PART C -Decision under Appeal The de cisi o n under a ppeal is the reconsideration decision of the Ministry of Soci Social Innovatio n ( th e mi nistry ) dated January 6, 2014 den wit h disabilit ies (PWD). The ministry dete rmined tha cri teria required for PWD d esignati o n as set out i n the Employment and Assis Disabilities Act (EAPWDA) sec tion 2. The ministry f of age (in that she is over 18), and that in the op inion lik ely to continue for two or more years. However, the ministry determ inf o rm ati on provi ded, the followi n g criter i a set out in section 2(2)(b) of the EAPWD • The m inister is s a tisfied that t he a ppel lant h a • In the opinion of a presc ribed pro f e s si onal, the app ab i lity to perform daily living act ivities (DLA) either co periods; and • As a result of t he re str ic tions, the appellant requi anot h er pers o n to perfor m t h e DL A res tricted PART D -Rele v ant Legis lat ion E m ployment and Assistance for Pers o ns with Dis abilities Ac E m ployment a nd A s sistance for Pers o ns with Disabilities E M T 0 03( 10106101) al Developm ent and y in g the appellant designatio n as a person t th e appe l lant did no t meet three of th e five t a nce for Person s w ith ound that t he appellant m e ets t he fi rst two crite r i a of a medi cal pract itioner, her impairment is ined th at, based on th e A were not met: s a sev e re mental or physical imp airment. ellant 's i mpairment significan tl y restricts her n tinuously or periodically for e xtended res the signifi cant help or sup erv ision of by her impairment . t (E APWDA ) s ecti on 2 R egul a tion (EAP WDR ) -section 2
PART E -Summary of Facts The evidence before the ministry at reconsideration consisted of the following: 1. The appellant's PWD Designation Application, containing the f o llowing three parts: • The appellant's Self Report (SR) completed July 10, 2013; • The Physician Report (PR) dated July 15, 2013 completed by the appellant's family physician who indicates he has known the appellant for 2 years and had seen her 2-10 times in the previous year; and • The Assessor Report (AR) dated July 31, 2013 completed by a social worker who indicates that the date of completing the AR was her first contact with the appellant. 2. A 2-page letter dated April 26, 2011 from the head of vascular surgery at a hospital to the appellant's former physician reporting that the appellant attended at hospital in March 2011 with swelling and lump in her left wrist and an MRI showed a mass which may be a low flow vascular malformation. 3. A 2-page medical imaging report prepared March 23, 2011 confirming a lobulated mass along the volar and ulnar soft tissues of the appellant's left wrist. 4. A 2-page outpatient clinic note dated December 20, 2011 prepared by a specialist in hand surgery ("Hand Surgeon") stating "this right-hand dominant previous child care worker who is currently not working returns to see me with regards to a vascular anomaly in the left forearm." In this note, the Hand Surgeon writes, "[the appellant] continues to have daily symptoms as a result of this lesion. She avoids many activities as a result of her left f o rearm and hand pain and feels that her hand is quite weak. She avoids using the left hand for most heavy activities as a result of pain." The report indicates the appellant had agreed to proceed with an operation to remove the lesion. 5. A one-page ministry Medical Report-Employability form completed by the appellant's family physician on May 1, 2012 in which he identified her primary medical condition as left forearm vascular anomaly fo r which the expected duration was more than 2 years but the prognosis was "unknown at this time" and the physician wrote that she is "unable to use L forearm properly." 6. A 2-page outpatient clinic note dated May 1, 2013, prepared by the Hand Surgeon, in which he notes the appellant "is now almost 1 year out from attempted resection of a low-flow vascular anomaly" and that she "initially did reasonably well" but had started to develop some neuropathic pain so he had started her on pain medication. In this note, the Hand Surgeon wrote that the appellant's condition, in particular the neuropathic pain, was likely to be a chronic issue although he hoped to be able to control it with medication. The Hand Surgeon also wrote, "I would support her claim for long-term disability as she is having difficulty using the left hand and she works with children. She is unable to perform any 1-handed duties using just the right hand." 7. The appellant's request for reconsideration dated December 17, 2013 to which she attached the followinQ: EMT 003(10/06/01)
• O n e p a g e w r i t t e n s u b m i s s i o n ; a n d • T w o p a g e q u e s t i o n n a i r e p r e p a r e d b y t h e a p p w r i t t e n n o t e s b y t h e H a n d S u r g e o n a n d d a t e o n t h e f o r m i s D e c e m b e r 1 9 , 2 0 1 4 , b u t t h i s T h e a p p e l l a n t c o m p l e t e d h e r n o t i c e o f a p p e a l o n J a o n t h e f a c t s o f m y c a s e i t w a s u n r e a s o n a b l e t o d e n y s u b m i s s i o n o n a p p e a l i s a o n e p a g e p r i n t o u t f r o m t h c r e d e n t i a l s . I n h e r w r i t t e n s u b m i s s i o n s o n a p p e a l , t g r a n t e d h e r s t a t u s a s a p e r s o n w i t h p e r s i s t e n t m u l t i p t h a t s h e h a s a s e v e r e i m p a i r m e n t i n h e r l e f t a r m t h a p e r f o r m h e r D L A a n d , a s a r e s u l t , s h e r e q u i r e s a s s i s T h e f o l l o w i n g i s a s u m m a r y o f t h e e v i d e n c e f r o m t h e m e d i c a l r e p o rt s , a s t h e y r e l a t e t o t h e P W D c r i t e r i a a t o t h e a p p e l l a n t ' s S R i n t h e P W D a p p l i c a t i o n , a s w e a n d t h e h e a r i n g . S e v e r i t y o f i m p a i r m e n t s ( c r i t e r i a s e t o u t i n s u b s . 