PART C-Decision under Appeal The decision being appealed is the Ministry of Social Development and Social Innovation (the "Ministry") January 27, 2014 reconsideration decision in which the Ministry determined that the Appellant was not eligible for Persons with Disabilities ("PWD") designation because she did not meet all the requirements for PWD designation in section 2(2) of the Employment and Assistance for Persons with Disabilities Act. Based on the information provided, the Ministry was not satisfied that the Appellant has a severe mental or physical impairment that in the opinion of a prescribed professional (i) directly and significantly restricts her ability to perform daily living activities either continuously or periodically for extended periods; and, (ii) as a result of those restrictions she requires help to perform those activities. The Ministry was satisfied that the Appellant has reached 18 years of age and in the opinion of a medical practitioner her impairment is likely to continue for at least 2 years. PART D -Relevant Legislation · Employment and Assistance for Persons with Disabilities Act ("EAPWDA") Section 2(2) and 2(3). Employment and Assistance for Persons with Disabilities Regulation ("EAPWDR") Section 2. EAAT 003(10/06/01)
PART E -Summary of Facts With the consent of both parties, the hearing was conducted as a written hearing pursuant to section 22(3)(b) of the Employment and Assistance Act. For its reconsideration decision, the Ministry had the following evidence: 1. Appellant's PWD application dated September 17, 2013 and consisting of: • The Appellant's self-report. • A physician's report ("PR") completed on September 16, 2013 by a doctor who indicated that the Appellant had been his patient for 4½ years and he had seen her between 2-10 times in the year preceding the completion of the report. • An assessor's report ("AR") completed by the same doctor on the same day. 2. Appellant's request for reconsideration with a statement from the Appellant. For this appeal, the Appellant submitted a written statement from her advocate and also signed by her. That statement has arguments to support the Appellant's appeal which are summarized in Part F of this decision. The Appellant also submitted a written statement with information about her conditions and how they impact her daily life. The Panel finds that the Appellant's written statement and information in the joint advocate/Appellant statement provide clarification and additional details about the Appellant's conditions. Therefore, pursuant to section 22(4) of the Employment and Assistance Act, the Panel admits the information in both statements as being in support of the evidence that was before the Ministry at reconsideration. The Panel summarizes the relevant evidence as follows: Diagnoses In the PR, the doctor diagnosed the Appellant with rheumatoid arthritis with flexion deformities of her hands and intellectual impairment. Physical Impairment In her self-report and reconsideration statement, the Appellant described her disabilities as follows: • She believes that the arthritis was noticed around 2004. • Arthritis affects most parts of her body -wrist, hands, knees, ankles, shoulders and her ability to walk long distances. • The arthritis is mostly noticeable through the winter season, cold times of the year. • The medication that has been prescribed causes her to tire easily and she has been told by the doctor that the meds will cause vision problems as well. • Working in a position requiring physical work for many years and only completing part of grade 5 caused her big problems finding any sort of job; she has been hired for a job for which no education is needed, but she can do just the basic things so she goes at her own pace. • The work is very tiring because of the arthritis throughout her whole body. In her appeal statements, the Appellant described her impairment as follows: • She has had rheumatoid arthritis since 2004 and is on a lifelong medication regime, involving two different medications. She is unable to work at meaningful jobs; has no skills and does not have the education required for employment; she did not finish grade 5 and there is no possibility of getting a job that does not require physical work • The older she qets, the less and less she can walk distances and totally unable to stand for EMT003(10/06/01)
