APPEAL# I _____ ___, PART C -Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (the ministry) reconsideration decision dated January 22, 2014 which found that the appellant did not meet three of the five statutory requirements of Section 2 of the Employment and Assistance for Persons with Disabilities Act for designation as a person with disabilities (PWD). The ministry found that the appellant met the age requirement and that his impairment is likely to continue for at least two years. However, the ministry was not satisfied that the evidence establishes that: • the appellant has a severe physical or mental impairment; • the appellant's daily living activities (DLA) are, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods; and, • as a result of these restrictions, the appellant requires the significant help or supervision of another person, the use of an assistive device, or the services of an assistance animal to perform DLA. PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Act (EAPWDA), section 2 Employment and Assistance for Persons with Disabilities Regulation (EAPWDR), section 2
P A R T E S u m m a r v o f F a c t s T h e e v i d e n c e 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 D i s a b i l i t i e s ( P W D ) A p p l i c a t i o n c o m p r i s e d o f t h e a p p l i c a n p h y s i c i a n r e p o r t ( P R ) d a t e d A u g u s t 1 2 , 2 0 1 3 a n d p r e p a r a s s e s s o r r e p o r t ( A R ) d a t e d A u g u s t 2 2 , 2 0 1 3 a n d c o m p l e s i n c e D e c e m b e r 1 9 , 2 0 1 2 . A l s o i n c l u d e d w e r e t h e f o l l o w i n g : 1 ) L e t t e r d a t e d J a n u a r y 3 , 2 0 1 3 p r e p a r e d b y t h e a p p h y s i o t h e r a p i s t w h o p r e p a r e d t h e A R . 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T h e m i n i s t r y r e p r e s e n t a t i v e d i d n o t o b j e c t t o t h e a d m i t s t h e G P R e p o r t a s w r i t t e n t e s t i m o n y i n s u p p o r t o f m i n i s t e r w h e n t h e d e c i s i o n b e i n g a p p e a l e d w a s m a d e p u A s s i s t a n c e A c t . D i a g n o s e s T h e a p p e l l a n t h a s b e e n d i a g n o s e d b y h i s g e n e r a l p r a c t i t s p i n e w i t h t h e d a t e o f o n s e t b e i n g 2 0 1 2 . P h y s i c a l I m p a i r m e n t • I n t h e P R , t h e g e n e r a l p r a c t i t i o n e r i n d i c a t e d i n t h e p a i n i s m i l d t o m o d e r a t e . I t a f f e c t s h i s a b i l i t y t o l i f • T h e g e n e r a l p r a c t i t i o n e r r e p o r t e d t h a t t h e a p p e l l a i m p a i r m e n t . • I n r e s p o n s e t o t h e q u e s t i o n a s t o w h e t h e r t h e a p p o r m o r e t h e g e n e r a l p r a c t i t i o n e r d o e s n o t c h e c k e S p i n e d e g e n e r a t i o n i s u n l i k e l y t o i m p r o v e . P a i n m • F u n c t i o n a l s k i l l s r e p o r t e d i n t h e P R i n d i c a t e t h a t t m o r e s t e p s u n a i d e d , a n d h e c a n l i f t 2 t o 7 k g ( 5 -• I n t h e a d d i t i o n a l c o m m e n t s t o t h e P R , t h e g e n e r a c o n t i n u e t o a t t e n d p h y s i c 1 -2 x / m o n t h . " • I n t h e G P R e p o r t , t h e g e n e r a l p r a c t i t i o n e r d e s c r i b " c o n s t a n t p a i n i n l e f t a r m , n e c k , b a c k / r i g h t a r m n u m e d i c a l c o n d i t i o n a s s e v e r e . • I n t h e G P R e p o r t , t h e g e n e r a l p r a c t i t i o n e r n o t e s t h l b s w i t h h i s l e f t a r m , h e i s u n a b l e t o s i t o r s t a n d f o b l o c k s . • I n t h e A R , t h e o h v s i o t h e r a p i s t s u m m a r i z e d t h e a n A P P E A L # I s i d e r a t i o n d e c i s i o n i n c l u d e d t h e P e r s o n W i t h t i n f o r m a t i o n a n d s e l f r e p o r t d a t e d J u l y 1 0 , 2 0 1 3 , a e d b y t h e a p p e l l a n t ' s g e n e r a l p r a c t i t i o n e r a n d a n t e d b y a p h y s i o t h e r a p i s t w h o h a s k n o w n t h e a p p e l l a n t p e l l a n t ' s a d v o c a t e a n d a d d r e s s e d t o t h e a p p e l l a n t ' s a s k s t h e p h y s i o t h e r a p i s t t o a n s w e r f i v e q u e s t i o n s b y g n e d b y t h e p h y s i o t h e r a p i s t a t t h e b o t t o m o f t h e L e t t e r ' ' ) ; a p p e l l a n t ' s g e n e r a l p r a c t i t i o n e r w h o c o m p l e t e d t h e ( " t h e G P L e t t e r' ' ) ; a n d , a r y 3 , 2 0 1 4 a t t a c h i n g 3 p a g e s o f w r i t t e n s u b m i s s i o n s 3 , 2 0 1 3 ( t o g e t h e r , " t h e R F R S u b m i s s i o n s " ) . o e v i d e n c e a o n e p a g e m e d i c a l r e p o r t d a t e d J a n u a r y o m p l e t e d t h e P R ( " t h e G P R e p o r t ' ' ) . T h i s r e p o r t i s a a n d d e s c r i b e s h i s p h y s i c a l c o n d i t i o n , p r o g n o s i s a n d e d i n t h e G P R e p o r t r e f l e c t s t h a t w h i c h i s s e t o u t i n G P R e p o r t ' s a d m i s s i b i l i t y . T h e p a n e l t h e r e f o r e t h e i n f o r m a t i o n a n d r e c o r d s t h a t w e r e b e f o r e t h e 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 y m e n t a n d i o n e r w i t h a r m p a i n s e c o n d a r y t o o s t e o a r t h r i t i s i n h i s h e a l t h h i s t o r