P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e r e c o n s i d e r a t i o n d e S o c i a l I n n o v a t i o n ( t h e m i n i s t r y ) d a t e d 2 0 J a n u a r y 2 0 w i t h d i s a b i l i t i e s ( P W D ) . T h e m i n i s t r y d e t e r m i n e d t h a c r i t e r i a f o r P W D d e s i g n a t i o n s e t o u t i n t h e E m p l o y m A c t , s e c t i o n 2 . S p e c i f i c a l l y , t h e m i n i s t r y d e t e r m i n e d t h e a p p e l l a n t h a s a s e v e r e m e n t a l o r p h y s i c a l i m p a i p r o f e s s i o n a l ( i ) d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s h i s a b i l i t y t o p c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s ; a n ( i i ) a s a r e s u l t o f t h o s e r e s t r i c t i o n s , h e r e q u i r e s h e T h e m i n i s t r y d e t e r m i n e d t h a t t h e a p p e l l a n t s a t i s f i e d a g e a n d h i s i m p a i r m e n t i n t h e o p i n i o n o f a m e d i c a l p y e a r s . P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E M T 0 0 3 ( 1 0 1 0 6 1 0 1 )c i s i o n o f t h e M i n i s t r y o f S o c i a l D e v e l o p m e n t a n d 1 4 d e n y i n g t h e a p p e l l a n t d e s i g n a t i o n a s a p e r s o n t t h e a p p e l l a n t d i d n o t m e e t a l l o f t h e r e q u i r e d e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b i l i t i e s t h a t t h e i n f o r m a t i o n p r o v i d e d d i d n o t e s t a b l i s h t h a t r m e n t t h a t i n t h e o p i n i o n o f a p r e s c r i b e d e r f o r m d a i l y l i v i n g a c t i v i t i e s ( D L A ) e i t h e r d , l p t o p e r f o r m t h o s e a c t i v i t i e s . t h e o t h e r 2 c r i t e r i a : h e h a s r e a c h e d 1 8 y e a r s o f r a c t i t i o n e r i s l i k e l y t o c o n t i n u e fo r a t l e a s t 2 i l i t i e s A c t ( E A P W D A ) s e c t i o n 2 i l i t i e s R e g u l a t i o n ( E A P W D R ) s e c t i o n 2
PART E -Surnrnarv of F a cts The evi d ence befo r e t he ministry at reco nsideration 1. The appellant's PWD Designatio n App lication • A Physician R eport (PR) dated 23 July 2013, completed practitioner (GP), wh o h as known the appellant since Ma ti mes in that time. • An Assess or Rep ort (AR ) da t e d 29 July 2 013 ( PT), wh o has known him for 2 months and • A Self R e port (SR ) co m pleted b y t he a ppellant. 2. The appellant ' s Request for Reconsider ation, stat ement b y the appellant a nd an ad v oc ate-prepa attached were s everal infor mation sheets r egarding referrals and numerous prescript i on dr u g r e I n the P R , th e GP diag n ose s t he appellant's impair ( onset 198 0) a nd C OPD (chronic obstructive pulmona T h e pan el will first summa r ize the e vide n c e from t he i ssu e. Sev erit y o f impai rment Ph ys ical impai rment PR: Un d er Health Hi s t or y, the GP w r ites t hat th e a ppellant spi n e for q uite s ome t ime. He is u nable to per f or m on a job or at home. The p ain is only c ontrol led with analg The GP indicates that the appella n t has not been prescr interfere with his ability to perform DLA. The GP also indic prostheses or aids for hi s impairment. The GP reports that the appellant can walk unaided on a flat surface limited to lif tin g u nde r 5 lb s . a nd can remain seated 2 to 3 hours. The GP comments that the appellant has an issue with lifting heavy things and exertion/work. He is unable to work for more than 2 -3 hours. He is able to take care of himself like grooming, cooking, cleaning and wa shi ng, et c. AR: T he PT describes t h e appe l lant's impa i rm ent t ha t i mpacts his ability to disc disease in lumbar spine plus left rotator cuff tendinitis. Mental impairment EAAT 003(10/06/01) consisted of the following: dated 23 July 2013. The Application contained: by the appellan t 's general y 2013 and has se en him 2-10 comp leted by a ppellant's p h ysical ther apist s e en him 2-10 ti mes in that pe riod. dated 0 5 Janua ry 2014, with an attac hed red qu e sti o nnaire completed by his G P; a l s o his prescription m e dications, treatment ceipts. m ent as d egene rati ve disc dis eas e, l um b ar spine r y dis eas e), ch ronic br onchi tis (o n se t 2001 ) . PR a nd the AR it re lat es to the PWD cr iter ia a t has had de g e ner ativ e di sc dise ase of l um b ar hi s d ai ly ac t iv ities and oth er k inds of ph ysi cal w or k esics. ib ed any medication and/or treatments that a tes that the appellant doe s not require any 2 to 4 blocks, c l i mb 5+ s t eps , is m a nage DLA as degen era tive