2 ( 2 T h e a p p e l l a n t ' s f a m i l y p h y s i c i a n d i a g n o s e d h e r i n t h v e n o u s ] m a l f o r m a t i o n w i t h a n o n s e t o f 2 0 1 1 , d e p r e s k i d n e y s t o n e s / n e p h r o l i t h i a s i s o n s e t i n 2 0 1 1 . T h e l e f t t h e m e d i c a l r e p o r t s o f t h e H a n d S u r g e o n . I n t h e P R m e d i c a l c o n d i t i o n s r e l e v a n t t o h e r i m p a i r m e n t , t h e p m a l f o r m a t i o n c a u s e d " c h r o n i c n e u r o p a t h i c p a i n " a n d i n c l u d i n g f e e d i n g , b a t h i n g , w r i t i n g , l a u n d r y , s h o p p i n g a p p e l l a n t h a s b e e n p r e s c r i b e d m e d i c a t i o n t h a t i n t e r f e x p l a i n t h e n a t u r e o f t h e i n t e r f e r e n c e , o n l y t h e n a m e t h e a p p e l l a n t n e e d s a i d s o f b a t h r o o m g r a b b a r s f o r s w h i l e l i k e l y t o c o n t i n u e f o r 2 y e a r s o r m o r e , t h e p r o g o r c e r t a i n " a n d t h e a p p e l l a n t h a s a " s e v e r e c h r o n i c c I n t h e 2 p a g e q u e s t i o n n a i r e o f D e c e m b e r 1 9 , 2 0 1 3 , t h e i m p a c t o f h e r m e d i c a l c o n d i t i o n s o n h e r d a i l y f u n a s e v e r e i m p a i r m e n t ? I f s o , p l e a s e e x p l a i n " a s fo l l o w a r t e r y v a s c u l a r m a l f o r m a t i o n c o n s t a n t n e u r o p a t h i c f o r e a r m . " I n h i s e a r l i e r r e p o r t o f M a y 1 , 2 0 1 3 , t h e H a [ a p p e l l a n t ] p r e v i o u s l y , t h e v a s c u l a r a n o m a l y i s l i k e l y i s s u e . S h e i s l i k e l y t o h a v e w a x i n g a n d w a n i n g s y m s y m p t o m s . . . . I w o u l d s u p p o rt h e r c l a i m f o r l o n g t e r m h a n d a n d s h e w o r k s w i t h c h i l d r e n . S h e i s u n a b l e t o h a n d . " I n t h e f u n c t i o n a l s k i l l s a s s e s s m e n t i n t h e P R , t h e a p p c o u l d w a l k 2 -4 b l o c k s u n a i d e d o n a f l a t s u r f a c e , w r i t i n e e d s f u r t h e r R x f o r a s t h m a " , t h a t s h e c o u l d c l i m b 5 E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )e l l a n t ' s a d v o c a t e a n d c o m p l e t e d w i t h h a n d d D e c e m b e r 1 9 , 2 0 1 3 [ t h e p a n e l n o t e s t h e d a t e i s a n e r r o r ] . n u a r y 1 3 , 2 0 1 4 , a n d o n i t s h e w r o t e t h a t " b a s e d t h e P W D d e s i g n a t i o n . " A t t a c h e d t o h e r w r i t t e n e i n t e r n e t p r o v i d i n g h e r H a n d S u r g e o n ' s h e a p p e l l a n t i n d i c a t e d t h a t t h e m i n i s t r y h a s l e b a r r i e r s t o e m p l o y m e n t . T h e a p p e l l a n t w r o t e t 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 e r a b i l i t y t o t a n c e w i t h t h e t a s k s o f D L A . P R a n d t h e A R , a s w e l l a s t h e a p p e l l a n t ' s o t h e r t i s s u e . T h e p a n e l h a s a l s o i n c l u d e d r e f e r e n c e l l a s h e r w r i t t e n s u b m i s s i o n s o n r e c o n s i d e r a t i o n ) E A P W D A ) e P R a s h a v i n g l e f t u l n a r a r t e r y A V [ a r t e r i a l s i o n o n s e t i n 2 0 1 1 , a s t h m a o n s e t i n 2 0 1 3 a n d u l n a r a r t e r y m a l f o r m a t i o n i s c o n f i r m e d i n a l l o f s e c t i o n i n d i c a t i n g t h e s e v e r i t y o f t h e a p p e l l a n t ' s h y s i c i a n w r o t e t h a t t h e a p p e l l a n t ' s l e f t u l n a r a rt e r y s h e i s " u n a b l e t o u s e l e f t h a n d f o r a c t i v i t y [ a n d ] d r e s s i n g . " T h e p h y s i c i a n i n d i c a t e d t h a t t h e e r e s w i t h h e r a b i l i t y t o p e r f o r m D L A , b u t d i d n o t o f t h e m e d i c a t i o n . T h e p h y s i c i a n i n d i c a t e d t h a t u p p o r t . T h e p h y s i c i a n a l s o w r o t e i n t h e P R t h a t n o s i s f o r t h e a p p e l l a n t ' s i m p a i r m e n t i s " u n k n o w n o n d i t i o n [ t h a t ] w i l l r e q u i r e f u r t h e r s u r g e r y . " t h e H a n d S u r g e o n a n s w e r e d t h e q u e s t i o n , " W h e n c t i o n i n g i s c o n s i d e r e d , d o e s [ t h e a p p e l l a n t ] h a v e s : " Y e s , l e f t u l n a r n e u r o p a t h y s e c o n d a r y t o u l n a r p a i n a n d s e v e r e d y s f u n c t i o n o f l e f t h a n d / n d S u r g e o n w r o t e t h a t " a s d i s c u s s e d w i t h t h e t o b e a c h r o n i c a n d s o m e t i m e s e v e n p e r m a n e n t p t o m s t o a d e g r e e b u t a l w a y s h a v i n g s o m e d i s a b i l i t y a s s h e i s h a v i n g d i f f i c u l t y u s i n g t h e l e f t p e r f o r m a n y 1 h a n d e d d u t i e s u s i n g j u s t t h e r i g h t e l l a n t ' s p h y s i c i a n 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 n g , " d u e t o S . O . B . [ s h o r t n e s s o f b r e a t h ] s h e + s t e s u n a i d e d , t h a t s h e c o u l d l i f t 2 -7 k 5 -1 5
poun ds) but with the c o mme nt, "n ot able to u se L [left] hand she co uld r emain sea ted. T he p hysician also note d u nde r comm u nica ti o n, wh ich he identified as, "canno I n the AR, t he s ocial worker ide nt i f i ed th e a p pella nt 's impairments as de pres sio n, a s thma a nd kidn ey ston es. " Th e so c ial significantly l on ger than ty pica l for a ll asp ect s o f m obility th e soci al wor k e r wro te, "2-4 bl ocks m ax , shortness of br als o check ed that the a p pe lla nt u ses an assistive d evi max". F or stand ing, the social w o rker wro te, " 5 m in holdi ng , the s ocial worker wrote, " no lifti n g L h a nd, 10 lbs max commented that al l moving about t a k es a t lea st 3 t imes th e A R, th e soci a l worke r comme nted that o v e rus e [repetiti v e s tr a in injur y] in shoul der." In the P R, the p hy sician che cke d that the a p pel lant emot io nal fu nc t ion in the areas o f emotional d istur b comme nta r y . In th e AR, the social w o rker i ndicated appell ant h ad go od h e a ring, h er s pea ki n g an d reading w with the com men t, " ver y p o or l i teracy l eve l. Wr iti n g inc assessm ent o f the effec t of the a pp el lan t' s men t al impairment on h fun ction i n g, the social w o rker i n dicat ed that t h e appell th