y t h a t " t h e [ a p p e l l a n t ' s ] a r m a n d s h o u l d e r t a n d d o h e a v y l a b o u r . " n t d o e s n o t r e q u i r 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 e l l a n t ' s i m p a i r m e n t i s l i k e l y t o c o n t i n u e f o r t w o y e a r s i t h e r t h e " y e s " o r " n o " b o x e s b u t c o m m e n t s " U n c e r t a i n . a y v a r y b a s e d o n t h e r a p y . " h e a p p e l l a n t c a n w a l k 4 o r m o r e b l o c k s a n d c l i m b 5 o r 1 5 l b s . ) a n d r e m a i n s e a t e d w i t h o u t l i m i t a t i o n . l p r a c t i t i o n e r r e p o r t e d t h a t t h e a p p e l l a n t " s h o u l d e s t h e a p p e l l a n t ' s s e c o n d a r y m e d i c a l c o n d i t i o n a s m b n e s s " a n d s h e d e s c r i b e s t h e a p p e l l a n t ' s o v e r a l l a t t h e a p p e l l a n t i s u n a b l e t o c a r r y o r l i f t m o r e t h a n 5 r e x t e n d e d p e r i o d s a n d u n a b l e t o w a l k m o r e t h a n 2 -3 n e l l a n t ' s i m o a i r m e n t s t h a t i m p a c t h i s a b i l i t v t o
APPEAL# I manage daily living activities as ".:.left shoulder/arm weakness and pain affects/restricts his ability to left/carry [more than] 5 lbs for a reasonable time. [Appellant] is left hand dominant." • The physiotherapist indicated that the appellant is independent walking indoors and outdoors, climbing stairs and standing. The physiotherapist indicated that the appellant requires periodic assistance from another person with lifting, carrying and holding and added the comment "[appellant] is limited in the use of his left hand/arm and must use his right more often for weight [greater than] 5 -8 lbs. [Appellant] is left handed." • The physiotherapist added further comments with respect to the appellant's mobility and physical ability stating "[Appellant] will require assistance for heavier items from friends and store staff." • In the GP Letter, she revises her opinion with respect to the duration of the appellant's impairment saying "I now wish to affirm my professional opinion that [the appellant's] impairment is likely to continue for two years or more from the time of the report." The general practitioner also indicates that she has initialed each page of the appellant's December 23, 2013 written submissions "as attestation to the veracity of the information provided therein. .." Mental Impairment • In the PR, the general practitioner reported no significant deficits with cognitive and emotional function and that the appellant does not have difficulties with communication. • In the AR, the general practitioner assessed the appellant's speaking, reading, writing and hearing as good but adds the comment that writing causes left arm pain to persist for a few hours. • In the AR, the physiotherapist noted no impacts to daily functioning in all areas of cognitive and emotional functioning and wrote "N/A" on the page. • The physiotherapist answered "N/A" with respect to the appellant's social functioning, immediate and extended social networks, with no further comment provided. Daily Living Activities (DLA) • The general practitioner reported that the appellant has not been prescribed medications or treatments that interfere with his ability to perform his daily living activities (DLA) • In the PR, the general practitioner does not indicate whether or not the appellant's impairment directly restricts his ability to perform DLA. However, the general practitioner reported that the appellant is periodically restricted in meal preparation, basic housework and daily shopping while he is not restricted in personal self care, management of medications, mobility inside and outside the home, use of transportation and management of finances with a comment added that the periodic restriction is "related only to left arm pain, ie, lifting and carrying." With respect to the degree of restriction, the general practitioner comments "mild to moderate." • In the AR, the physiotherapist indicated that the appellant is independent with all tasks of the DLA personal care but comments with respect to grooming that the appellant is "able, but left shoulder/arm pain develops." Continuing in the AR, the physiotherapist indicated that the appellant is independent with all aspects of basic housekeeping but comments "Able, but left shoulder arm pain will persist a few hours." • For shopping, the appellant is assessed in the AR as independent in all aspects other than carrying purchases home and the physiotherapist references her previous comment that the appellant is limited to the use of his left hand and arm and must use his right more often for weight that is greater than 5-81bs. • For meals, the appellant is assessed as independent in all aspects and the physiotherapist comments that with respect to food preparation and cooking, the appellant is "able, but activity causes pain into his arm." • For paying rent and bills, medications and transportation, the appellant is assessed as independent in all aspects without further comment. • Under additional comments, the phy;;iotherapist notes that the appellant is "applying for home support to assist with food prep and cookina meals to reduce the severity of symptoms into his arm.