P R : T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t h a s n o d i f f i c u l t T h e G P a s s e s s e s t h e a p p e l l a n t w i t h a s i g n i f i c a n t d a r e a o f e m o t i o n a l d i s t u r b a n c e , c o m m e n t i n g t h a t c h A R : T h e P T a s s e s s e s a s g o o d t h e a p p e l l a n t ' s a b i l i t y i n T h e P T p r o v i d e s t h e f o l l o w i n g a s s e s s m e n t s o f t h e d a i l y f u n c t i o n i n g : m o d e r a t e i m p a c t i n t h e a r e a s o f e i m p a c t i n t h e a r e a s o f b o d i l y f u n c t i o n s a n d i m p u l s e i m p a c t t a b l e b a s e d o n h o w p h y s i c a l a i l m e n t a f f e c t s w a s f o r m e n t a l i m p a i r m e n t o r b r a i n i n j u r y . A b il i t y t o p e l f o r m O L A P R : T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t ' s i m p a i r m e n t s p e rf o r m D L A . T h e G P a s s e s s e s t h e a p p e l l a n t i n d e p e n d e n t f o r a l a n s w e r t o t h e q u e s t i o n a s t o w h a t a s s i s t a n c e t h e a A R : T h e P T r e p o r t s t h a t t h e a p p e l l a n t l i v e s a l o n e . R e g a r d i n g m o b i l i t y a n d p h y s i c a l a b i l i t y , t h e P T a s s i n d o o r s , w a l k i n g o u t d o o r s , c l i m b i n g s t a i r s , s t a n d i n g 2 a c t i v i t i e s a r e r e s t r i c t e d t o < 5 l b s . T h e P T c o m m e w i t h l i f t i n g / c a r ry i n g i f h e s t a y s w i t h i n g u i d e l i n e s . T h e G P a s s e s s e s t h e a p p e l l a n t a s i n d e p e n d e n t f o r w i t h a m e n t a l o r p h y s i c a l p a i r : p e r s o n a l c a r e , b a s i c b i l l s , m e d i c a t i o n s , a n d t r a n s p o r t a t i o n W i t h r e s p e c t t o s o c i a l f u n c t i o n i n g , t h e P T p r o v i d e s r e q u i r e d o r i m p a c t s o n s o c i a l f u n c t i o n i n g w i t h i m m e H e l p p r o v i d e d /r e q u i r e d P R : T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t d o e s n o t r e q u i r A R : T h e P T d o e s n o t i n d i c a t e t h a t t h e a n n e l l a n t i s p r o v i E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )i e s w i t h c o m m u n i c a t i o n e f i c i t w i t h c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n t h e r o n i c p a i n c a n l e a d t o d e p r e s s i o n o r a n x i e t y . s p e a k i n g , r e a d i n g , w r i t i n g a n d h e a r i n g . i m p a c t o f t h e a p p e l l a n t ' s m e n t a l i m p a i r m e n t o n m o t i o n a n d a t t e n t i o n / c o n c e n t r a t i o n ; m i n i m a l c o n t r o l . T h e P T n o t e s t h a t h e s t a r t e d t o f i l l o u t t h i s m e n t a l f u n c t i o n b u t t h e n r e a d t h a t t h e s e c t i o n d o n o t d i r e c t l y r e s t r i c t t h e a p p e l l a n t ' s a b i l i t y t o l l i s t e d D L A , i n c l u d i n g s o c i a l f u n c t i o n i n g , a n d i n p p e l l a n t n e e d s w i t h D L A a n s w e r s " N o n e . " e s s e s t h e a p p e l l a n t i n d e p e n d e n t f o r w a l k i n g , l i f t i n g a n d c a r r y i n g a n d h o l d i n g , n o t i n g t h e l a t t e r n t s t h a t t h e a p p e l l a n t i s a b l e t o b e i n d e p e n d e n t a l l a s p e c t s o f a l l o t h e r D L A a p p l i c a b l e t o a p e r s o n h o u s e k e e p i n g , s h o p p i n g , m e a l s , p a y i n g r e n t a n d n o a s s e s s m e n t w i t h r e s p e c t t o s u p p o rt / s u p e r v i s i o n d i a t e a n d e x t e n d e d s o c i a l n e t w o r k s . e a n y p r o s t h e s e s o r a i d s f o r h i s i m p a i r m e n t . d e d a s s i s t a n c e b v o t h e r o e o o l e , c o m m e n t i n q " n o t
a t t h a t l e v e l . N o h e l p r e q u i r e d . " I n t e r m s o f a s s i s t a n c e p r o v i d e d t h r o u g h t h e u s e o f " b r e a t h i n g d e v i c e , " c o m m e n t i n g t h i s i s r e q u i r e d f o r S e lf r e p o rl I n h i s S R t h e a p p e l l a n t w r i t e s t h a t h i s d e g e n e r a t i v e g o t t e n p r o g r e s s i v e l y w o r s e w i t h m o r e a r e a s a f f e c t e p a i n m e d i c a t i o n j u s t t o g e t o u t o f b e d i n t h e m o r n i n c o u p l e o f h o u r s b e f o r e h e n e e d s t o r e s t , l i e d o w n , m e d i c a t i o n a f t e r a r e s p i t e o f a n h o u r o r t w o . H e h a d i a g n o s e d a r t h r i t i c s y m p t o m s a l o n g w i t h h i s d i s c d H e w r i t e s t h a t h e u s e d t o b e a b l e t o w o r k a l l d a y a w o r k . T h i s h a s r e a l l y t a k e n i t s t o l l o v e r t h e l a s t r e c e c a n n o t s t a y a t a n y t h i n g v e r y l o n g b e f o r e b e i n g a ff e h i m t o b e i n a h u n c h e d o v e r , u n c o o r d i n a t e d a n d p a H e c o n c l u d e s b y w r i t i n g t h a t h e s t i l l h a s t h e a b i l i t y I n t h e R e q u e s t f o r R e c o n s i d e r a t i o n t h e a p p e l l a n t w c o n f u s i n g , a s d i d h i s G P w h o h a d r e c e n t l y a r r i v e d c o m p l e t e d o n t h e p r e m i s e o f w h a t w o u l d b e t h e m a l o w e s t t h r e s h o l d t h e p a i n . H o w e v e r a s e v e r y o n e k n h o u r t o h o u r . T h e r e f o r e h e i s s u b m i t t i n g a s u p p l e m n o t e s t h a t h i s G P h a s d i a g n o s e d a d e f i c i t w i t h c o g n d e p r e s s i o n a n d a n x i e t y t h i s i s a l s o a g e n e t i c t r a i t c h r o n i c p a i n . H e q u e s t i o n s t h e q u a l i f i c a t i o n s o f t h e t h i s r e s p e c t . H e a l s o n o t e s t h a t h e i s c u r r e n t l y a t t e n t o o e a r l y i n t h e t r e a t m e n t t o k n o w i f i t w i l l b e e f f e c t i s i d e e f f e c t o f v e r y s t i f f , s o r e m u s c l e s a n d t r e a t e d a a p p r o x i m a t e l y 2 4 -3 6 h o u r s . T h i s a f f e c t s h i s a b i l i t y h e l p . H e c o n c l u d e s b y p r o v i d i n g a h i s t o r y o f m e d i c I n t h e a d v o c a