e li st ed areas, a mo der ate impa ct in the a rea o f bod em otion a nd other n eu ro psy cho l o g i c a l prob lems em class du e to le arning difficu lties. Depre s sion , r elated I n her submiss io ns on a p peal , the a ppel lant said that her physic sh ow i n creasi n g di sabilit y i n her le f t f orear m an d hand. Ab ili ty to perf o r m DL A (crit e ria se t out in subs. 2(2/ (b) In the DLA section of the PR, the appellant's physici continuo usly in th e DLA s of persona l self care, meal prepar hou sework, daily shopping, mobility out s id e the home social fu nc tion i n g. T he physician in dicated the a p pellant outside th e ho me o r management of finances. The physician wrote the following explanation for periodic restriction, "Withdrawn and isolated" and the comment regarding the degree of restric "cannot use L hand." The physician's comment regarding the impact on the appel functioning was, "withdrawn -needs to be star ted on medications." The physician also wrote in the PR, "not being able to use L hand disrupts her ADLs -chronic pain." In the AR, the social worker indicated that the appellant takes significantly longer than typical to perform almost every listed task of each of the DLAs. indicated that in addition to taking significantly longer than typical to perform all 8 listed tasks, the appellant requires periodic assistance f o r bathing and toileting and uses an assistive device for bathing and toileting commenting, "needs grab bars." The social worker indicated the appellant also requires periodic assistance dressina, "cannot use L hand" and with aroomina. For the 2 tasks of the EMT003(10/06/01) , " an d there wa s no limitation on th e t ime that t he ap pellan t h a d difficulties wit h w rit ing t us e L hand f o r keybo arding." , " L ulna r a rtery m a l forma ti on, worker as se s sed the a p pel lant as ta kin g an d physic a l ab i lity. F or wal k ing ou tdo ors , eath." Fo r clim bing s t a i r s, the s ocial w orker c e, writing , "n eeds r ail, n o do w n stairs, 10 s teps max," a nd f or bot h l i fting an d ca rrying and R [ a rm] ." The so cial work e r longer. In t he a ddit ional i nformation se ction o o f th e a ppe ll a n t 's r ight side " now c aus i ng RSI h as si gnifi cant de fici ts w i th cogniti ve and a nc e and m ot ivati on, b u t did n ot p rov ide any t hat of th e ap pellant' s communicat io n skills , the ere satisfacto ry, b ut s he h ad p o or wri ting o mprehe nsi b le." Fu rthe r in the AR in t he e r c ogn itive and e mo tio n a l a n t' s m en tal im p airm ent ha d no i m p act o n 11 of ily f uncti on, and a m ajo r impact in th e a reas of o ti on , writing t h e comment , "Al w ays in spe cia l e d to disa b i l it ies a nd mobility rest rictio ns." ian re p ort s and the me dical consults EAPWDA) an indic ated that the appellant wa s restricted at ion, manage ment of medications, basic , u s e of transportation , and periodically with was not r e st ricted in perfo r man c e of mob ility tion, lant's social For the DLA of personal care, the social worker
D L A o f b a s i c h o u s e k e e p i n g , t h e s o c i a l w o r k e r i n d i c a s s i s t a n c e f r o m a n o t h e r p e r s o n o r u n a b l e , w r i t i n g " a o f t h e D L A o f s h o p p i n g , t h e s o c i a l w o r k e r i n d i c a t e d t y p i c a l a n d r e q u i r e s p e r i o d i c a s s i s t a n c e f r o m a n o t h e t a s k : " n e e d s o n g o i n g h e l p . " T h e s o c i a l w o r k e r w r o t e o n g o i n g h e l p w i t h d r e s s i n g , w a s h i n g , m e a l p r e p , o p t r a n s p o r t a t i o n ( n o d r i v i n g a n d s h e c a n n o t h a n g o n w I n t h e A R , t h e s o c i a l w o r k e r i n d i c a t e d t h a t t h e a p p e t a s k s o f p a y i n g r e n t a n d b i l l s , w r i t i n g t h e c o m m e n t " o f m e d i c a t i o n s , t h e s o c i a l w o r k e r i n d i c a t e d t h a t t h e s a f e h a n d l i n g a n d s t o r a g e , b u t t h a t s h e r e q u i r e d p e a n d t a k i n g a s d i r e c t e d , w r i t i n g t h e c o m m e n t " o f t e n n m e a l s , t h e s o c i a l w o r k e r i n d i c a t e d t h a t t h e a p p e l l a n m e a l p l a n n i n g , w r i t i n g " n e e d s s o m e h e l p , " a n d f o r t h a p p e l l a n t r e q u i r e s c o n t i n u o u s a s s i s t a n c e o r i s u n a b " a l w a y s n e e d s h e l p " b e s i d e t h e s e 2 t a s k s . F o r t h e D t h a t t h e a p p e l l a n t c o u l d i n d e p e n d e n t l y p e r f o r m t h e t t r a n s p o r t a t i o n , b u t t h a t s h e r e q u i r e d p e r i o d i c a s s i s t a p u b l i c t r a n s i t , w r i t i n g " n e e d s s e a t & s o m e a s s i s t a n c e c o m m e n t a s o n t h e p r e v i o u s p a g e ( " S h e n e e d s s i g n p r e p , o p e n i n g m e d i c a t i o n s , h o u s e w o r k , s h o p p i n g a n o n w h i l e o n b u s ) . " ) . I n t h e A R s e c t i o n r e g a r d i n g t h e a p p e l l a n t ' s s o c i a l f u a p p e l l a n t i s i n d e p e n d e n t i n t h e a s p e c t o f a p p r o p r i a t e t h e 3 a s p e c t s o f " a b l e t o d e v e l o p a n d m a i n t a i n r e l a t i " a b l e t o s e c u r e a s s i s t a n c e f r o m o t h e r s . " F o r t h e a s p u n e x p e c t e d d e m a n d s , " t h e s o c i a l w o r k e r i n d i c a t e d t w r o t e , " s t r e s s e d & o v e r w h e l m e d . " T h e s o c i a l w o r k e r f u n c t i o n i n g w i t h h e r i m m e d i a t e a n d e x t e n d e d s o c i a l e a c h . I n t h e 2 p a g e q u e s t i o n n a i r e o f D e c e m b e r 2 0 1 3 , t h e q u e s t i o n " i s [ t h e a p p e l l a n t ' s ] l e v e l o f a c t i v i t y s i g n i f i c a i m p a i r m e n t ? " a n d w r o t e i n r e s p o n s e t o t h e q u e s t i o n , r e s t r i c t e d i n h e r d a i l y f u n c t i o n i n g b y o n e o r m o r e o f h a n s w e r t o t h e q u e s t i o n , " o v e r a l l , d o [ t h e a p p e l l a n t ' s ) t o p e r f o r m a r a n g e o f d a i l y l i v i n g a c t