HomeMy WebLinkAbout2001-7641 Benefits Claimant 01-07-04 Decision
IN THE MATTER OF AN APPEAL
BEFORE
THE SUBCOMMITTEE OF THE
JOINT INSURANCE BENEFITS REVIEW COMMITTEE
REGARDING CLAIM # 7641
CHAIR LORETTA MIKUS
APPEARING FOR THE UNION MARK BARCLAY
APPEARING FOR THE EMPLOYER YASMEENA MOHAMED
CLAIM # 7641 1
Included In the most recent collectIve agreement between the partIes are the folloWIng
provIsIOns
Article 22 - Grievance Procedure
Article 22.9 - Insured Benefits Grievance
229 1 An allegatIOn that the Employer has not provIded an Insured benefit that has
been contracted for In thIS Agreement shall be pursued as a Umon gnevance filed
under ArtIcle 22 13 (Umon Gnevance)
22 9 1 Any other complaInt or dIfference shall be referred to the Claims ReVIew
SubcommIttee of JOInt Insurance Benefits RevIew CommIttee (JIBRC)
establIshed under AppendIx 4 (JOInt Insurance Benefits RevIew CommIttee),
for resolutIOn.
Appendix 4
JOINT INSURANCE BENEFITS REVIEW COMMITTEE
1 Name of Committee
The CommIttee shall be referred to as the JOInt Insurance Benefits RevIew CommIttee
2. Purpose of Committee
The purpose of thIS CommIttee IS to facIlItate commumcatIOns between the Employer
and the OPSEU on the subject of Group Insurance, IncludIng BaSIC LIfe Insurance,
Supplementary LIfe Insurance, Extended Health Insurance, Long Term Income
ProtectIOn Insurance, and such other negotIated benefits as may from tIme to tIme, be
Included In the Group Insurance Plane
It IS understood that the Group Insurance benefits to be provIded to employees and the
cost shanng arrangements between the Employer and ItS employees shall be as set out In
any applIcable collectIve agreement or arbItratIOn award, and the matters for
consIderatIOn by thIS CommIttee shall be only as set out In these terms of reference
3 Composition of Committee
The CommIttee shall be composed of an equal number of representatIves from the
Employer and from the OPSEU wIth not more than eIght (8) representatIves In total At
meetIngs of the CommIttee, each party may be accompamed by an Actuary to provIde
CLAIM # 7641 2
techmcal advIce and counsel
4 Duties of the Committee
The dutIes of the CommIttee shall consIst of the folloWIng
(I) Development of the specIficatIOns for the publIc tendenng of any
negotIated benefits whIch may be Included In the Group Insurance Plan (to
cover the bargaInIng umt only)
(iI) DetermInatIOn of the manner In whIch the specIficatIOns wIll be made
avaIlable for publIc tendenng;
(ill ) ConsIderatIOn and eXamInatIOn of all tenders submItted In response
the specIficatIOns for tender and preparatIOn of a report thereon,
(iv) RecommendatIOn to the Government of Ontano on the selectIOn of
the Insurance carner or carners to underwnte the Group Insurance Plans
(v) ReVIew of the semI-annual financIal reports on the Group Insurance
Plan, and
(VI) RevIew of contentIOus claims and recommendatIOns thereon, when
such claim problems have not been resolved through the eXIstIng
admInIstratIve procedures
The specIficatIOns for tender wIll descnbe the benefits to be provIded, the cost
shanng arrangement between the Employer and ItS employees, the past financIal
hIStOry of the Insurance plans, the employee data, the format for the retentIOn
IllustratIOn for each coverage and the financIal reportIng reqUIrements Tenders shall
be entertaIned by the CommIttee from any IndIVIdual Insurance carner actIng solely
on ItS own behalf ThIS shall not preclude such carner from arrangIng reInsurance as
may be necessary
The basIs for recommendatIOn of an Insurance carner( s) wIll Include the abIlIty of the
carner(s) to underwnte the plan, complIance of the carner's quotatIOn wIth the
specIficatIOns for tender the carner's servIce capabIlItIes and the expected long term
net cost of the benefits to be provIded.
1 Experience Review
2. Claims Review Subcommittee
(a) There shall be a subcommIttee whose mandate IS to reVIew and make
decIsIOns on, complaInts or dIfferences InvolvIng the demal of Insured benefits
CLAIM # 7641 3
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under the Central CollectIve Agreement, when such Issues have not been
resolved through the eXIstIng admInIstratIve procedures, save and except a
complaInt or dIfference an SIng under ArtIcle 22 9 1 (Insured Benefits Gnevance)
of the Central CollectIve Agreement. The subcommIttee shall be composed of
two (2) representatIves selected by the Employer two (2) representatIves selected
by OPSEU and an Independent thIrd party who IS agreed to by both partIes
(b) Appropnate ImpartIal medIcal consultants shall be avaIlable to the
subcommIttee In an advIsory capacIty to provIde InfOrmatIOn on the nature of
specIfic Illnesses or dIsabIlItIes
~ MembershIp on the subcommIttee shall be for one (1) year penod, and IS
renewable at the dIscretIOn of the nomInatIng party or partIes In the case of the
renewal of the term of the Independent thIrd party
(d) DeCISIOns of the subcommIttee are final and bIndIng.
(e) The fees and expenses of the medIcal consultants referred to In clause (b),
and the Independent thIrd party referred to In clause (a), shall be dIvIded equally
between the Employer and the Umon.
Article 42 - Long Term Income Protection
Total dIsabIlIty means the contInUOUS InabIlIty as the result of Illness, mental
dIsorder or Injury of the Insured employee to perform the essentIal dutIes of hIS or
her normal occupatIOn dunng the qualIficatIOn penod, and dunng the first twenty-
four months of the benefit penod' and thereafter dunng the balance of the benefit
penod, the InabIlIty of the employee to perform the essentIal dutIes of any gaInful
occupatIOn for whIch he or she IS reasonably fitted by educatIOn, traInIng or
expenence
Subsequent to the sIgmng of thIS collectIve agreement the partIes negotIated and sIgned terms
of reference regardIng the establIshment of a subcommIttee to deal wIth dIsputes between the
partIes regardIng Long Term Income ProtectIOn (hereInafter referred to as "L TIP") That
memorandum stated
JIBRIC CLAIMS REVIEW SUBCOMMITTEE
TERMS OF REFERENCE
CLAIM # 7641
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AUTHORITY
The JIBRC subcommIttee IS establIshed under ArtIcle 229.2 and AppendIx 4 of the
collectIve agreement between The Crown In Right of Ontano and the Ontano PublIc
ServIce Employees Umon.