t e p r e p a r e d q u e s t i o n n a i r e , c o m p l e t e d 2 0 1 3 , t h e G P i n d i c a t e s w i t h a t i c k m a r k t h a t h e a g r • h e i s a b l e t o w a l k u p t o o n l y 1 b l o c k o n f l a t s • h e h a s t o u s e a h a n d r a i l a t a l l t i m e s w h e n c l • h e i s o n l y a b l e t o l i f t u p t o 4 p o u n d s a t a t i m e • h e i s o n l y a b l e t o s i t f o r 3 0 -4 5 m i n u t e s a t t h • h e n e e d s t o h o l d o n t o s o m e t h i n g f o r s u p p o r t T h e G P a l s o i n d i c a t e s a g r e e m e n t w i t h t h e a p p e l l a n a s s i s t a n c e f r o m f a m i l y a t l e a s t 3 -4 d a y s p e r w e e k t r a n s f e r s i n / o u t o f b e d a n d t h a t h e n e e d s t o b e p u l l e w e e k . T h e G P a l s o i n d i c a t e s a r e e m e n t w i t h t h e a e l l a n EAA T 0 0 3 ( 1 0 / 0 6 1 0 1 )a n a s s i s t i v e d e v i c e , t h e P T p u t s a t i c k m a r k b e s i d e C O P D . d i s c d i s e a s e s t a r t e d i n t h e m i d -1 9 8 0 s a n d h a s d . I t i s g o t t e n t o t h e p o i n t w h e r e h e h a s t o t a k e g . H e c a n n o t w o r k c o n t i n u o u s l y f o r m o r e t h a n a c h a n g e p o s i t i o n s o r i n m o s t c a s e s h a v e m o r e s s e e n a d o c t o r i n h i s h o m e c i t y w h o h a s i s a b i l i t i e s . n d h a s a l w a y s h a d o n l y p h y s i c a l l y d e m a n d i n g n t y e a r s . I n t h e l a s t t w o y e a r s i t s e e m s t h a t h e c t e d b y i n t e n s e l o w e r b a c k a n d s c i a t i c p a i n , f o r c i n g i n f u l p o s t u r e . t o c o o k a n d c l e a n fo r h i m s e l f . r i t e s t h a t h e f o u n d t h e A p p l i c a t i o n f o r m v e r y f r o m a n o t h e r c o u n t r y . T h e o r i g i n a l a p p l i c a t i o n w a s x i m u m o f h i s f u n c t i o n a l s k i l l s o n h i s b e s t d a y , o r o w s , p a i n l e v e l s c a n v a r y f r o m d a y t o d a y o r e v e n e n t a l f o r m p r o v i d e d t o h i s G P b y h i s a d v o c a t e . H e i t i v e a n d e m o t i o n a l f u n c t i o n i n g i n t h e a r e a o f h i s f a m i l y a s w e l l a s b e i n g b r o u g h t o n b y h i s P T t o c o n t r a d i c t o r d i m i n i s h t h e G P ' s d i a g n o s e s i n d i n g a p a i n c l i n i c i n a n o t h e r c i t y , t h o u g h i t i s s t i l l v e i n a n y d e g r e e . H o w e v e r t h e r e i s a n u n f o r t u n a t e r e a s , a c c o m p a n i e d b y e x t r e m e l e t h a r g y f o r t o t e n d f o r h i m s e l f a n d h e h a s t o r e l y o n o t h e r s f o r a t i o n s h e h a s r e c e n t l y t r i a l e d . , s i g n e d a n d s t a m p e d b y t h e G P o n 1 3 D e c e m b e r e e s w i t h t h e a p p e l l a n t ' s s t a t e m e n t s t h a t : u r f a c e . i m b i n g s t a i r s . . e t i m e . a t a l l t i m e s w h e n s t a n d i n g . t ' s s t a t e m e n t t h a t f o r d r e s s i n g , h e n e e d s p e r i o d i c w i t h p u t t i n g o n p a n t s , s h o e s a n d s o c k s a n d f o r d o u t o f b e d b y n e p h e w a t l e a s t 4 -5 d a y s p e r t ' s s t a t e m e n t t h a t h e i s i n n e e d o f c o n t i n u o u s
assistance or is unable to do the following DLA due to his health conditions: • laundry -has to rely on nephew to do his laundry as he is unable to do all the bending required to complete this task. • carrying purchases home -unable over 4 pounds maximum. • budgeting -has gotten himself and financial difficulties. • pay rent and bills -currently behind on rent. The panel notes that, while space is provided in the advocate-prepared questionnaire form specifically for comments, none is provided by the GP. In his Notice of Appeal, dated 04 February 2014 2014, the appellant writes that he does not agree with the decision and will submit further medical information from specialists and doctors if required At the hearing, in his opening presentation and in answer to questions, the appellant provided the following information: • In the time since his original application was completed in July 2013 his condition due to his degenerative disc disease has deteriorated significantly -he estimates that he now has only 1 day/week as a "good day." • He has gone downhill since Christmas and his condition is more in line with the answers provided by the GP in the questionnaire submitted at reconsideration. • He lives in the bottom part of the house, with the upper part occupied by his nephew and family. His nephew will drive him for shopping and appointments 2 -4 /week and help him get up in the mornings and get dressed 4 -5 times/week. He estimates that he is 60 to 70% dependent on other people for his DLA. • Due to the short period of time between being advised of the reconsideration decision and the appeal hearing, he was not able to get appointments to obtain up-to-date information from the specialists he is seeing. In particular, he is seeing a specialist at a pain clinic and at a COPD clinic. The balance of the appellant's remarks went to argument (see Part F, Reasons for Panel Decision, below). The panel finds that the information provided by the appellant in his oral testimony is in support of the evidence before the ministry when ii made the decision under appeal, explaining the answers provided in the GP-completed questionnaire submitted at reconsideration. The panel therefore admits the information provided the appellant under section 22(4) of the Employment and Assistance Act. EMT 003(10/06/01)