• In the PT Letter, the physi otherap i st h as indi c ated her agr by th e a dvocate who p r ep a red th e letter b y c h ecking the l etter: • The a ppellant ha s diffi culty with meal prepa chopping meats or ve getables; • The appellant req u ires he lp to lift full pots of water, transfer off/ pain in h is left arm, neck and bac k; • The appe llant ne eds h e lp ca rr yin g pur ch ases with his righ t arm an d requir es help carrying the rest; • The appel lant is not able to scrub and clean his home the way he shou to pain in his ba c k, nec k and left arm; and • The ap pellant's conditi on is severe, t ha t he ha resu l t r e qu ires continuous assistance with those activities no N eed for Help • In th e PR , the g ener al prac ti tioner did not indicate • Th e physiotherapist r ep orted in th e AR that the assi friend s o r " o ther' ' and comments furthe r th at '1riends carrying ite ms heavier than 10 l bs . " I n the RFR written s ubmis sion s, the appel lant states tha t a nd that hi s p h ysic ian ha s now c onfirmed that his p hysic more. Th e appell an t lists his c on d itions as i ncludi n g ost eo a nd left a rm p ain and nu mb ness i n th e r i g h t hand and fo arm pain impairs his ab il ity reg a r d ing a l l a c t ivit ies e very day. a ppellant st ates tha t wh ile he used to walk for miles, he no can climb stai r s but not wi thou t discomf ort an d tha t l i fting of what he c ould lift wi th his ri ght hand on ly. He adds tha experiencing neck an d bac k di s comfo rt. Continuing in t he RFR submis sions, th e a ppell a n t sta te s tha l iving acti vit ies due t o h is disabi lity and requi res ass ista n some pers onal care and l aund r y n eeds . In his Notice of Appeal dated February 3, 2014, the a ppell pra ctitioner a s sessed hi s con d ition as severe and worsened since onset. 7, 2014, his physiotherapist assessed his condition as severe and that he has significant restrictions with his DLA and as a result requires continuous assistance. At the hearing, the appellant stated that: • His physio t herapis t confirm ed in t h e PT Lett e r that his condition is severe, that he has significant restrictions with his DLA and as a result he requires continuous assistance. • His general practitioner confirms in the GP R epo rt GP Lette r that his impairment is expected to continue for 2 years or more. • His general physician and physiotherapist know him well, both consider his condition to be severe and their opinions should be given significant weight. • H is physical impairm ent includes constant left arm and neck pain, back pain due to activity. APPEAL# I eemen t w i t h the following statements set out "Ag ree" space an d signin g a nd d atin g the r a ti on a nd cooking and a great deal of difficulty on the sto ve, d r ain, etc due to o ut o f the store, he is only able to carry on e bag ld to keep it sanitary due s significant restrictions with his DLA a nd as a ted above. that th e a ppe ll an t r e qu i res an assist i ve d e vi ce. stance p r o v i ded by other peo ple f or DLA includ e s an d store staf f assist as neede d with lifting and he has sat isfied the ag e cr iteria for P W D d esig n atio n a l i mpair m ent is l i kel y t o cont inu e for two y ears or a rthritis of the spine, n eck p ain, bac k pa in, sho uld e r rearm and he says th at his ne c k, b a c k, shou lder and W ith respect to his fun c t ional a biliti e s, the w exp eri en c es back pain after 2 or 3 blocks, tha t he 5 -15 lbs as p r o v i ded in the PR was his own es t imat e t he c a n only sit f or ap proxi m a t ely 1 0 m inut es be f ore t he has dif fi culty w ith ho use k ee p in g a n d n ormal c e wi th hou s ekeeping, meal prepa rat ion a n d clean up, a n t states that as of January 20, 2014 his general He notes f urther that a s of Janu ar y t hat his condition is severe and she confirmed in the
• H e f i n d s i t p a i n f u l t o r e a c h f o r a n d l i l t o b j e c t s , h e h a r d t i m e c o o k i n g . I n r e s p o n s e t o a q u e s t i o n , t h e a p p e l l a n t s t a t e d t h a t w h e n s o b a s e d o n a p e r s o n a l i n t e r v i e w w i t h h i m a n d t h a t s h e o f m o t i o n . T h e a p p e l l a n t s a i d t h a t p r i o r t o t h e P T R e p o r a p p r o x i m a t e l y 5 m o n t h s . I n r e s p o n s e t o a q u e s t i o n , t h e a p p e l l a n t s t a t e d t h a t t h e P b e c a u s e t h e A R w a s c o m p l e t e d b y t h e p h y s i o t h e r a p i s t q T h e a p p e l l a n t s t a t e d t h a t h e d i d n ' t k n o w h o w g o o d o f a p d e t e r m i n e h i s D L A . I n r e s p o n s e t o a q u e s t i o n , t h e a p p e l l a n t s t a t e d t h a t h e p h i s g e n e r a l p r a c t i t i o n e r ' s o f f i c e a t w h i c h t i m e s h e r e a d t h T h e m i n i s t r y r e l i e d o n i t s r e c o n s i d e r a t i o n d e c i s i o n . A t t h D e c i s i o n i s b a s e d o n t h e i n i t i a l P W D a p p l i c a t i o n w h i c h d l e g i s l a t i v e r e q u i r e m e n t f o r P W D s t a t u s . T h e m i n i s t r y c o m p r e s e n t e d b y t h e a p p e l l a n t d i d n o t a l l o w f o r a r e a s s e s s m I n r e s p o n s e t o a q u e s t i o n , t h e m i n i s t r y s t a t e d t h a t i n c o n w e r e i n i t i a l e d b y t h e a p p e l l a n t ' s g e n e r a l p r a c t i t i o n e r , t h e y I A P P E A L # i s n o t a b l e t o c l e a n · h i s h o u s e p r o p e r l y a n d h e h a s a h i s p h y s i o t h e r a p i s t c o m p l e t e d t h e P T R e p o r t , s h e d i d d i d n o t u n d e r t a k e a n y o b j e c t i v e t e s t i n g s u c h a s r a n g e t i n t e r v i e w , h e h a d n o t s e e n h i s p h y s i o t h e r a p i s t f o r T L e t t e r s h o u l d b e p r e f e r r e d a s o p p o s e d t o t h e A R u i c k l y a n d w i t h o u t s u f f i c i e n t t h o u g h t a n d c o n s i d e r a t i o n . o s i t i o n s h e w o u l d h a v e b e e n i n t o a c c u r a t e l y r e p a r e d t h e R F R s u b m i s s i o n s a n d t h e n t o o k t h e m t o r o u g h t h e m a n d i n i t i a l e d e a c h p a g e . e h e a r i n g , t h e m i n i s t r y s t a t e d t h a t t h e R e c o n s i d e r a t i o n i d n o t p r o v i d e s u f f i c i e n t i n f o r m a t i o n t o m e e t t h e m e n t e d f u rt h e r t h a t t h e a d d i t i o n a l i n f o r m a t i o n e n t a t r e c o n s i d e r a t i o n . s i d e r i n g t h e R F R s u b m i s s i o n s a n d t h e f a c t t h a t t h e y d i d n o t a d d a n y t h i n g t o t h e P W D a p p l i c a t i o n .