PURPOSE OF SUBCOMMITTEE
To reVIew and make decIsIOns on appeals from employees on claims InvolvIng the
demal of Insured benefits under the collectIve agreement whIch have prevIOusly been
removed from JIBRC
REFERRAL TO THE SUBCOMMITTEE
Employees wIth claims that have been removed from JIBRC wIll be notIfied of such,
In a tImely manner by letter (referred to as the "NotIce Letter") to theIr last known
address
An employee whose claim has been removed, has 45 days, from the date of the notIce
letter to submIt a request In wntIng to OPSEU askIng that OPSEU refer theIr case to
the subcommIttee ThIS letter must be copIed to the Management Co-Chair of the
JIBRC
OPSEU has 90 days from the date of the notIce letter to advIse the Management Co-
Chair of JIBRC of theIr decIsIOn to agree or deny the request to appeal If notIce IS
not receIved from OPSEU wIthIn 90 days from the notIce letter then the claim wIll be
deemed to be wIthdrawn.
SCOPE OF COMMITTEE
The SubcommIttee represents the final stage In the appeal process
The SubcommIttee wIll clanfy medIcal eVIdence as needed, wIth a medIcal
consultant agreed to by both MBS and OPSEU
DeCISIOns of the SubcommIttee are final and bIndIng.
Upon receIpt of the decIsIOn, a Memorandum of Settlement (as attached) wIll be
prepared and sIgned by the partIes and forwarded to the Insurer
SUBCOMMITTEE MEMBERSHIp.
CLAIM # 7641
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The subcommIttee wIll consIst of resource representatIves from OPSEU and MBS
and an Independent thIrd party "Chair" to be named by MBS and OPSEU
ROLE OF THE CHAIR"
To reVIew case representatIOns from MBS and OPSEU
To make a determInatIOns In wntIng wIth respect to each case DeCISIOns must be In
accordance wIth the OPS CollectIve Agreement between the Employer and OPSEU
and consIstent WIth the group Insurance plans In place at the tIme facts gIVIng nse to
the dIspute arose
ROLE OF MEDICAL CONSULTANTS
Appropnate ImpartIal medIcal consultants wIll be agreed by the partIes and shall be
avaIlable to the SubcommIttee In an advIsory capacIty If the partIes cannot agree on
a medIcal consultant, the Chair may call on a consultant from a roster supplIed by the
College of PhysIcIans and Surgeons
The medIcal consultants wIll provIde InfOrmatIOn on the nature on of specIfic
Illnesses or dIsabIlItIes
The Chair may request an InterpretatIOn of medIcal reports, test results and other
medIcal documentatIOn on file
The medIcal consultant IS not a member of the commIttee and wIll not provIde an
OpInIOn related to a decIsIOn on the appeal
FEES
Fees and expenses, as approved by the partIes, of medIcal consultants and the Chair
shall be dIvIded equally between MBS and OPSEU
FORMA T OF MEETINGS
Each appeal wIll be dealt wIth separately
Both partIes, through theIr representatIves wIll provIde, full dIsclosure of the
supportIng documentatIOn upon whIch they Intend to rely ThIS dIsclosure wIll take
place at least two weeks In advance of the meetIng of the subcommIttee dealIng wIth
the subJ ect matter of the appeal
CLAIM # 7641
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If the Chair reqUIres clanficatIOn of medIcal eVIdence, a meetIng of the
SubcommIttee wIll be arranged wIth a medIcal consultant agreed to by both MBS and
OPSEU or faIlIng such agreement, wIth a medIcal consultant called by the Chair
MBS and OPSEU wIll JOIntly present a statement of agreed upon facts (to the extent
possIble) for the appeal to the Chair
ASIde from the ImpartIal medIcal consultant dIscussed above, no other wItnesses wIll
be called, except by request of the Chair However the IndIVIdual claimant wIll be
allowed to file a wntten statement In lIeu of testIfYIng. If the IndIVIdual claimant
chooses to file a statement It must be provIded to the Management Co-Chair of
JIBRC at the same tIme as OPSEU's request for appeal MBS has the nght to
Introduce a wntten response to thIS statement.
OPSEU wIll present ItS posItIOn on the case wIth supportIng arguments to the Chair
MBS wIll present ItS posItIOn on the case wIth supportIng arguments to the Chair and
wIll respond to OPSEU' s posItIOn. OPSEU wIll have nght of reply PresentatIOn by
both partIes wIll be based upon the InformatIOn/record on file before the Insurance
carner at the tIme the matter IS removed from the JIBRC the employee statement If
any and MBS's response to the statement.
EIther party may If necessary request the attendance of the claimant, who shall be
allowed a leave of absence wIthout pay wIth no loss of credIts, to attend the sub-
commIttee meetIng as an observer only
The Chair wIll render a wntten decIsIOn wIth supportIng ratIOnale
FREQUENCY OF MEETINGS
On an as needed basIs as determIned by MBS and OPSEU JOIntly
The partIes agree to these Terms of Reference In support of the ImplementatIOn of
ArtIcle 22 9 2 and AppendIx of the collectIve agreement.
Dunng the term of the prevIOUS collectIve agreement, the partIes attempted to resolve these
dIsputes between themselves Not surpnsIngly there were a number of Instances whereIn
they were unable to agree Those matters sImply remaIned unresolved. Those outstandIng
matters are now beIng brought forward before the subcommIttee as set out above In
accordance wIth the agreement of the partIes, ArbItrator FelIcIty Bnggs and I were asked to
CLAIM # 7641
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act as the thIrd party or Independent chair
At the first day of heanng the partIes agreed that the Chair should render a decIsIOn statIng
that the claim was properly or Improperly demed wIthout elaboratIng on the quantum of the
remedy but remaIn seIzed of the matter Subsequent to the Issuance of the deCIsIOn the partIes
wIll negotIate and hopefully agree upon a memorandum of agreement as to the appropnate
remedy
There was also dIscussIOn between the partIes about the extent and content reqUIred In
decIsIOns Issued by the ChaIr(s) I thInk IS It fair to say the partIes agreed that, at the
begInmng the ChaIr(s) wIll attempt to set out In some detaIl the dIspute and the reasons for
the decIsIOn. The partIes' antIcIpate that the ChaIr(s) wIll establIsh some pnncIples they can
be guIded by In asseSSIng future dIsputes It IS hoped that as the Junsprudence develops, there
wIll be less need for lengthy decIsIOns because the fundamental pnncIples wIll already by
establIshed.