i v i t i e s o n a n o n g p r e p , t r a n s p o r t a t i o n ( u n a b l e t o u s e L h a n d t o h o l d o n I n h e r s u b m i s s i o n s o n a p p e a l , t h e a p p e l l a n t r e i t e r a t e t h e A R , a s w e l l a s b y t h e H a n d S u r g e o n i n h i s D e c e A s s i s t a n c e r e q u i r e d / p r o v i d e d ( c r i t e r i a s e t o u t i n s u b s I n t h e P R , t h e a p p e l l a n t ' s o h v s i c i a n w r o t e t h e f o l l o w i E AA T 0 0 3 ( 1 0 1 0 6 1 0 1 )a t e d t h a t t h e a p p e l l a n t r e q u i r e s c o n t i n u o u s l w a y s n e e d s h e l p " f o r b o t h t a s k s . F o r t h e 5 t a s k s t h a t t h e a p p e l l a n t t a k e s s i g n i f i c a n t l y l o n g e r t h a n r p e r s o n , w i t h t h e f o l l o w i n g c o m m e n t f o r e a c h t h e a d d i t i o n a l c o m m e n t , " s h e n e e d s s i g n i f i c a n t , e n i n g m e d i c a t i o n s , h o u s e w o r k , s h o p p i n g a n d h i l e o n b u s ) . l l a n t r e q u i r e s p e r i o d i c a s s i s t a n c e t o p e r f o r m a l l 3 o f t e n n e e d s h e l p " b e s i d e e a c h t a s k . F o r t h e D L A a p p e l l a n t c o u l d i n d e p e n d e n t l y p e r f o r m t h e t a s k o f r i o d i c a s s i s t a n c e fo r f i l l i n g / r e f i l l i n g p r e s c r i p t i o n s e e d s h e l p " b e s i d e e a c h t a s k . F o r t h e D L A o f t r e q u i r e s p e r i o d i c a s s i s t a n c e w i t h t h e t a s k o f e t a s k s o f f o o d p r e p a r a t i o n a n d c o o k i n g , t h e l e t o p e r f o r m t h e t a s k , w r i t i n g t h e c o m m e n t L A o f t r a n s p o r t a t i o n , t h e s o c i a l w o r k e r i n d i c a t e d a s k o f u s i n g t r a n s i t s c h e d u l e s a n d a r r a n g i n g n c e a n d u s e s a n a s s i s t i v e d e v i c e w h e n u s i n g . " T h e s o c i a l w o r k e r w r o t e t h e s a m e a d d i t i o n a l i f i c a n t , o n g o i n g h e l p w i t h d r e s s i n g , w a s h i n g , m e a l d t r a n s p o r t a t i o n ( n o d r i v i n g a n d s h e c a n n o t h a n g n c t i o n i n g , t h e s o c i a l w o r k e r i n d i c a t e d t h a t t h e s o c i a l d e c i s i o n s , r e q u i r e s p e r i o d i c a s s i s t a n c e f o r o n s h i p s , " " i n t e r a c t a p p r o p r i a t e l y w i t h o t h e r s , " a n d e c t o f " a b l e t o d e a l a p p r o p r i a t e l y w i t h h a t t h e a p p e l l a n t r e q u i r e s c o n t i n u o u s s u p p o r t a n d 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 h a s m a r g i n a l n e t w o r k s , w r i t i n g " w i t h d r a w n a n d i s o l a t e d " f o r H a n d S u r g e o n w r o t e " y e s " i n a n s w e r t o t h e n t l y r e d u c e d a s a d i r e c t r e s u l t o f h e r " h o w o f t e n i s [ t h e a p p e l l a n t ] s i g n i f i c a n t l y e r m e d i c a l c o n d i t i o n s ? " t h e w o r d " d a i l y . " I n h e a l t h l i m i t a 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 e r a b i l i t y o i n g b a s i s ? " t h e H a n d S u r g e o n w r o t e , " y e s , m e a l ) , s e l f c a r e , u s e o f c o m p u t e r . " d t h e i n f o r m a t i o n s e t o u t b y t h e s o c i a l w o r k e r i n m b e r 2 0 1 3 q u e s t i o n n a i r e . . 2 ( 2 ) ( b )(i i ) E A P W D A ) n a i n r e s p o n s e t o t h e q u e s t i o n r e q a r d i n a t h e
a s s i s t a n c e t h e a p p e l l a n t n e e d s w i t h D L A : " n e e d s b w a s h i n g , m e a l p r e p , o n g o i n g m e d i c a t i o n s , t r a n s p o r 2 0 1 3 , t h e H a n d S u r g e o n w r o t e " y e s , s h e r e q u i r e s h g e t t i n g d r e s s e d " i n a n s w e r t o t h e q u e s t i o n " a s a r e s [ t h e a p p e l l a n t ] n e e d s s i g n i f i c a n t h e l p f r o m o t h e r p e o S u r g e o n i n d i c a t e d t h e a p p e l l a n t n e e d s t h i s h e l p " d a I n t h e s e c t i o n o f t h e A R d e s c r i b i n g t h e a s s i s t a n c e p 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 r e c e i v e s h e l p f r o m h e r f a s s i s t a n c e a n d s u p e r v i s i o n w i t h A D L s . A f r i e n d p r o s o c i a l w o r k e r a l s o w r o t e t h a t t h e a p p e l l a n t r e q u i r e s f u n c t i o n i n g . T h e p a n e l f i n d s t h a t t h e n e w i n f o r m a t i o n p r o v i d e d b a p p e a l , i n c l u d i n g t h e o n e p a g e p r i n t o u t o f h e r H a n d b e f o r e t h e m i n i s t r y a t t h e t i m e o f t h e r e c o n s i d e r a t i o n i n f o r m a t i o n i n h e r S R a n d s u b m i s s i o n s o n r e c o n s i d e a n d t h e h e l p p r o v i d e d h e r i n m a n a g i n g h e r D L A s . T t e s t i m o n y p u r s u a n t t o s e c t i o n 2 2 ( 4 ) ( b ) o f t h e E m p l o E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )a t h r o o m g r a b b a r s , h e l p w i t h d r e s s i n g a n d t a t i o n . " I n t h e 2 p a g e q u e s t i o n n a i r e o f D e c e m b e r e l p w i t h m e a l p r e p , t r a n s p o r t a t i o n , h o u s e w o r k , u l t o f h e r h e a l t h c o n d i t i o n s c a n y o u c o n f i r m t h a t p l e a n d / o r a s s i s t i v e d e v i c e s ? " a n d t h e H a n d i l y . " r o v i d e d f o r t h e a p p e l l a n t , t h e s o c i a l w o r k e r a m i l y a n d f r i e n d s , w r i t i n g , " h e r p a r e n t s p r o v i d e v i d e s t r a n s p o r t a t i o n a s t r a n s i t i s t o o d i ff i c u l t . " T h e " s u p p o r t i v e c o u n s e l i n g " t o a s s i s t w i t h h e r s o c i a l y t h e a p p e l l a n t i n h e r w r i t t e n s u b m i s s i o n s o n S u r g e o n ' s c r e d e n t i a l s , s u p p o r t s t h e i n f o r m a t i o n . T h e s u b m i s s i o n s o f t h e a p p e l l a n t r e i t e r a t e t h e r a t i o n a n d d e s c r i b e t h e e x t e n t o f h e r i m p a i r m e n t h e p a n e l t h e r e fo r e a d m i t s t h e a p p e l l a n t ' s w r i t t e n y m e n t a n d A s s i s t a n c e A c t .
