I APPEAL# PART C Decision under Appeal The decision under appeal is the Ministry of Social Development (the ministry) reconsideration decision dated March 5, 2013 which found that the appellant did not meet two of the five statutory requirements of Section 2 of the Employment and Assistance for Persons with Disabilities Act for designation as a person with disabilities (PWD). The ministry found that the appellant met the age requirement and that she has a severe mental impairment that, in the opinion of a medical practitioner, is likely to continue for at least two years. However, the ministry was not satisfied that the evidence establishes that: • the appellant's daily living activities (DLA) are, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods; and, • the appellant requires the significant help or supervision of another person, the use of an assistive device, or the services of an assistance animal to perform DLA. PART D Relevant Legislation Employment and Assistance for Persons with Disabilities Act (EAPWDA), Section 2 Employment and Assistance for Persons with Disabilities Regulation (EAPWDR), Section 2 I
I APPEAL# PART E Summary of Facts The evidence before the ministry at the time of the reconsideration decision included the following: 1) Person With Disabilities (PWD) Application comprised of the applicant information dated December 12, 2012 and the physician report dated November 4, 2012 and completed by a general practitioner who has treated the appellant for 1 year and an assessor report dated October 9, 2012 completed by a social worker who has known the appellant for more than 10 years; 2) Statement dated February 1, 2013 by a friend and former roommate of the appellant in which he states in part that he has witnessed the appellant's pain and that she stays with him a few times a week and sometimes longer if she is having one of her "down" spells. The appellant has a hard time getting up in the morning and sometimes needs help to get out of bed or up from a chair. Some days she does not have enough energy to do anything and those are "pyjama days" for her. The pain in her neck and arms seems to have gotten worse and when the pain is particularly bad, she has a hard time doing things with anything heavier than a coffee cup. Her hip and lower back are always sore and she moves a lot slower and favours her left hip even when standing. The appellant does basic small chores at her place in her room, bathroom, and her dishes but she still needs to take breaks after a few minutes. She hurts more in winter time and she cannot go on her short walks for fear of falling. He lent her money to pay for her first 5 lidocaine infusions because it allowed her 20 minutes on her feet as opposed to 5 minutes; 3) Fax Sheet dated February 5, 2013 from the ministry to the general practitioner who completed the physician report and requesting clarification on a couple of points. Firstly, to clarify the frequency and duration of the periodic assistance required for personal self care, meal preparation, basic housework, daily shopping, and mobility inside and outside the home and the note in the report that "when has pain function deteriorates." The general practitioner responded that the appellant "has baseline chronic pain that affects these AOL's. Monthly flares of pain that make these worse." Secondly, in response to a request to specify the impacts to the appellant's cognitive and emotional functioning, the general practitioner indicated major impacts to bodily functions and emotion, moderate impacts to attention/concentration, executive, memory, and motivation. Minimal or no impacts are reported to the remaining 9 areas of functioning. The general practitioner notes that the PHQ score is 28 (over 20 is indicated as major depression, severe) and the GAD score is 19 and that the appellant is to see a counselor; and, 4) Request for Reconsideration-Reasons. Diagnoses The appellant has been diagnosed by her general practitioner with depression/ anxiety, fibromyalgia, and cervical spinal stenosis. Although the general practitioner also listed rheumatoid arthritis, it was noted that this is "being worked up currently." The general practitioner commented in the health history that the appellant claims to have rheumatoid arthritis but there is no verification of this within her current or previous charts. The general practitioner provided additional comments that the appellant will be seeing a rheumatologist to discuss a diagnosis of rheumatoid arthritis. Physical Impairment • In the physician report under health history, the general practitioner indicated that the appellant has " ... debilitating pain from chronic cervical stenosis ... affects all aspects of patient's life. Has not been functional for many years ... lidocaine infusions were benefitting patient and she was able to get off narcotic pain killers. However, she is not currently covered and is not getting infusions presently." • Functional skills reported in the physician report indicated that the appellant can walk 2 to 4 blocks unaided, she can climb 5 or more steps unaided, she can lift under 5 lbs. and remain seated less than 1 hour. • The general practitioner reported that the appellant has been prescribed medications that interfere with her ability to perform her daily living activities (DLA) as they cause drowsiness, and she does require an aids for her impairment with the note " ... patient states uses cane for lonq walks." In the assessor