The claimant, Mrs P was employed wIth the Mimstry of Health as a PsychIatnc NursIng
AssIstant at the BrockvIlle PsychIatnc HospItal In 1991 she had a hysterectomy recovered
from the surgery very qUIckly and returned to work after eIght weeks However subsequent
to that surgery she began exhIbItIng symptoms of depressIOn. Her first applIcatIOn for
benefits IS dated In September of 1992 and was completed by her famIly physIcIan, Dr L In
It, he noted that her symptoms began to appear In November of 1991 and became dIsablIng In
Apnl of 1992 His dIagnosIs was depressIOn wIth a secondary dIagnosIs of menopause He
noted on the applIcatIOn that she was prevented from performIng her own or any occupatIOn
for an Indefimte penod of tIme
As a result of the applIcatIOn and the doctors lIsted thereIn, the ConfederatIOn LIfe Insurance
Company wrote letters to the doctors named on the applIcatIOn askIng for more InfOrmatIOn
CLAIM # 7641
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about the claimant's medIcal condItIOns Dr L responded on October 14 1992 adVISIng the
Insurance company that the claimant had been a patIent of hIS SInce 1987 and that he had
seen her on several occaSIOns over the prevIOUS months In Apnl of 1992 he first began to
notIce that she was depressed, had trouble toleratIng medIcatIOns and had trouble COpIng wIth
thIngs In general He referred her to an obstetncal gynaecologIcal specIalIst for hormone
treatment. It was hIS VIew at that tIme that she had developed a depressIve Illness and was
unable to work because of that depressIOn. He opIned that she would be off for several
months
Dr C an AssocIate Professor at the DIVISIOn of ReproductIve Endocnnology and InfertIlIty
found the claimant to be depressed and exhIbItIng a vanety of symptoms such as vasal motor
flushIng, fatIgue unnary frequency and decreased libIdo He started her on an estrogen
patch and one month later stated that she was remarkably better wIth her vasal motor
symptoms almost completely resolved. He antIcIpated that over the next few months she
would contInue to feel better
In a follow-up letter of November 6 1992, Dr C advIsed the Insurer that he had seen the
claimant on two occaSIOns regardIng her "dIsablIng menopausal symptoms, most lIkely
secondary to profound estrogen depnvatIOn." He also suggested that It was lIkely thIS hypo-
estrogemc state and depressIOn mIght have dIsabled her to such an extent that she had been
unable to work over that penod of tIme, but that she seemed to be much better
In about December of 1992 the claimant applIed for dIsabIlIty benefits under the Canada
PenSIOn Plan, whIch was subsequently demed.
In a letter dated January 14 1993 Dr J C a psychIatnst, noted that he had seen the patIent
In September of 1992 and on one other occaSIOn. At the tIme she presented wIth depressIve
features, lowered mood, fatIgue dIfficulty concentratIng and remembenng. She was gIven a
CLAIM # 7641
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workmg dIagnosIs of Orgamc Mood Syndrome - depressIve type She was seen monthly for
psychotherapy and was placed on an antI-depressant, whIch she seemed to be respondmg to
It was hIS VIew that the claimant's depressIOn clearly mterfered wIth her abIlIty to concentrate
and apply herself appropnately to her work sItuatIOn. He belIeved that they could reasonably
expect her to be able to return to work wIthm four to SIX weeks
On the basIs of the precedmg medIcal mformatIOn, the claimant was mformed on February 1
1993 that she had been approved for dIsabIlIty benefits on the basIs of total dIsabIlIty from
her own occupatIOn and that It was antIcIpated that her benefits would not extend beyond
March of 1993
On March 22, 1993 Dr J C completed an Attendmg PhYSIcIan's Statement of Contmumg
DIsabIlIty m whIch he suggested that she be allowed to work half days for Apnl and to
resume full tIme work by May of 1993 By letter dated Apnl 15 1993 the msurer advIsed
the claimant that she was able to start rehabIlItatIve employment and that her monthly benefit
would be reduced by fifty percent of the rehabIlItatIve mcome They expected her return to
work on a full tIme basIs by May 3
The claimant remamed offwork and on June 29 1993 Dr L completed another Attendmg
PhysIcIan's Statement of Contmumg DIsabIlIty m whIch he stated the claimant was totally
dIsabled from her own and any occupatIOn for an unknown penod of tIme and that she was
not sUItable for a form of tnal employment.
The claimant contmued to rem am off work and on November 18 1993 another Attendmg
PhysIcIan's Statement of Contmumg DIsabIlIty was sIgned by Dr S H. wIth a pnmary
dIagnosIs of maJor depreSSIOn and the followmg comment:
Although patIent had mild Improvement, she contmues to retam dIfficultIes to be able to
return back to work. It IS dIfficult to predIct when she would be able to go back to work.
PatIent will be referred for an assessment WIth a vocatIOnal servIce regardmg what type of
CLAIM # 7641
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work she would be able to do
The Insurer requested a more complete narratIve report from Dr S H. whIch was never
provIded. In the meantIme, the employer In an effort to determIne her contInued elIgIbIlIty
arranged for a ConsultatIve PsychIatnc Assessment wIth Dr S S In Ottawa. He saw her on
May 10 1994 revIewed her medIcal and psychologIcal hIstOry to date and stated he was
"satIsfied on the basIs of my eXamInatIOn and a reVIew of the matenal at hand that Mrs P
dId expenence a maJor depressIve dIsorder In assocIatIOn WIth her hysterectomy and
oophorectomy" He also noted that "she dId expenence estrogen deficIent symptoms and she
also expenenced maJor depressIve epIsode wIth classIc symptomatology" It was hIS VIew
that she had recovered qUIte well wIth respect to the estrogen deficIency and stated the
folloWIng:
At the present tIme I would regard Mrs P as suffenng from dysthymIa - a lesser
form of depreSSIOn, she does not current!, fulfill cntena for a major depressIve
dIsorder but her low self-esteem, poor concentratIOn, mdecIsIveness and low energy
and fatIgue come wIthm the categon of dysthymia. I doubt whether an, addItIonal
or alternatIve antI -depressant would modr/\ thIS partIcular cluster of
symptomatologies.