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e i n t h i s a p p e a l i s w h e t h e r 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 t h a t t h e a p p e l l a n t i s i n e l i g i b l e f o r P W D d e s i g n a t i o n b e c a u s e s h e d i d n o t m e e t a l l t h e r e q u i r e m e n t s i n s e c t i o n 2 o f t h e E A P W D A . 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 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 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 a n d / o r p h y s i c a l i m p a i r m e n t a n d t h a t t h e i n fo r m a t i o n p r o v i d e d d i d n o t d e m o n s t r a t e t h a t h e r i m p a i r m e n t s 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 p r o f e s s i o n a l 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 e r a b i l i t y t o p 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 e i t h e r 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 d , 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 s h e r e q u i r e s h e 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 f o l l o w i n g s e c t i o n o f t h e E A P W D A a p p l i e s t o t h i s a p p e a l : 2 ( 1 ) I n t h i s s e c t i o n : " a s s i s t i v e d e v i c e " m e a n s a d e v i c e d e s i g n e d t o e n a b l e a p e r s o n t o p e r f o r m a d a i l y l i v i n g a c t i v i t y t h a t , b e c a u s e o f 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 r m e n t , t h e p e r s o n i s u n a b l e t o p e r f o r m ; " d a i l y l i v i n g a c t i v i t y " h a s t h e p r e s c r i b e d m e a n i n g ; " p r e s c r i b e d p r o f e s s i o n a l " h a s t h e p r e s c r i b e d m e a n i n g . ( 2 ) T h 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 w h o h a s r e a c h e d 1 8 y e a r s o f a g e a s a p e r s o n w i t h d i s a b i l i t i e s f o r t h e p u r p o s e s o f t h i s A c t 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 t h e p e r s o n 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 r m e n t t h a t ( a ) i n t h e o p i n i o n o f a m e d i c a l p 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 f o r a t l e a s t 2 y e a r s , a n d ( b ) 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 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 t h e p e r s o n ' s a b i l i t y t o p 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 e i t h e r ( A ) c o n t i n u o u s l y , o r ( B ) 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 d ( 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 , t h e p e r s o n r e q u i r e s h e 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 . ( 3 ) F o r t h e p u r p o s e s o f s u b s e c t i o n ( 2 ) , ( a ) a p e r s o n w h o h a s a s e v e r e m e n t a l i m p a i r m e n t i n c l u d e s a p e r s o n w i t h a m e n t a l d i s o r d e r , a n d ( b ) a p e r s o n r e q u i r e s h e l p i n r e l a t i o n t o a d a i l y l i v i n g a c t i v i t y i f , i n o r d e r t o p e rf o r m i t , t h e p e r s o n r e q u i r e s ( i ) a n a s s i s t i v e d e v i c e , ( i i ) t h e s i g n i f i c a n t h e l p o r s u p e r v i s i o n o f a n o t h e r p e r s o n , o r ( i i i ) t h e s e r v i c e s o f a n a s s i s t a n c e a n i m a l . T h e f o l l o w i n g s e c t i o n o f t h e E A P W D R a p p l i e s t o t h i s a p p e a l : 2 ( 1 ) F o r t h e p u r p o s e s o f t h e A c t a n d t h i s r e g u l a t i o n , " d a i l y l i v i n g a c t i v i t i e s " , ( a ) i n r e l a t i o n t o a p e r s o n w h o 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 n t o r a s e v e r e m e n t a l i m p a i r m e n t , m e a n s t h e f o l l o w i n g a c t i v i t i e s : ( i ) p r e p a r e o w n m e a l s ; ( i i ) m a n a g e p e r s o n a l f i n a n c e s ; ( i i i ) s h o p f o r p e r s o n a l n e e d s ; ( i v ) u s e p u b l i c o r p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s ; ( v ) p e r f o r m h o u s e w o r k t o m a i n t a i n t h e p e r s o n ' s p l a c e o f r e s i d e n c e i n a c c e p t a b l e s a n i t a r y c o n d i t i o n ; ( v i ) m o v e a b o u t i n d o o r s a n d o u t d o o r s ; ( v i i ) p e r f o r m p e r s o n a l h y g i e n e a n d s e l f c a r e ; ( v i i i ) m a n a g e p e r s o n a l m e d i c a t i o n , a n d ( b \ i n r e l a t i o n t o a o e r s o n w h o h a s a s e v e r e m e n t a l i m o a i r m e n t , i n c l u d e s t h e f o l l o w i n q a c t i v i t i e s : E AA T 0 0 3 ( 1 0 1 0 6 1 0 1 )
(i ) ma k e d eci sio ns a bo ut p erso nal a c tiv itie s, care or f ( i i) rela t e to, commu nicate or interac t with o t he r s e ffectively. S everity of im p ai r ments In her w rit ten s u bmiss io ns, th e ap pellant p ointed to the i his May 1, 20 13 repo r t that s he is s uff ering from ong a chro nic issue th at the d octor ho pes t o co nt rol throug f a mi ly phys i c i a n ind i c ate tha t the appellant c ann ot us mal format ion . The appe l lant s ubmit ted t hat " to un derst it's necessar y to r ec og nize that ina bility t o u se h er le submissi ons, t he appellant took issue with the mini s th e AR af ter on e visi t with the a ppell ant, wr it ing, "the so cial w orker who under took [t he AR] aft er the doc tor appe l lant ca nnot a f fo r d the us er fe e inv olved in se eing a l o ng e nough to hav e such a pe r s on ac t a s a s se s so r wo r k er in p riv a te practice to see he r multip le tim e s b T o he r credit, the so cia l wo r k er in this ca se probed d lear ning d isa bilit y. " In its recons i der at ion decision, the m i nistr y comment a s t he [AR] w as com pl et ed by .. . a social worker who met the [AR] and us ed [the appe l lant' s SR] an d t h e phy sician's i s i ntended to be completed b y a prescribed professional e x pe rien c e wi t h the ap plicant and is to be bas ed on dat a and exp eri enc e. " Th e minis t ry f o cuse d on t h e i p hys i c i a n in the PR regarding t he appel lant' s fun ctiona (due to shor t ne ss o f breath ) , to c limb 5+ steps u naid li m it ati ons in sit ting. Th e min istry note d the info rma tio (in de pen de nt func tion walk ing i n doors and o utdoors help liftin g (no li fting with l e f t hand , 10 pou nds max right ministr y also wrote that its file review "located medica left arm; these show that [the appe ll a nt] is right-hand domina limi tations related to usage of [the appellant's ] right a social worker's comments in the AR ar e unsupported b and found tha t as t he appellant's fun ctional skill s limi lifting with her left arm, it wa s not satisfied t hat the i n physical impairment. The ministry also noted the additional information provided by the Hand Surgeon in the December 2013 questionnaire, but found that while limitations with the appellant's left hand are ack n owledged, m odifications a re a v a i lab l e and n o p athology ex ists with her righ t hand and arm, the Hand demonstrate either a severe impairment or significa nt her DLA. The ministry also determined in the reconsideration decision that the information and narrative provided b y th e appellant's physi cian a nd the social work