PART F -Reasons for Panel Decision The issue in this appeal is whether the ministry reasonably determined that the appellant is ineligible for PWD designation because he did not meet all the requirements in section 2 of the EAPWDA. Specifically the ministry determined that the information provided did not establish that the appellant has a severe mental or physical impairment that in the opinion of a prescribed professional (i) directly and significantly restricts his ability to perform daily living activities either continuously or periodically for extended periods; and, . · (ii) as a result of those restrictions he requires help to perform those activities. The ministry determined that he met the 2 other criteria in EAPWDA section 2(2) set out below. The following section of the EAPWDA applies to this appeal: 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. The following section of the EAPWDR applies to this appeal: 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; (iv) use public or personal transportation facilities; (v) perform housework lo maintain the person's place of residence in acceptable sanitary condition; (vi) move about indoors and outdoors; (vii) perform personal hvaiene and self care; EMT 003(10/06/01)
(v iii) manage personal medication, and ( b ) in relat i on to a person who ha s a severe mental im (i) mak e decisions about personal activities, care or finances; (ii ) relate to, communicate or inte rac t with others effectively. The panel will consider each p a rty 's p ositi on regard under the applicable PWD criteria at issue in this appeal. Severit y o f i m pai rm en t For P WD designation, the legislation requires that a severe mental or physica established. The determinati on of the severity of impa into a ccount a ll the evidence, in cluding that of the applicant. However, the medical e vid ence, with the legislation requiring that a appe llant's GP) identify the im pairment and confir m years . I n the dis cu ssi o n belo w conce rning th e i nf o rm ation imp air ments , the pane l has d ra w n upon the m i nistry cons ists of "cause " an d "impact " com ponents: " impairmen a nat o m i ca l or p h ys i ologica l st ru ct u r e o r function [t h e ca f u nction in de pendently, e f f ectively, appropri a tely o r f is no t se t out i n l e gi s l a ti on and is not binding on th e describes t he legislative in tent . Th e ca u se i s usua lly or even a symp to m (e.g . pain or shortness of br eath). cau s e t o have a s ig nificant i m p a ct on dail y fun ct i oni The p a nel also n otes t h at the le g is lat ion req ui r es that for PWD de "satis f ie d " t h at t he pe rs o n ha s a seve re m ental or physical i "satis f ie d " that the person's i mp a irment is s eve re , the ex p e ct that t h e i nfor ma t i on p rov ide d presen ts a cl ear the impacts o f t he p ers o n's m edi ca l co ndi t i on s on dai Phys ical impai rment I n the r econ si d eration decision t h e m inistry r ev ie ws and co and AR and the information provided by the GP in the advocate-reconsideration. The ministry also noted the app el lant's statement in his request fo that his medication s and treatments have changed. The m are included with his ap pli c ation to help determine the severity of his impairments (e.g. X-ray, MRI). The ministry states that the appellant's original applica the physical therapist, who both agreed that all of his DLA are perform GP indicate s that a few of his DLA are now restricted, he does not provide adequate inf confirm a severe physical impairment. The position of the ministry is that, while the new information has been considered in conjunction with that presented with the original application, the ministry is not satisfied that the information provided is evidence of a severe physical impairmen The a EAAT 003(10106101) p airm en t, inclu d e s the foll o wing a c tivi ties : i ng the reasonableness of t he ministry's decision l impa i r ment b e irment is a t the di scret i on of the m inister, taking star ting point must be m edica l pra cti tioner (i n this case, the that impairmen t will continue for at lea st two pro vi ded regar d ing t he se ver i t y of the ap pellant's 's defi n i t i on of "imp air ment ." T his d e f inition t is a lo s s o r abnorm al ity o f psych olo gical, u s e] ca u sing a restric t i on in t he ab i lity t o or a reas o nabl e d ur ati on [ i mp act]." T his definition panel, but in the pane l 's v i ew it a p prop riat el y set out as a di s ease, co ndi t ion, syndro m e, in j u ry A severe imp air ment requires th e ide n tified ng. sig na t io n, th e minist er must b e mp ai rme n t. F or the m i niste r to be panel con s iders it reasonable for the m inis t ry t o an d comp let e p icture o f the nature an d extent o f l y functioning. mpares the in f o rmati o n provid ed in the P R prepared questionnaire submitted at r re c onsideration i nistry n ot es that n o other medic al reports tion was assessed by both the physician and ed independently. Although the o rmation to t.
