P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e M i n i s t r y o f S o c i a l r e c o n s i d e r a t i o n d e c i s i o n d a t e d D e c e m b e r 2 3 , 2 0 1 3 o f t h e f i v e s t a t u t o r y r e q u i r e m e n t s o f S e c t i o n 2 o f t h D i s a b i li t i e s A c t f o r d e s i g n a t i o n a s a p e r s o n w i t h d i s a p p e l l a n t m e t t h e a g e r e q u i r e m e n t a n d t h a t h i s i m p H o w e v e r , t h e m i n i s t r y w a s n o t s a t i s f i e d t h a t t h e e v i • 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 o r m e n t a • t h e a p p e l l a n t ' s d a i l y l i v i n g a c t i v i t i e s ( D L A ) a r 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 e i t h e r c o n • a s a r e s u l t o f t h e s e r e s t r i c t i o n s , t h e a p p e l l a n a n o t h e r p e r s o n , t h e u s e o f a n a s s i s t i v e d e v i c p e r f o r m D L A . P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e fo r P e r s o n s w i t h D i s a b E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b . . . I A P P E A L # D e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ( t h e m i n i s t r y ) w h i c h f o u n d t h a t t h e a p p e l l a n t d i d n o t m e e t t h r e e e E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h a b i l i t i e s ( P W D ) . T h e m i n i s t r y f o u n d t h a t t h e 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 a t l e a s t t w o y e a r s . d e n c e e s t a b l i s h e s t h a t : l i m p a i r m e n t ; e , 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 , 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 , t r e q u i r e s 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 e , o r 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 o i l i t i e s A c t ( E A P W D A ) , S e c t i o n 2 i l i t i e s R e g u l a t i o n ( E A P W D R ) , S e c t i o n 2 . . . •. . . . . . . .
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 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 2 0 1 3 , a n d a p h y s i c i a n r e p o r t ( P R ) d a t e d J u l y 8 , 2 0 a n d b o t h c o m p l e t e d b y a g e n e r a l p r a c t i t i o n e r w h o h 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 ) M e d i c a t i o n R e v i e w d a t e d J u l y 1 9 , 2 0 1 2 l i s t i n 2 ) P a t i e n t M e d i c a l E x p e n s e s p r i n t e d N o v e m b e 3 ) L e t t e r d a t e d N o v e m b e r 2 7 , 2 0 1 3 p r e p a r e d b 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 r e p o 4 ) R e q u e s t f o r R e c o n s i d e r a t i o n d a t e d N o v e m b 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 d i a b e t e s , s e v e r e o b e s i t y , a n d l o w b a c k p a i n / h i p p a 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 " . . . c h r o n i c p a i n i n h i s l o w b a c k , k n e e s , a n d h h i s A O L ' s [ a c t i v i t i e s o f d a i l y l i v i n g ] b u t m a r k e O A [ o s t e o a r t h r i t i s ] i n h i s k n e e s a n d h i p . H e w h i c h c o n t r i b u t e s t o h i s m u s c u l o s k e l e t a l p r o • 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 " c a n e f o r s t a i r s , n e o p r e n e k n e e b r a c e s b i l a t e • F u n c t i o n a l s k i l l s r e p o rt e d i n t h e P R i n d i c a t e d a n d c l i m b 5 o r m o r e s t e p s ( w i t h a n o t e a d d e d t o 1 6 k g ( 1 5 -3 5 l b s . ) a n d r e m a i n s e a t e d f o r • 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 " m a r k e d o b e s i t y c o n t r i b u t e s t o h i s c h r o n i c m u a n d b a c k l i m i t m o b i l i t y a n d m a k e h i m a p o o r • I n t h e A R , t h e g e n e r a l p r a c t i t i o n e r s u m m a r i z e a b i l i t y t o m a n a g e d a i l y l i v i n g a c t i v i t i e s a s " . . . c [ o s t e o a r t h r i t i s ] i n h i s h i p a n d k n e e s . H i s m o r [ m u s c u l o s k e l e t a l ] p a i n . H e i s l i m i t e d i n b o t h h t o l e r a n c e . " • 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 t h a t t h e a p f o r h i s i m p a i r m e n t . • I n h i s s e l f r e p o r t , t h e a p p e l l a n t w r o t e t h a t h i s w i t h h i s l e f t a r m . H e i s v e r y l i m i t e d w i t h h o l d i a r e w e a k . H e c a n w a l k h a l f a b l o c k a n d h a s w a l k s w i t h a k n e e b r a c e o n e a c h k n e e . H e i s h i g h c h o l e s t e r o l a n d h i g h b l o o d p r e s s u r e . H e • I n t h e l e t t e r f r o m t h e g e n e r a l p r a c t i t i o n e r d a t e m a d e b y t h e a p p e l l a n t , i n c l u d i n g t h a t h e i s o n s t o p a n d t a k e a b r e a k , a n d t h a t h e i s u n a b l e t I A P P E A L # r e c o n 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 p l i c a