I APPEAL# report, the social worker also indicated the use of a cane as an assistive device and noted " ... uses cane on long walks." • The appellant is assessed by the social worker as independent with walking indoors and walking outdoors and with climbing stairs and standing as well as with lifting and carrying and holding. The social worker also indicated that the appellant takes significantly longer with walking indoors ("takes twice as long") and with standing ("limited-no more than 20 minutes"). The social worker reported that the appellant uses an assistive device for walking outdoors ("needs a cane") and with climbing stairs ("uses cane or railing"). Periodic assistance from another person is also indicated for lifting and carrying and holding ("needs help with lifting and carrying groceries. Relies on room-mate or neighbours"). The social worker also commented that the appellant requires frequent trips to the doctor, that the lidocaine infusions are not being paid for by the ministry, leaving the appellant in pain. • Regarding the degree and course of the impairment, the general practitioner wrote that the appellant's " ... condition is degenerative and will likely deteriorate over time. Medications control symptoms to some degree but do not alter the course of the disease." • In her self-report included with the PWD application, the appellant wrote that she has stenosis in her neck that affects the muscles in her neck, shoulders, arms and hands. She has degenerative disc disease in L4 and LS which involves daily pain. With her fibromyalgia, "everything feels bruised" from her neck down. She is affected mostly in her left hip and leg with rheumatoid arthritis. • The appellant stated that all of her conditions mean that she is in pain all the time and her life is focused on pain management. She takes 17 pills a day for the purpose of managing her pain. The medications make her feel "woozy." She is exhausted all the time due to all these conditions. • The appellant stated that the pain gets worse with walking but she tries to push herself, that she always walks slowly and can walk about 4 blocks before she needs to rest. The appellant wrote that she is also slow climbing the stairs and always uses the railing to pull herself up. Due to her arm pain, she can lift only less than 5 lbs. She can only remain seated for less than an hour. If she stays in a position too long, she seizes up. She gets muscle spasms in her hip and lower back and "it burns." • In her Request for Reconsideration, the appellant wrote that her muscles are in pain all the time which affects her mobility and her stamina to do things. She does things slowly and requires rests. • The appellant wrote that when she goes out for short walks to address her pain, she always takes her cane with her. She needs her cane for most trips outside her home. Her home is small so she does not need her cane indoors but she needs to lean up against things for stability. • The appellant wrote that stairs are painful and she avoids them when she can. • The appellant wrote that she has bars in the bathroom that she needs for getting in and out of the tub. Mental Impairment • The general practitioner reported that the appellant has no difficulties with communication and the social worker indicated that she has a good ability to communicate in all areas with the note that she is unable to write sometimes because her hands seize up. • In the physician report, the general practitioner indicated that there are significant deficits in the appellant's cognitive and emotional functioning in the areas of consciousness, emotional disturbance, motivation, motor activity and attention or sustained concentration, with the comment that the appellant has " ... history of suicide attempts due to stress, depression, anxiety. History of physical and psychological abuse." • In the assessor report, the social worker indicated that the appellant has major impacts to her cognitive and emotional functioning in the areas of bodily functions and emotion. Moderate impacts are indicated in consciousness, attention/concentration, memory and motivation. No or minimal impacts are reported in the remaining 8 areas of functioning. • The social worker indicated that the appellant independently manages 4 of 5 listed aspects of social functioning, including making appropriate social decisions, developing and maintaining relationships, interactinq aooropriately with others, and securinq assistance from others ("qood at asking for and
I APPEAL# allowing others to help") The social worker reported that the appellant requires periodic support/supervision with dealing appropriately with unexpected demands, with the explanation that she " ... can get upset and emotional; friends support her through this"). The social worker indicated that the appellant has marginal functioning with her immediate social network ("can be defensive; gets frustrated") and good functioning in her extended social networks. Daily Living Activities (OLA) • In the physician report, the general practitioner indicated that the appellant is periodically restricted with personal self care, meal preparation, basic housework, daily shopping, mobility inside the home and mobility outside the home. The appellant is not restricted with management of medications, use of transportation, management of finances, or social functioning. The general practitioner explains for periodic restrictions that " ... when has pain function deteriorates." • In the assessor report, the appellant is assessed as independent with walking indoors and walking outdoors, 2 to 4 blocks unaided. The appellant requires a cane for longer distances. • The social worker reported that all listed tasks of the DLA personal care are performed independently. She requires periodic assistance from another person and takes significantly longer than typical with dressing ("needs help with zippers. 