l o n g p e r i o d s o f t i m e t h e r e i s n o p o s s i b i l i t y o • H e r a rt h r i t i s i s g e t t i n g w o r s e a s t i m e g o e s o n . I n t h e P R , t h e d o c t o r d e s c r i b e d t h e A p p e l l a n t ' s p h y s • S h e h a s r h e u m a t o i d a r t h r i t i s w h i c h m o s t l y a f f h e a v y p h y s i c a l l a b o r ; s h e h a s p e r m a n e n t h a n • S h e 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 • S h e c a n w a l k u n a i d e d f o r 4 + b l o c k s , c l i m b 5 + r e m a i n i n g s e a t e d . M e n t a l I m p a i r m e n t I n t h e P R , t h e d o c t o r r e p o rt e d t h a t t h e A p p e l l a n t : • W i l l h a v e l i f e l o n g i n t e l l e c t u a l i m p a i r m e n t . • H a s d i f f i c u l t i e s w i t h c o g n i t i v e c o m m u n i c a t i o n t h i n g s r e p e a t e d t o h e r . • H a s s i g n i f i c a 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 l a n g u a g e , m e m o ry , a n d a t t e n t i o n o r s u s t a i n e I n t h e A R , t h e d o c t o 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 : • H a s s a t i s f a c t o r y a b i l i t y t o c o m m u n i c a t e i n t h e c o m m u n i c a t i o n a b i l i t y i n r e a d i n g a n d w r i t i n g . • I n a r e a s o f 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 a t t e n t i o n / c o n c e n t r a t i o n , e x e c u t i v e , a n d m e m a n d j u d g e m e n t , l a n g u a g e a n d o t h e r n e u r o p s f u n c t i o n s , e m o t i o n , i m p u l s e c o n t r o l , m o t i v a t i o e m o t i o n a l o r m e n t a l p r o b l e m s . D a il y L i v i n g A c t i v i t i e s T h e f o l l o w i n g i n f o r m a t i o n a b o u t t h e A p p e l l a n t ' s a b i l i i n t h e A p p e l l a n t ' s a p p e a l s t a t e m e n t s : • I s w o r k i n g b u t s u f f e r s m u c h p a i n w h i l e w o r k i n • T a k e s m u c h m e d i c a t i o n t o c o p e w i t h d a i l y l i v i n • H a s f r i e n d s a n d f a m i l y t o h e l p w i t h d a i l y l i v i n g l i f t i n g o r c a r r y i n g ( g r o c e r y s h o p p i n g ) . • D o e s n o t h a v e a c a r , s o t o s h o p , g o t o m e d i c a a c t i v i t i e s t h a t r e q u i r e l e a v i n g h e r r e s i d e n c e , s g o n e a r w h e r e s h e h a s t o g o ; w a l k i n g i s h e r o d a y . • L e s s e n i n g a b i l i t y t o w a l k d i s t a n c e s a n d i n a b i l i r e s t r i c t d a i l y l i v i n g a c t i v i t i e s r e q u i r i n g a m b u l a t I n t h e P R , t h e d o c t o r i n d i c a t e d t h a t : • T h e A p p e l l a n t h a s n o t b e e n p r e s c r i b e d a n y m p e r f o r m d a i l y l i v i n g a c t i v i t i e s . I n t h e A R , t h e d o c t o 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 : • I s i n d e p e n d e n t w a l k i n g i n d o o r s a n d o u t d o o r s , h o l d i n g -" i f [ A p p e l l a n t ] n e e d e d t o d o h e a v y l i a s s i s t a n c e . " • I s i n d e o e n d e n t i n m a n a a i n a a l l t a s k s i n t h e a r E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )f t h i s i s i m p r o v i n g . i c a l i m p a i r m e n t a s f o l l o w s : e c t s h e r h a n d s a n d s h e i s n o t a b l e t o p e r f o r m d d e f o r m i t i e s f r o m t h e r h e u m a t o i d a r t h r i t i s . f o r h e r i m p a i r m e n t . s t a i r s u n a i d e d , h a s n o l i m i t a t i o n s i n l i f t i n g o r d i f f i c u l t y c o m p r e h e n d i n g , o f t e n n e e d s t o h a v e t i o n a l f u n c t i o n i n t h e a r e a s o f e x e c u t i v e , d c o n c e n t r a t i o n . a r e a s o f s p e a k i n g a n d h e a r i n g ; p o o r g , h a s m o d e r a t e i m p a c t s i n o r y ; m