n 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 6 , 1 3 a n d a n a s s e s s o r r e p o r t ( A R ) d a t e d J u l y 9 , 2 0 1 3 a s k n o w n t h e a p p e l l a n t f o r 2 2 y e a r s . g m e d i c a t i o n s ; r 2 3 , 2 0 1 3 ; y t h e a p p e l l a n t ' s a d v o c a t e a n d s i g n e d b y t h e r t s f o r t h e P W D : a n d , e r 2 7 , 2 0 1 3 . r a c t i t i o n e r w i t h o s t e o a rt h r i t i s i n h i s k n e e s , i n . i n t h e 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 h a s i p . I t d o e s n o t i m p a i r h i s a b i l i t i e s w i t h r e s p e c t t o d l y l i m i t s h i s e m p l o y a b i l i t y . H i s X R a y s c o n f i r m a l s o h a s d i a b e t e s s e c o n d a r y t o h i s m o r b i d o b e s i t y b l e m s . " p e l l a n t r e q u i r e s a n a i d f o r h i s i m p a i r m e n t , n a m e l y r a l l y . " t h a t t h e a p p e l l a n t c a n w a l k 1 t o 2 b l o c k s u n a i d e d t h a t t h e a p p e l l a n t " u s e s c a n e " ) , a n d h e c a n l i f t 7 l e s s t h a n 1 h o u r . 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 n t ' s s c u l o s k e l e t a l p a i n . C h r o n i c p a i n i n h i p , k n e e s c a n d i d a t e f o r e m p l o y m e n t . " d t h e a p p e l l a n t ' s i m p a i r m e n t s t h a t i m p a c t h i s h r o n i c p a i n i n h i s l u m b a r s p i n e , a s w e l l a s O A b i d o b e s i t y c o n t r i b u t e s t o h i s M S K i s m o b i l i t y a s w e l l a s h i s s t a n d i n g / s i t t i n g p e l l a n t r o u t i n e l y u s e s a c a n e t o h e l p c o m p e n s a t e w a l k i n g i s a f f e c t e d a s w e l l a s h i s a b i l i t y t o g r a b n g a n y t h i n g a n d h a s s e r i o u s p a i n . B o t h h i s l e g s t o s t o p a n d r e s t h i s l e g s o r h e w i l l b e i n p a i n . H e o n m e d i c a t i o n f o r T y p e 2 D i a b e t e s a n d h e h a s d o e s n o t s l e e p w e l l d u e t o t h e p a i n . d N o v e m b e r 2 7 , 2 0 1 3 , h e a g r e e d w i t h s t a t e m e n t s l y a b l e t o w a l k u p t o o n e b l o c k b e f o r e h e h a s t o o c l i m b a n y s t a i r s w i t h o u t t h e u s e o f a c a n e . T h e
g e n e r a l p r a c t i t i o n e r a g r e e s t h a t t h e a p p e l l a n m i n u t e s b e f o r e h e h a s t o s i t d o w n . • I n t h e l e t t e r , t h e g e n e r a l p r a c t i t i o n e r d i s a g r e e a b l e t o s i t f o r u p t o 1 0 m i n u t e s a t a t i m e . M e n t a l I m p a i r m e n t • 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 n o s i g n i f i c a a n d t h a t t h e a p p e l l a n t d o e s n o t h a v e d i f f i c u l t • R e g a r d i n g t h e a p p e l l a n t ' s a b i l i t y t o c o m m u n i s p e a k i n g , r e a d i n g , w r i t i n g a n d h e a r i n g a s g o • I n t h e A R , t h e g e n e r a l p r a c t i t i o n e r a s s e s s e d c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n g a n d n o t e • 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 t h a t t h e a p f u n c t i o n i n g , i n c l u d i n g m a k i n g a p p r o p r i a t e s o r e l a t i o n s h i p s , i n t e r a c t i n g a p p r o p r i a t e l y w i t h o d e m a n d s , a n d s e c u r i n g a s s i s t a n c e f r o m o t h e f u n c t i o n i n g i n b o t h h i s i m m e d i a t e a n d e x t e n d p r o v i d e d b y t h e g e n e r a l p r a c t i t i o n e r . D a il y L i v i n g A c t i v i t i e s ( D L A ) • 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 t r e a t m e n t s t h a t i n t e r f e r e w i t h h i s a b i l i t y t o p e • 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 h e a l " . . . c h r o n i c p a i n i n h i s l o w b a c k , k n e e s , a n d h h i s A O L ' s b u t m a r k e d l y l i m i t s h i s e m p l o y a b i l i 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 t r e s t r i c t h i s a b i l i t y t o p e r f o r m D L A . D e s p i t e t h a p p e l l a n t i s r e s t r i c t e d i n a l l a r e a s o f D L A b u t e i t h e r p e r i o d i c o r c o n t i n u o u s o r p r o v i d e a n y f • T h e g e n e r a l p r a c t i t i o n e r a s s e s s e d t h e a p p e l l a o u t d o o r s , w i t h c l i m b i n g s t a i r s a n d s t a n d i n g , w c a r r y i n g a n d h o l d i n g , w i t h a c o m m e n t a d d e d • I n t h e A 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 t m e a l s , p a y i n g r e n t a n d b i l l s , m e d i c a t i o n s a n d n o n e e d f o r a s s i s t a n c e . • F o r b a s i c h o u s e k e e p i n g , t h e a p p e l l a n t i s a s s e h i s a b i l i t y t o d o l a u n d r y , w i t h t h e g e n e r a l p r a c h o w . " T h e g e n e r a l p r a c t i t i o n e r a l s o c o m m e n t d o e s l i m i t h