health condition" that si nificantl limits the a ellant's abilit EAAT 003( 10/06/01) ina nce s; nf ormat i o n pro vided by he r Han d S urge on in oi n g neuropathic pa i n and tha t this is likely l o be h medicat i on . Bo t h t h e Hand S ur g eon a nd the e her left ha nd as a r e su l t of the vasc ular and the natur e and e xte nt of [he r ] impa irment , ft ha nd dis rup ts a ll h er ADL s." In her tr y' s comm en t about t h e so cial work er pr epari ng adjudicator's c omm en t a bout t he efficac y of the had comp leted [ the P R] is u nrealistic . .. . The phys iothe rapis t or occupat ional ther apis t . .. .. The a ppe l lan t c anno t afford to pay a social ef o re the soc ial wo r ke r completes [the AR ]. . .. eeply a nd un cove r e d the app ella nt's l ifelong e d that t he appe llan t ' s app li ca ti o n "is probl em atic [ the app ellan t] for the fir s t ti me to co m plete [PR] as s ourc es of info rm a t ion. [The A R] h av in g a hist or y of contact and re c e nt k nowle dge o f the app lic a nt, ob serva ti o ns, cli n i cal nformati o n provid ed by the ap pella nt's fam ily l s ki ll s t h at she i s abl e to walk 2-4 bl o cks ed , l ift 5-15 lbs ( b ut not w ith h er le ft h an d) an d no n provide d b y the s o c ia l wo rke r i n t he A R , cl imb stai rs w ith a rail 10 steps max, periodic han d) an d stan din g 5 minu t e s max ) . Th e l consults related to arterial malfor mation of the nt and there are no reported functional rm or hand." The ministry determined that the y th e appe l lan t's fam ily phys ician in the PR t ations are no t significantly re stricted asid e from formation provided is evidence of a severe as t he a ppellant is right-hand dominant and Surgeo n's new i nformation "does not restriction" in the appellant's ability to perform er "are n ot supportive of a s evere mental to function either continuous! or
pe r iodicall y f or extend ed pe r iod s . The ministry not ed r ea ctive d epression "wi thout d escribing reme dia l me co g nitive and em otiona l f unctioning ( emo t io n a l disturbanc the informa t i o n fr o m the so cial worker th a t t h e a p pe o n her bodily fun c t i on s and two major impac ts on emotion and "other d es cribed as "always in specia l ed class due to lea rni and m ob ili ty restrictio ns." The m inistry noted, " no co or diagno sed by a med ica l p rofessional . .. p l ease n rel a te d to an id en t ifie d me ntal impairmen t o r brain injury p ract itioner. " Analysi s and decisi o n Th e l egislat io n prov i de s t hat the mi n is t er may designate a pers that the person has a severe ment a l or p hy sical imp prac ti tione r i s lik ely to conti nue f o r at leas t 2 years (subs. 2(2)(a) ph y sician confirmed i n th e PR s ection o f th e PWD a A V ma lformati on , rea ctiv e depress ion, chr on i c as t hma w or k er i n dicates in the A R th a t the appe llan t has a l med ica l con d iti on s am ount to sev er e p h y sica l and me In t he PW D ap plica t ion f o rm, the ministr y has prov i ded is n ot s et out in t he applicable le gi s lati on , offers g ui d an ap plicant ' s impairment . The mi nist r y states, "impai psy ch o logi c al, anatomical or phys i ol ogica l s tru ctu re fu ncti on inde pend ently, effectively, ap pro priate ly or for a reasonab s everity of an impa i rm e n t, there is both a ca use -the to w hich it rest r i c t s t he a b il i ty to fu n ction ind ep en dently d uration . T he legi slation provide s that t he det ermin discreti o n of the min ist er , t a king int o account al l of the However, the sta rtin g po in t must b e th e me dica l evidenc of the PWD application, togethe r with th e a dditio n al The panel notes that alt h ough th e appe llant has been diagnos her ability to walk distances) and kidney stones, the focus of the information in the PR and AR is on the impact of the vascular malformation in the appellant's left f and chronic pain and reactive depression. In the PR, the appellant's physician indicated she could walk 2-4 blocks unaided on a flat surface and that the restriction was related to her asthma (shortness of breath for which she needs further prescriptions), she could climb 5+ steps unaided, had no limitations remaining seated, and could lift 5-15 pounds with her right hand, b with h er l ef t hand. Alt ho ug h the ministry d i s co unte d information provided by the social worker in the AR a dissimilar to that of the physician: the social worker indicated the appellant could climb stairs with a railing 10 steps max, could walk 2-4 blocks limited by shortness of breath, could not lift with her left hand, but could lift 1 O pounds max with her right hand. The social worker noted limitation in standing "5 min max" which is contrary to the information of the physician and commented that all moving about takes at least 3 times lonaer, with no explanation provided for the cause of this limitation aiven EMT 003( 10106101) that the phy sician in the PR diagnose d her with as ures ta ken" and had indicat ed t w o defic its with e a nd m otivati on). T he mini s try also n o te d lla nt 's m en t al i mpa irment had a m oder ate i mpa ct neuropsyc holo gic a l problems" ng d ifficulties, de pr e s sion related to disa bi lities g nitive defi c i t or learning disab ility was r epo r t e d o te that impac t s on dai ly functio n ing mus t be n either has be en c on firmed by a med ica l o n as a P WD if t he minist e r is satisfied airme n t th at in th e o pinio n of a medical of the EAPWDA ) . The appel lant' s p plica t ion that th e app ellant has lef t uln ar ar tery and k i d ney sto nes/ n ep h r olithiasis . Th e s ocial e a rn in g disabi l i ty. The ap pellant a sserts that h er ntal im pairmen ts . a def ini tion of "impa i rm e nt" wh ich, althou gh i t ance in cons i dering the ex isten ce and s eve r ity of r m ent " is a "loss or abnormalit y of or func t ioni n g causing a restricti on in the ability to l e dura t ion." To de t e r m i n e t he impairment itsel f -and an eff ect -t he de gre e , ef fecti ve ly, app ropr i a t ely o r f or a re as onabl e ation of the seve rity of an i m p a i rme nt is at th e evi dence, i ncluding that o f the a ppellant . e the in for mation s et out i n t he PR se ctio n medi c al information. ed w it h asthma (a n d this cu rre nt ly limits o rearm with the associated weakness u t co u ld not lift the inform a tion of the social worker in the AR, the bou t the appellant's functional skills is not
