Docket:
T-1737-11
Citation:
2012 FC 567
Ottawa, Ontario, May 10, 2012
PRESENT: The Honourable Madam Justice Gleason
BETWEEN:
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JULIA SLOANE
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Applicant
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and
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THE ATTORNEY GENERAL OF CANADA
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Respondent
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REASONS FOR
JUDGMENT AND JUDGMENT
[1]
In
this application for judicial review, Julia Sloane seeks to have the Court set
aside the decision of the Veterans Review and Appeal Board [VRAB or the Board],
issued on October 3, 2011, in which the VRAB denied Ms. Sloan entitlement to a
disability pension under subsection 21(2) of the Pension Act, RSC, 1985,
c P-6.
[2]
Ms.
Sloan spent her career serving in the Canadian Armed Forces [CF]. She enlisted
in 1970 and has recently retired. The Department of National Defence assumed
responsibility for her medical care when she was in the CF, as it does for all
servicemen and women (Pension Review Board, Interpretation Decision I-25 at p 2
[Decision I-25]; Gannon v Canada (Attorney General), 2006 FC 600 at para
20, 292 FTR 280).
[3]
Early
in her career, Ms. Sloan developed a non-malignant tumour in her ear. As is
more specifically detailed below, there was considerable delay in diagnosing
the tumour, despite Ms. Sloan's repeated visits to the base physician and
frequent complaints of ongoing symptoms of escalating severity. The tumour grew
rapidly, and, once discovered, necessitated surgical intervention. Due to the
tumour’s size, complications from the surgery resulted, which left Ms. Sloan
with permanent hearing loss, permanent partial facial paralysis, impaired
speech and a corneal abrasion. Ms. Sloan asserts that the severity of the
tumour and the complications she experienced were a result of the inadequate
medical treatment she received from the base doctor, who failed to conduct the
required tests or to refer her to a specialist in a timely fashion.
[4]
Ms.
Sloan did not apply for pension entitlement until 1990, when her condition
worsened. Her application was denied by the Canada Pension Commission (the
predecessor to the VRAB). She did not appeal that decision until 2004; however,
the Veterans
Review and Appeal Board Act, SC 1995, c 18 [VRAB Act] does not
place time limits on appeals and, accordingly, the appeal was
heard on the merits. In 2006, the VRAB denied Ms. Sloan’s appeal. Ms. Sloan
sought review of that decision to an Entitlement Appeal Panel of the VRAB in
2009, which denied her further appeal. She then sought reconsideration of the
Entitlement Appeal Panel’s decision, and on April 22, 2010, the VRAB dismissed
her reconsideration application. Ms. Sloan brought a judicial review
application to this Court in respect of the April 22, 2010 decision, and, on
consent, that decision was set aside by Order of Mr. Justice Zinn, dated
January 18, 2011, in which he held that the VRAB had “erred in law by failing
to draw the proper inferences from the evidence in light of the facts and
record and
s.39 of the [VRAB Act]”. Pursuant
to the terms of Justice Zinn’s Order, Ms. Sloan’s reconsideration application was
remitted back to a different panel of the VRAB, which issued the decision that
is the subject of the present application for judicial review.
[5]
Ms.
Sloan argues that the VRAB’s decision of October 3, 2011 should be set aside
because the VRAB:
1. failed
to properly consider sections 3 and 39 of the VRAB Act in establishing the
standard and burden of proof for medical mismanagement claims;
2. erred
in law by fettering its discretion in considering Decision I-25 of the Pension
Review Board to be a binding precedent setting out the interpretation of when a
pension may be awarded for disabilities associate with inadequate medical
treatment;
3. erred
in law by failing to draw favourable inferences from the medical and affidavit
evidence in the record, contrary to section 39 of the VRAB Act; and
4. issued
inadequate reasons, thereby violating the requirements of natural justice.
[6]
The
respondent, on the other hand, argues that the decision was reasonable and
should be maintained. More specifically, the respondent asserts that the VRAB’s
consideration and treatment of sections 3 and 39 of the VRAB Act were
reasonable, that the VRAB correctly followed and applied Decision I-25 as it
was required to do, that its conclusions and inferences are reasonable and
comply with requirements of section 39 of the VRAB Act and that, in light of
the recent decision of the Supreme Court of Canada in Newfoundland and
Labrador Nurses’ Union v Newfoundland and Labrador (Treasury Board), 2011
SCC 62, [2011] 3 S.C.R. 708 [Newfoundland Nurses] inadequacy of reasons
cannot constitute a stand-alone basis for judicial review.