i s e m p l o y a b i l i t y . " • I n h i s s e l f r e p o r t , t h e a p p e l l a n t w r o t e t h a t t h e w a l k a n d t o g r a b a n d h o l d . • I n t h e l e t t e r d a t e d N o v e m b e r 2 7 , 2 0 1 3 , t h e g e t h e a p p e l l a n t t h a t , f o r d r e s s i n g , h i s w i f e h e l p s t o n o t b e i n g a b l e t o p u l l c l o t h e s f r o m f e e t o n t t h e a p p e l l a n t i s u n a b l e t o d o l a u n d r y b e c a u s e p r a c t i t i o n e r a g r e e d t h a t , f o r b a s i c h o u s e k e e p i o r t o b e n d t o c l e a n o u t t h e b a t h t u b . T h e n e n e I A P P E A L # t s t a t e s h e i s o n l y a b l e t o s t a n d f o r u p t o 1 0 s 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 i s o n l y n t d e f i c i t s w i t h c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i e s w i t h c o m m u n i c a t i o n . c a t e , t h e g e n e r a l p r a c t i t i o n e r a s s e s s e d h i s o d . n o i m p a c t s t o d a i l y f u n c t i o n i n g i n a l l a r e a s o f d " c h r o n i c p a i n w i t h s l e e p l o s s . " p e l l a n t i s i n d e p e n d e n t i n a l l a r e a s o f s o c i a l c i a l d e c i s i o n s , d e v e l o p i n g a n d m a i n t a i n i n g t h e r s , d e a l i n g a p p r o p r i a t e l y w i t h u n e x p e c t e d r s . T h e a p p e l l a n t i s a s s e s s e d w i t h g o o d e d s o c i a l n e t w o r k s , w i t h n o f u r t h e r c o m m e n t p e l l a n t h a s n o t b e e n p r e s c r i b e d m e d i c a t i o n s o r rf o r m h i s d a i l y l i v i n g a c t i v i t i e s ( D L A ) t h h i s t o r y o f t h e P R t h a t t h e a p p e l l a n t h a s i p . I t d o e s n o t i m p a i r h i s a b i l i t i e s w i t h r e s p e c t t o y . " 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 d o e s n o t d i r e c t l y i s , 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 d o e s n o t a s s e s s t h e r e s t r i c t i o n i n e a c h a r e a a s u r t h e r c o m m e n t o n t h e d e g r e e o f r e s t r i c t i o n . n t a s i n d e p e n d e n t w i t h w a l k i n g i n d o o r s a n d h i l e r e q u i r i n g p e r i o d i c a s s i s t a n c e w i t h l i f t i n g a n d " w e a k n e s s i n l e f t a r m a n d d i f f i c u l t y w i t h g r i p . " h a t a l l t a s k s o f t h e D L A p e r s o n a l c a r e , s h o p p i n g , t r a n s p o rt a t i o n a r e p e r f o r m e d i n d e p e n d e n t l y w i t h s s e d a s i n d e p e n d e n t a n d h e i s n o t a s s e s s e d f o r t i t i o n e r c o m m e n t i n g " c a p a b l e b u t d o e s n o t k n o w e d : " h i s c h r o n i c p a i n d o e s n o t l i m i t h i s A O L ' s b u t p a i n i n h i s a n d l e g s a n d a r m l i m i t h i s a b i l i t y t o n e r a l p r a c t i t i o n e r a g r e e d w i t h t h e s t a t e m e n t s b y h i m w i t h u n d e r w e a r , p a n t s a n d s o c k s d a i l y d u e o b o d y . T h e g e n e r a l p r a c t i t i o n e r a l s o a g r e e d t h a t h e d o e s n o t k n o w h o w t o d o i t . T h e g e n e r a l n g , t h e a p p e l l a n t i s u n a b l e t o s t a n d t o d o d i s h e s , r a l n r a c t i t i o n e r a a r e e d w i t h t h e s t a t e m e n t t h a t ,
for cooking, the app ella nt re lies on his wife o ho w t o do much c ook ing ot her th an boil ing wa • The g eneral p ract itione r disagree s wi th the stateme from sto res the app ellan t w i ll n ot even go into a st t he g roce ry s t o r e an d his wife does i t f o r h i m disagrees that th e appe llant ca nno t stan d to p Nee d for Help • I n the re port s in c lud ed in th e P W D app l ica t ion ap pe ll a nt re qu i res a c ane as an assist ive devi • The general pra c tit ion er re ported in the A R that DL A is "N/A ," or no t appli c able. • I n re s p onse to th e r e qu est to d esc ribe the ass re quired but no ne i s avail able, t he general pra pain is a ba rri e r to e mplo ymen t, no t AOL's." In his Notice of Ap peal dated Ja nuary 2, 2 0 14 , the app recon side r a ti o n d ecisi o n b eca use t he m inistry reli e d on eve report ed. T he appellant wrote that h e disa gree s w ith the gener li s t ened and r a r el y wro te anyt hing d own. He h as tri he should s t ay with his c urrent d oc tor. The app ellant his medical situa tion has chan ged in t h e p ast 6 t o 8 mon sleep he ge t s ev er y nigh t (2 to 4 hours) becau se o f cr a m ps in both hands an d ca nno t h old a nyt hing fo r any At the he aring , the ap pella nt stat ed that: • He set o ut most o f the inform ation in h i s written parag cra m p s in his le gs, "cha rl e y horses ", which make it to 3 hou rs of sleep per nigh t , h e d oe s not fe el he coul • He is no w get ting c ramp s in bot h of his h and He gets constant chest pa i