He was In agreement wIth Dr L 's suggestIOn that she have ongOIng psychotherapy and was
of the VIew that she was able to engage In the actIvItIes of dally lIvIng as well as to perform
the dutIes of her normal occupatIOn. It was hIS recommendatIOn that she be returned to work
on a two to three day basIs for two to three months and then graduated to a full tIme basIs
He concluded that she dId not satIsfy that defimtIOn of total dIsabIlIty and descnbed her as "a
sensIble lady who has clearly been Impacted by her Illness but has recovered to a reasonably
satIsfactory degree to allow her to return to the work force"
Upon the basIs of Dr S S' s report, the Insurer advIsed the claimant by letter dated June 21
1994 that the current medIcal InfOrmatIOn dId not support total dIsabIlIty from her own
occupatIOn and that they antIcIpated her return to work on a full tIme basIs by the mIddle of
August 1994 She was further advIsed that she was elIgIble for the rehabIlItatIve provIsIOns
CLAIM # 7641
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of a gradual return to work and that her L TIP benefits would termInate on October 31 1994
unless she returned to work earlIer
By letter dated September 13 1994 and completed by Dr M. P at the Menopause Centre In
Ottawa the Insurer was advIsed that the claimant had been seen at theIr clImc first In
December of 1991 before her hysterectomy and more recently had returned for an
assessment. In that August assessment It was dIscovered that the symptoms she was
mamfestIng of mastalgIa, nausea, calf cramps and vertIgo IndIcated a thyrOId problem whIch
accelerated the estrogen absorptIOn whIch was causIng her problems They started an antI-
thyrOId treatment on September 12, whIch would reqUIre four months of actIve treatment. It
was Dr M. P 's VIew that he could not guarantee that she would be capable of returmng to
work before that and that January 5 1995 was a reasonable target date for her return to work.
She had responded appropnately to estrogen therapy In the past and It was hIS belIef that,
once the thyrOId problem was dealt wIth, her estrogen therapy could be reIntroduced wIthout
sIde effects She could be expected to remaIn stable for three - five years at the conclusIOn of
treatment.
The subsequent letter dated November 17 1994 from Dr M. P answered questIOns posed by
the Insurance company as follows
Ready for work tnal - Although Mrs P has made sIzable progress, she remaInS
unpredIctable as to the days when she breaks down, we cannot therefore state that she
IS ready at thIS tIme for a tnal
CommutIng - The forty-five mInutes to and from work wIth twelve hours of work In
between IS unbecomIng, twelve hour shIfts themselves are unbecomIng of her
capacItIes
LImItatIOns - At the present tIme the lImItatIOns are senous enough to forbId a return
to work In the new year she may on a tnal basIs go back to work half days, three
days per week for a mImmum of SIX weeks She has found to perform satIsfactonly
she can go to full tIme, condItIOns permIttIng
Capable of returnIng to Former Work - SUCCInctly no
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A physIcal capacItIes form was completed at the same tIme In whIch It was noted that the
claimant could stand for two to four hours a day walk up to two hours a day SIt for two to
four hours a day and dnve ten to thIrty mInutes a day It was noted that she would be able to
return to work to lIght duty on January 5 1995 and to full duty on February 20 1995 at the
soonest.
Her L TIP benefits were contInued dunng thIS tIme, offset by the amount of money she earned
through employment. A performance appraisal dated March 1 1995 IndIcated that her
apprehensIOn had reduced, her self-confidence had Increased and she was performIng her Job
satIsfactonly She worked untIl Apnl16 1996 when she produced a medIcal note from Dr
Leonard adVISIng the employer that she would be off work from Apnl16 - 23 then to May 1
and finally to May 9 1996 At the same tIme she provIded a letter from Dr M. P at the
Menopause Centre dated May 7 1996 In whIch It was Said she had been plagued wIth
recurnng hormonal problems InvolvIng menopause and her thyrOId and adrenal glands and
was currently havIng a recurrence of those problems wIth accompanYIng Insomma, fatIgue,
weakness, memory lapses and poor concentratIOn. They had prevIOusly ordered her on bed
rest for four months and, SInce she had already been off for one month, It was theIr VIew that
It was essentIal she have another three months off In order for a complete recovery The
pnmary dIagnosIs was hypercortIsolIsm wIth a secondary dIagnosIs ofhyperthyrOIdIsm and a
tertIary dIagnosIs of menopause It was theIr recommendatIOn that she abstaIn from workIng
untIl August 16 1996
A subsequent attendIng physIcIan's statement completed by Dr L and dated August 16
1996 gave a pnmary dIagnosIs of maJor umpolar depressIOn, symptoms of whIch first
appeared In March 1996 and resulted In total dIsabIlIty around mId-Apnl It was hIS VIew
that she was dIsabled from her own and any occupatIOn for one to three months but would be
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sUItable for tnal employment begInmng October 1 1996 He also noted that he was WaitIng
for an assessment from Dr D a psychIatnst.
Before hIS report was receIved the Insurer receIved a copy of a letter from Dr S a
rheumatologIst, to Dr L dated September 30 1996 In that letter Dr S referred to a "maJor
flare-up oflower back paIn In March 1996" and noted that the claimant had been unable to
work SInce Apnl She noted that the claimant had receIved physIOtherapy In KentvIlle and
was of the VIew that she suffered from mechamcal back paIn and fibromyalgIa
A letter dated the same day from Dr L noted that the claimant contInued to be Incapable of
meetIng the demands of her Job and was sIgmficantly symptomatIc It was hIS VIew that she
had suffered an acute exacerbatIOn of her depressIve symptoms on September 10 contributed
to by a flare-up of her back paIn. She was admItted to the KentvIlle DIstnct HospItal for a
two-week penod for cnSIS InterventIOn. It was hIS assessment that she would not be fit to
work on October 1 1996 and that her benefits should be extended.
A follow-up letter by Dr S dated October 14 1996 gave a pnmary dIagnosIs of depressIOn
complIcated by mechamcal back paIn and fibromyalgIa. It was her understandIng that the
complaInant was totally dIsabled from performIng her normal dutIes because of her
depressIOn and that, absent the depressIOn, she mIght be able to attempt part-tIme sedentary
work.