a p p l i c a t i o n w a s s u b m i t t e d i n J u l y 2 0 1 3 a n d t h a t t h e d e m o n s t r a t e s t h a t h i s m e d i c a l c o n d i t i o n s s i g n i f i c a n t e s t a b l i s h i n g t h a t h e h a s a s e v e r e p h y s i c a l i m p a i r m e P a n e l f i n d i n g s T h e G P h a s d i a g n o s e d t h e a p p e l l a n t ' s i m p a i r m e n t s C O P D w i t h c h r o n i c b r o n c h i t i s . T h e P T h a s a d d e d a t h i s i s n o t b e e n c o n f i r m e d b y t h e G P a s a n i m p a i r m p a n e l n o t e s t h a t t h e d i a g n o s i s o f c h r o n i c m e d i c a l c o s e v e r e i m p a i r m e n t . A t i s s u e i s i m p a c t o f t h e s e c o n d a b i l i t y t o p e r f o r m D L A . O n e i m p a c t r e p o r t e d i s a r e s l e s s t h a n 5 p o u n d s . I t i s n o t c l e a r t o t h e p a n e l w h e t h d i s c d i s e a s e o r t h e l e f t r o t a t o r c u f f t e n d i n i t i s . T h e p a s t a t e m e n t s m a d e b y t h e G P . U n d e r H e a l t h H i s t o r y t p e r f o r m h i s d a i l y a c t i v i t i e s a n d o t h e r k i n d s o f p h y s i c c o m m e n t i n g t h a t h e i s a b l e t o t a k e c a r e o f h i m s e l f l i A s t h e m i n i s t r y h a s n o t e d , b o t h t h e G P a n d t h e P T h a s p e c t s o f a l l D L A . T h e G P h a s p r o v i d e d r e v i s e d a s q u e s t i o n n a i r e s u b m i t t e d a t r e c o n s i d e r a t i o n a n d a t t h r e v i s e d a s s e s s m e n t s r e f l e c t e d h i s a b i l i t i e s o n " b a d d d e t e r i o r a t i n g p h y s i c a l c o n d i t i o n a n d t h e s i d e e f f e c t s h a s n o t e d , t h e G P d i d n o t t a k e t h e o p p o r t u n i t y p r o v i a n y e x p l a n a t i o n f o r t h e r e v i s e d a s s e s s m e n t s o r a n y c o n d i t i o n . G i v e n t h e c o n s i s t e n t e v i d e n c e i n t h e P R a c h a n g e s i n a s s e s s m e n t s p r o v i d e d b y t h e G P i n t h e w a s r e a s o n a b l e i n d e t e r m i n i n g t h a t a s e v e r e p h y s i c a M e n t a l i m p a i r m e n t . I n t h e r e c o n s i d e r a t i o n d e c i s i o n t h e m i n i s t r y n o t e s t h m i n i s t r y a l s o n o t e s t h a t t h e G P h a s i n d i c a t e d t h a t t h c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n g , w i t h t h e c o m m e a n x i e t y . T h e P T h a s i n d i c a t e d t h a t t h e a p p e l l a n t ' s c o i m p a c t s o n h i s d a i l y f u n c t i o n i n g . N o r e f e r r a l s t o m e n m e n t i o n e d . T h e p o s i t i o n o f t h e m i n i s t r y i s t h a t f o r t h e i n f o r m a t i o n p r o v i d e d i s e v i d e n c e o f a s e v e r e m e n t a l T h e p o s i t i o n o f t h e a p p e l l a n t , a s e x p l a i n e d i n h i s s t a R e c o n s i d e r a t i o n , i s t h a t G P h a s d i a g n o s e d h i m w i t h f u n c t i o n i n g , w i t h h i s p a i n l e v e l s c a u s i n g d e p r e s s i o n e x p e r t i s e o r t r a i n i n g t o d i m i n i s h t h e s e v e r i t y o f t h e G s u f f i c i e n t e v i d e n c e t o e s t a b l i s h a s e v e r e m e n i a l i m p a P a n e l f i n d i n g s T h e a n e l n o t e s t h a t t h e G P h a s n o t d i a n o s e d a m E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )n e w i n f o r m a t i o n p r o v i d e d b y h i s G P c l e a r l y l y r e s t r i c t h i s a b i l i t y t o p e r f o r m D L A , t h e r e b y n t . a s d e g e n e r a t i v e d i s c d i s e a s e , l u m b a r s p i n e , a n d d i a g n o s i s o f l e f t r o t a t o r c u f f t e n d i n i t i s , a l t h o u g h e n t t h a t w i l l c o n t i n u e f o r a t l e a s t 2 y e a r s . T h e n d i t i o n s i s n o t i n i t s e l f s u f f i c i e n t t o e s t a b l i s h a i t i o n s o n d a i l y f u n c t i o n i n g a n d i n p a r t i c u l a r o n t h e t r i c t i o n i n t h e a p p e l l a n t ' s a b i l i t y t o l i f t , l i m i t e d t o e r t h i s r e s t r i c t i o n r e s u l t s f r o m h i s d e g e n e r a t i v e n e l a l s o n o t e s s o m e i n c o n s i s t e n c y i n t h e h e G P c o m m e n t e d t h a t t h e a p p e l l a