n s. He also has numbness on the outside of both • Th ere i s a chi p in h i s kne e fr o m an ac cident h "float around. A total knee replacement is being considered for his left to swell and is painful. He has talked to an orth scheduled. In Februa ry 2012 he had tried to go back to work and he could not do it. • The bottom o f his f eet a re pe eling a nd cracking and he has been told it is a result of his diabetes and the medications he takes for his high blood pressure and cholesterol. • H i s medical condition has changed in the mon were compl e t ed, but the do c tor will not listen to him. There have been changes walk, s i t an d c l im b stairs. • Although the doctor said he can walk up to 2 blocks, he canno warehouse, and has to stop and rest. • He sometimes wears braces on both knees for walking longer distances outdoors. cane for support for cli mbing stairs and getting in and out of his vehicle. cane when walking ou tdoors. Indoo rs, he will himself. • . The doctor said he can climb stairs unaided but he has to use his cane and also hanq on A P PEA L# I r r oommates t o d o c ook ing as h e do es n ot kno w t e r . nts by the ap pel lant that f o r g oin g to and o re a s he can not ph ys icall y make it a roun d . For foo d p repa ratio n, the g ene ral prac titione r repa re f ood . , t he ge nera l p r a c titione r repo rted that th e ce . the assist ance provided by oth er pe ople for is tance that w ould be n ece ss ary if h elp i s ctit ion er indicated "ch r on ic b ack , hip and knee ell an t ex pr e ssed his disagree ment wi th t he r y t hing that the general practit ioner al pract i t i oner because he rar el y e d t o se e new doct or s but t hey have advised that sta t e d t ha t he to l d t he ge ne ral prac t it ioner that th p er iod. His biggest wor ry is the la ck of the musc l e spasms in his legs. He now ha s length of time. raph subm i tt ed on the a ppea l. He g ets har d to sleep at n i gh t. Sinc e he only gets 2 d do full day's w or k. s and cann ot hold on to anythi ng for ve ry lo ng. hand s . e had in Jun e 2 011 a nd the chip con t i nues t o k nee since it continues opedic surge on b ut nothing ha s been ths since the reports for the PWD app lication in his ability to t walk the length of a grocery He uses his He tries not to use hi s hold onto things when he needs to stea dy the
I APPEAL# railing. He needs to rest after climbing 4 or 5 steps if he is carrying something, like groceries. • He fell down 10 steps yesterday because one of his knees "let go" and he was fortunate that some garbage bags broke his fall. It took him about 40 minutes to compose himself and get back up. • He cannot sit for more than 10 minutes and he starts to shake. The doctor said he can lift up to 35 lbs. but he cannot. He can only drive f o r 10 minutes at the most. At the hearing, the appellant's neighbor stated that: • She is close neighbours with the appellant and has seen him move about his home while the doctor has not. The doctor says he is independent with walking but she sees the difficulty that the appellant experiences, and being able to do an activity does not necessarily mean that one is "independent." The appellant needs help to climb stairs and uses his cane. She understands that the appellant fell yesterday trying to climb some stairs. • Since the appellant tried to go back to work, his condition has become worse. She sees that the appellant is in poor health. He needs to meet with an orthopedic surgeon and have someone advocate on his behalf. • His chronic back, knee and hip pain is a barrier to his employment and he needs a knee replacement. If he tries to do his daily living activities on his own, he ends up hurting himself more. He also needs supplements. • She sees that the appellant is also in so much pain all the time. He has his own family and she is supporting her mother and has supported the appellant in this process, but he does not get the help that he needs. • Her mother also has diabetes and she has seen firsthand the impact of this disease. For example, it takes a person much longer to heal. The ministry did not object to the admissibility of the evidence provided by the appellant in his Notice of Appeal and the oral testimony of the appellant and his neighbour. The panel admitted the evidence as further detail of the appellant's condition and being information that was before the ministry at reconsideration or in support of the information and records bef o re the ministry on reconsideration, pursuant to section 22(4) of the Employment and Assistance Act. The ministry relied on its reconsideration decision. At the hearing, the ministry acknowledged that the appellant has a physical impairment that restricts his prospects f o r employment, and reiterated that employability is not a component of a PWD application.