[7]
For
the reasons set out below, it is my view that the VRAB did not inappropriately
fetter its discretion and that the alleged inadequacy of its reasons does not
provide any basis for intervention. That said, I have determined that the
VRAB’s decision must be set aside because the Board’s findings contradict
critical evidence and, in light of the requirements of section 39 of the VRAB
Act, the conclusion the VRAB reached in its October 3, 2011 decision was not
reasonably open to it.
[8]
Counsel
for the parties asserted the VRAB’s October 3, 2011 decision must be read in
conjunction with the earlier VRAB Entitlement Appeal Panel's decision of April
22, 2010 (that was quashed by Justice Zinn’s Order) and the October 29, 2009
decision of the VRAB (that was the subject of review in the reconsideration
applications). I concur that this context is important for a proper
understanding of the Board’s October 3, 2011 decision as each of the previous
decisions provides a backdrop to it.
[9]
Prior
to reviewing the three decisions, though, it is necessary to summarize the
medical evidence before the VRAB because this judicial review application very
much turns on the nature of the factual record before the Board.
I. THE
FACTUAL BACKGROUND
[10]
In
addition to affidavits from Ms. Sloan and her husband, as well as the various
medical records relevant to Ms. Sloan’s condition and treatment, the Board had
before it four medical reports: a report dated March 14, 1974 from Dr. Hill
Britton, one of the surgeons who removed Ms. Sloan's tumour; a report dated
March 23, 1994 from Dr. Hitselberger, the other surgeon who removed Ms. Sloan's
tumor; a third-party expert report dated April 8, 2009 from Dr. Sévigny, an
ENT (“Ear, Nose, and Throat” or otolaryngology) specialist; and a report dated
February 6, 2006 from Dr. Slaunwhite, the SSO Surgeon General employed by the
Canadian Forces, whose report was also a third-party expert report. As is
typically the case, the third-party experts based their reports on a review of
the medical documentation contained in the file.
[11]
Ms.
Sloan first consulted the base doctor in 1971, complaining of a sore throat and
ear pain. She saw the doctor seven times during the course of the year to
complain of the same symptoms, and the treatment prescribed was antihistamines
and decongestants. In 1972, Ms. Sloan saw the base doctor at least six times
and complained of additional symptoms, namely, a recurrent feeling of fullness
when chewing, persistent sore throat, nasal congestion and headaches. The
doctor diagnosed a middle ear infection and continued to prescribe
antihistamines and decongestants. He did not have an audiogram or other hearing
test performed, despite the fact that the equipment to do so was readily
available on the military base where it was used to test pilots’ hearing.
[12]
In
February of 1973, Ms. Sloan began to experience facial numbness. On her own
initiative, she consulted the base dentist on February 20, 1973, who concluded
that her symptoms were not dental in origin and referred her back to the base
doctor for further investigation. Ms. Sloan saw the base doctor on the same day
and complained to him that she was suffering from facial numbness, dizziness
and pain in her right ear. Between February and December of 1973, Ms. Sloan saw
the base doctor eight times, each time complaining of right ear pain,
dizziness, facial numbness and hearing loss. Once again, the diagnosis of ear
infection remained unchanged, and the base doctor continued to prescribe
decongestants and antihistamines (and added eardrops as a further treatment).
No hearing test was conducted. During this period, Ms. Sloan was in such pain
that she even complained of the symptoms to her gynaecologist and to an ophthalmologist,
whom she consulted. Eventually, she and her husband begged and then insisted
that the base doctor refer her to an ENT specialist. He eventually agreed to do
so at the end of 1973.
[13]
Ms.
Sloan saw the ENT specialist in December 1973, and he immediately performed an
audiogram. It showed significant hearing loss in her right ear. Thereafter, the
specialist had an X-ray taken, and, based on these investigations he made a
diagnosis of a right acoustic neuroma (or tumour in the ear). Shortly
thereafter, Ms. Sloan was referred to Drs. Hill Britton and Hitselberger in the
United States, who were leading specialists in treatment of tumours of this
nature. In March of 1974 they conducted surgery to remove the tumour and, as
noted, due to its size, Ms. Sloan experienced permanent hearing loss and
permanent facial paralysis, which, in turn, led to a speech impediment. In
1990, Ms. Sloan developed a corneal abrasion as a further complication from her
surgery, which resulted from impairment to her tear ducts that were damaged in
the surgery.
