View high contrast version of the site View high contrast version of the site Decrease text size Increase text size

Case Studies » Sickness » Invalidity Pension- Case from 2016 Annual Report (ref: 2016/12)

2016/12 Invalidity Pension

Oral hearing

Question at issue: Eligibility (medical)

Background: The appellant, in his early 50s, had been diagnosed with diabetes mellitus, diabetic neuropathy (peripheral neuropathy) and retinopathy, vascular disease and obstructive sleep apnoea. In completing the medical report which forms part of the Invalidity Pension claim form, his G.P. stated that his certified incapacity was expected to preclude the appellant from returning to work indefinitely. In completing the ability/disability profile, his G.P. assessed his condition as affecting to a moderate to severe degree his ability to lift/carry, and to a moderate degree in terms of walking, sitting, bending, kneeling and vision, while other categories were assessed as normal.

His claim was disallowed on grounds that he was not deemed to be permanently incapable of work. In a letter in support of his appeal, the appellant’s G.P. made reference to multiple medical issues which are life-long and would require management and treatment indefinitely. He outlined details of multiple drug therapies which had been prescribed for the appellant, as well as details of the Consultants he was attending.

Oral hearing: The appellant, accompanied by his wife, submitted additional medical evidence in the form of letters from a consultant respiratory physician, confirming a diagnosis of severe sleep apnoea and advising that he had commenced continuous positive airway pressure (CPAP) therapy, and a list of the prescribed medication associated with each of the conditions diagnosed.

In support of his appeal, the appellant made the following points. His work history was mainly in construction, following which he had completed a Community Employment (CE) scheme. He reported that his blood sugar levels remained persistently high and this unstable diabetic condition had led to significant other health issues for which he was also receiving treatment. This includes attending the diabetic, podiatry and cardiology clinics at his local hospital, as well as attending an ophthalmic consultant. He advised that he was undergoing tests in connection with the diagnosis of sleep apnoea and reported that he falls to sleep four or five time every day and feels exhausted all the time. He advised that he no longer walks anywhere due to the pain in his feet and dizziness associated with high blood pressure, and said that he is unable to help with housework or cooking at home because of his health issues.

Consideration: The Appeals Officer referred to the governing legislation, which provides that entitlement to Invalidity Pension is subject to a person being permanently incapable of work. He noted that this condition is satisfied where, at the time of making a claim, a person has been continuously incapable of work for:

  •   twelve months – and is likely to remain incapable of work for a further twelve months, or
  • • less than twelve months – and is likely to be incapable of work for life.

The Appeals Officer noted that by virtue of his certification for purposes of entitlement to Illness Benefit, the appellant had already established that he had been incapable of work for more than one year prior to making a claim for Invalidity Pension. Accordingly, the question to be determined was whether he was likely to remain incapable of work for twelve months beyond the date of his claim for Invalidity Pension. In this context, he noted that his diabetes remained unstable and had led to the development of neuropathy and retinopathy and that he had also been diagnosed with sleep apnoea. He was satisfied that the appellant would continue to need acute treatment of and support in the management of all of these conditions beyond the relevant date and that the combined impacts of these conditions on his daily living abilities were such as to render him incapable of work beyond this timeframe.

Outcome: Appeal allowed.