APPEAL# I PART F -Rea s o ns f or Pane l De cis ion The issue on t he app eal i s whet her t he minis try 's r eco ns ider at i on dec isio n, w h ich f oun d th a t the a ppel lant i s not e l igibl e for desi g nati on a s a pers on with dis abiliti es (PW D) , was r e asonabl y s up ported by the evi dence or wa s a reason ab le app licati on o f the app licable enactme nt in the c i rcum s tance s of th e ap pe l lant. Th e ministry foun d that th e ap pell a nt doe s no t have a seve r e mental o r physical im pair m ent and that his dail y li ving activities (DLA ) are n ot , in the opinion of a p r e s cribed p r ofessi on al, d i rectly and si gni fica nt ly re stricte d e i the r con tinuou s ly or pe r iodica l ly for e xt en ded peri o d s and that, a s a r e s u lt o f t hose rest r i ctions , it co uld not b e determ i n ed t h at the appellant req uires the sig n ificant help or supervi sion of a n oth er person , the us e o f an a s sisti v e dev i c e, or th e ser vice s o f an as sist ance anim a l t o p e r form DL A. The criteria fo r b eing d esi g n a te d as a person wi t h d is abiliti es (PWD) are s et o ut in S ec t ion 2 o f th e EAPWDA a s fol low s : Persons wit h d is abili tie s 2 ( 1) I n t his sec ti on: "ass istlve device" means a device desig n ed to en ab le a person to perform a daily l i vin g a c t ivity th at, b ecause o f a s eve r e ment al or p h ysica l i mpai rmen t, t h e per son i s una b le to per for m; "da i ly liv ing ac t ivity" has the p re scribe d me a nin g; "prescr i b ed profes sion al " has the pre s cribe d meanin g. (2 ) Th e minis ter may desi g nate a pers on who has re a che d 18 y ea rs of age as a person wit h dis a biliti e s fo r the purpos es o f thi s Act if t he m i nister is sa ti sfie d tha t th e p er son h as a s ev ere m ental or phys i cal impairment t hat ( a) i n th e o p ini on of a medical pra c t iti on er is l ikel y t o c ontinu e fo r at least 2 years, a nd ( b ) i n the opi ni on of a p rescribed p ro fess ional (i) directl y an d signifi c ant ly re stricts the p erson's abi lity to perfo rm dai l y l i v i ng act ivit ies eith e r (A) con tin uously, or (B ) pe rio dica lly for e xte nde d peri ods, a nd (ii ) as a re su lt of tho se res t ri ctions, the perso n r equires he lp to p e rform tho s e a ctivities. (3) F o r the p u rposes of subsect ion (2), (a) a person who has a se vere mental impairment includes a person with a mental disorder, and (b) a person req u ires h e lp i n relati on to a dai l y 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 assis t a n ce anima l . ( 4 ) The ministe r ma y rescind a d e sig nation u nder su bsection (2). Section 2(1)(a) of t h e EAPWDR defines DLA for a person who has a s evere p hy s i c al 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) _man _ age personal finances; -----. . . ----., . .
(iii) shop fo r perso nal n eeds; (iv) u se public or p er sonal tra nsportat ion f a cil ities; (v) p er for m h o usewo rk to maint ain th e pe rso n's p lace (vi) mov e a bout indoo rs and outd o or s; (vii) p er for m person al hygiene an d s elf c ar e; ( v i ii) man age p e r sonal m edicatio n, and (b ) in r e lation to a p e r son who has a s evere me nt al i mp (i) ma ke d e ci sions ab out person al act i v ities , care or f (ii) r e lat e to, c o m mun i ca te or int eract w i th o thers ef fecti Severe P hysical I mpairment The appell a nt's p o s i tion is that a sever e physi c a l i m pain d ue to oste oart hrit is in hi s knees and hip, as we appell an t arg ue d that hi s cond ition h a s g otte n wor s p ro p erl y refl ec te d in the r ep orts by his doctor. T he mini s t ry 's posi tion i s t h at the min istry do es n ot pra ctitioner to co n fi r m that the a pp e llant has a seve in t erms o f phy s ical fun c ti onin g , t he general practiti oner i block s unaide d and climb 5 or m o re steps using a ca for less t h an 1 ho u r. T he min istry ar gu e d that the gene in de p e nde ntl y walk indo ors and ou td o or s, climb stairs and periodic ass i s t ance with lifting a nd carr ying and ho ldin g r ip. " Th e ministr y ar g u e d tha t th e impacts r ep o rted, in terf ere wit h t h e app ell ant' s abilit y to independently mana a r gued that the eviden c e shows the appel lan t h a s a reconsi derat ion , the ministry p o inte d o ut that althou on the appel lant ' s abi lit y to wor k as a r esult o f his con for P WD d esignation. P an e l Decisio n The diagnosis of a medical condition is not itself determinativ the s everity of a n impairment one must cons i der t he nature appel lant 's abil it y to ma nage h i s DLA as evidenced DLA, and the degree of independence in performing DLA. The mini when it defines the word "impairment" in the physician repo psychological, anatomical or physiological structure or function causing a restriction in the ability to funct ion independentl y , effectively, appropri ately or for set out in legislati on and is not binding on the panel, but in the panel's view it quite app describes the legislative intent. The legislation clearly provides that the dete r min ation the minister, taking into account all of the evidence including that of the appellant. legislation is also clear that the fundamental basis for the analysis is the evidence from a prescribed rofessional res ectin the nature of the im airmen! and its im I APPEAL# __-------� o f r esi denc e i n a cce p table san i tary c on d ition; airment , i n cl u des the fol lowing ac tivitie s: in ances ; vel y . pai r ment is established by the evidence o f the ll as pa i n in his lower back and bo th hands . Th e e in the pas t 6 to 8 mon ths an d thi s has n ot b e en have enough infor m a tion fr om the ge neral re p hys ic al imp airment. Th e m inistr y argue d that, ndicate d t h at the a ppella n t ca n w alk 1 to 2 ne, he c an li ft 15 to 3 5 lbs. and remai n s eated ra l prac t itio ner i ndicated that the app e ll a nt can s t and, whi le noti ng the requir em en t fo r g as "weakness in le ft a r m and difficu l t y with acc o rding to the gene ra l p r actit ioner, do no t g e t he ma j or ity of his D L A . Th e min istry moderate deg ree of physic al impairme n t. At gh the g ener al practitioner refer red to the i m pact dition s , employabili ty i s n ot an eligib ility crit e rion e of a severe impairment. To assess o f the impai rme n t and its impact on the by functional skill limitat ions, the restrictions to s try descr i be s this approa c h rt as being "a loss or abn ormality of a reasonab l e durat ion." T his d efinition is n ot r op riately of severity of impairment is at the discretion of However, the act on dail functionin .