APPEAL II I PART F -Reasons for Panel Decision The issue on the appeal is whether the ministry's reconsideration decision, which found that the appellant is not eligible for designation as a person with disabilities (PWD), was reasonably supported by the evidence or was a. reasonable application of the applicable enactment in the circumstances of the appellant. The ministry found that the appellant does not have a severe mental or physical impairment and that his daily living activities (DLA) are not, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods and that, as a result of those restrictions, it could not be determined that the appellant requires the significant help or supervision of another person, the use of an assistive device, or the services of an assistance animal to perform DLA. The criteria for being designated as a PWD are set out in Section 2 of the EAPWDA as follows: Persons with disabilities 2 (1) In this section: "assistive device" means a device designed to enable a person to perform a daily living activity that, because of a severe mental or physical impairment, the person is unable to perform; "daily living activity" has the prescribed meaning; "prescribed professional" has the prescribed meaning. (2) The minister may designate a person who has reached 18 years of age as a person with disabilities for the purposes of this Act if the minister is satisfied that the person has a severe mental or physical impairment that (a) in the opinion of a medical practitioner is likely to continue for at least 2 years, and (b) in the opinion of a prescribed professional (i) directly and significantly restricts the person's ability to perform daily living activities either (A) continuously, or (B) periodically for extended periods, and (ii) as a result of those restrictions, the person requires help to perform those activities·. (3) For the purposes of subsection (2), (a) a person who has a severe mental impairment includes a person with a mental disorder, and (b) a person requires help in relation to a daily living activity if, in order to perform it, the person requires (i) an assistive device, (ii) the significant help or supervision of another person, or (iii) the services of an assistance animal. (4) The minister may rescind a designation under subsection (2). Section 2(1)(a) of the EAPWDR defines DLA for a person who has a severe physical or mental impairment as follows: Definitions for Act 2 (1) For the purposes of the Act and this regulation, "daily living activities" (a) in relation to a person who has a severe physical impairment or a severe mental impairment, means the following activities: (i) prepare own meals; (ii) manage personal finances; (iii) shop for personal needs; (iv) use public or personal transportation facilities;
APPEAL II I (v) perform housework to maintain the person's place of residence in acceptable sanitary condition; (vi) move about indoors and outdoors; (vii) perform personal hygiene and self care; (viii) manage personal medication, and (b) in relation to a person_ who has a severe mental impairment, includes the following activities: (i) make decisions about personal activities, care or finances; (ii) relate to, communicate or interact with others effectively. Severity of impairment Section 2(2){a) of the EAPWDA is clear that when addressing the issue of a severe physical or mental impairment in the context of a person applying for a PWD designation, that person must be found to have a severe physical impairment that, in the opinion of a medical practitioner, is likely to continue for at least 2 years. Severity of mental impairment The appellant did not advance an argument at the hearing that he suffered from a severe mental impairment. The ministry takes the position that the evidence does not establish that the appellant suffers from a severe mental impairment. Panel Decision In the PR, the appellant's general physician does not diagnose the appellant with a mental impairment and notes that he does not experience any significant deficits with cognitive and emotional function. Reviewing the balance of the evidence including the AR and the appellant's submissions attached to the RFR, the panel notes that there is no mention of the appellant suffering from a mental impairment or brain injury. The panel therefore concludes that the ministry was reasonable in determining that the evidence did not establish that the appellant has a severe mental Impairment under section 2(2) of the EAPWDA. Severity of physical impairment The appellant takes the position that the evidence demonstrates that he has a severe physical impairment. In this regard, he points to the PR and the AR as well as the PT Letter, the GP Report and his RFR submissions which have been initialed by his general practitioner. The ministry takes the position that the PWD application is the foundation for the appellant's claim and does not establish that he suffers from a severe physical impairment. The ministry states that the additional evidence does not add to that in the PWD application. Panel Decision The panel notes that the appellant's general practitioner, who has treated the appellant for more than 5 years and between 2 and 1 O times in the 12 months prior to completing the PR, has described his condition in the PR as mild to moderate arm pain secondary to osteoarthritis in his spine with onset in 2012, that the appellant is able to walk more than 4 blocks unaided on a flat surface, climb more than 5 stairs unaided, lift between 2 and 7 kg and sit without limitation. The panel notes that the general practitioner has commented that the aooellant's pain may vary based on therapy.