n t i s u n a b l e t o a l w o r k o n a j o b o r a t h o m e , w h i l e l a t e r k e g r o o m i n g , c o o k i n g , c l e a n i n g a n d w a s h i n g , e t c . a v e a s s e s s e d t h e a p p e l l a n t i n d e p e n d e n t i n a l l s e s s m e n t s i n t h e a d v o c a t e p r e p a r e d e h e a r i n g t h e a p p e l l a n t e x p l a i n e d t h a t t h e s e a y s , " n o w m o r e f r e q u e n t b e c a u s e o f h i s o f h i s p a i n m e d i c a t i o n . H o w e v e r , a n d a s m i n i s t r y d e d i n c o m p l e t i n g t h e q u e s t i o n n a i r e t o p r o v i d e c o n f i r m a t i o n o f t h e d e t e r i o r a t i n g p h y s i c a l n d A R , a n d t h e l a c k o f a n y e x p l a n a t i o n f o r t h e q u e s t i o n n a i r e , t h e p a n e l f i n d s t h a t t h e m i n i s t r y l i m p a i r m e n t h a d n o t b e e n e s t a b l i s h e d . a t n o m e n t a l i m p a i r m e n t s a r e d i a g n o s e d . T h e e a p p e l l a n t h a s o n e s i g n i f i c a n t d e f i c i t w i t h n t t h a t c h r o n i c p a i n " c a n " l e a d t o d e p r e s s i o n o r g n i t i v e a n d e m o t i o n a l f u n c t i o n i n g h a s n o m a j o r t a l h e a l t h s p e c i a l i s t s ( i . e . t h e p s y c h i a t r i s t ) a r e a b o v e r e a s o n s i i i s n o t s a t i s f i e d t h a t t h e i m p a i r m e n t . t e m e n t a c c o m p a n y i n g h i s R e q u e s t f o r a s i g n i f i c a n t d e f i c i t i n c o g n i t i v e a n d e m o t i o n a l a n d a n x i e t y . T h e P T i n t h e A R d i d n o t h a v e t h e P ' s d i a g n o s i s . T h e a p p e l l a n t s u b m i t s t h a t t h e r e i s i r m e n t . e n t a l h e a l t h c o n d i t i o n a s a n i m a i r m e n ! . T h e G P
h a s d i a g n o s e d a s i g n i f i c a n t c o g n i t i v e a n d e m o t i o n a t h e p a n e l d o e s n o t c o n s i d e r t h i s t h e s a m e a s a d i a g m e n t a l i m p a i r m e n t . W h i l e t h e P T h a s a s s e s s e d a c o A R , i t w o u l d s e e m t o t h e p a n e l t h a t s h e r e t r a c t e d t h t h e i m p a c t t a b l e s h e w a s f i l l i n g o u t r e l a t e d o n l y t o a b r a i n i n j u r y . T h e p a n e l n o t e s t h a t n e i t h e r t h e G P n o c o m m u n i c a t i o n s o r s o c i a l f u n c t i o n i n g , a r e a s t h a t w o i m p a i r m e n t . I n t h e q u e s t i o n n a i r e c o m p l e t e d b y t h e G a n d p a y i n g r e n t a n d b i l l s a r e n o t e d b u t n o t e x p l a i n e d i f f i c u l t i e s a r i s e f r o m a m e n t a l h e a l t h i s s u e o r t h e a p p a n e l f i n d s t h a t t h e m i n i s t r y w a s r e a s o n a b l e i n d e t e b e e n e s t a b l i s h e d . S i g n i f i c a n t r e s t r i c t i o n s i n t h e a b il i t y t o p e rf o r m D I n t h e r e c o n s i d e r a t i o n d e c i s i o n t h e m i n i s t r y n o t e s t h a s s e s s e d b y b o t h h i s G P a n d P T , a n d b o t h a g r e e d A l t h o u g h n e w i n f o r m a t i o n w a s s u b m i t t e d i n d i c a t i n g a n d c o n t i n u o u s l y r e s t r i c t e d i n o t h e r s , t h e G P s i m p l y d o e s n o t p r o v i d e a n e x p l a n a t i o n a s t o w h y h i s a b i l i t i p r o v i d e a n y o t h e r s u p p o r t i n g n a r r a t i v e . R e g a r d l e s s , D L A a r e s t i l l r e p o r t e d a s i n d e p e n d e n t . M o r e o v e r t h e t h r o u g h m e d i c a t i o n s , a n d i t i s d i f f i c u l t t o d e t e r m i n e t m e d i c a t i o n s v e r s u s b e i n g o ff . T h e m i n i s t r y a l s o n o t e d o e s n o t r e q u i r e a n y a s s i s t i v e d e v i c e . O v e r a l l , t h e m n o t e s t a b l i s h t h a t a n i m p a i r m e n t s i g n i f i c a n t l y r e s t r i c t p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s . T h e p o s i t i o n o f t h e a p p e l l a n t i s t h a t h i s m e d i c a l c o n d h i s D L A a n d t h a t t h e e x t e n t o f t h e s e r e s t r i c t i o n s i s c b y h i s G P a t r e c o n s i d e r a t i o n . T h i s e v i d e n c e d e m o n s P a n e l f i n d i n g s T h e p a n e l n o t e s t h a t , a c c o r d i