50% longer than normal"), and takes 50% longer than typical with grooming and bathing and takes twice as long with transfers in/out of bed ("needs to roll out-stiff in mornings"). • The appellant is assessed as being independent with basic housekeeping but taking 50% longer than typical with doing laundry and basic housework. • For shopping, the social worker assessed the appellant as independent with all tasks. She also requires periodic assistance from another person with carrying purchases home ("limited strength; needs help with groceries") and takes significantly longer than typical with going to and from stores ("walks slowly"). • The social worker reported that the appellant is independent with all tasks of the DLA meals and takes 50% longer than typical with food preparation, cooking and safe storage of food. • All listed tasks for the DLA of paying rent and bills are managed independently with no noted restrictions. • For medications, the social worker reported that the appellant is independent with all tasks and requires periodic assistance from another person with filling/refilling prescriptions ("sometimes needs someone else to pick up meds"). • For transportation, the social worker indicated that the appellant is independent in all areas and requires periodic assistance from another person with getting in and out of a vehicle ("depends on height of vehicle") with the note that the appellant "uses bus system or asks friends for rides; has had to hitchhike at times." Additional comments by the social worker are that the appellant " ... describes herself as stubborn, which has forced her to be very independent, sometimes to the point where she exceeds her limitations, resulting in pain and no energy for days." • The social worker assessed the appellant as being independent in 4 of 5 areas of social functioning. • In her self-report, the appellant wrote that there are days when she stays in her pajamas all day long because of the pain she experiences and she estimates that this happens 3 days a week. The appellant wrote that she loves to cook but it takes her 50% longer because of her condition. She usually has help cooking. Basic housekeeping takes her significantly longer than typical and she gets help with tasks that involve lifting and carrying. She gets help with daily shopping, with lifting. • In her Request for Reconsideration, the appellant wrote that while she is in pain every day, sometimes her activities are even more restricted than usual. About 3 days a week her friend is able to do her DLA for her so she can manage her pain. Some of the medications she is taking can "take the edge off' her pain, but it does not remove it.
IA PPEAL# Need for Help • The social worker reported that the appellant lives alone in shared accommodation and uses a cane as an assistive device "on long walks." • The social worker indicated that the help required for DLA is provided by friends and she "talks with doctor about emotional issues." In her Notice of Appeal, the appellant expressed her intention to dispute the reconsideration decision. Prior to the hearing, the appellant provided a letter dated April 4, 2013 from the general practitioner who completed the reports for the PWD application and included the following : • The general practitioner was asked by the appellant to clarify his comment that she has "flares of her baseline pain." The general practitioner wrote that, since completing the initial PWD report, he has " ... been able to verify with an independent opinion." He wrote that " ... it was her long-term partner which may bias his opinion but I felt that he was being honest in his opinion." • The general practitioner wrote that the appellant has significant pain that interferes with her DLA every day of the week. It seems to be so bad that she is exhausted and in pain after doing something as simple as making the bed. This interferes with her ability to complete her DLA and precludes her ability to pursue gainful employment at this time. • The general practitioner wrote that the appellant " ... experiences flares of her pain that happen weekly and bring her pain from an average of 6/1 Oto 8-9/1 O and last from hours to days. During these periods of flares that patient is unable to do any activity without experiencing significant pain." At the hearing, the appellant provided the following oral evidence: • The appellant stated that her bad spells are when her pain is particularly bad and she will not get out of bed. Her fibromyalgia is in her whole body plus her hip and back are bad, especially on a rainy day. The appellant estimated that she has these bad spells 3 or 4 times per week, that they are triggered by cold or damp weather, increased activity, or stress. • The appellant agreed that her conditions are episodic in nature in that the pain is worse when it is raining but she is always in pain. The fibromyalgia also attacks her neck and hip. • The appellant stated that she has known the social worker who completed the assessor report for over 10 years and sees him at the hospital when she goes for her lidocaine injections. • The appellant stated that in a few days she has a consult appointment with a rheumatologist and that she has waited 3 1/ 2 years to meet with this specialist. The appellant acknowledged that, until she meets with the specialist, a diagnosis of rheumatoid arthritis is not yet confirmed. • The appellant stated that she lives in shared accommodation and that she used to get help from her room-mate but her room-mate has children and "family hanging around quite a bit" so she is not able to help much anymore. • The appellant stated that they share a kitchen so if her room-mate is cooking a meal, the appellant will "chip in" and do what she can, but she has a hard time lifting heavy pots. The appellant stated that most of the time she will "cook light." • The appellant stated that she has been hanging out with her boyfriend more and he helps her, as well as the appellant's friends who live in the neighbourhood. • The appellant stated that right now her cane is "wrecked" and she has a stick she uses for walking but she has not been walking much. • The appellant stated that she has light exercises she does at home and she enjoys yoga to help her warm up.