I APPEAL# The medical practitioner, the appellant's general practitioner of 22 years, diagnosed the appellant with osteoarthritis in his knees and hip, diabetes, severe obesity, and low back pain. In his comments regarding the appellant's health history, the general practitioner wrote that the appellant has ". .. chronic pain in his low back, knees, and hip. It does not impair his abilities with respect to his AOL's but markedly limits his employability. His X-Rays confirm OA [osteoarthritis] in his knees and hip. He also has diabetes secondary to his morbid obesity which contributes to his musculoskeletal problems." Functional skills reported in the PR indicated that the appellant can walk 1 to 2 blocks unaided and climb 5 or more steps with the use of a cane, and he can lift 15 -35 lbs. and remain seated for less than 1 hour. In the letter dated November 27, 2013, the general practitioner agreed with statement made by the appellant that he is only able to walk up to one block before he has to stop and take a break, and that he is unable to climb any stairs without the use of a cane. In the AR, the general practitioner assessed the appellant as independent with walking indoors and outdoors, with climbing stairs and standing. The appellant requires periodic assistance with lifting and carrying and holding, with a comment added by the general practitioner: "weakness in left arm and difficulty with grip." The appellant wrote in his self-report that his walking is affected as well as his ability to grab with his left arm, that he is very limited with holding anything and has serious pain. Both the general practitioner and the appellant emphasized the weakness in the appellant's left arm and did not describe restrictions to lifting with his right arm. At the hearing, the appellant stated that his condition has gotten worse since the reports were completed for the PWD application and, while the doctor reports that he can lift up to 35 lbs, he cannot. The doctor said he can climb stairs unaided but this is not correct as he has to use his cane and also hang on the railing. He uses his cane f o r support for climbing stairs and getting in and out of his vehicle, but tries not to use his cane when walking outdoors. He sometimes wears braces on both knees for walking longer distances outdoors. Indoors, he will hold onto things when he needs to steady himself. The appellant stated that he cannot sit f o r more than 10 minutes and he starts to shake; however, the general practitioner disagreed with this statement in the November 27, 2013 letter prepared by the advocate. In the additional comments to the PR, the general practitioner reported again that the appellant's "chronic pain in hip, knees and back limit mobility and make him a poor candidate for employment." For an impairment to be a "severe impairment," section 2 of the EAPWDA requires that the ministry must be satisfied that the evidence demonstrates restrictions to a specified degree in certain specified areas of daily functioning. The legislation reads that for PWD designation, the minister must be satisfied that "the person has a severe mental or physical impairment that .... directly and significantly restricts the person's ability to perform [prescribed] daily living activities and as a result of those restrictions, the person requires help [an assistive device, the significant help or supervision of another person, or the services of an assistance animal to perform those activities."] As ability to search for, accept or continue in employment is not listed as one of prescribed DLA, the panel finds that the ministry reasonably held that employability is not a factor in assessing eligibility for PWD designation. While the appellant stated that his condition has deteriorated since the reports were prepared for the PWD application, the functional skills as reported by his long-time physician in the additional letter dated November 27, 2013, are consistent with the ranges set out in the original PR. The appellant did not provide further medical reports from the orthopedic surgeon with whom he met or other specialists to support a worsening of his conditions. The panel finds that the ministry reasonably determined that, based on the available evidence, the appellant's current level of physical functioning points to a moderate physical impairment and does not establish that the appellant has a · severe physical impairment under section 2(2) of the EAPWDA.