A letter dated October 31 1996 came to a totally dIfferent conclusIOn. Dr D began seeIng
the claimant In August 1994 and had dIscharged her from hIS care on July 28 1995 She was
referred back In September wIth a questIOn about her long term dIsabIlIty benefits and was
seen at the tIme to have chromc muscular spasm, back paIn, and back and abdomInal spasms
His workIng dIagnosIs was recurrent depreSSIOn wIth dysthymIa, fibromyalgIa and a current
GAF of 71-80 Treatment suggested was cogmtIve and SUpportIve psychotherapy and
CLAIM # 7641
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psychopharmacology on a monthly basIs It was VIew that the lImItIng factor In her return to
work had been the claimant's fibromyalgIa and that her recurrent depressIOn was not the
reason for her total dIsabIlIty He said "thIS patIent IS respondIng to the antIdepressant. She
IS resIstant to go back to work because of her physIcal problems"
On the basIs of those reports the claimant was Informed on November 22, 1996 that her
claim for her L TIP benefits had been demed.
In an effort to establIsh her claim, the claimant saw Dr G a specIalIst In PhysIcal MedICIne
and RehabIlItatIOn, and, In hIS report of January 10 1997 he concluded that she had a
fibromyalgIa pattern of chromc paIn syndrome and a socIetal clImcal depreSSIOn. He felt that
she was functIOmng at an extremely low level and had encouraged her to ImtIate a
reactIvatIOn program. He dId not feel that she was a candIdate for a more defimtIve paIn
treatment program because of her depressIOn whIch, In hIS VIew was the pnncIple Issue to be
dealt wIth. Her long-term prognosIs was uncertaIn and her condItIOn was not consIstent WIth
return to work In eIther a full tIme or part tIme capacIty
Dr L receIved a letter from Dr J concermng the claimant whIch descnbed her maJor
symptoms as fatIgue headaches, tensIOn and depressIOn. He noted that the depressIOn was
cyclIcal and that when the depressIOn lIfted, her aches and paInS subsIded to some extent. He
also noted that she had been seen by Dr S and Dr G who had concurred wIth the dIagnosIs
of fibromyalgIa. He stated that the patIent presented wIth a hIStOry consIstent WIth two
maJor problems, one beIng chromc depressIOn that had recently gotten worse and the other
fibromyalgIa. It was hIS VIew that repeated OpInIOnS would not be appropnate as all of the
doctors concerned had come to the same dIagnosIs He stated, however that there was very
lIttle they could offer the patIent because she had tned all of the basIc antI-depressants
avaIlable ASIde from SupportIve care and mIld exerCIse, Dr J could offer no other
treatment recommendatIOns He concluded hIS letter wIth the folloWIng
CLAIM # 7641
16
I would have to concur wIth the other phYSICIans that at the moment she would not be
m a posItIOn to work due to her health. But an effort should be made for mild actIvI~
such as walkmg or sWImmmg on a daih basIs to get her health back.
Dr L had also referred her to a psychIatnst at the BrockvIlle PsychIatnc HospItal, Dr K.
who prepared a report dated February 5 1997 His conclusIOn was that she was suffenng
from a MaJor DepressIve DIsorder umpolar supenmposed on a super-dysthymIa dIsorder
He also noted that she had a hIStOry of prevIOUS dIagnoses of fibromyalgIa and gave her a
GAF ratIng of 35 Dr K. concluded wIth the folloWIng:
her condItIon IS rather chromc and complex wIth sIgmficant somatIc overla,
whIch ma, be the pnman depreSSIOn or underlvmg chromc fatIgue s,ndrome I am
certamh comfortable m statmg m her present state she IS unable to work.
In a letter dated March 13 1997 ManulIfe advIsed the claimant that her L TIP claim had been
approved on the basIs of total dIsabIlIty from performIng the dutIes of her own occupatIOn.
Those benefits were to commence on October 18 1996 and would contInue for a penod of
30 months The claimant was also advIsed that, as the dIsabIlIty was the result of a mental
dIsorder contInuIng elIgIbIlIty would depend upon contInUOUS treatment by a medIcally
certIfied specIalIst In psychIatry and that, In June of 1997 they would be requestIng a
physIcIan's statement from her treatIng psychIatnst.
Shortly thereafter the claimant was asked to attend a rehabIlItatIOn assessment to prepare her
for a return to work. An ImtIal assessment by the rehabIlItatIve consultant at Global
RehabIlItatIve ServIces IndIcated that her rehabIlItatIOn potentIal was "good" It was noted
that Dr L was of the OpInIOn that If the BrockvIlle PsychIatnc HospItal would accommodate
the claimant by placIng on a ward wIth mImmal physIcal demands, by schedulIng her for no
mght ShIft work, preferably eIght hour ShIftS, he would not be opposed to an attempt at a pre-
dIsabIlIty employment. The reference to the mght ShIftS was a response to the gnevor' s VIew
that, after workIng SIX steady weeks of mght ShIftS In Apnl 1996 she had suffered a relapse
of her depreSSIOn. She attnbuted that relapse to the extended mght schedule that she had
been reqUIred to work.
CLAIM # 7641
17
Global RehabIlItatIve ServIce provIded updates on the claimant's condItIOn and In June of
that year noted that she was to be assessed by a physIOtherapy clImc on June 16 1997 On
June 18 1997 the Global update Included the fact that the psychIatnst at the psychIatnc
outreach team In KemptvIlle was leavIng and that the claimant had chosen to commence
psychIatnc counsellIng wIth J S a regIstered nurse on the outreach team The weekly
updates also Included the claimant's contInuIng VISItS to Dr J who In dealIng wIth her
chromc paIn management, had reported a gradual decrease In muscle paIn and bladder
spasms wIth an Increase In the dosage of Prozac The mId-July report proposed that the
claimant be encouraged to seek part tIme volunteer employment as soon as possIble to
Improve her physIcal and emotIOnal status and prepare her for an eventual return to work.
Global also entered Into dIscussIOns wIth the employer about accommodatIOns that would be
needed In order to facIlItate the claimant's return. The employer IndIcated a wIllIngness to
negotIate a gradual return to work plan wIth modIfied dutIes to reIntegrate the claimant Into
her prevIOUS abIlIty employment posItIOn on her old ward. She would return to work on a
part-tIme baSIS, gradually IncreaSIng her hours to full tIme over a three month penod. The
employer was also agreeable to adJustIng the schedules to enable the claimant to work only
on the 1000 to 2000 hours or 0700 to 2100 ShIft for SIX weeks upon her return to work.