I n t h e A R , t h e a p p e l l a n t ' s p h y s i o t h e r a p i s t c o m m e n t s t h a i n d e p e n d e n t i n a l l a s p e c t s o f 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 u s e o f h i s l e f t h a n d a n d a r m a n d m u s t u s e h i s r i g h t h 5 S l b s . T h i s e v i d e n c e m u s t b e c o n s i d e r e d i n l i g h t o f t h e G P L e t t R F R S u b m i s s i o n s w h i c h w e r e r e v i e w e d a n d i n i t i a l e d b y R e p o r t , t h e g e n e r a l p r a c t i t i o n e r i s a s k e d t o d e s c r i b e t h e b y c h e c k i n g t h e " s e v e r e " b o x . W h i l e t h e g e n e r a l p r a c t i t i o c o n d i t i o n h a s " w o r s e n e d s i n c e o n s e t ' ' w h i c h i s n o t e d i n t c o n t r a d i c t s t h a t i n t h e P R i n w h i c h t h e g e n e r a l p r a c t i t i o n e m o d e r a t e . S i m i l a r l y , i n t h e P T L e t t e r t h e p h y s i o t h e r a p i s t i s a s k e d t o a p p e l l a n t ' s " c o n d i t i o n " i s s e v e r e , t h a t h e h a s s i g n i f i c a n t r c o n t i n u o u s a s s i s t a n c e w i t h t h e a c t i v i t i e s l i s t e d p r e v i o u s l y " A g r e e " b o x . T h e p a n e l n o t e s h o w e v e r t h a t i t i s t h e a p p e c o n c l u s i o n w a s r e a c h e d b a s e d o n a n i n p e r s o n i n t e r v i e w a p p e l l a n t h a d n o t a t t e n d e d a n y t h e r a p y s e s s i o n s w i t h h i s i n t e r v i e w . F u r t h e r n o t e d b y t h e p a n e l a r e t h e a p p e l l a n t ' s R F R s u b m g e n e r a l p r a c t i t i o n e r f o r h e r r e v i e w . I n t h o s e s u b m i s s i o n s 2 o r 3 b l o c k s , t h a t h e c a n c l i m b s t a i r s b u t n o t w i t h o u t d i s c e s t i m a t e a s t o w h a t h e c o u l d l i f t w i t h h i s r i g h t h a n d . H e f 1 O m i n u t e s b e f o r e e x p e r i e n c i n g n e c k a n d b a c k d i s c o m f o i m p a i r m e n t o f m y a b i l i t y t o a c t i n d e p e n d e n t l y w i t h r e g a r d m a j o r i t y o f m y [ D L A ] a n d d o e s , i n f a c t , e s t a b l i s h t h a t I h a i n d e p e n d e n t l y , e f f e c t i v e l y a n d / o r f o r a r e a s o n a b l e d u r a t i o T h e p a n e l n o t e s h o w e v e r t h a t t h e a p p e l l a n t ' s e v i d e n c e a s u b m i s s i o n s i s c o n s i s t e n t w i t h t h a t i n t h e P R . F o r e x a m p t o w a l k 4 o r m o r e b l o c k s u n a i d e d . I n t h e R F R S u b m i s s i o r a t h e r s a y s h e e x p e r i e n c e s b a c k p a i n a f t e r w a l k i n g 2 . o r 3 P R r e p o r t s t h e a p p e l l a n t a s b e i n g a b l e t o c l i m b 5 o r m o r e t h a t h e c a n c l i m b s t a i r s b u t n o t w i t h o u t d i s c o m f o r t . T h e a b e t w e e n 2 a n d 7 k g a n d h e c l a r. i f i e s i n t h e R F R S u b m i s s i o h a n d . W h i l e t h e P R d e s c r i b e s t h e a p p e l l a n t a s b e i n g a b d e s c r i b e s h i m s e l f a s o n l y b e i n g a b l e t o s i t f o r 1 0 m i n u t e s T h e p a n e l n o t e s t h a t i n d e s c r i b i n g t h e a p p e l l a n t ' s o v e r a l l e v i d e n c e t h a t t h e g e n e r a l p r a c t i t i o n e r a p p e a r s t o r e l y o n p r o v i d e d b y t h e a p p e l l a n t h i m s e l f i n t h e R F R s u b m i s s i o n d e s c r i b e t h e a p p e l l a n t ' s o v e r a l l m e d i c a l " c o n d i t i o n " a s s e i t i s t h e " i m p a i r m e n t ' ' t h a t m u s t b e d e m o n s t r a t e d a s b e i n g S i m i l a r l y , w h i l e t h e p h y s i o t h e r a p i s t a g r e e s t h a t t h e a p p e l P T L e t t e r d o e s n o t c o m m e n t f u r t h e r o n t h e a p p e l l a n t ' s f u h i s D L A . F u r t h e r , t h e p a n e l n o t e s t h a t t h e p h y s i o t h e r a p i s i s i n c o n s i s t e n t w i t h h e r f i n d i n g s i n t h e A R t h a t t h e a p p e l l a n h v s i c a l a b i l i t v . L a s t l v , t h e o a n e l n o t e s t h e a n n e l l a n t ' s e v I A P P E A L # t h e h a s l e f t s h o u l d e r a n d a r m w e a k n e s s a n d t h a t h e i s a d d i n g t h e c o m m e n t s t h a t t h e a p p e l l a n t i s l i m i t e d i n a n d a n d s h o u l d e r m o r e o f t e n f o r w e i g h t s t h a t e x c e e d e r , t h e P T L e t t e r , t h e G P R e p o r t a n d t h e a p p e l l a n t ' s h i s g e n e r a l p r a c t i t i o n e r . F o r e x a m p l e , i n t h e G P a p p e l l a n t ' s " o v e r a l l m e d i c a l c o n d i t i o n " a n d r e s p o n d s n e r c o m m e n t s i n t h e G P R e p o r t t h a t t h e a p p e l l a n t ' s h e r e p o r t a s 2 0 1 1 , t h e p a n e l f i n d s t h a t t h i s e v i d e n c e r d e s c r i b e s t h e a p p e l l a n t ' s s h o u l d e r p a i n a s m i l d t o e i t h e r a g r e e o r d i s a g r e e w i t h t h e s t a t e m e n t