doctors thought the explanation for his health at the time was due to PTSD, physical health issues, or substance use. It took a lot of time for the medical system to correctly diagnose him with bipolar disorder which is why there isn’t psychiatric evaluations before the end of 2015 in the file.

[21] I believe what the Appellant and his family told me about how his limitations impact him. Their testimony was candid. They provided plausible explanations that filled in the gaps the medical evidence left.

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 no later than December 31, 2015, or within the proration period of January to November 30, 2017.^{Footnote 11}

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

[24] The available medical evidence doesn’t support that the Appellant had a physical condition that caused chest pain by the end of 2015 or within 2017 by November. The Appellant reported chest pain to his family doctor in 2021. There is a brief note saying he attended the emergency room due to chest pain in 2020. He saw cardiology in 2022 after a referral for chest pain.^{Footnote 12} Because of this, I didn’t factor in limitations from a chest pain condition.

[25] The medical evidence references that he has PTSD, with an onset of 19 years old. He has nightmares, which sometimes causes poor sleep.^{Footnote 13}

[26] The Appellant had serious mental health concerns by 2015. His family doctor noted a symptom onset of an anxiety disorder in August 2015. He had panic attacks, vomiting, wasn’t sleeping, or eating. He collapsed at work and was hospitalized.^{Footnote 14} By September 2015, the Appellant’s counsellor noted that his depression scores were high. She thought he needed an immediate psychiatric assessment at that time.^{Footnote 15}

[27] The medical report completed by the family doctor noted that Appellant had physical symptoms of heart palpitations, severe restless leg syndrome, and difficulty controlling his breathing. He was unable to leave his home. He had difficulty interacting with people and was unable to do his activities of daily living on a regular basis.^{Footnote 16}

[28] After 2015, the Appellant continued to struggle with his mental health. In August 2017, psychiatrist Dr. Bhargave diagnosed the Appellant with major depressive disorder and generalized anxiety disorder. He later saw psychiatrist Dr. Kelkie. In July 2020, he presented to the emergency department with severe agitation, mania, and psychosis. He was admitted under the mental health act. By 2022, Dr. Kelkie diagnosed him with bipolar disorder and a panic disorder with secondary depression.^{Footnote 17}

[29] The medical evidence supports that the Appellant’s mental health limitations prevented him from doing his usual job.

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

The Appellant followed medical advice

[31] To receive a disability pension, an appellant must follow medical advice.^{Footnote 18}

[32] The Appellant followed medical advice. The Minister didn’t argue otherwise. In my review I saw no concerns of adherence to medical advice.

[33] In 2015, the Appellant began trialling mental health medication. In 2022, he was taking divalproex, olanzapine, fluoxetine, and methadone.^{Footnote 19} At the time of the hearing, the Appellant wasn’t sure of the names of the medications he was taking.

[34] 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 20}

The Appellant can’t work in the real world

[35] 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.

[36] 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 21}

[38] I find that the Appellant can’t work in the real world. He hasn’t been able to work since September 2015.

[39] The Appellant’s background characteristics support employability. He has many years left in the workforce before the usual age of retirement. He speaks English. He has high school education with varied direct-entry level experience. He doesn’t have many transferable skills.

[40] The Appellant’s limitations outweigh his positive characteristics. He cannot consistently perform his activities of daily living independently. He requires continued significant support from his wife and parents. I believe that if he could work, he would. Unfortunately, his limitations prevented him from working reliably and consistently. This conclusion is reinforced by his attempts to maintain employment since 2015.

The Appellant tried to find and keep a suitable job for years

[41] The Appellant tried to work more than four different jobs from 2015 to 2021. He wasn’t successful because of his medical conditions. These efforts show that his disability got in the way of him earning a living.

[42] The Appellant’s work attempts show that he made many efforts to work suitable and flexible jobs. He had supportive and understanding employers. His family directly assisted him in completing his work duties. He couldn’t maintain a set schedule. Without their help, he wouldn’t likely have been able to maintain these positions for as long as he did. He also didn’t earn enough to support a living.