I APPEAL# The ministry did not object to the admissibility of the letter or to the appellant's oral evidence. The panel admitted the letter from the general practitioner and the oral evidence, pursuant to Section 22(4) of the Employment and Assistance Act, as providing further detail relating to the appellant's medical conditions and being in support of information that was before the ministry on reconsideration. At the hearing, the ministry relied on its reconsideration decision.
IA PPEAL# PART F Reasons for Panel Decision The issue on the appeal is whether the ministry's decision, that the appellant is not eligible for designation as a person with disabilities (PWD) as she does not meet all the criteria in Section 2 of the EAPWDA, was reasonably supported by the evidence or was a reasonable application of the applicable enactment in the circumstances of the appellant. The ministry found that the appellant has a severe mental impairment but that her daily living activities (DLA) are not, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods and that, as a result of those restrictions, it could not be determined that the appellant requires the significant help or supervision of another person, the use of an assistive device, or the services of an assistance animal to perform DLA. The criteria for being designated as a person with disabilities (PWD) are set out in Section 2 of the EAPWDA as follows: Persons with disabilities 2 (1) In this section: "assistive device" means a device designed to enable a person to perform a daily living activity that, because of a severe mental or physical impairment, the person is unable to perform; "daily living activity" has the prescribed meaning; "prescribed professional" has the prescribed meaning. (2) The minister may designate a person who has reached 18 years of age as a person with disabilities for the purposes of this Act if the minister is satisfied that the person has a severe mental or physical impairment that (a) in the opinion of a medical practitioner is likely to continue for at least 2 years, and (b) in the opinion of a prescribed professional (i) directly and significantly restricts the person's ability to perform daily living activities either (A) continuously, or (B) periodically for extended periods, and (ii) as a result of those restrictions, the person requires help to perform those activities. (3) For the purposes of subsection (2), (a) a person who has a severe mental impairment includes a person with a mental disorder, and (b) a person requires help in relation to a daily living activity if, in order to perform it, the person requires (i) an assistive device, (ii) the significant help or supervision of another person, or (iii) the services of an assistance animal. (4) The minister may rescind a designation under subsection (2). Section 2(1)(a) of the EAPWDR defines DLA for a person who has a severe physical or mental impairment as follows: Definitions for Act 2 (1) For the purposes of the Act and this regulation, "daily living activities" , (a) in relation to a person who has a severe physical impairment or a severe mental impairment, means the following activities: (i) prepare own meals; (ii) manage personal finances; (iii) shop for personal needs;
I APPEAL# (iv) use public or personal transportation facilities; (v) perform housework to maintain the person's place of residence in acceptable sanitary condition: (vi) move about indoors and outdoors; (vii) perform personal hygiene and self care; (viii) manage personal medication, and (b) in relation to a person who has a severe mental impairment, includes the following activities: {i) make decisions about personal activities, care or finances; (ii) relate to, communicate or interact with others effectively. (2) For the purposes of the Act, "prescribed professional" means a person who is authorized under an enactment to practice the profession of (a) medical practitioner, (b) registered psychologist, (c) registered nurse or registered psychiatric nurse, (d) occupational therapist, (e) physical therapist, (f) social worker, (g) chiropractor, or (h) nurse practitioner. The panel considered each party's position regarding the reasonableness of the ministry's decision under the applicable PWD criteria at issue in this appeal. Severe Physical Impairment The appellant's position is that a severe physical impairment is also established by the evidence of the pain in her back and neck from her cervical spinal stenosis and fibromyalgia. The advocate argued that the evidence from the doctor in the PWD application and the letter dated April 4, 2013, together with the appellant's evidence that she takes 17 pills a day for pain management establishes that she has a severe physical impairment. The ministry's position is that while it is recognized that the appellant has limitations as a result of her physical conditions, the ministry finds that the functional skill limitations are more in keeping with a moderate degree of impairment. The ministry argued that the general practitioner reported that, in terms of physical functioning, the appellant is able to walk 2 to 4 blocks and to climb 5 or more steps unaided, to lift less than 5 lbs. and to sit for less than an hour. The general practitioner indicated that the appellant uses a cane for walking long distances. The ministry argued that in terms of mobility and physical ability the social worker reported that the appellant is independent in all areas and takes twice as long when walking indoors and needs a cane for walking outdoors. Panel Decision The diagnosis of a medical condition is not itself determinative of a severe impairment. To assess the severity of an impairment one must consider the nature of the impairment and its impact on the appellant's daily functioning as evidenced by functional skill limitations and the restrictions to DLA. The ministry describes this approach well when it defines the word "impairment" in the physician report as being "a loss or abnormality of psychological, anatomical or physiological structure or function causing a restriction in the ability to function independently, effectivelv, annrooriatelv or for a reasonable duration." This definition is not set out in