t h e physi cian's r ec omm en dation of furthe r pr e sc ript sy mpt oms . The in f o r mation of t he H an d S u rg eo n i n t h e a p pellant' s impairment is r elat ed to th e malf ormat secondary to u l nar artery v as cul ar m alforma t i on -co of left hand/fo rea r m." W hi le the soci a l worker r e f e rred to repetitive sh ould er, this h as n o t bee n c onfirmed by the medica q uestionnaire. I n the P R, th e appellant's physicia n i ndi cated that the a a b ility t o perform sever a l of he r D LA on a continu ous ma nagemen t of me dications, b a sic hous e wor k , daily shopping, t ra n spo rtat i o n and social f unctio n i n g) . The p hysi c i an "can not us e L hand" and the appellant needs bathroom g w ash ing, meal p re p , open i n g m ed i cati o n s and tr anspo further na rrativ e to d escrib e the degr e e of the appe ll her ot her m edic a l cond i t i ons. Th e H and Su r ge on indic support s a claim for l o n g t e r m dis abili ty si n ce the app s he works w ith children; how e v e r , e mplo y ab il ity i s not a fac des ignatio n. Th e Han d Su r ge on co nfirms in t he qu esti th i nks th e appellan t's imp a i m )ent is sever e, but h is f appe llant 's le ft ha nd/forearm. T he panel notes th e m inis tr y's fin ding tha t t he appellan t he Hand Surgeo n in t he Decemb er 2 011 note, an d impact o f t h e a pp el lan t's i mpa irme n t in he r left hand/f ce rtain . Th e mini stry a ck n o wl edge d l i mitat i on s w ith t he minist r y r easonably conc lud ed that modi f i cati o ns d omina nt an d no p at ho logy ex i st s wit h her ri g ht h and a appe l lan t's ph y sic ian d iagn o sed her w i t h reactive depr by t h e physi cian a bout the d egree to which t h e app el tha n "low motivat i on." The soc ia l worker indic a tes that the appe appellant's ph ysicia n did no t co nfirm th is in formation identified it or provid ed a n opi n ion that it is likely to continue for 2 years or more. The legisl re quires that a medical prof e ssi onal c on firm the a ppe not a medical professional (although she is a "prescribed professiona i nf ormation provided by the a ppellant's physician and the Hand Surge ministry's determinat ion that the infor m a t ion provi ded impa i r me n t is reasonable. Direc t and significant restrictions in the abilitv to perform DLA. In he r w ritten sub missions, the ap pell a nt repeated t he in AR that indi c ated that the appell a nt ta kes si gnificant listed task of each of the DLAs, and several of the tasks are indicated as requiring periodic assistance. In the PR, as noted above, the appellant's physic impairment restric te d her ability to perform several of her DLA on a continuous basis, writing "cannot use L hand" and needs help with dressina, washina, meal oreo, ooenina medications and EAAT 003( 10/06/01) ions to a l leviate t h e a p pellant's asthma t h e December 20 1 3 question naire reiterates th at ion i n her left a r m : " l e f t u l nar neuropath y nstant neurop a thic pain and sever e dysfu nc t io n str a i n in ju ry in the a p pe l lant's right l practi tioners in eit he r the PR or the m ore recent ppell a nt's impairment d irectly restricts h e r basis (pe r sonal s el f c a re, meal prepara tion, m obili ty outsi de the h ome, use of i ndic a ted in t h e PR th at the rest ric t io n wa s rab ba r s , and help with d r e ssing and r tat i on. T he phy sicia n d id not pro vide a ny ant ' s res tric tio ns o r w h e t h e r any w ere r e lat e d t o ated i n h i s lett er d ate d Ma y 1, 2013 that he e llant is hav ing di f fic ulty usi ng her let ha nd and tor in ass essi n g eli g i bility fo r PWD onna i re dated December 1 9, 2013 tha t he o cus is on th e se vere dysf u nction of t he t is rig h t-han d do min ant, w hich w as st ated by tha t t he focus of the medica l in forma t ion is on th e orearm f or w hich t he prog n o sis is u nknown for the appellan t's l e ft h and a nd the pan el finds t hat ar e a vaila b l e as the app e llant is right -ha nd nd arm. F urt her, th e panel notes that th e ession , but there i s littl e information provid ed lant's d epres sion imp a c t s her daily living, oth e r llant ha s a learning d i sability, but th e an d none of th e other treating p hysicians a tion llant's medical condition and a social worker is l"). Acc ord ingly, given the o n, the panel finds that the does not e st ablish a severe physical or mental formation provided by the social wo rker i n the ly long er tha n typical to p erform a lm o st every ian indicated that the appellant's
t r a n s p o r t a t i o n . 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 d e t e r m a p p e l l a n t d o e s n o t h a v e f u l l u s e o f h e r l e f t a r m a n d a c t i o n s " t h e a p p e l l a n t ' s r i g h t a r m i s n o t a f f e c t e d a n d m e d i c a t i o n . T h e m i n i s t r y f o u n d t h a t " a s t h e f u n c t i o n r e a s o n a b l y r e s t r i c t y o u r f u n c t i o n o n a g l o b a l b a s i s , t d o e s n o t e s t a b l i s h t h a t 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 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 m i n i s t r y a l s a p p e l l a n t ' s p h y s i c i a n h a d c o m m e n t e d t h a t t h e a p p e d e p r e s s i o n ( r e l a t i n g t o b e i n g w i t h d r a w n a n d i s o l a t e d t r e a t m e n t o f h e r m o o d s o t h e m i n i s t r y c o u l d n o t d e t e A n a l y s i s a n d d e c i s i o n S u b s e c t i o n 2 ( 2 ) ( b ) o f t h e E A P W D A r e q u i r e s t h a t a p a p p e l l a n t ' s i m p a i r m e n t s 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 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 . T h e p a n e l n o t e i n d i c a t e t h a t , b e c a u s e o f a r e s t r i c t i o n , a n i n d i v i d u a l 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 , t h i s d o e s n o t n e c e 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 " t o t h e p e r s o n ' s a b i l i t y t o p s e t o u t i n s u b s . 2 ( 1 ) o f t h e E A P W D R , a s f o l l o w s : • P r e p a r e o w n m e a l s ; • M a n a g e p e r s o n a l f i n a n c e s ; • S h o p f o r p e r s o n a l n e e d s ; • U s e p u b l i c o r p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s • P e r f o r m h o u s e w o r k ; • M o v e a b o u t i n d o o r s a n d o u t d o o r s ; • P e r f o r m p e r s o n a l h y g i e n e a n d s e l f c a r e ; a n d • M a n a g e p e r s o n a l m e d i c a t i o n . T h e a p p e l l a n t ' s p h y s i c i a n i n d i c a t e d i n t h e P R t h a t t h h e r a b i l i t y t o p e r f o r m s e v e r a l D L A s ( p e r s o n a l s e l f c a m e d i c a t i o n s , b a s i c h o u s e w o r k , d a i l y s h o p p i n g , u s e o o u t s i d e t h e h o m e b u t n o t i n s i d e t h e h o m e ) . T h e p r e s t r i c t i o n w a s " c a n n o t u s e L h a n d " a n d t h a t n o t b e i n I n t h e D e c e m b e r 2 0 1 3 q u e s t i o n n a i r e , t h e H a n d S u r g r e s t r i c t e d h e r a b i l i t y i n m e a l p r e p , t r a n s p o r t a t i o n a s s c a r e a n d u s e o f c o m p u t e r , e c h o i n g t h e i n f o r m a t i o n p 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 r e a s o n a b l y c o n c l u d l i s t e d D L A a n d , i n s t e a d , r e l a t e s t o e m p l o y m e n t s k i l l s d e s i g n a t i o n . I n t h e A R , t h e s o c i a l w o r k e r h a s i n d i c a t e d t h a t t h e a p a l m o s t e v e r y t a s k o f t h e l i s t e d D L A s ( a l l 8 t a s k s o f p a l l 5 t a s k s o f s h o n n i n a , 3 o f 4 t a s k s o f m e a l p l a n n i n q E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )i n e d t h a t a l t h o u g h i t a c k n o w l e d g e d t h a t t h e h a n d a n d t h i s " w o u l d r e s t r i c t s o m e p h y s i c a l t h e c h r o n i c p a i n i s m