I APPEAL# Severe Mental Impairment The appellant did not take a position regarding a severe mental impairment. The ministry's position is that there is insufficient evidence to establish that the appellant has a severe mental impairment. The ministry argued that the general practitioner reported no significant deficits to cognitive and emotional functioning and that his impairment has no impact on his cognitive and emotional functioning. Panel Decision The general practitioner did not diagnose a mental disorder in the PR. No significant deficits were reported with cognitive and emotional functioning and no impacts were indicated to all areas of daily functioning. The general practitioner added a handwritten comment in the AR that the appellant's chronic pain causes sleep loss. In the PR, the general practitioner reported that the appellant does not have difficulties with communication and, in the AR, that the appellant has a good ability to communicate in all areas. In the AR, the appellant is assessed as independent in all areas of social functioning and with good functioning in both his immediate and extended social networks. Given the absence of a mental disorder diagnosis and no impacts reported to mental or social functioning, the panel finds that the ministry reasonably determined that a severe mental impairment was not established under section 2(2) of the EAPWDA. Restrictions in the ability to perform DLA The appellant's position is that his physical impairment directly and significantly restricts his ability to perform DLA on an ongoing basis to the extent that he requires the significant assistance of another person or the use of a cane and knee braces as assistive devices. The ministry's position is that there is not enough evidence from the general practitioner to confirm the appellant's impairment directly and significantly restricts his DLA continuously or periodically for extended periods. The ministry argued that the appellant is able to manage the majority of his DLA independently. The ministry pointed out that the general practitioner reported that the appellant chronic pain "does not limit his AOL's but does limit his employability"; however, employability is not a component of a PWD application. Panel Decision The evidence of the appellant's general practitioner provided by way of handwritten notes in both the PR and AR is that the appellant's chronic pain does not impair his abilities with respect to his activities of daily living, but markedly limits his employability. While the general practitioner checked "yes" with respect to restrictions in each DLA as set out in the PR, including social functioning, he does not assess the restriction in each area as either periodic or continuous or provide any further comment on the degree of restriction. The general practitioner also checked "no" to indicate that the appellant's impairment does not restrict his ability to perform DLA. In the AR, the general practitioner indicated that all tasks of the DLA personal care, shopping, meals, paying rent and bills, medications, transportation, and social functioning are performed independently with no need f o r assistance. Given the inconsistency between the one checklist in the PR and the other information, the panel has placed more weight on the general practitioner's handwritten comments and the evidence consistent with these notes. · The panel finds that, in makina these notes, the aeneral practitioner has taken the
t i m e t o t u r n h i s m i n d t o t h e i s s u e a n d t o d e s c r i b e t h e v i d e n c e i s , t h e r e fo r e , m o r e r e l i a b l e . I n t h e A R , t h e a p p e l l a n t i s a s s e s s e d a s i n d e p e n d e n a s s e s s m e n t p r o v i d e d fo r t h e a p p e l l a n t ' s a b i l i t y t o d h a n d w r i t t e n c o m m e n t : " c a p a b l e b u t d o e s n o t k n o w " h i s c h r o n i c p a i n d o e s n o t l i m i t h i s A O L ' s b u t d o e s l m u s t b e a c a u s a l c o n n e c t i o n b e t w e e n t h e i m p a i r m e t h a t a l a c k o f k n o w l e d g e o f h o w t o p e r f o r m a t a s k , w b r a i n i n j u r y , h a s n o t b e e n r e l a t e d t o t h e a p p e l l a n t ' s I n t h e l e t t e r d a t e d N o v e m b e r 2 7 , 2 0 1 3 , t h e g e n e r a l a p p e l l a n t t h a t , f o r d r e s s i n g , h i s w i f e h e l p s h i m w i t h a b l e t o p u l l c l o t h e s f r o m f e e t o n t o b o d y . F o r b a s i c t h a t t h e a p p e l l a n t i s u n a b l e t o s t a n d t o d o d i s h e s , o p r a c t i t i o n e r a g r e e d t h a t t h e a p p e l l a n t r e l i e s o n h i s w k n o w h o w t o d o m u c h c o o k i n g o t h e r t h a n b o i l i n g w a t h i s l a c k o f k n o w l e d g e r e g a r d i n g c o o k i n g h a s n o t b e i m p a i r m e n t . T h e g e n e r a l p r a c t i t i o n e r d i s a g r e e d w i t a n d f r o m s t o r e s t h e a p p e l l a n t w i l l n o t e v e n g o i n t o a g r o c e r y s t o r e a n d h i s w i f e d o e s i t f o r h i m . T h e g e n e t h a t , f o r f o o d p r e p a r a t i o n , t h e a p p e l l a n t c a n n o t s t a n F o r t h o s e D L A w h i c h r e l a t e t o a m e n t a l i m p a i r m e n t , i s r e s t r i c t e d i n m a k i n g d e c i s i o n a b o u t p e r s o n a l a c t i v c o m m u n i c a t i n g o r i n t e r a c t i n g w i t h o t h e r s e f f e c t i v e l y p r a c t i t i o n e r a s h a v i n g n o d i f f i c u l t y w i t h c o m m u n i c a t i t h e a p p e l l a n t a s i n d e p e n d e n t i n a l l a r e a s o f s o c i a l f u d e c i s i o n s , d e v e l o p i n g a n d m a i n t a i n i n g r e l a t i o n s h i p s 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 a l s o d e m o n s t r a " m e n t a l " t a s k s o f m a n a g i n g h i s f i n a n c e s a n d m e d i c a m a k i n g a p p r o p r i a t e c h o i c e s w h e n s h o p p i n g . I n t h e A R , t h e g e n e r a l p r a c t i t i