t h a t t h e e s t r i c t i o n s w i t h h i s D L A a n d a s a r e s u l t h e r e q u i r e s i n t h e l e t t e r a n d t h e p h y s i o t h e r a p i s t c h e c k s t h e l l a n t ' s e v i d e n c e a t t h e h e a r i n g o f t h i s m a t t e r t h a t t h i s w i t h o u t a n y o b j e c t i v e t e s t i n g a n d t h a t f u r t h e r , t h e p h y s i o t h e r a p i s t i n t h e f i v e m o n t h s p r i o r t o t h a t i s s i o n s w h i c h h e p r e p a r e d a n d p r e s e n t e d t o h i s , h e s a y s t h a t h e e x p e r i e n c e s b a c k p a i n a f t e r w a l k i n g o m f o r t a n d t h a t h i s a b i l i t y t o l i f t 2 -7 k g w a s a n u r t h e r i n d i c a t e s t h a t h e c a n o n l y s i t f o r a p p r o x i m a t e l y r t . H e s a y s t h a t t h e s e f a c t o r s c o n s t i t u t e " s u b s t a n t i a l s t o m o b i l i t y , p h y s i c a l a b i l i t i e s a n d a s i g n i f i c a n t v e a s e v e r e r e s t r i c t i o n i n m y a b i l i t y t o f u n c t i o n n . " s t o h i s f u n c t i o n a l s k i l l s a s s e t o u t i n t h e R F R l e , i n t h e P R t h e a p p e l l a n t i s d e s c r i b e d a s b e i n g a b l e n s , t h e a p p e l l a n t d o e s n o t r e d u c e t h a t f i g u r e b u t b l o c k s . W i t h r e s p e c t t o c l i m b i n g s t a i r s u n a i d e d , t h e w h i l e t h e a p p e l l a n t s t a t e s i n t h e R F R S u b m i s s i o n s p p e l l a n t i s d e s c r i b e d i n t h e P R a s b e i n g a b l e t o l i f t n s t h a t t h i s i s w i t h h i s r i g h t , a l b e i t n o n d o m i n a n t l e t o r e m a i n s e a t e d w i t h o u t l i m i t a t i o n , t h e a p p e l l a n t i n t h e R F R S u b m i s s i o n s . m e d i c a l c o n d i t i o n i n t h e G P R e p o r t a s " s e v e r e , " t h e i s i n c o n s i s t e n t w i t h t h a t i n t h e P R a n d w i t h t h a t s . F u r t h e r , b o t h t h e G P R e p o r t a n d t h e P T L e t t e r v e r e w h i l e s e c t i o n 2 ( 2 } o f t h e E A P W D A p r o v i d e s t h a t s e v e r e . l a n t ' s " c o n d i t i o n " i s s e v e r e , t h e p a n e l n o t e s t h a t t h e n c t i o n a l a b i l i t i e s b u t r a t h e r f o c u s e s o n r e s t r i c t i o n s o n t ' s d e s c r i p t i o n o f t h e a p p e l l a n t ' s c o n d i t i o n a s s e v e r e n t i s i n d e p e n d e n t i n a l l a s p e c t s o f m o b i l i t y a n d i d e n c e t h a t h e h a d n o t b e e n e x a m i n e d b v h i s
p h y s i o t h e r a p i s t f o r a p p r o x i m a t e l y 5 m o n t h s p r i o r t o h e r c W h e r e t h e r e i s i n c o n s i s t e n t o r c o n t r a d i c t o r y e v i d e n c e a s t o s e e w h e t h e r t h e a p p e l l a n t p r o v i d e s a r e a s o n a b l e e x p l f i n d s u c h a n e x p l a n a t i o n . T h e g e n e r a l p r a c t i t i o n e r a n d p a p p e l l a n t ' s f u n c t i o n a l a b i l i t i e s i n t h e P W D a p p l i c a t i o n a n d q u e s t i o n o f w h e t h e r t h e a p p e l l a n t h a s a s e v e r e p h y s i c a l w e i g h t o n t h i s e v i d e n c e t h a n t h a t i n t h e G P R e p o r t , t h e G S u b m i s s i o n s . D e s p i t e t h e g e n e r a l p r a c t i t i o n e r ' s d i a g n o s i s o f s p i n a l o s t a n d c o n t r a d i c t o r y n a t u r e o f t h e G P R e p o r t , G P L e t t e r , P T t h e P W D a p p l i c a t i o n l e a d s t h e p a n e l t o c o n c l u d e t h a t t h e e v i d e n c e 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 A P W D A . 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 ri o r m D L A T h e a p p e l l a n t t a k e s t h e p o s i t i o n t h a t h e h a s s i g n i f i c a n t r e 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 i t h a s n o t b e e n e s t a b l i s h e d D L A h a s b e e n 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 b y h i s p f o r e x t e n d e d p e r i o d s a s r e q u i r e d b y s e c t i o n 2 ( 2 ) o f t h e E P a n e l D e c i s i o n 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 i n t h e o p i n 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 e d b y t h e i r s e v e r e i m p a i r m p e r i o d s . I n t h e P R , t h e g e n e r a l p r a c t i t i o n e r r e p o r t s t h e a p p e l l a n t t m a n a g e m e n t o f m e d i c a t i o n s , m o b i l i t y i n s i d e a n d o u t s i d e f i n a n c e s . H e i s d e s c r i b e d a s b e i n g p e r i o d i c a l l y r e s t r i c t e d s h o p p i n g b u t t h a t t h e p e r i o d i c r e s t r i c t i o n i s " r e l a t e d o n l y t I n t h e A R , t h e p h y s i o t h e r a p i s t 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 t w i t h r e s p e c t t o g r o o m i n g , l a u n d r y , b a s i c h o u s e k e e p i s h o u l d e r a n d a r m p a i n w h i c h w i l l p e r s i s t f o l l o w