However she would then be reqUIred to return on the same scheduled rotatIOn as the other
employees, IncludIng mghts ShIftS If the claimant wanted to change ShIftS to aVOId workIng
mghts, she could do so by exchangIng wIth other staff members In the meantIme the
physIOtherapy assessment report found that the claimant was suffenng from myophasIaI paIn
syndrome wIth exacerbatIOn due to assocIated stress factors and that she would benefit from
a graduated actIve to functIOnal resIsted exerCIse program and personal goal settIng.
The mId-August report from Global noted that Dr J felt there was a strong emotIOnal
component to her reports of generalIzed paIn and that the rehabIlItatIOn specIalIst had
suggested that the claimant be referred to Dr K. R. a psychologIst who specIalIzed In the
CLAIM # 7641
18
management of chronIC paIn.
She saw Dr KR. on October 24 1997 and hIS report of November 6 1997 contaIned the
folloWIng:
The MultI-DImenSIOnal Pam Inventon showed a hIgher degree of mterference m
daih actIvItIes and a tendenc, towards reportmg shghth hIgher levels of emotIOnal
dIstress On the whole her actIvI~ level was comparable to mdIvIduals WIth perSIstent
pam problems. On the Beck DepreSSIOn Inventon II screenIng of depressIve
symptomatology she obtamed a markedh elevated score that suggested a level of
depressIve symptom endorsement above the mdIvIduals WIth chronIC pam problems
and well above that of ~'pIcal s,mptoms of people WIth fibromvalgIa.
She completed a paIn drawIng whIch IndIcated dIffuse paIn at multIple sItes throughout her
body In response to the dIrect questIOns from the Insurer Dr K R. IndIcated hIS strong
agreement wIth the other phYSICIan's assessment that the claimant's present subJectIve
complaInts of generalIzed paIn and physIcal lImItatIOns had a strong emotIOnal component.
He was In agreement wIth general goals of the proposed return to work plan desIgned by Dr
L and Global RehabIlItatIOn ServIces but had some concerns wIth ItS ImplementatIOn. The
earlIest realIstIc tIme frame that would allow her to be at optImum functIOnal level was a
mInImUm of three to four months To faCIlItate the ImplementatIOn of that plan the claimant
would have to begIn a routIne set of actIvItIes geared towards IncreaSIng her physIcal strength
and endurance Dr K R. expressed some concern about the fact that the claimant had never
had any appropnate paIn management educatIOn and that she had a tendency to overdo thus
sabotagIng her efforts at contInued well-beIng. All of the plans were geared towards physIcal
reactIvatIOn and a work hardenIng program so that the claimant could return to her pre-
dIsabIlIty employment.
A November 10 1997 letter from Dr J reVIewed her symptoms and the reports of other
phYSICIans and concluded as follows
On reVIew of thIS patIent s work status, she felt she could not work due to the level of
pam. The fact that her s,mptoms fluctuate on ada, b, da, basIs WIthout much
Improvement. On days where she trIes to attempt to do an, actIVItIes she seems to
CLAIM # 7641
19
worsen as a result I do not see her return to an, gamful occupatIOn m the near future
but unpredIctable ConsIdenng thIS had been gomg on for a few years there IS the
possibIh~ thIS ma, become long term.
A January 28 1998 progress note from Dr KR. was very encouragIng. The claimant had
reported marked Improvement In her mood and her paIn tolerance and was gOIng to be
startIng a condItIOnIng program wIth a phYSIOtherapISt. Also after ten years of canng for a
dIsabled spouse who had dIed earlIer In the year the claimant had met someone and had
decIded to remarry whIch was In part responsIble for the Improvement In her mood, her
COpIng and her health status In general Dr K R. stated that she was startIng to descnbe
some specIfic occupatIOnal dIrectIOn USIng some of her nursIng skIlls and transfernng them
to other employment sItuatIOns That same Improvement In mood was noted In the February
report from Global
Later In February the BrockvIlle PhysIOtherapy and Sports InJunes ClInIC prepared a
dIscharge summary for the claimant. She had been attendIng for a total of eIghteen seSSIOns
between June and December of 1997 and dunng that tIme had shown an Improvement In her
overall physIcal capabIlItIes, partIcularly wIth respect to her tIredness and low energy levels
The report however concluded wIth the folloWIng
Although Mrs. P dId show Improvement wIth general actIve exerCIse I feel that she
has ven fixed notIOns as regards her condItIon and degree of dIsabih~ All attempts
at reSIsted exerCIse faIled to produce a satIsfacton result. I therefore feel that she
would not be smtable for further rehabIhtatIOn m that a progressIve functIOnal
reSIsted exerCIse program would mevItabh mcrease her subJectIve complamts The
goal of an, such rehabihtatIOn program would be to return to some form of
occupatIOnal actIvI~ and I do not beheve that Mrs P IS wilhng to entertam that Idea
at thIS tIme
It was recommended that she contInue WIth her actIve exerCIse program but concluded WIth
the comment "I'm afraid that I am at a loss to suggest any mean by whIch her capabIlItIes
could be Improved at thIS tIme due maInly to the behavIOural aspect of her underlYIng
condItIOn"
CLAIM # 7641
20
The March summary from Global contaIned the folloWIng comments wIth respect to the
emotIOnal status of the claimant
There has been no reported or noted change m the claimant S emotIOnal status smce
m, last progress report. Mrs P contmues to self-sabotage her rehabihtatIve efforts b,
not pacmg her actIVItIes WIth a subsequent crash m her physIcal tolerance She IS
also exhibItmg some mampulatIve behavIOur For example she contmues to be non-
comphant WIth m, request that she complete daih tIme logs of her actIVItIes
A report from Dr L dated March 27 1998 concluded wIth the folloWIng "I cannot yet
IdentIfy a realIstIc date that she could return to paid work. She does not cope wIth the
actIVItIes that have been scheduled for her dunng the past couple of months"
A dIscharge summary dated Apnl 2, 1998 by Dr K. R. revIewed hIS SIX VISItS WIth the
claimant and concluded as follows
I do not thmk that she has an, psychological bamers related to the regulatIOn of
emotIOns, behavIOurs, commumcatIOns or cogmtIOn that would mterfere wIth her
abih~ to engage m domestIc or occupatIOnal actIvI~ In terms of functIOmng, she
has had some comments remforced through a long hIston ofbemg able to dIve mto
vanous SItuatIOns and she needs to contmualh remmd herself to pace her actIVItIes,
approach tasks slowh plan and thmk how she wIll undertake thmgs and to watch her
stress levels As long as she can do that I thmk there would certamh be some ~'pes
occupatIOnal actIVItIes m whIch she could engage agam. However the StrIct use of
copmg strategIes and s~'le wIth whIch she approaches the domestIc and occupatIOnal
actIVItIes will determme her success.