[43] In 2015, the Appellant tried working two different jobs. He lost these jobs because of his health conditions. While working as a truck driver he had anxiety and panic attacks at work which prevented him from continuing.^{Footnote 22}

[44] Despite wanting to work, his limitations prevented him from maintaining employment. From 2016 to 2019, the Appellant worked part-time as a custodian for his family’s church. The pastor wrote that he had a strong work ethic but that he had emotional and mental struggles. He was let go from this position.^{Footnote 23}

[45] The Appellant said that his family “covered for him” at least half of the time at the church. He explained that his family would go with him to work as a team or work on his behalf when he was too sick because of his mental health.

[46] From 2017 to 2019, the Appellant worked as a car cleaner for Enterprise. The employer completed a questionnaire. He earned $11.70 per hour. He stopped going to work without providing a reason to his employer. The Minister says that the questionnaire doesn’t support that his disability prevented him from working this job because his attendance was good, his work was satisfactory, and his medical condition didn’t affect his ability to work.^{Footnote 24}

[47] At the hearing, I asked the Appellant about the responses from his employer. The Appellant told me that he wasn’t directly supervised by the person who completed the questionnaire. His direct manager didn’t work at the same location anymore. He said that his direct manager was very understanding of his mental health struggles. His accommodations were informal. For instance, he would get sick and had a garbage can beside him when he worked cleaning cars. He says he missed an “immense amount” of time because of his mental health. He couldn’t recall why he stopped working. He thought it could be because of a bipolar episode where he stopped showing up to work.

[48] The Appellant’s explanation is possible if the author of the questionnaire wasn’t his direct supervisor and had no knowledge of his work and limitations. Yet I struggle to understand why his missed time wasn’t noted in the employer questionnaire. This issue wasn’t fatal to his disability claim. I considered the total evidence about all his work efforts, which overall support that his limitations prevented him from doing any work.

[49] Lastly, the Appellant had his own small seasonal business mowing lawns from 2017 to 2020 and from May 2021 to September 2021. He mowed about 10 lawns per week which took him somewhere between 10 to 20 hours per week.^{Footnote 25} His father would work with him. He stopped this job when his health became “unmanageable” where he was in bed for significant amounts of time. It isn’t reasonable for an employer in the real world to maintain an employee that cannot attend work for large durations of time.

[50] I find that his disability was severe. The Appellant’s efforts show that, as of September 2015, he could not regularly do any work he could earn a living from.

The Appellant’s disability was prolonged

[51] The Appellant’s disabling mental health condition began by 2015. This has continued since then.^{Footnote 26}

[52] The Appellant’s conditions will more than likely continue indefinitely. His family doctor recommended that he stop working. His bipolar disorder is episodic and expected to last for more than one year.^{Footnote 27}

[53] The family doctor wasn’t sure if she expected him to return to any type of work in the future. She noted that he has tried repeatedly over the years to be employed. His severe anxiety and bipolar symptoms were continual barriers.^{Footnote 28}

[54] The evidence doesn’t support that any return-to-work efforts are recommended by any medical practitioners. The evidence also doesn’t suggest that there has been a reduction in his limitations over time or that future treatment may improve his prognosis.

[55] I find that the Appellant’s disability was prolonged as of September 2015.

When payments start

[56] The Appellant had a severe and prolonged disability in September 2015.

[57] However, the Canada Pension Plan says a person can’t be considered disabled more than 15 months before the Minister receives their disability pension application.^{Footnote 29} After that, there is a 4-month waiting period before payments start.^{Footnote 30}

[58] The Minister received the Appellant’s application in August 2022. That means he is considered to have become disabled in May 2021.

[59] His pension payments start as of September 2021.

Conclusion

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

[61] This means the appeal is allowed.