I APPEAL# PART C-Decision under Appeal The decision under appeal is the ministry's reconsideration decision dated January 20, 2012 which denied the appellant's request for a supplement to cover the full cost of custom-made footwear. The ministry found that the request for a health supplement is for a cost which exceeds the limit of $1,650 as set out in Schedule C, Section 3.10(4) of the Employment and Assistance for Persons With Disabilities Regulation (EAPWDR). PART D Relevant Legislation Employment and Assistance for Persons With Disabilities Regulation (EAPWDR), Section 62 and Schedule C, Section 3.10
I APPEAL# PART E -Summarv of Facts The evidence before the ministry at the time of the reconsideration decision consisted of: 1) Letter dated September 21, 2011 from the ministry to the appellant approving his request for custom-made footwear, with the cost not to exceed $1,650.00, to be supplied by the hospital; 2) Letter dated December 14, 2011 from a certified prosthetist/ orthotist stating in part that the appellant has been referred to him for the management of the appellant's congenital deformities and $1,650 is not enough funds to cover the cost of a pair of custom made boots for the appellant; a request is made for an additional $450, for a total cost of $2,100; 3) Letter dated December 19, 2011 from the ministry to the appellant stating in part that the appellant's request for custom-made footwear has been denied as not all the regulatory criteria have been met, with enclosed decision summary; and, 4) Request for Reconsideration-Reasons, including photographs of toes (1 photograph) and boots (4 photographs. Prior to the hearing, the appellant provided an additional letter from a certified prosthetist/ orthotist dated February 17, 2012 which states in part that the appellant requires a new pair of custom made boots as his current custom manufactured boots are completely worn out; the appellant cannot wear any type of off the shelf footwear; the cost of the new pair of custom footwear is $2,100. The ministry did not object to the admission of either document. The panel reviewed the letter and admitted it as information regarding the cost of the requested custom-made footwear and being in support of the information before the ministry on reconsideration, pursuant to Section 22(4) of the Employment and Assistance Act. The appellant's mother stated that it has been about 1O years since the appellant has had a new pair of shoes. She stated that the appellant's toe is going through the right side of the shoe and it makes it hard for him to walk. The appellant's mother stated that the material of the footwear is completely worn out, and she showed where the shoes had been repaired, with a patch over the leather. The appellant's mother explained that the appellant received some shoes for use with a brace but they were useless for walking and are really only to be worn at night. The appellant's mother stated that she lives on the same property as the appellant and she helps him with things, such as lifting him into the car. The panel admitted the testimony of the appellant's mother as relating to the appellant's need for custom-made footwear, and being in support of the information before the ministry on reconsideration, pursuant to Section 22(4) of the Employment and Assistance Act. The appellant stated that he set out his main reasons for his request in the letter with the Request for Reconsideration, and he has found the cheapest place to get custom-made footwear made in his community. The appellant stated that he has a medical condition which results in changes in his bones and the shape of his feet, and he showed his leg and foot where he had surgery and that now his little toe is longer than the other toes. The appellant stated he can no longer wear his current shoes which are his only pair of footwear. The appellant explained that he usually walks with crutches but he has been stuck in a wheelchair until he can get a new pair of shoes. The appellant demonstrated where his shoe is bulging and his toe is starting to come through the worn material. The appellant showed that his footwear is not something off the shelf, that it is custom-made and the left is elevated more than the right shoe, and that all the leather is getting cracked and is fatigued. The appellant stated that he first went to the hospital orthotics department and was given a quote of $2,800 for the custom-made footwear, and he checked with another supplier who also quoted $2,800. The appellant stated that the supplier that prepared the letter dated February 17, 2012 agreed to a reduction of the fee and is willing to make the shoes for $2,100. The appellant stated that there may be other suppliers outside his community who may be willing to make the footwear for less, but the customization requires three fittings and the cost of his travel would be more than any savings. The appellant stated that no one will make the footwear that he reouires for the amount of $1,650 since there is so much custom work reouired, that each foot