n g t o t h e l e g i s l a t i o n , t h p e r f o r m D L A m u s t b e a r e s u l t o f a s e v e r e i m p a i r m e n t h i s a p p e a l . T h i s D L A c r i t e r i o n m u s t a l s o b e c o n s i d e o f s e c t i o n 2 o f t h e E A P W D A , w h i c h p r o v i d e s t h a t t h e w i t h d i s a b i l i t i e s " i f t h e m i n i s t e r i s s a t i s f i e d t h a t " a l l t h c o n f e r r e d b y t h e l e g i s l a t i o n , i t i s r e a s o n a b l e t h a t t h e p r e s c r i b e d p r o f e s s i o n a l b e s u b s t a n t i a t e d b y i n f o r m a s a t i s f y t h e m i n i s t e r t h a t t h e r e a r e d i r e c t a n d s i g n i f i c a c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s , b y n a t u r e a n d e x t e n t o f t h e s e r e s t r i c t i o n s . A s t h e m i n i s ! E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )l d e f i c i t i n t h e a r e a o f e m o t i o n a l d i s t u r b a n c e , b u t n o s i s o f a m e n t a l h e a l t h c o n d i t i o n g i v i n g r i s e t o a u p l e m o d e r a t e i m p a c t s o n d a i l y f u n c t i o n i n g i n t h e e s e i m p a c t a s s e s s m e n t s o n c e s h e r e a l i z e d t h a t p e r s o n d i a g n o s e d w i t h a m e n t a l i m p a i r m e n t o r r t h e P T a s s e s s e d a n y d i f f i c u l t i e s w i t h u l d b e e x p e c t e d t o b e i m p a c t e d b y m e n t a l P a t r e c o n s i d e r a t i o n , d i ff i c u l t i e s w i t h b u d g e t i n g d , l e a v i n g i t u n c l e a r a s t o w h e t h e r t h e s e p e l l a n t ' s f i n a n c i a l c i r c u m s t a n c e s . A c c o r d i n g l y t h e r m i n i n g t h a t a s e v e r e m e n t a l i m p a i r m e n t h a d n o t L A . a t t h e a p p e l l a n t ' s o r i g i n a l a p p l i c a t i o n w a s t h a t a l l o f h i s D L A a r e p e rf o r m e d i n d e p e n d e n t l y . t h a t h e i s p e r i o d i c a l l y r e s t r i c t e d i n s o m e a r e a s p r o v i d e s a c h e c k m a r k i n d i c a t i n g h e a g r e e s , b u t e s h a v e c h a n g e d s i n c e t h e o r i g i n a l a p p l i c a t i o n o r t h e m i n i s t r y n o t e s t h a t t h e l a r g e m a j o r i t y o f h i s G P w r i t e s t h a t t h e a p p e l l a n t ' s p a i n i s c o n t r o l l e d h e a p p e l l a n t ' s l e v e l o f c a p a b i l i t y b e i n g o n d t h a t t h e G P h a s i n d i c a t e d t h a t t h e a p p e l l a n t i n i s t r y f o u n d t h a t t h e i n f o r m a t i o n p r o v i d e d d o e s s t h e a p p e l l a n t ' s D L A e i t h e r c o n t i n u o u s l y o r i t i o n s s i g n i f i c a n t l y r e s t r i c t h i s a b i l i t y t o m a n a g e l e a r l y d o c u m e n t e d i n t h e q u e s t i o n n a i r e c o m p l e t e d t r a t e s t h a t t h i s c r i t e r i o n h a s b e e n m e t . e d i r e c t a n d s i g n i f i c a n t r e s t r i c t i o n i n t h e a b i l i t y t o t , a c r i t e r i o n w h i c h h a s n o t b e e n e s t a b l i s h e d i n r e d i n t e r m s o f t h e p r e c e d i n g l e g i s l a t i v e l a n g u a g e m i n i s t e r m a y d e s i g n a t e a p e r s o n a s a p e r s o n e c r i t e r i a a r e m e t . I n e x e r c i s i n g t h e d i s c r e t i o n m i n i s t e r w o u l d e x p e c t t h a t t h e o p i n i o n o f a t i o n f r o m t h e p r e s c r i b e d p r o f e s s i o n a l t h a t w o u l d n t r e s t r i c t i o n s i n t h e a b i l i t y t o p e r f o r m D L A , e i t h e r p r e s e n t i n g a c l e a r a n d c o m p l e t e p i c t u r e o f t h e