o n e r a s s e s s e d t h e a p p o u t d o o r s . H o w e v e r , i n t h e l e t t e r d a t e d N o v e m b e r 2 a p p e l l a n t i s o n l y a b l e t o w a l k u p t o o n e b l o c k b e f o r e s t a t e d t h a t h e s o m e t i m e s u s e s h i s k n e e b r a c e s f o r w p r a c t i t i o n e r h a s n o t p r o v i d e d f u r t h e r d e t a i l r e g a r d i n g t o 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 , b u t e m p h a s i z e k n e e p a i n i s a b a r r i e r t o e m p l o y m e n t a n d n o t t o A D L r e a s o n a b l y c o n c l u d e d t h a t , f o r t h e r e m a i n i n g a p p l i c a p e r f o r m s a 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 , i n c l u d A R . T h e r e f o r e , t h e p a n e l f i n d s t h a t t h e m i n i s t r y r e a s e v i d e n c e f r o m t h e p r e s c r i b e d p r o f e s s i o n a l t o e s t a b l i r e s t r i c t s h i s a b i l i t y t o m a n a g e h i s D L A e i t h e r c o n t i n u t h e r e b y n o t s a t i s f y i n g t h e l e g i s l a t i v e c r i t e r i o n o f s e c t A P P E A L # I e a p p e l l a n t ' s i m p a i r m e n t i n m o r e d e t a i l a n d t h i s t w i t h b a s i c h o u s e k e e p i n g a n d , w h i l e t h e r e i s n o o l a u n d r y , t h e g e n e r a l p r a c t i t i o n e r a d d e d a h o w . " T h e g e n e r a l p r a c t i t i o n e r a l s o c o m m e n t e d : i m i t h i s e m p l o y a b i l i t y . " T h e p a n e l n o t e s t h a t t h e r e n t a n d t h e r e s u l t i n g r e s t r i c t i o n t o a D L A , a n d f i n d s h i l e p o s s i b l y c o n n e c t e d t o a m e n t a l d i s o r d e r o r p h y s i c a l i m p a i r m e n t . p r a c t i t i o n e r a g r e e d w i t h t h e s t a t e m e n t s b y t h e u n d e r w e a r , p a n t s a n d s o c k s d a i l y d u e t o n o t b e i n g h o u s e k e e p i n g , t h e g e n e r a l p r a c t i t i o n e r a g r e e d r t o b e n d t o c l e a n o u t t h e b a t h t u b . T h e g e n e r a l i f e o r r o o m m a t e s t o d o c o o k i n g a s h e d o e s n o t t e r . A s p r e v i o u s l y d i s c u s s e d , t h e p a n e l f i n d s t h a t e n c o n n e c t e d t o t h e a p p e l l a n t ' s p h y s i c a l h t h e s t a t e m e n t s b y t h e a p p e l l a n t t h a t f o r g o i n g t o s t o r e a s h e c a n n o t p h y s i c a l l y m a k e i t a r o u n d t h e r a l p r a c t i t i o n e r a l s o d i s a g r e e d w i t h t h e s t a t e m e n t d t o p r e p a r e f o o d . t h e r e i s n o e v i d e n c e t o s u g g e s t t h a t t h e a p p e l l a n t i t i e s , c a r e o r f i n a n c e s , o r r e l a t i n g t o , . T h e a p p e l l a n t i s a s s e s s e d b y t h e g e n e r a l o n . I n t h e A R , t h e g e n e r a l p r a c t i t i o n e r a s s e s s e d n c t i o n i n g , i n c l u d i n g m a k i n g a p p r o p r i a t e s o c i a l , a n d i n t e r a c t i n g a p p r o p r i a t e l y w i t h o t h e r s . T h e t e s t h a t t h e a p p e l l a n t i s i n d e p e n d e n t w i t h t h e t i o n a s w e l l a s r e a d i n g p r i c e s a n d l a b e l s a n d e l l a n t a s i n d e p e n d e n t w i t h w a l k i n g i n d o o r s a n d 7 , 2 0 1 3 , t h e g e n e r a l p r a c t i t i o n e r a g r e e d t h a t t h e h e h a s t o s t o p a n d t a k e a b r e a k . T h e a p p e l l a n t a l k i n g l o n g e r d i s t a n c e s o u t d o o r s . T h e g e n e r a l t h e d e g r e e o f r e s t r i c t i o n t o t h e a p p e l l a n t ' s a b i l i t y d h i s o p i n i o n t h a t t h e a p p e l l a n t ' s b a c k , h i p a n d s . T h e p a n e l a l s o f i n d s t h a t t h e m i n i s t r y b l e D L A , t h e e v i d e n c e s h o w s t h a t t h e a p p e l l a n t i n g a l m o s t a l l o f t h e t a s k s o f D L A a s l i s t e d i n t h e o n a b l y c o n c l u d e d t h a t t h e r e i s n o t e n o u g h s h t h a t t h e a p p e l l a n t ' s i m p a i r m e n t s i g n i f i c a n t l y 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 , i o n 2 ( 2 ) ( b ) ( i ) o f t h e E A P W D A . . . · , • . . . ' . I I
I APPEAL# Help to petform DLA The appellant's position is that he requires the significant assistance of another person or an assistive device to perform DLA. The ministry's position is that because it has not been established that DLA are significantly restricted, it cannot be determined that significant help is required. The ministry acknowledged that a cane is required as an assistive device. Panel Decision Section 2(2)(b )(ii) of the EAPWDA requires that, as a result of direct and significant restrictions in the ability to perform DLA, a person requires help to perform those activities. Help is defined in subsection (3) as the requirement for an assistive device, the significant help or supervision of another person, or the services of an assistance animal in order to perform a DLA. The evidence of the general practitioner, as a prescribed professional, is that the assistance provided by other people with DLA is "N/A" or not applicable. In response to the request to describe the assistance required by the appellant with DLA, the general practitioner indicated that his pain is not a barrier to his AOL's, and that a cane is used as an assistive device. The panel finds that the ministry reasonably determined that as direct and significant restrictions in the appellant's ability to perform DLA have not been established, it cannot be determined that the appellant requires help to perform DLA as a result of those restrictions, as defined by section 2(3)(b) of the EAPWDA. Conclusion Having reviewed and considered all of the evidence and relevant legislation, the panel finds that the ministry's reconsideration decision which determined that the appellant was not eligible for PWD designation was reasonably supported by the evidence, and therefore confirms the decision.
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