I APPEAL# legislation and is not binding on the panel, but in the panel's view it quite appropriately describes the legislative intent. The legislation clearly provides that the determination of severity of impairment is at the discretion of the minister, taking into account all of the evidence including that of the appellant. However, the legislation is also clear that the fundamental basis for the analysis is the evidence from a medical practitioner or prescribed professional respecting the nature of the impairment and its impact on daily functioning. The medical practitioner, the appellant's general practitioner of one year, has diagnosed the appellant with cervical spinal stenosis and fibromyalgia. The general practitioner described the appellant's medical condition as " ... debilitating pain from chronic cervical stenosis ... affects all aspects of patient's life. Has not been functional for many years ... lidocaine infusions were benefitting patient and she ... is not getting infusions presently." The general practitioner assessed the appellant's functional skills as able to walk 2 to 4 blocks unaided, to climb 5 or more steps unaided, to lift under 5 lbs. and remain seated less than 1 hour. Likewise, the social worker who has known the appellant over 10 years assessed her as independent with walking indoors, walking outdoors, with climbing stairs and standing, as well as with lifting and carrying and holding. The social worker reported that the appellant uses a cane for walking outdoors as well as with climbing stairs and requires periodic assistance from another person for lifting and carrying and holding. In her self-report, the appellant stated that she takes 17 pills a day for the purpose of managing her pain and that the medications make her feel "woozy." The appellant wrote that she is also slow climbing the stairs and always uses the railing to pull herself up. Due to her arm pain, she can lift only less than 5 lbs. She can only remain seated for less than an hour since if she stays in a position too long, she seizes up. The appellant stated that the pain gets worse with walking but she tries to push herself, that she always walks slowly and can walk about 4 blocks before she needs to rest. The appellant stated that she needs her cane for most trips outside her home, and both the general practitioner and the social worker indicated that the appellant needs a cane for longer walks, which the panel finds would be for distances in excess of 4 blocks. In response to the request of February 5, 2013 for clarification of the comment that "when has pain function deteriorates", the general practitioner responded that the appellant "has baseline chronic pain that affects these AOL's, monthly flares of pain that make these worse." In the April 4, 2014 letter the general practitioner further responded to the appellant's request to clarify his comment that she has "flares of her baseline pain" and there is no explanation provided by the general practitioner as to the reason for changing his previous clarification to the ministry that the appellant experiences monthly flares of pain. He wrote that the appellant's long-term partner, whom the general practitioner believed was being honest regardless of the potential for bias, provided independent evidence of the appellant's flares of pain. The general practitioner wrote in his letter, based on the opinion of the appellant's partner, that the appellant experiences weekly flares of her pain that bring it from an average of 6/10 to 8-9/10 and last from hours to days. In his February 1, 2013 statement, the appellant's partner stated that the appellant stays with him a few times a week and sometimes longer if she is having one of her "down" spells. He also stated that "some days" the appellant does not have enough energy to do anything and those are "pyjama days" for her, and the panel finds that it is not clear whether the appellant's down spells or pyjama days or the flares of her pain are one and the same. Given the range of opinion on the frequency and duration of these flares of the appellant's pain, from monthly to a few hours a week to several days each week, the panel finds that the ministry reasonably concluded that the evidence does not establish significant restrictions to the appellant's physical functioning beyond the functional skill limitations identified, which indicate a moderate degree of impairment. The panel finds that the ministry's determination that the evidence does not establish that the appellant has a severe physical impainment as required under Section 2(2) of the EAPWDA was reasonable. Severe Mental Impairment At reconsideration, the ministry was satisfied that the information provided is evidence of a severe mental impairment.