i n i m i z e d t h r o u g h a l l i m i t a t i o n o f y o u r n o n d o m i n a n t h a n d d o e s n o t h e i n f o r m a t i o n f r o m y o u r ' p r e s c r i b e d p r o f e s s i o n a l s i c t s d a i l y l i v i n g a c t i v i t i e s e i t h e r c o n t i n u o u s l y o r o n o t e d t h a t i n t h e P R o f J u l y 2 0 1 3 , t h e l l a n t " n e e d s t o b e o n m e d i c a t i o n " f o r h e r ) b u t t h a t t h e r e w a s n o u p d a t e o n t h e a p p e l l a n t ' s r m i n e t h e c u r r e n t e m o t i o n a l s t a t u s . r e s c r i b e d p r o f e s s i o n a l c o n f i r m t h a t t h e t r i c t h e r a b i l i t y t o p e r f o r m h e r D L A c o n t i n u o u s l y s t h a t a l t h o u g h a p r e s c r i b e d p r o f e s s i o n a l m a y e q u i r e s a s s i s t a n c e e i t h e r c o n t i n u o u s l y o r s s a r i l y m e e t t h e l e g i s l a t i v e t e s t o f b e i n g a " d i r e c t e r f o r m D L A . T h e D L A t o b e c o n s i d e r e d a r e , a s ; e a p p e l l a n t ' s i m p a i r m e n t c o n t i n u o u s l y r e s t r i c t e d r e , m e a l p r e p a r a t i o n , m a n a g e m e n t o f f t r a n s p o r t a t i o n , s o c i a l f u n c t i o n i n g a n d m o b i l i t y h y s i c i a n i n d i c a t e d i n t h e P R t h a t t h e d e g r e e o f g a b l e t o u s e h e r l e f t h a n d " d i s r u p t s " h e r D L A s . e o n 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 i m p a i r m e n t h e i s u n a b l e t o u s e h e r l e f t h a n d t o h o l d o n , s e l f r o v i d e d b y t h e a p p e l l a n t ' s p h y s i c i a n i n t h e P R . e d t h a t t h e u s e o f a c o m p u t e r i s n o t o n e o f t h e w h i c h a r e n o t a s s e s s e d a s p a r t o f a P W D p e l l a n t t a k e s s i g n i f i c a n t l y l o n g e r t o p e rf o r m e r s o n a l c a r e , b o t h t a s k s o f b a s i c h o u s e k e e p i n g , , a l l 3 t a s k s o f p a y i n q r e n t a n d b i l l s , 2 o f 3 t a s k s
of medications, and 2 of 3 tasks of transportation). The social worker has also indicated that in addition to taking significantly longer than typical to perform, the appellant requires periodic assistance from another person to perform several of the tasks of DLA (3 of the 8 tasks of personal care, all 5 tasks of shopping, 1 of the 4 tasks of meals, all 3 tasks of paying rent and bills, 2 of the 3 tasks of medications, and 1 of the 3 tasks of transportation). The social worker has also indicated that -in addition to taking significantly longer than typical to perform -the appellant requires continuous assistance or is unable to perform both tasks of basic housekeeping and 2 of the 4 tasks of meals. However, the social worker's comments to explain and describe the restrictions and requirements for help are "always needs help," "needs ongoing help," or "often needs help" comments which are not explanatory. The social worker has written the same comment on both pages of the AR that the appellant "needs significant, ongoing help with dressing, washing, meal prep, opening medications, housework, shopping and transportation (no driving and she cannot hang on while on bus)." The social worker's comments in the AR do not tie the restrictions of the appellant's DLA to her impairment and the need for periodic assistance when reading prices and labels or making appropriate choices when shopping, for example, may relate to an undiagnosed learning disability since the social worker assessed the appellant's reading ability as satisfactory and the physician identified difficulties with communication as "cannot use left hand for keyboarding." Likewise, there is no elaboration regarding the need for periodic assistance with meal planning, banking, budgeting, paying rent and bills, filling/refilling prescriptions or taking medications as directed. The panel finds that, in the absence of this detail, the ministry reasonably concluded that the frequency and duration of the periodic assistance is not established as being needed for extended periods of time, as required by subs. 2(2)(b) of the EAPWDA. The panel finds that the ministry reasonably determined that the functional limitation of the appellant's non-dominant hand does not reasonably restrict her function on a global basis and the extent of the restrictions from the appellant's other conditions have not been sufficiently described. The information provided does not demonstrate that the appellant's impairment directly and significantly restricts her ability to perform DLA either continuously or periodically f o r extended periods. Without detailed information in the AR, and based on the evidence provided by the appellant's physician in the PR and by the Hand Surgeon, the panel finds that the ministry's determination that the information provided does not establish that this impairment significantly restricts her DLA continuously or periodically for extended periods is reasonable. Help with DLA In her written submissions, the appellant repeated the information provided by her physician in the PR that she needs bathroom grab bars, and requires help with dressing, washing, meal prep, opening medications and transportation. This information is repeated by the Hand Surgeon in the December 2013 questionnaire and by the social worker in the AR. In its reconsideration, the ministry noted that as it "has not been established that [DLA] are significantly restricted ... it cannot be determined that significant help is required from other persons. Bathroom grab bars are recommended." The leQislation requires in subs. 2(2)(b)(ii) that in the opinion of a prescribed professional, as a result EAAT 003( 10/06/01)
of the appellant's restrictions, the appellant requires help to perform DLA and subs. 2(3)(b) provides that a person requires help in relation to a DLA if, in order to perform it, the person requires an assistive device, the significant help or supervision of another person, or the services of an assistance animal. The panel notes that the legislation is not limited to help from another person. The panel notes the evidence before the ministry at the reconsideration as set out by the appellant's physician in the PR was that the appellant requires grab bars in the bathroom, and needs help with some DLA because she cannot use her left hand. While the social worker indicated that the appellant requires help with the performance of several tasks of her DLA, the social worker did not provide detail to explain the degree of help required or tie it to the appellant's impairment. The panel finds that the ministry's determination that because it has not been established that DLA are directly and significantly restricted, it cannot be determined that help is required as provided under section 2(2)(b )(ii) of the EAPWDA, is reasonable. Conclusion Having reviewed and considered all of the evidence and the relevant legislation, the panel finds that the ministry's decision that the appellant was not eligible for PWD designation is reasonably supported by the evidence. The panel therefore confirms the ministry's decision. EAAT 003(1 0/06/01)
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.