[14]
The
uncontradicted evidence before the VRAB was to the effect that the primary
symptoms of acoustic neuroma are pain, hearing loss, facial numbness and
dizziness, and that this was known in 1971. The evidence also established that
Ms. Sloan's tumour was a fast-growing one, having increased in size from 2.5 to
3 cm in diameter in January of 1974 to 3.5 to 4 cm in diameter in early March
of 2004.
[15]
Several
of the medical reports before the Board indicated that, had the tumour been
diagnosed earlier, it is possible that the complications Ms. Sloan suffered
might have been avoided or have been less severe. Several of the medical
reports also suggest that the base doctor's treatment of Ms. Sloan did not meet
the standard one would expect.
[16]
In
this regard, Dr. Hitselberger opined as follows:
… the delay from May of '72 to December of '73 would
perhaps be considered an unreasonable delay before referral to an Otolayrngologist
specialty since... [Ms. Sloan's] symptoms were no better and, in fact, had
gotten worse. I would certainly say that this might have made a difference in
[Ms. Sloan's] ultimate outlook.…
The difficulty that anyone has in evaluating the
situation is what we're talking about here occurred over twenty years ago. It
is very hard to apply the standards that we have a 1994 to those that existed
back in 1972. There have been many advances made in the diagnosis of these
lesions and I'm not sure, but at that particular point in time, [Ms. Sloan was]
in the framework of reasonable care and treatment for a patient with [her]
symptoms … I may be a little hasty in stating that [Ms. Sloan] should have
gotten to an otolaryngologist a little sooner. It does seem that a year and a
half delay before referral to an otolaryngologist was perhaps a little long
especially since [Ms. Sloan's] symptoms seemed to be getting worse, or
certainly no better during this period of time.
[17]
Dr.
Sévigny was much more forceful in his opinion. He concluded that prior to 1972
Ms. Sloan's symptoms did not suggest the presence of an acoustic neuroma.
However, he opined that as of 1972, the neuroma ought to have been diagnosed,
once Ms. Sloan began to complain of hearing loss. He wrote in this regard:
Par
contre, votre cliente a commencé à se plaindre de surdité droite en 1972. Je
suis étonné de ne pas retrouver d’audiogramme au dossier avant celui demandé
par l’oto-rhino-laryngologiste en décembre 1973. À l’époque et même
maintenant, l’audiogramme demeure un examen essentiel dans l’évaluation des
problèmes otologiques. Chez les patients présentant un problème infectieux
qui persiste malgré le traitement médical, l’audiogramme est utile pour
permettre d’exclure une atteinte plus sévère de l’oreille moyenne ou encore
de l’oreille interne. Dans le cas de votre cliente, le médecin qui la suivait
aurait dû demander un audiogramme on aurait découvert la perte auditive
relativement rapide s’étant développée en moins de 3 ans. Il faut comprendre
que même si le médecin traitant avait demandé un audiogramme dans le but d’évaluer
un problème infectieux, l’atteinte neuro-sensorielle aurait été découverte.
À
l’origine de la présente expertise, vous me demandiez si le délai dans
l’investigation et le diagnostic a pu causer préjudice à votre cliente. Les
documents disponibles confirment que l’évolution de la lésion s’est faite
très rapidement, les symptômes étant apparus essentiellement dans l’année qui
a précédé l’investigation oto-rhino-laryngologique. La lésion a donc évolué
de façon significative durant cette période; l’audiogramme normal à
l’enrôlement ainsi que l’évolution rapide des symptômes durant la dernière
année confirment la croissance de la tumeur.
Il
est évident que les risques et complications chirurgicales augmentent avec la
grosseur de la lésion. Chirurgicalement, un neurinome acoustique est enlevé
morceaux par morceaux et les structures anatomiques normales disséquées
progressivement. Plus la lésion est grosse, plus la dissection est longue.
Dans le cas de votre cliente, l’atteinte du nerf facial en est le témoin. Si
votre cliente avait subi un audiogramme lorsqu’elle s’est plainte de trouble
otologique, il y aurait eu de fortes chances d’éviter l’atteinte faciale
puisque l’intervention chirurgicale aurait été pratiquée un an ou un et demi
plus tôt.