Mrs P IS certamh aware of approaches to copmg WIth her s,mptoms. The onh thmg
I can encourage IS contmued remforcement of what she has become aware of and
learned. There do seem to be pen ods of tIme wIth better functIOnmg and from m,
perspectIve the self managed behavIOurs and habIts that she gets mto ma, be a factor
here at dIfferentIatmg those tImes where she copes more effectIveh or less
effectIveh
In June of 1998 the claimant was adVIsed that her rehabIlItatIOn and InterventIOn servIces
WIth Global RehabIlItatIOn ServIces had been termInated. A final letter from Global to the
Insurer concluded that "we belIeved that thIS claimant would be able to resume at least part
tIme sedentary employment, but was not motIvated to proceed."
CLAIM # 7641
21
In mId-June the claimant was advIsed that she dId not meet the defimtIOn of wholly and
contInuously dIsabled from any occupatIOn and that her L TIP benefits would be termInated
as of October 18 1998 The letter to the claimant Included a reference to the BrockvIlle
PhysIOtherapy and Sports InJury ClImc commentIng on her Improvement In range of motIOn
and paIn, Dr K. R.' s report In whIch he stated that there were no psychologIcal barners to
Interfere wIth her abIlIty to work and a transferable skIlls analysIs that had determIned that
she would be qualIfied for a data entry clerk posItIOn, a call centre agent and small office co-
ordInator/assIstant. On the basIs of those reports the Insurer had determIned that she was fit
for employment.
An August 21 1998 report from the Computer and BusIness SkIlls TraInIng Academy of
LearnIng advIsed ManulIfe that the claimant had completed her basIc computer traInIng and
employabIlIty skIlls/job search on schedule, that she had done well In her program and that
she had a good polIshed resume to assIst her In a Job search. However SInce she had
relocated, she would not be takIng part In the placement portIOn of the program The
reference In that letter to the faIlure to complete the program related to the fact that the
claimant had resIgned her posItIOn WIth the BrockvIlle PsychIatnc Umt on October 19 1998
Subsequent to her resIgnatIOn the Insurer receIved a letter from a financIal servIce worker
wIth Saskatchewan SocIal ServIces askIng for InformatIOn about the claimant who had
applIed for government assIstance In MooseJaw In response to a request from the claimant,
the Insurer sent an AttendIng PhysIcIan's Statement to be completed by her physIcIan. That
statement, dated the 17th ofF ebruary 1999 was sIgned by Dr L and lIsted the date oflatest
treatment as that same date He noted that the claimant was totally dIsabled from her regular
and any occupatIOn and was not sUItable for a form oftnal employment. He remarked that
the patIent was sIgmficantly symptomatIc and unfit to return to work. ManulIfe reJ ected that
form as beIng InSUfficIent to establIsh a state of total dIsabIlIty and contInued to deny the
claim The claimant subsequently provIded the Insurer wIth a letter dated August 3 1999
from Dr J In whIch he noted that her condItIOn remaIned essentIally unchanged and that she
CLAIM # 7641
22
contInued to have symptoms offibromyalgIa and depressIOn. He stated that she had not been
able to return to any type of gaInful employment and that there was very lIttle else that could
be done for her aSIde from SupportIve care
A letter a month later from ManulIfe demed the claim one more tIme on the basIs that she
was not undergoIng contInUOUS treatment, certIfied as medIcally necessary by a specIalIst In
eIther neurology or psychIatry To be more clear In a letter March 2, 2000 ManulIfe set out
ItS reasons for the demal of the claim It defined total dIsabIlIty and went on to say'
The claim file mdIcates that m August 1998 you elected not to fimsh the
rehabihtatIOn program, m partIcular the placement portIOn of the program. Instead
you moved to Saskatchewan to partake m Bible college There IS no medIcal
documentatIOn showmg regular ongomg medIcal treatment from Dr J s letter of
Ma, 13 1998 As a result, 'total dIsabIh~ IS not contmuoush supported.
As you resIgned your emplo,ment WIth the Provmce of OntarIO effectIve October 19
1998 you ceased to be msured effectIve October 31 1998 On December 4 1998
you called our office to enqmre about appeahng the deCISIOn to termmate your
benefits effectIve October 18 1998 At that tIme havmg resumed actIvI~ equatmg
to a sedentan level offunctIOnmg (that bemg attendmg Bible College and workmg
part-tIme) you no longer had group msurance on whIch to base an appeal for
benefits.
As noted m your file there was never a return to work on a full-tIme baSIS. While you
mdIcated an exacerbatIOn IS (SIC) s,mptoms m your telephone call of December 4
1998 there IS no medIcal documentatIOn m support of thIS change of health status
wIthm three months of October 18 1998
In summan we cannot accept your appeal L TIP benefits due to the followmg'
I You elected not to complete the estabhshed vocatIOnal rehabihtatIOn
program and mstead moved out of provmce to attend College and work part-
tIme
2 You resIgned your emplo,ment from the Provmce of Ontano effectIve
October 19 1998 and there remams no group msurance on whIch to claim a
recurrence of dIsabih~
3 You became engaged m an actIvI~ (attendmg College) that equates m
functIOnah~ to a sedentan occupatIOn. You also mdIcated takmg on
addItIonal part-tIme work
4 You dId not return to work on a full tIme baSIS to quald\ for
CLAIM # 7641
23
consIderatIOn under the recurrence provISIOn
5 You are not under the regular and ongomg care of a phYSICIan
In a letter dated May 15 2000 the claimant wrote to the Umon settIng out the grounds upon
whIch she was appealIng her demal of benefits In the first Instance she stated that she had
elected to further her vocatIOnal rehabIlItatIOn by gOIng to BIble College because was
attemptIng holIstIc treatment of her problems That holIstIc treatment however gave her a
"false sense of well-beIng" and left her no better off She also wanted to make It clear that
whIle she was attendIng college her dIsabIlIty contInued to plague her She was unable to
maIntaIn regular attendance at school or at her part-tIme Job and suffered from lack of sleep
fatIgue, lack of concentratIOn, poor memory retentIOn etc She also said that her "regular a
ongOIng care of a physIcIan was maIntaIned whIle out of the proVInce for SIX months as I
contInued to follow Dr L and Dr J 's treatment as set out for me pnor to attendIng college"
When her symptoms returned she returned home ImmedIately
The only addItIOnal medIcal documentatIOn she provIded for the tIme between her
resIgnatIOn In October of 1998 and her appeal In the year 2000 was a letter dated November
11 1999 from Dr J In whIch he repeated hIS OpInIOn that she could not perform any kInd of
work, sedentary or otherwIse, and an August 3 1999 letter In whIch he agreed that she could
not return to any type of gaInful employment. The only recommendatIOn he had at the tIme
was to contInue her on ElavIl or FlexIrol Finally there was a May 30 2000 note from Dr
AC a psychIatnst, who said sImply "I have been treatIng thIS patIent for a maJor
depressIve dIsorder due to a cOmbInatIOn of her senous medIcal and psychIatnc Illnesses I
conSIder her permanently unfit for employment."