i n g a c t i v i t i 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 r p e r s o n . A g a i n , t h e e v i d e n c e i n t h e P R a n d A R m u s t b e c o n s i d e r e w i t h r e s p e c t t o D L A , i n t h e P T R e p o r t t h e p h y s i o t h e r a p i s h a s d i f f i c u l t y w i t h m e a l p r e p a r a t i o n a n d c o o k i n g , h e i s n o t o k e e p i t i n a s a n i t a r y c o n d i t i o n a n d t h a t h i s n e c k , b a c k a a n d v a c u u m i n g . T h e p h y s i o t h e r a p i s t f u r t h e r c h e c k s " A g r " s i g n i f i c a n t r e s t r i c t i o n s w i t h h i s a c t i v i t i e s o f d a i l y l i v i n g . . . " I n h i s e v i d e n c e a t t h e h e a r i n g , t h e a p p e l l a n t a r g u e d t h a t i n t h e P T R e p o r t a s o p p o s e d t o t h e A R a s i t w a s m o r e r e t h e A R w a s p r e p a r e d q u i c k l y a n d w i t h o u t a d e q u a t e c o n s e v i d e n c e t h a t t h e P T R e p o r t , p r e p a r e d b y h i s a d v o c a t e , w s e e n t h e a e l l a n t i n t h e f i v e m o n t h s r i o r t o i t s c o m l e t i A P P E A L / I I o m p l e t i n g t h e P T L e t t e r . t o t h e a p p e l l a n t ' s f u n c t i o n a l s k i l l s , t h e p a n e l m u s t l o o k a n a t i o n a n d i n t h e p r e s e n t c a s e , t h e p a n e l i s u n a b l e t o h y s i o t h e r a p i s t b o t h p r o v i d e d e v i d e n c e o f t h e f o r t h e r e a s o n s s e t o u t a b o v e , i n c o n s i d e r i n g t h e i m p a i r m e n t , t h e p a n e l p r e f e r s a n d p l a c e s g r e a t e r P L e t t e r , t h e P T L e t t e r o r t h e a p p e l l a n t ' s R F R e o a r t h r i t i s a n d a s s o c i a t e d a r m p a i n , t h e i n c o n s i s t e n t L e t t e r a n d R F R s u b m i s s i o n s w h e n v i e w e d i n l i g h t o f 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 r m i n i n g t h a t t h e e p h y s i c a l i m p a i r m e n t u n d e r s e c t i o n 2 ( 2 ) o f t h e s t r i c t i o n s w i t h h i s D L A . b y t h e e v i d e n c e t h a t t h e a p p e l l a n t ' s a b i l i t y t o p e r f o r m h y s i c a l i m p a i r m e n t 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 A P W D A . 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 , a p e r s o n ' s D L A a r e e n t 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 o e x p e r i e n c e n o r e s t r i c t i o n s w i t h p e r s o n a l s e l f c a r e , t h e h o m e , u s e o f t r a n s p o r t a t i o n a n d m a n a g e m e n t o f w i t h m e a l p r e p a r a t i o n , b a s i c h o u s e w o r k a n d d a i l y o l e f t a r m p a i n , i e , l i f t i n g a n d c a r r y i n g . " t i s i n d e p e n d e n t i n 2 7 o f 2 8 t a s k s o f D L A . S h e s a y s n g , 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 a t h e d e v e l o p s l e f t e s a n d t h a t f o r c a r r y i n g p u r c h a s e s h o m e h e r e q u i r e s d i n l i g h t o f t h e a d d i t i o n a l e v i d e n c e . F o r e x a m p l e , t c h e c k s " A g r e e " w i t h t h e s t a t e m e n t s t h a t t h e a p p e l l a n t t a b l e t o s c r u b a n d c l e a n t h e w a y h i s h o m e s h o u l d b e n d l e f t a r m p a i n p r e v e n t h i m f r o m p r o p e r l y s w e e p i n g e e " w i t h t h e s t a t e m e n t t h a t t h e a p p e l l a n t h a s . t h e p a n e l s h o u l d p r e f e r t h e p h y s i o t h e r a p i s t ' s e v i d e n c e c e n t i n t i m e . H e f u r t h e r s t a t e d t h a t t h e e v i d e n c e i n i d e r a t i o n . H o w e v e r , t h e p a n e l n o t e s t h e a p p e l l a n t ' s a s c o m p l e t e d b y t h e p h y s i o t h e r a p i s t w h o h a d n o t o n . T h e a n e l f u r t h e r n o t e s t h a t w h i l e t h e
p h y s i o t h e r a p i s t a g r e e s t h a t t h e a p p e l l a n t h a s s i g n i f i c a n t t h e P T R e p o r t i s w i t h m e a l p r e p a r a t i o n , c o o k i n g a n d b a s t h e A R w i t h s o m e m i n o r q u a l i f i c a t i o n s . C o n s i d e r i n g t h e I n t h e R F R s u b m i s s i o n s i n i t i a l e d b y t h e g e n e r a l p r a c t i t i o h o u s e k e e p i n g a n d n o r m a l l i v i n g a c t i v i t i e s b e c a u s e o f m y c l e a n i n g , m e a l p r e p a r a t i o n a n d c l e a n u p , s o m e p e r s o n a e v i d e n c e o f t h e g e n e r a l p r a c t i t i o n e r i n t h e P R i s c o n s i s t e I n t h e p r e s e n t c a s e , t h e e v i d e n c e o f t w o p r e s c r i b e d p r o f p h y s i o t h e r a p i s t , i 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 p e rf o r m t h t h e P R t h a t r e q u i r e p e r i o d i c a s s i s t a n c e m e a l p r e p a r a t i i s t h a t t h e p e r i o d i c n a t u r e i s r e l a t e d o n l y t o t h e a p p e l l a n t p r a c t i t i o n e r i n t h e P R a s