I APPEAL# Restrictions in the ability to perform DLA The appellant's position is that her physical and mental impairments directly and significantly restrict her ability to perform DLA and she requires the significant assistance of another person or the use of an assistive device to perform many DLA. The ministry's position is that the evidence of the prescribed professionals does not establish that the appellant's impairment significantly restricts DLA either continuously or periodically for extended periods of time. The ministry argued that taking 50% longer with 8 aspects of DLA, twice as long with one aspect of DLA and walking slowly to and from stores reflects a moderate restriction in the appellant's ability to perform DLA. The ministry argued that monthly flares of pain which more significantly impact the appellant's ability to perform DLA are of unspecified duration and does not indicate that the appellant's DLA are restricted periodically for extended periods. Panel Decision The evidence of the prescribed professionals, the appellant's general practitioner and a social worker, is that the appellant is independent with walking indoors and with walking outdoors up to 4 blocks unaided, and that she requires a cane for walking longer distances. The general practitioner indicated that the appellant is periodically restricted with several DLA, including personal self care, meal preparation, basic housework, daily shopping, mobility inside the home and mobility outside the home and that she is not restricted with several DLA, namely management of medications, use of transportation, management of finances, or social functioning. The general practitioner explained that, for the periodic restrictions, " ... when has pain function deteriorates." As set out above, in response to requests to clarify the frequency and duration of the deteriorations, the general practitioner first clarified with the ministry in February 2013 that these are monthly flares of pain and, in April 2013, that these are weekly and range from hours to days. In the assessor report, · the social worker reported that all listed tasks of all DLA are performed independently with a need for periodic · assistance from another person with 5 aspects of DLA and no further clarification provided of the frequency or duration of the periodic assistance. The social worker also indicated that the appellant takes 50% longer with 8 aspects of DLA, and twice as long with one aspect, all due to physical impacts of stiffness, limited strength and pain. Additional comments by the social worker are that the appellant " ... describes herself as stubborn, which has forced her to be very independent, sometimes to the point where she exceeds her limitations, resulting in pain and no energy for days." Given the range of opinion on the frequency and duration of the flares of the appellant's pain, the panel finds that the ministry reasonably concluded that the evidence does not establish that the appellant's physical impairment significantly restricts her ability to perform DLA either continuously or periodically for extended periods of time. For those DLA relating to a person with a severe mental impairment, the general practitioner indicated in the · physician report that the appellant is not restricted with social functioning and she has no difficulties with communication. In the assessor report, the social worker indicated that the appellant is independent with making appropriate social decisions, with developing and maintaining relationships, interacting appropriately with others, and securing assistance from others and that she is " ... good at asking for and allowing others to help." The panel concludes that the noted restrictions in the appellant's ability to perform some aspects of some DLA were reasonably viewed by the ministry as not constituting a direct and significant restriction of the appellant's ability to perform DLA in the opinion of a prescribed professional thereby not satisfying the legislative criterion of Section 2(2)(b)(i) of the EAPWDA. Help to perform DLA The appellant's position is that she requires the significant assistance of another person to perform DLA and the use of a cane as an assistive device.
I APPEAL# The ministry's position is that because it has not been established that DLA are significantly restricted, it cannot be determined that significant help is required from other persons, and a cane is required as an assistive device for long walks. Panel Decision Section 2(2)(b)(ii) of the EAPWDA requires that, as a result of direct and significant restrictions in the ability to perform DLA, a person requires help to perform those activities. Help is defined in subsection (3) as the requirement for an assistive device or the significant help or supervision of another person or the services of an assistance animal in order to perform a DLA. The social worker reported that the appellant lives alone in shared accommodation, that she uses a cane as an assistive device on long walks, and that help required for DLA is provided by friends and she "talks with doctor about emotional issues." While the panel finds that the evidence of the prescribed professional establishes that the appellant requires some assistance with tasks of some DLA, the panel also finds that the ministry reasonably determined that, as direct and significant restrictions in the appellant's ability to perform DLA have not been established, it cannot be determined that the appellant requires help to perform DLA as a result of those restrictions. Conclusion Having reviewed and considered all of the evidence and relevant legislation, the panel finds that the ministry's reconsideration decision which determined that the appellant was not eligible for PWD designation was reasonably supported by the evidence, and therefore confirms the decision.
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