i n i m a l i m p a c t s i n c o n s c i o u s n e s s , i n s i g h t y c h o l o g i c a l p r o b l e m s ; a n d , n o i m p a c t i n b o d i l y n , m o t o r a c t i v i t y , p s y c h o t i c s y m p t o m s , a n d o t h e r 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 w a s p r o v i d e d g . g a n d h o u s e h o l d c h o r e s . ; e . g . , r i d e s , c l e a n i n g h e r a p a rt m e n t a n d a n y l o r o t h e r a p p o i n t m e n t s , o r o t h e r d a i l y l i v i n g h e h a s t o w a l k i f a b u s i s n o t r u n n i n g o r d o e s n o t n l y o p t i o n e v e n i n g s a n d s o m e t i m e s d u r i n g t h e t y t o s t a n d f o r l o n g p e r i o d s o f t i m e s i g n i f i c a n t l y o r y a b i l i t i e s . e d i c a t i o n s t h a t i n t e r f e r e w i t h h e r a b i l i t y t o c l i m b i n g s t a i r s , s t a n d i n g , l i f t i n g , c a r r y i n g a n d f t i n g ( e . g . m o v i n g f u r n i t u r e ) s h e w o u l d n e e d e a s o f o e r s o n a l c a r e , b a s i c h o u s e k e e o i n a ,
shopping, meals, paying rent and bills, medications and transportation. • Is independent in all areas of social functioning. The doctor wrote that he has no information about the Appellant's relationship with her immediate or extended social networks. Help with Daily Living Activities In the AR, the doctor wrote that the Appellant lives independently and does not receive help, other than social assistance. Regarding assistance provided by other people, the doctor wrote "no help provided". He also reported that she does not use any assistance device or equipment. For equipment required he wrote "N/A" [not applicable] and indicated that the Appellant does not have an assistance animal. The Appellant stated that she has friends and family to help with daily living; e.g., rides, cleaning her apartment and any lifting or carrying (grocery shopping). EMT003(10/06/01)
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e i n t h i s a p p e a l i s w h e t h e r t h e M i n i s t r y r e a s e l i g i b l e f o r P W D d e s i g n a t i o n b e c a u s e s h e d i d n o t m E A P W D A , a n d s p e c i f i c a l l y , t h a t t h e A p p e l l a n t d o e s n t h a t i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l ( i ) d i r p e r f o r m d a i l y l i v i n g a c t i v i t i e s e i t h e r c o n t i n u o u s l y o r p , . r e s u l t o f t h o s e r e s t r i c t i o n s s h e r e q u i r e s h e l p t o p e rf o T h e e l i g i b i l i t y c r i t e r i a f o r P W D d e s i g n a t i o n a r e s e t o u 2 ( 2 ) T h e m i n i s t e r m a y d e s i g n a t e a p e r s o n w h o h a s d i s a b i l i t i e s f o r t h e p u r p o s e s o f t h i s A c t i f t h e m i n i s t e r o r p h y s i c a l i m p a i r m e n t t h a t ( a ) i n t h e o p i n i o n o f a m e d i c a l p r a c t i t i o n e r i s l i k e l y t o ( b ) i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l ( i ) d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s t h e p e r s o n ' s a b i l ( A ) c o n t i n u o u s l y , o r ( B ) p e r i o d i c a l l y f o r e x t e n d e d p e r ( i i ) a s a r e s u l t o f t h o s e r e s t r i c t i o n s , t h e p e r s o n r e q u i r ( 3 ) F o r t h e p u r p o s e s o f s u b s e c t i o n ( 2 ) , ( a ) a p e r s o n w h o h a s a s e v e r e m e n t a l i m p a i r m e n t i n ( b ) a p e r s o n r e q u i r e s h e l p i n r e l a t i o n t o a d a i l y l i v i n g r e q u i r e s ( i ) a n a s s i s t i v e d e v i c e , ( i i ) t h e s i g n i f i c a n t h e ( i i i ) t h e s e r v i c e s o f a n a s s i s t a n c e a n i m a l . T h e " d a i l y l i v i n g a c t i v i t i e s " r e f e r r e d t o i n E A P W D A s e 2 ( 1 ) F o r t h e p u r p o s e s o f t h e A c t a n d t h i s r e g u l a t i o n , ( a ) i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e p h y s i c a l m e a n s t h e f o l l o w i n g a c t i v i t i e s : ( i ) p r e p a r e o w n m e a l s ; ( i i ) m a n a g e p e r s o n a l f i n a n c e s