PART C -Decision u nder Appeal The decis i on unde r appeal i s the Ministry of Socia l "M i nistry") J anuary 14, 2014 reconsid erat i o n decision d With Disa bili ties ("P WD"), for off-the-shelf orthosis fo did not m e et the requirem ent s in S chedule C section the orthosis be prescribed by a medical prac ti tione r PAR T D -Relevant L e gislat io n Employ ment an d As sist an ce for Persons with D isabilit Schedul e C, Section 3.10 . EAA T003(10/06/01) De velop me nt and Social Innovat ion (the enying a r eq uest f r o m t h e Appella nt, a Person r her s on, b ecause t he i n formation in th e r e qu e st 3.1 0(2 )(a) of the EAPW DR , wh ich require s that or nurse practitioner. ie s Re g u l ation ("EAPWDR ") S ec t i o n 6 2 and
PART E -Summary of Facts For its reconsideration decision the Ministry had the following evidence: 1. Information in its records that the Appellant receives disability assistance and she has a dependent child, her son, who received custom-made foot orthotics in about October 2012. 2. An Orthoses Request and Justification for off-the shelf shoes completed on July 23, 2013 by a certified orthotist/certified pedorthist, providing the following information about the son: • He has severe per planus feet, limiting his walking ability. • Orthotics have already been supplied and he needs proper footwear/motion control shoes for them to work. • Motion control shoes with the orthotics reduce the excess pronation forces on the lower limbs. • Off-the-shelf shoes are required to assist in physical healing from surgery, injury or disease and to improve physical functioning that has been impaired by a neuro-musculo-skeletal condition -"really this is the issue". • With his condition, he will need new motion control shoes every 6 months. 3. Consultation Note dated July 2, 2013 from the same certified orthotist/certified pedorthist stating that the Appellant's son has severe pes planus feet, has orthotics from a specialty orthotics supplier, but is unable to benefit from them until he has adequate footwear. This orthotist recommended New Balance 927s which cost $160 at local shoe stores. The orthotist also wrote that he cannot see any lesser shoe working in the long run. 4. Quote for $168 for New Balance 927 shoes from a shoe supplier dated August 7, 2013 and a letter from the supplier stating that the Appellant's son was recommended to them by the orthotist because he needs shoes large enough to provide structure and support to help with his severe pes planus feet. The letter also states that the New Balance 927 was recommended because it offers larger sizes, width options, fits the orthotic and provides proper support. The cost is $160, but the supplier will do them for $150. They tried shoes at a lower price but were unable to find ones that fit the son's needs. 5. Letter dated September 3, 2013 from a doctor stating that the Appellant's son requires bilateral orthotics for foot problems. 6. Appellant's request for reconsideration dated December 30, 2013, in which she stated that her son has been assessed by a certified pedorthist who strongly recommended the New Balance 927 shoe. No shoe retailer will custom make this very needed shoe for severe pes planus feet. She also wrote that she understands that the Ministry only pays $125. She is willing to pay the difference for this urgent need for her son. At the hearing, the Appellant stated that her son has very severe per planus feel. He is in lots of pain and urgently needs the shoes. The shoes he has have holes in them and limit his walking ability. The New Balance shoe was recommended by the orthotist. The Appellant's representative submitted oral arguments supporting the Appellant's position because of her limited financial means. Pursuant to section 22(4) of the Employment and Assistance Act, the Panel admits the Appellant's oral testimony because it provided details about her son's need for the requested shoes and therefore is in support of the evidence that was before the Ministry at reconsideration. The Ministry relied on and reaffirmed its reconsideration decision. EAA T003(10/06/01)
The Pane l ma k es t h e foll o win g f i ndin gs of fac t : 1 . The Ap pell a n t receives disab ility assista nce. 2 . A cer tifie d orth o tist/ce rtifi ed pedort h i s t recomm ended New Ba lan ce o ff-th e-s he lf sh oes for the App ella nt's dep enden t so n. 3. The re is n o inf orm a tion tha t th e certi fie d orthotist/certif ie d ped or t hist is li c e nsed to pr a ctic e m e d icine in the p rovin ce o r that h e is a licensed n urs e pra c tit ion er. 4. A m ed ica l doctor prescrib ed bil a t era l orth otics f or the Appe ll ant's son' s foot p ro ble m s . EAAT 003( 10/06/01)
PART F -Reasons f or Pa ne l Decision The issue in th is appeal is whether the Minis tr y reaso n ably d e n ie d a request from the Appella n t for o f f-the-shelf orthosis for her son b e c ause the information in the request did not meet the eligibility re q uir ements in Schedule C section 3 . 1 0(2)(a) of th e EAPWDR , wh ich req uires that the orthosis be p rescribed, by a m e d i c al pr actiti one r o r n urse prac t it i o ner. The f o llowing sec t io n s of th e EAPWDR apply t o t h i s app eal: Ge n e ral health supp l e ments 62(1) S ubject to subsections ( 1.1) a nd (1.2), the m i n i ster may pr o v ide any h ealth supplement set out in section 2 [gene r al health s upplements] or 3 [medical equipment and devices] of Schedule C to or for a family unit i f th e h ealth supplement is provided t o o r for a per so n in the family unit who is (a) a recipient of disabili ty assistance . S c hed ule C Health Supp lements Medical e quipmen t and dev i c e s -orthoses 3. 10(1) In this sect i on, "off-t h e -sh e lf" , in re latio n t o an or t h osis, m eans a prefa b ri cated , m ass -produc e d ortho si s that is n o t u niqu e to a partic ular per so n : "orthos i s " mean s (a) a cu s t om-,mad e o r off-t h e -sh e lf fo ot o rtho t ic : (2) S ubject to subse c t io ns ( 3 ) to (11) o f t hi s section, an orthosis is a health sup plem e nt for the p u r poses o f se c t i on 3 of this Sch edule i f ( a ) the orthosis is p rescrib e d by a me di cal pract itioner or a nurse pra ctiti oner . T h e Part i es' P o si tions The Appellan t submitt ed tha t her son urge ntly nee d s the of f -the-s helf shoes r ecommended by the o rtho t i st . The Mi n i st ry note d tha t the reco mmenda ti on f o r of f-the -shelf sho e s was not complet ed by a medica l p ractit i one r a s r equ ire d b y Schedule C s ection 3. 10( 2)( a ) o f the EAPWDR. The me dica l d o ctor's no t e referr ed only to b ilateral orth otics for f oot p robl e ms and theref ore, the Mi nist ry deter mi n ed that th e Appellant di d not meet the eligibility requirement for the orthosis in section 3.10(2)(a). The Panel's Findings and Conclusion T h e P anel fin ds th at th e re is no d ispute that t h e medic al d octor did not pr escribe the r equested off the-shelf shoes in his note. Also, there is no evidence that the orthotist, who recommended the requested shoes, is a medical practitioner or nurse practitioner as required by Schedule C section 3.10(2)(a) of the EAPWDR. Therefore, the Panel finds that the Ministry reasonably concluded that the Appellant had not met th e r equirement in Sch ed ule C section 3.10(2)(a) for off-t h e s h e l f o r tho sis. In co nclu s ion, h a v i n g co nsider ed all of the evid ence, the Pa n el f i n ds that the M inistry's re con sider ation decision was reas o nably supported b y the evidence. Therefore, the Pa n el c onfirms the reconsideration decision EAAT 003( 10106/01)
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