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However,
your client began complaining of hearing loss on the right side in 1972. I am
surprised to not find an audiogram on her file before that requested by the
otolaryngologist in December 1973. Then and even now, an audiogram is an
essential diagnostic tool in the assessment of otolaryngolic ailments.
For
patients presenting with infections that continue despite medical treatment,
audiograms allow the exclusion of more serious conditions of the middle or
inner ear. In the case of your client, had the treating doctor requested an
audiogram, the client’s loss of hearing that had occurred relatively rapidly
in less than 3 years would have been discovered. It must be understood that
even if the treating physician had ordered an audiogram to evaluate an
infection, the patient’s neuro-sensory problems would have been discovered.
In
the present opinion, I was asked whether the delays in the evaluation and
diagnosis caused harm to your client. The available documents confirm that
the tumour developed very rapidly, and that symptoms began appearing in the
year preceding the otolaryngolic assessment. The tumour thus developed
significantly during this period; the patient’s normal audiogram when she
enlisted, as well as the rapid development of symptoms in that last year
confirm the tumour’s growth.
It
is evident that risks and surgical complications increase with the size of
the tumour. In surgery, an acoustic neuroma is removed piece by piece and
healthy anatomical structures are increasingly impacted. The larger the tumour,
the longer the surgery. In your client’s case, the injury to the facial
nerve is evidence of this problem. If your client had had an audiogram when
she first complained of hearing problems, there is a strong chance she would
have avoided facial paralysis because her surgery would have been performed a
year to a year and one half earlier.
[Unofficial
translation]
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[18]
Even
the Canadian Armed Forces doctor, Dr. Slaunwhite corroborates these points to a
certain extent. She notes that the Armed Forces' medical files documented 25
recorded clinical assessments "in which plausible symptoms of an early
acoustic neuroma were being described", prior to the point at which the
referral to the ENT specialist was made. Dr. Slaunwhite goes on to note that it
is "of concern" that Ms. Sloan felt compelled to raise the symptoms
with her gynaecologist. She further opined that:
It is not possible to know with certainty if the
symptoms in 1971 in 1972 were unrelated or not. We can be more sure that the
facial numbness described in 1973 was a clear sign of nerve involvement, and
would have been sufficient reason to pursue close follow-up, re-evaluation and
specialist referral if the symptom did not fully resolve. The chart notes
(dental and medical) do not indicate that this symptom prompted a serious
evaluation at that time. In a worst case scenario, if LCol Sloan did possess a
fast-growing neuroma (capable of doubling its volume in six months to a year),
then the time taken to go from facial numbness to definite x-ray, hearing tests
and diagnosis in Dec73, to surgery Mar74, may have resulted in a greater
likelihood of irreversible symptoms…. It is also, on the surface, somewhat
puzzling to count 24 medical visits for ENT related symptoms and these did not,
of their own account, trigger referral to look for other underlying causes at
an earlier point in time.
In summary, it cannot be said that this CF General
Practitioner or General Dentist practiced below a Canadian standard from 1971
until 1973. Certainly there was a missed opportunity to act on the more ominous
symptom of facial numbness that was first presenting in Feb 1973, and other
practitioners might have made more definitive evaluations of this symptom. …
Earlier referral, diagnosis and surgical treatment were possible, and … it is
possible there could have been less severe surgical consequences. It is my
opinion that it can be said that some linkage exists between the treatment
received and the surgical outcome. While we cannot say with certainty that
there was bad medical practice, the missed occasion to pursue the symptoms of
nerve involvement in Feb 1973 remains unexplained.
II.
THE VRAB’s DECISIONS
[19]
In
the first of the trilogy of the decisions at issue here, which was issued on October
29, 2009, the Entitlement Appeal Panel of the VRAB applied decision I-25 of the
Pension Review Board and held that, in order for a pension claim to succeed,
there needed to be evidence showing that the “accepted legal and professional
standard of care was not observed”, which could be demonstrated by showing that
there was the duty of care owed to the claimant, a failure to meet that
required standard of care, and a disability that occurred as a direct result of
the failure (at page 9 of the decision). In a single paragraph at the very end
of its decision, the VRAB applied this test to the facts of Ms. Sloan's case,
concluding that there was no medical mismanagement and, accordingly, that Ms.