m i l d t o m o d e r a t e . T h e p a n e l n o r e g a r d i n t h a t t h e q u a l i f y i n g c o m m e n t s b y t h e p h y s i o t h e r h o u s e k e e p i n g , f o o d p r e p a r a t i o n , c o o k i n g a n d c a r r y i n g p a n d s h o u l d e r p a i n . B a s e d o n t h e e v i d e n c e , t h e p a n e l c o n c l u d e s t h a t t h e m i n p h y s i c a l i m p a i r m e n t d o e s n o 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 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 u n d e r s e c t i o n 2 { 2 ) { b ) o H e l p w i t h D L A 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 h e r e q u i r e s a s s i s t a n c e t o s u b m i s s i o n s t h a t h e h a s , r e q u e s t e d a s s i s t a n c e i n t h e p a s s o m e p e r s o n a l c a r e a n d l a u n d r y . 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 a b l i s h 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 d e t e r m i n e d t h a t s i g n i P a n e l D e c i s i o n S e c t i o n 2 { 2 ) { b ) ( i i ) o f t h e E A P W D A r e q u i r e s t h a t , a s a r e s p e r f o r m D L A , a p e r s o n r e q u i r e s h e l p t o p e rf o r m t h o s e a c 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 L A i f , i n o r d e r t o p 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 t h e s A s n o t e d a b o v e , t h e p a n e l h a s f o u n d t h e m i n i s t r y ' s c o n c d o e s 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 r e q u i r e s a s s i s t a n c e e x t e n d e d p e r i o d s o f t i m e t o b e r e a s o n a b l e . T h e p a n e l t h e r e f o r e f i n d s t h a t a s t h e m i n i s t r y r e a s o n a b l y i n t h e a p p e l l a n t ' s a b i l i t y t o p e r f o r m D L A h a v e n o t b e e n e r e q u i r e s h e l p t o p e r f o r m D L A a s a r e s u l t o f t h o s e r e s t r i c t 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 a n d r e c o n s i d e r a t i o n w h i c h 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 w a s a p p l i c a t i o n o f t h e a p p l i c a b l e e n a c t m e n t i n t h e c i r c u m s t a n d e c i s i o n .I A P P E A L # r e s t r i c t i o n s o n h i s D L A , t h e o n l y e v i d e n c e o f s u c h i n i c h o u s e w o r k w h i c h w e r e a l l n o t e d a s i n d e p e n d e n t i n e v i d e n c e , t h e p a n e l p r e f e r s t h e A R t o t h e P T R e p o r t . n e r , t h e a p p e l l a n t s t a t e s t h a t h e h a s " d i f f i c u l t y w i t h d i s a b i l i t y " a n d t h a t h e r e q u i r e s a s s i s t a n c e w i t h " h o u s e l c a r e a n d l a u n d e r i n g n e e d s . " T h e p a n e l n o t e s t h a t t h e n t w i t h t h e s e c o m m e n t s . e s s i o n a l s , t h e a p p e l l a n t ' s g e n e r a l p r a c t i t i o n e r a n d e m a j o r i t y o f h i s D L A i n d e p e n d e n t l y . F o r t h e t a s k s i n o n , b a s i c h o u s e w o r k a n d d a i l y s h o p p i n g t h e e v i d e n c e ' s l e f t a r m p a i n w h i c h i s d e s c r i b e d b y t h e g e n e r a l t e s t h a t t h e e v i d e n c e i n t h e A R i s c o n s i s t e n t i n t h a t a p i s t w i t h r e s p e c t t o g r o o m i n g , l a u n d r y , b a s i c u r c h a s e s h o m e , w h i l e a l l i n d e p e n d e n t , c a u s e l e f t a r m i s t r y w a s r e a s o n a b l e i n f i n d i n g t h a t t h e a p p e l l a n t ' s 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 , e i t h e r c o n t i n u o u s l y o r f t h e E A P W D A . p e r f o r m D L A . S p e c i f i c a l l y , h e s a y s i n h i s R F R t f o r h o u s e k e e p i n g , m e a l p r e p a r a t i o n a n d c l e a n u p , e d t h a t t h e a p p e l l a n t ' s D L A a r e d i r e c t l y a n d f i c a n t h e l p i s r e q u i r e d f r o m o t h e r p e r s o n s . u l t o f 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 s i n t h e a b i l i t y t o t i v i t i e s . S e c t i o n 2 ( 3 ) o f t h e E A P W D A p r o v i d e s t h a t a r f o r m i t , t h e p e r s o n r e q u i r e s a n a s s i s t i v e d e v i c e , t h e 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 . l u s i o n t h a t t h e e v i d e n c e o f 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 w i t h h i s D L A 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 d e t e r m i n e d t h a t a s 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 s s t a b l i s h e d , i t c a n n o t b e 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 o n s , a s d e f i n e d i n s e c t i o n 2 ( 3 ) ( b ) o f t h e E A P W D A . 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 t h e m i n i s t r y ' s n o t 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 w a s a r e a s o n a b l e c e s o f t h e a p p e l l a n t , a n d t h e r e f o r e c o n f i r m s t h e
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.