IA PPEAL# needs to be cast. The appellant stated that none of the funds have been received from the ministry as the supplier requires the full amount of $2,100 prior to making the footwear. The appellant stated that the supplier will not take less than $2,100 because he is already giving a discount. The appellant explained that his rent and utilities are $750 per month and he is going into debt each month because his expenses are higher than the amount he receives, so he cannot put aside money for the footwear. In his Request for Reconsideration, the appellant states that his request for the additional amount to cover the cost of custom-made footwear at a total of $2,100 is the cheapest way to go and is saving almost 50% over the other quote that was submitted. The appellant states that every other place wants way more to build a new pair of shoes; one supplier submitted a quote for $2,800 and every other place wants the same or more. The appellant states that even if a supplier in another community could do it cheaper, he has no way to travel, he could not afford to travel and he would be required to attend three times, for casting and molding, the first fitting and the final fitting. The appellant states that he needs a new pair of shoes immediately since if he wears his current shoes for more than half an hour, his toe gets irritated and swells up, and he is going to end up being in a wheelchair permanently. The appellant explains that he has had his current shoes for close to 5 years and they are totally shot and falling apart, as he tried to show in the photographs. The appellant states that his shoes are so worn out that they are becoming a hazard as he has fallen and he could break an arm or leg and end up in a wheelchair, and that he is confined to his house. The appellant states that if he does not get approved for a new pair of shoes, he is going to have to bring this to the media's attention. In his Notice of Appeal, the appellant adds that he has had his current shoes for 1O years and they are falling apart. The appellant states that he has had surgery and he cannot wear his current footwear without great pain. The appellant states that nobody will make him a new pair of shoes for the amount that he was approved for. The ministry relied on the reconsideration decision and acknowledges that, as a recipient of disability assistance, the appellant is eligible to receive health supplements. On September 21, 2011, the appellant was approved for custom-made footwear up to the legislated amount of $1,650. On December 14, 2011, the appellant requested an additional $450 over and above the $1,650 as set out in the legislation, for a total of $2,100. The ministry stated that all it is authorized to pay for custom-footwear is $1,650 and the ministry cannot pay more for this item, so it becomes the recipient's responsibility to find a way to fund the balance. The ministry pointed out some of the options available to a recipient, such as finding a supplier that will make the footwear for $1,650, borrowing the extra amount from family or friends, or saving up the extra money over time.
I APPEAL# PART F Reasons for Panel Decision The issue on the appeal is whether the ministry's decision, which denied the appellant's request for a supplement to cover the full cost of custom-made footwear because the request is for a cost which exceeds the limit of $1,650 as set out in Schedule C, Section 3.10(4) of the Employment and Assistance for Persons With Disabilities Regulation (EAPWDR), was reasonably supported by the evidence or a reasonable application of the applicable enactment in the circumstances of the appellant. Under Section 62 of the Employment and Assistance for Persons with Disabilities Regulation (EAPWDR), in order to eligible for health supplements in Section 2 or 3 of Schedule C, the person must be a recipient of disability assistance, be a person with disabilities, or be a dependent of a person with disabilities as detailed in the section. If that condition is met, Schedule C of the EAPWDR specifies additional criteria that the person's family unit must meet in order to qualify for specified medical equipment and devices. Medical equipment and devices -orthoses 3.10 (1) In this section: "off-the-shelf', in relation to an orthosis, means a prefabricated, mass-produced orthosis that is not unique to a particular person; "orthosis" means (a) a custom-made or off-the-shelf foot orthotic; (b) custom-made footwear; (c) a permanent modification to footwear; (d) off-the-shelf footwear required for the purpose set out in subsection (4.1) (a); (e ) off-the-shelf orthopaedic footwear; (f) an ankle brace; (g) an ankle-foot orthosis; (h) a knee-ankle-foot orthosis; (i) a knee brace; 0) a hip brace; (k) an upper extremity brace; (I) a cranial helmet used for the purposes set out in subsection (7); (m) a torso or spine brace. (2) Subject to subsections (3) to (11) of this section, an