Sloan was not entitled to a pension. The conclusion regarding lack of medical
mismanagement hinged entirely on Dr. Slaunwhite’s comment that it could not be
said that the Canadian Forces general practitioner or general dentist practiced
below a Canadian standard. The VRAB concluded that, while the medical evidence
“… suggest[ed] that there is a possibility that an earlier referral diagnosis
and surgical treatment could have resulted in less severe surgical
consequences, …it cannot be said with certainty that there was medical
mismanagement”. The Board did not give any weight to the several contradictory
statements made in the medical reports, cited above, nor did it consider the
impact of section 39 of the VRAB Act in resolving the conflicting views
contained in the medical reports.
[20]
As
noted, Ms. Sloan sought reconsideration of the October 29, 2009 decision of the
VRAB Entitlement Appeal Panel. In both of her reconsideration applications, she
argued that the Board had not properly applied section 39 of the VRAB Act,
which creates certain evidentiary and legal presumptions in favour of pension
claimants. The section provides:
39. In all proceedings
under this Act, the Board shall
(a) draw from all the
circumstances of the case and all the evidence presented to it every
reasonable inference in favour of the applicant or appellant;
(b) accept any uncontradicted
evidence presented to it by the applicant or appellant that it considers to
be credible in the circumstances; and
(c) resolve in favour
of the applicant or appellant any doubt, in the weighing of evidence, as to
whether the applicant or appellant has established a case.
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39. Le Tribunal
applique, à l’égard du demandeur ou de l’appelant, les règles suivantes en
matière de preuve :
a) il tire des
circonstances et des éléments de preuve qui lui sont présentés les
conclusions les plus favorables possible à celui-ci;
b) il accepte tout
élément de preuve non contredit que lui présente celui-ci et qui lui semble
vraisemblable en l’occurrence;
c) il tranche en sa
faveur toute incertitude quant au bien-fondé de la demande.
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[21]
In
its decision of April 22, 2010 on the first reconsideration application, the
VRAB applied decision I-25 and, while mentioning the evidentiary presumptions
contained in section 39 of the VRAB Act, held that “section 39 requires a
logical explanation as to why a panel rejected evidence that the applicant may
have considered favourable but it does not require a favourable decision”. The
Board then went on to reject the reconsideration application, and did not
consider how section 39 applied to the various statements in the medical reports
that supported Ms. Sloan’s position.
[22]
As
noted, this reconsideration decision was quashed by the Order of Mr. Justice
Zinn, in which Justice Zinn held that the VRAB committed a reviewable error in
failing to draw the proper inferences from the evidence in light of the facts
in the record and section 39 of the VRAB Act.
[23]
The
matter was then remitted back to the VRAB for reconsideration in accordance
with the terms of Justice Zinn’s Order, and the Board issued the October 3,
2011 decision, that is the subject of the present application for judicial
review. The reasoning in the October 3, 2011 decision is substantially similar
to that contained in the April 22, 2010 decision of the Board, despite the
direction contained in Justice Zinn's Order. In this regard, in its October 3,
2011 decision, the VRAB held that decision I-25 required a pension claimant to
prove medical mismanagement, the elements of which are the existence of a duty
of care owed to the claimant, a failure to exercise the standard of care expected
and the occurrence of a disability as a direct result of the failure. In
applying the test to the evidence, the VRAB held that “the medical reports may
have suggested a possibility that earlier referral, diagnosis and treatment may
have led to a better result, but there was no evidence that treatment fell
below an accepted standard, or outside of a reasonable care and treatment
framework” [emphasis added]. It also held that the VRAB had not premised
its October 29, 2009 Entitlement Appeal Panel decision on an incorrect
interpretation of section 39 of the VRAB Act in that the Board did not require
Ms. Sloan to establish “with certainty” that medical mismanagement had occurred
but, rather, had used the term “with certainty” only as reference to Dr. Slaunwhite’s
report.
[24]
With
respect, this reading of the October 29, 2009 decision is completely untenable.
The only possible way in which to read the decision is that it turns on the
determination that Ms. Sloan has not established “with certainty” that medical
mismanagement has occurred. As is discussed below, such a finding flies in the
face of section 39 of the VRAB Act.
[25]
Moreover,
the Board’s statement that there was “no evidence that treatment fell below an
accepted standard or outside of a reasonable care and treatment framework”
directly contradicts the evidence before the VRAB. The above-cited portions of
the reports of Drs. Hitselberger, Sévigny and Slaunwhite all either state,
suggest or imply that Ms. Sloan's treatment fell below an accepted standard of
care and outside a reasonable care and treatment framework.
III.
ANALYSIS
[26]
The
claims that the VRAB improperly fettered its discretion and issued inadequate
reasons may be disposed of quickly.