t h e G P a n d t h e P T a s s e s s e d t h e a p p e l l a n t i n d e p e a p p e l l a n t p r o v i d e d n e w i n f o r m a t i o n a t r e c o n s i d e r a t i m i n i s t r y t o e x p e c t a n e x p l a n a t i o n f r o m t h e G P f o r t h t h o s e i n t h e P R a n d A R . T h e n e w a s s e s s m e n t s d e s m a n a g e t h e D L A o f m o v i n g a b o u t i n d o o r s a n d o u t d s u p p o r t a t a l l t i m e s w h e n s t a n d i n g ) , p e r i o d i c a s s i s t a d r e s s i n g a n d t r a n s f e r s i n / o u t o f b e d ) , a n d c o n t i n u o u a s p e c t o f d o i n g l a u n d r y ) a n d s h o p p i n g ( t h e a s p e c t o m a x i m u m ) . D i f f i c u l t i e s w i t h b u d g e t i n g a n d p a y i n g r e w h e t h e r t h i s i s a r e s u l t o f a m e n t a l h e a l t h c o n d i t i o n T h e p a n e l c o n s i d e r s r e a s o n a b l e t h e m i n i s t r y ' s a s s e t h e s e n e w a s s e s s m e n t s , t h e a p p e l l a n t i s a b l e t o m a a p p e l l a n t m a y b e s i g n i f i c a n t l y r e s t r i c t e d i n t h e D L A i n f o r m a t i o n i n d i c a t e s t h a t h e i s r e s t r i c t e d i n 2 o f 8 a s b a s i c h o u s e k e e p i n g a n d 1 o f 5 a s p e c t s o f s h o p p i n g a s s e s s m e n t s a n d t h e a s s e s s m e n t s o f i n d e p e n d e n t a n d A R , t h e p a n e l f i n d s t h a t t h e m i n i s t r y w a s r e a s o n b e e n m e t . H e l p w i t h D L A T h e m i n i s t r y ' s p o s i t i o n i s t h a t a s i t h a s n o t b e e n e s t c a n n o t b e d e t e r m i n e d t h a t s i g n i f i c a n t h e l p i s r e q u i r e T h e a p p e l l a n t ' s p o s i t i o n i s t h a t t h e e v i d e n c e p r o v i d e s u b m i t t e d a t r e c o n s i d e r a t i o n c l e a r l y s h o w s t h a t h e r P a n e l f i n d i n g s T h e p a n e l n o t e s t h a t t h e l e g i s l a t i o n r e q u i r e s t h a t i n t f o r h e l p m u s t a r i s e f r o m d i r e c t a n d s i g n i f i c a n t r e s t r i c c o n t i n u o u s o r p e r i o d i c f o r e x t e n d e d p e r i o d s . T h e p a t h a t s i n c e i t h a s n o t b e e n e s t a b l i s h e d t h a t D L A a r e d d e t e r m i n e d t h a t h e l p i s r e q u i r e d a s p r o v i d e d u n d e r s C o n c l u s i o n H a v i n g r e v i e w e d a n d c o n s i d e r e d a l l o f t h e e v i d e n c e t h e m i n i s t r y ' s d e c i s i o n t h a t t h e a p p e l l a n t w a s n o t e l i g s u p p o rt e d b y t h e e v i d e n c e . T h e p a n e l t h e r e f o r e c o n E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )n d e n t i n a l l a s p e c t s o f a l l D L A . A n d w h i l e t h e o n , t h e p a n e l f i n d s t h a t i t i s r e a s o n a b l e f o r t h e e c h a n g e s i n t h e a s s e s s m e n t s t h a t d i f f e r f r o m c r i b e r e s t r i c t i o n s i n t h e a p p e l l a n t ' s a b i l i t y t o o o r s ( a b l e t o w a l k o n l y u p t o 1 b l o c k , n e e d s n c e r e q u i r e d f o r p e r s o n a l s e l f c a r e ( t h e a s p e c t s o f s a s s i s t a n c e r e q u i r e d f o r b a s i c h o u s e k e e p i n g ( t h e f c a r r y i n g p u r c h a s e s h o m e -4 p o u n d s n t a n d b i l l s a r e a l s o m e n t i o n e d , b u t i t i s u n c l e a r o r h i s f i n a n c i a l c i r c u m s t a n c e s . s s m e n t t h a t , e v e n i f i i w e r e t o g i v e f u l l w e i g h t t o n a g e m o s t o f h i s D L A i n d e p e n d e n t l y . W h i l e t h e o f m o v i n g a b o u t i n d o o r s a n d o u t d o o r s , t h e n e w p e c t s o f p e r s o n a l s e l f c a r e , 1 o f 2 a s p e c t s o f . G i v e n t h e l a c k o f e x p l a n a t i o n a s t o t h e c h a n g e d f u n c t i o n i n g i n a l l o t h e r a s p e c t s o f D L A i n t h e P R a b l e i n d e t e r m i n i n g t h a t t h i s c r i t e r i o n h a d n o t a b l i s h e d t h a t D L A a r e s i g n i f i c a n t l y r e s t r i c t e d , i t d f r o m o t h e r p e r s o n s . d i n t h e q u e s t i o n n a i r e c o m p l e t e d b y t h e G P a n d e q u i r e s o n g o i n g d a i l y h e l p f r o m h i s n e p h e w . h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l t h e n e e d t i o n s i n t h e a b i l i t y t o p e r f o r m D L A t h a t a r e e i t h e r n e l f i n d s t h a t t h e m i n i s t r y r e a s o n a b l y d e t e r m i n e d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t e d , i t c a n n o t b e e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A . a n d t h e r e l e v a n t l e g i s l a t i o n , t h e p a n e l f i n d s t h a t i b l e f o r P W D d e s i g n a t i o n w a s r e a s o n a b l y f i r m s t h e m i n i s t ry ' s d e c i s i o n .
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.