orthosis is a health supplement for the purposes of section 3 of this Schedule if (a) the orthosis is prescribed by a medical practitioner or a nurse practitioner, (b) the minister is satisfied that the orthosis is medically essential to achieve or maintain basic functionality, (c) the minister is satisfied that the orthosis is required for one or more of the following purposes: (i) to prevent surgery; (ii) for post-surgical care; (iii) to assist in physical healing from surgery, injury or disease; (iv) to improve physical functioning that has been impaired by a neuro-musculo-skeletal condition, and (d) the orthosis is off-the-shelf unless (i) a medical practitioner or nurse practitioner confirms that a custom-made orthosis is medically required, and
I APPEAL# (ii) the custom-made orthosis is fitted by an orthotist, pedorthist, occupational therapist, physical therapist or podiatrist. (3) For an orthosis that is a custom-made foot orthotic, in addition to the requirements in subsection (2) of this section, all of the following requirements must be met: (a) a medical practitioner or nurse practitioner confirms that a custom-made foot orthotic is medically required; (b) the custom-made foot orthotic is fitted by an orthotist, pedorthist, occupational therapist, physical therapist or podiatrist. (c) Repealed. [B.C. Reg. 144/2011, Sch. 2.] (d) the custom-made foot orthotic must be made from a hand-cast mold; (e) the cost of one pair of custom-made foot orthotics, including the assessment fee, must not exceed $450. (4) For an orthosis that is custom-made footwear, in addition to the requirements in subsection (2) of this section, the cost of the custom-made footwear, including the assessment fee, must not exceed $1 650 .... The appellant's position is that his request for the additional amount to cover the full cost of custom-made footwear at $2,100 is the cheapest way to go and is saving almost 50% over the other quote that was submitted. The appellant argues that every other supplier wants $2,800 or more, and even if a supplier in another community could do it cheaper, the appellant could not afford to travel three times to complete all the fittings. The appellant argues that he needs a new pair of shoes immediately since if he wears his current shoes for more than half an hour, his toe gets irritated and swells up, and he is going to end up being in a wheelchair permanently. The appellant argues that he has had his current shoes for close to 10 years and they are totally shot and falling apart, and they are becoming a hazard as he has fallen and he could break an arm or leg and he has become confined to his house. The ministry's position is that the appellant, as a recipient of disability assistance, is eligible to receive health supplements under Section 62 of the EAPWDR, but that the appellant's request for a supplement to cover the full cost of custom-made footwear does not meet all of the legislative criteria set out in Schedule C. The ministry points out that for custom-made footwear, the cost of the footwear must not exceed $1,650 pursuant to Section 3.10(4) of Schedule C, and the quote for the custom-made footwear requested by the appellant is for a total of $2,100. The ministry argues that it has no legislative authority to approve funds above the legislated amount and, therefore, the appellant's request for an additional amount of $450 cannot be approved. The panel finds that it is not disputed that the appellant, as a recipient of disability assistance, is eligible to receive health supplements under Section 62 of the EAPWDR, and that the appellant's request has satisfied all but one of the additional criteria to qualify for custom-made footwear under Section 3.1 O of Schedule C of the EAPWDR. In particular, Section 3.10(4) of Schedule C stipulates that for an orthosis that is custom-made footwear, the cost of the custom-made footwear, including the assessment fee, must not exceed $1,650. The panel finds that the appellant has researched three options for suppliers of custom-made footwear, and has obtained a written confirmation dated February 17, 2012 that a supplier is prepared to provide the custom-made footwear at a cost of $2,100. Although this is considerably lower than the other quotes obtained at $2,800, it is in excess of the limit of $1,650 set out in Section 3.10(4) of Schedule C, and the panel finds that the ministry's determination that it has no legislative authority to approve funds above the limit was reasonable. The panel finds that the ministry's decision that denied the appellant's request for a supplement to cover the full cost of custom-made footwear as the appellant's request is for a cost which exceeds the limit of $1,650, as set out in Schedule C, Section 3.10(4) of the Employment and Assistance for Persons With Disabilities Regulation (EAPWDR), was a reasonable application of the applicable enactment and, therefore, confirms the ministrv's decision.
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