[27]
Counsel
for Ms. Sloan advances the proposition that VRAB fettered its discretion in
adopting and applying the reasoning in Decision I-25, asserting that
administrative tribunals cannot follow their earlier decisions (or treat them
as decisive authority) without improperly fettering the discretion they
possess. No authority is cited in support of this proposition, and it is
clearly without merit. While the principle of stare decisis does not
apply to administrative tribunals, it is both commonplace and highly desirable
that tribunals follow and consistently apply their previous awards so as to
thereby develop a predictable and coherent body of case law. Indeed, the courts
have recognised that tribunals may properly engage in tribunal-wide policy
discussions to develop consensus on important policy interpretations and do not
thereby improperly compromise individual members’ independence (see e.g. IWA v
Consolidated-Bathurst Packaging Ltd, [1990] 1 S.C.R. 282, 68 DLR (4th) 524 at
paras 47, 51).
[28]
The
position advanced regarding the inadequacy of the VRAB’s reasons amounting to a
violation of the principles of natural justice must be given similarly short
shrift. The recent decision in Newfoundland Nurses firmly settles that,
provided some reasons are given, their alleged shortcomings cannot amount to a
failure of natural justice. According to Justice Abella, writing for the Court:
It strikes me as an unhelpful elaboration on Baker
to suggest that alleged deficiencies or flaws in the reasons fall under the
category of a breach of the duty of procedural fairness and that they are
subject to a correctness review… where…there are reasons, there is
no…breach [of the duty of procedural fairness] (Newfoundland Nurses at
paras 21-22).
[29]
Insofar
as concerns the other assertions regarding the VRAB’s assessment of the
evidence and application of section 39 of the VRAB Act, the applicable standard
of review is that of reasonableness (Boisvert v Canada (Attorney General),
2009 FC 735 at para 36). The reasonableness standard of review is a deferential
one and requires that the Court not intervene unless it is satisfied
that the reasons of the Board are not “justified, transparent or intelligible” and
that the result does not fall “within the range of possible, acceptable
outcomes which are defensible in respect of facts and law” (Dunsmuir v New
Brunswick, 2008 SCC 9, [2008] 1 S.C.R. 190, at para 47). Where the ground of
review involves a challenge to a federal tribunal’s factual determinations, the
content of the reasonableness standard is enshrined in paragraph 18.1(4)(d) of
the Federal Courts Act, RSC, 1985, c F-7 [FCA],
which provides
that findings of fact may be set aside only if they are made in a perverse or
capricious manner or without regard to the material before the tribunal. A
finding for which there is no evidence before the tribunal is subject to
being set aside under paragraph 18.1(4)(d) of the FCA because
such a finding is made without regard to the material before the tribunal (see
e.g.
Gannon
v Canada (Attorney General), 2006 FC 600 at paras 29-31, 292 FTR 280; Canadian
Union of Postal Workers v Healy, 2003 FCA 380 at para 25, [2003] FCJ No
1517).
[30]
In
my view, the Board’s decision is unreasonable in two respects: first, in its
erroneous conclusion that there was no evidence that the treatment
Ms. Sloan received fell below an accepted standard and, second, in its
consideration of section 39 of the VRAB Act, which the Board effectively
ignored. In short, in light of the evidence before it and the requirements of
section 39 of the VRAB Act, the only reasonable conclusion open to the Board
was to grant the reconsideration and award Ms. Sloan the disability pension.
Indeed, that is precisely what Justice Zinn’s Order contemplated would occur.
[31]
This
Court has on
many occasions quashed decisions of the VRAB in circumstances similar to the
present. In Metcalfe v Canada (1999), 160 FTR 281, [1999] FCJ No 22 [Metcalfe],
the VRAB had found that the evidence before it did not establish with certainty
a causal link between the applicant’s deafness and his military service,
notwithstanding medical opinions stating that there was a strong possibility or
likelihood that the disability was the result of noise exposure during
service. Justice Evans concluded that the Board “could only have reached its
conclusion by misdirecting itself on the effect of section 39 of the Veterans
Review and Appeal Board Act” (para 17). He reasoned that while “no one can be
certain whether a causal link exists between the noise to which the applicant
was exposed while on military service and his present deafness…the applicant
produced sufficient credible evidence about the cause of his hearing loss that,
if the Board had complied with the directions contained in section 39, it must
in law have upheld his claim” (para 22). The Board’s decision was thus quashed.