REASONS FOR DECISION
NotwIthstandIng the letter from the Insurer denYIng the claimant's appeal on the techmcal
grounds of elIgIbIlIty the partIes presented thIS case as an Issue of her elIgIbIlIty for benefits
as of the change of defimtIOn from "own occupatIOn" to "any occupatIOn" The questIOn
CLAIM # 7641
24
before me then IS whether the claimant was Improperly demed benefits In October of 1998
when the defimtIOn of total dIsabIlIty changed. If the answer to that questIOn IS no her
employment status IS not relevant to the questIOn of her contInued elIgIbIlIty for benefits If,
at the tIme of her resIgnatIOn, she has no claim to contInuIng benefits, her resIgnatIOn barred
her from filIng any appeal Ifhowever her appeal succeeds, the Issue of her nght to benefits
remaInS to be determIned.
Therefore, wIth respect to that questIOn, It IS noteworthy that the medIcal reports have been
InCOnsIstent In many respects In 1996 It was Said that the claimant was unable to work
because of depressIOn and that, absent that depressIOn, there were no barners to her
employment. Another letter dated two weeks later from another doctor determIned that the
claimant was off work due to her physIcal problems and that she had responded well to
treatment of her depressIOn. In an effort to resolve those InCOnsIstencIes, the claimant was
seen by a specIalIst In MedICIne and RehabIlItatIOn who concluded that she was suffenng
from a fibromyalgIa syndrome and clImcal depressIOn and was unfit to return to work. It was
ultImately the report of a psychIatnst who concluded that she was suffenng from a maJor
depressIve dIsorder that persuaded the Insurer to approve her claim That psychIatnst gave
her a GAF score of35 whIch IndIcated a very low level of functIOn and supported her claim
for dIsabIlIty benefits, whIch were approved from October 18 1996
The claimant's mood and paIn tolerance Improved for a tIme but In February of 1998 she was
dIscharged from the PhysIOtherapy and Sports InJury ClImc wIth the negatIve suggestIOn that
she was delIberately sabotagIng her efforts by overdoIng her actIvItIes thereby precIpItatIng a
relapse The rehabIlItatIOn specIalIst also felt that she was not motIvated to return to work.
Dunng that tIme the medIcal eVIdence of her condItIOn IS based almost entIrely on her
subJectIve complaInts of paIn and depressIOn. There IS no questIOn that she expenenced paIn
on a contInual and ongOIng basIs However there IS no eVIdence that paIn was so
CLAIM # 7641
25
debIlItatIng so as to render her Incapable of performIng the dutIes of any occupatIOn. The
physIcal aspect of her condItIOn IS sImply not severe enough to conclude that she was unable
to work. She IS descnbed as havIng "fibromyalgIa syndrome" but there IS no report of any
clImcal findIngs of the reqUIsIte number of tngger pOInts to warrant a final dIagnosIs of
fibromyalgIa. Her claim for dIsabIlIty benefits cannot be sustaIned on the basIs of a physIcal
Impairment that would render her Incapable of performIng any occupatIOn.
The pnmary grounds for the approval of her claim rested on her mental or psychologIcal
condItIOn, namely that of depressIOn. Two psychIatnst examIned her one In October of
1996 the other In February of 1997 The first found her to be suffenng from recurrent
depressIOn and gave her a GAF score of 71-80 whIch IndIcates an abIlIty to functIOn at a
level sufficIent to manage the actIvItIes of dally lIvIng and work. The later report dIagnoses
her as havIng a MaJor DepressIve DIsorder wIth a GAF score of 35 whIch IndIcates
dIfficulty managIng most aspects of lIfe It would seem she contInued to receIve treatment
for her condItIOn and demonstrated a marked Improvement for a penod of tIme The
psychologIst she saw In October of 1997 concurred wIth a return to work plan that would see
her at optImum functIOnal level WIthIn three to four months It was after thIS report that the
Improvement In her condItIOn was noted, In part because of a new development In her
personal lIfe However even wIth the Improvement In her mood, a subsequent March 1998
report stated she was contInuIng to sabotage her work efforts and was not motIvated to return
to employment. There IS no subsequent clImcal evaluatIOn of her condItIOn to support her
claim of total dIsabIlIty There IS no follow-up GAF score to IndIcate her level of
functIOmng. The eVIdence of her actIvItIes however suggests that she was able to complete a
computer course, attend at a BIble College and work part-tIme whIch dOIng so All of those
actIvItIes are proof of an abIlIty to cope wIth some If not all aspect of lIfe, albeIt at a more
lImIted level
The medIcal reports concermng thIS claimant have been dIfficult to reconcIle The reasons
CLAIM # 7641
26
for her contInuIng InabIlIty to perform the dutIes of her own or any occupatIOn seem to
depend on what physIcIan was wntIng the report. In some cases It was because of the
symptoms of her clImcal depressIOn, In other cases It was because of the severe paIn she was
expenenCIng. It was also suggested that the seventy of her paIn was related to her
psychologIcal condItIOn and were exacerbated by a downswIng In her mood.
What I thInk IS clear however IS that, notwIthstandIng the acknowledged paIn and
depressIOn thIS claimant has and contInues to expenence, the medIcal documentatIOn on file
does not support a claim for a total InabIlIty of performIng the dutIes of any occupatIOn. She
has had the benefit of extensIve rehabIlItatIOn and retraInIng opportumtIes and was able to
complete a computer skIlls course In an effort to find employment consIstent WIth her
dIsabIlIty
For these reasons the appeal IS demed.
Dated thIS 4th day of July 2001
Loretta Mikus
CLAIM # 7641