[32]
Similarly,
in Schott v Canada (Attorney General), [2001] FCJ No 126, 199 FTR 225,
Justice Hansen found that the VRAB had misconstrued the evidence before it by
finding the medical opinions to be speculative, when in fact they had indicated
that a misdiagnosis by the original treating doctors was “certainly a factor”
in the delay in detecting the applicant’s cancer, leading to aggravated
disability and discomfort (see paras 20-22). As in Metcalfe, Justice
Hansen concluded at para 26 that “the VRAB could have reached its conclusion
only by ignoring the evidence of [the medical experts], misconstruing their
evidence, or misdirecting itself as to the effect of section 39 of the Act, in
the face of credible and trustworthy evidence”.
[33]
In
Smith v Canada (Attorney General), 2001 FCT 857, 209 FTR 172, Justice
MacKay quashed a decision of the Board because it required a “definitive
medical opinion” and thereby failed to have regard to section 39 of the VRAB
Act (paras 29 and 38). As Justice MacKay put it at para 33, “[t]he Board
failed to recognize that the medical opinions provided on behalf of the
applicant present only one possible diagnosis with only one plausible cause”.
[34]
Turning
to the present case, as noted, the Board's conclusion completely ignores
several passages in the medical reports of Drs. Hitselberger,
Sévigny and Slaunwhite, all of whom either actually state or suggest that the
base doctor ought to have conducted hearing tests or made a referral to a
specialist much earlier, which would have resulted in the surgery taking place
when the tumour was much smaller, thereby lessening the risk of complications.
All these statements support a finding of medical mismanagement.
[35]
In addition to
ignoring key elements of the evidence before it, the Board engaged in an unreasonable
interpretation of section 39 of the VRAB Act. That section provides that any
benefit of the doubt in weighing of the evidence must be resolved in favor of
the claimant. In this case, there was conflicting evidence before the Board
regarding whether or not medical mismanagement had taken place: on one hand,
there is the bald statement in Dr. Slaunwhite’s report to
the effect that she could not conclude that the base doctor had practiced below
a Canadian standard; on the other hand, there is the opposite statement in Dr.
Sévigny’s report, stating that the treating physician had failed to administer
an essential diagnostic test, as well as the multiple indications in all three
of the doctors' reports, noting that the standard tests were not conducted and
that there was an unreasonably long delay in referring Ms. Sloan to the ENT
specialist.
[36]
This case is
distinguishable from the facts before the Federal Court of Appeal in Canada (Attorney General) v Wannamaker, 2007 FCA 126, 361 NR 266 [Wannamaker],
cited by the respondent. In Wannamaker, the Court of Appeal overturned
this Court’s holding that a VRAB decision was unreasonable because it gave
insufficient attention to section 39. In rejecting that argument, Justice
Sharlow noted:
“The
Board was faced with contradictory evidence about whether Mr. Wannamaker
suffered back injuries in 1959 and 1961 as he claimed. The only direct evidence
came from Mr. Wannamaker himself… Mr. Wannamaker's evidence is also
contradicted by the contemporaneous medical records. Thus, this is not a
situation that engages paragraph 39(b), which requires the Board to “accept any
uncontradicted evidence” presented by the applicant that the Board considers “credible
in the circumstances.”” (para 29).
In contrast to
the situation in Wannamaker, here the Board did not face contradictory
evidence of this nature. The Board had a series of medical opinions which all
contained indications that the care received by the applicant did not meet
standard levels of care at the time. In face of this evidence and the
requirements of section 39 of the VRAB Act, the only possible reasonable
conclusion open to the Board was to uphold Ms. Sloan's claim.
IV. CONCLUSION
[37]
In
light of the foregoing, the decision of the VRAB, dated October 3,
2011, will
be set aside and Ms. Sloan’s reconsideration application will be remitted to
the VRAB for re-determination by a differently constituted panel of the Board.
JUDGMENT
THIS
COURT’S JUDGMENT is that:
1.
This
application for judicial review of the decision of
the VRAB, dated October 3, 2011 is granted and the decision is set aside;
2.
Ms.
Sloan’s reconsideration application is remitted to the VRAB for re-determination
by a differently constituted panel of the Board; and
3.
Ms.
Sloan is entitled to her costs of this application in accordance with Tariff B
of the Federal Courts Rules, SOR/2004-283, s. 2.
"Mary
J.L. Gleason"