p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s ; ( v ) p e r f o r m h o u s e w a c c e p t a b l e s a n i t a r y c o n d i t i o n ; ( v i ) m o v e a b o u t i n d o o a n d s e l f c a r e ; ( v i i i ) m a n a g e p e r s o n a l m e d i c a t i o n , a n ( b ) i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e m e n t a l i ( i ) m a k e d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r w i t h o t h e r s e f f e c t i v e l y . T h e P a n e l w i l l c o n s i d e r e a c h p a r t y ' s p o s i t i o n r e g a r d i u n d e r t h e a p p l i c a b l e P W D c r i t e r i a a t i s s u e i n t h i s a p p S e v e r e P h y s i c a l I m p a i r m e n t T h e A p p e l l a n t s u b m i t t e d t h a t h e r r h e u m a t o i d a r t h r i t i s l e s s a b l e t o w a l k d i s t a n c e s o r s t a n d f o r l o n g p e r i o d s r e q u i r i n g a m b u l a t o r y a b i l i t i e s . T h e a r t h r i t i s a l s o i m p a S h e n e e d s t o t a k e s t r o n g m e d i c a t i o n s f o r l i f e . T h e M i n i s t r y , i 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 , c o n s i d e r e p o r t a n d r e c o n s i d e r a t i o n r e q u e s t , a s w e l l a s t h e i n f M i n i s t r v n o t e d t h a t t h e d o c t o r r e p o r t e d t h a t t h e A o o e E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )o n a b l y d e t e r m i n e d t h a t t h e A p p e l l a n t w a s n o t e e t a l l o f t h e r e q u i r e m e n t s i n s e c t i o n 2 ( 2 ) o f t h e o t h a v e a s e v e r e m e n t a l o r p h y s i c a l i m p a i r m e n t e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s h e r a b i l i t y t o e r i o d i c a l l y f o r e x t e n d e d p e r i o d s ; a n d , ( i i ) a s a r m t h o s e a c t i v i t i e s . t i n t h e f o l l o w i n g s e c t i o n s o f t h e E A P W D A : r e a c h e d 1 8 y e a r s o f a g e a s a p e r s o n w i t h i s s a t i s f i e d t h a t t h e p e r s o n h a s a s e v e r e m e n t a l c o n t i n u e f o r a t l e a s t 2 y e a r s , a n d i t y t o p e r f o r m d a i l y l i v i n g a c t i v i t i e s e i t h e r i o d s , a n d e s h e l p t o p e r f o r m t h o s e a c t i v i t i e s . c l u d e s a p e r s o n w i t h a m e n t a l d i s o r d e r , a n d a c t i v i t y i f , i n o r d e r t o p e rf o r m i t , t h e p e r s o n 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 c t i o n 2 ( 2 ) ( b ) a r e d e f i n e d i n t h e E A P W D R a s : " d a i l y l i v i n g a c t i v i t i e s " , i m p a i r m e n t o r a s e v e r e m e n t a l i m p a i r m e n t , ; ( i i i ) s h o p f o r p e r s o n a l n e e d s ; ( i v ) u s e p u b l i c o r o r k t o m a i n t a i n t h e p e r s o n ' s p l a c e o f r e s i d e n c e i n r s a n d o u t d o o r s ; ( v i i ) p e r f o r m p e r s o n a l h y g i e n e d m p a i r m e n t , i n c l u d e s t h e f o l l o w i n g a c t i v i t i e s : f i n a n c e s ; ( i i ) r e l a t e t o , c o m m u n i c a t e o r i n t e r a c t n g t h e r e a s o n a b l e n e s s o f t h e M i n i s t r y ' s d e c i s i o n e a l . a f f e c t s m o s t p a r t s o f h e r b o d y . S h e i s l e s s a n d , w h i c h s i g n i f i c a n t l y r e s t r i c t d a i l y l i v i n g a c t i v i t i e s c t s h e r a b i l i t y t o l i f t t h i n g s a n d d o h e a v y l a b o u r . r e d t h e i n f o r m a t i o n f r o m t h e A p p e l l a n t i n h e r s e l f o r m a t i o n f r o m t h e d o c t o r i n t h e P R a n d A R . T h e l l a n t ' s r h e u m a t o i d a r t h r i t i s m o s t l v a f f e c t s h e r
hands so that she is not able to perform heavy physical labour. However, the Ministry also noted that employability is not an eligible criterion for designation as a PWD. The Ministry considered the information from the doctor that the Appellant is independent in all aspects of mobility and physical ability. Based on the information provided, the Ministry found that there was not enough evidence to establish a severe physical impairment. The Panel's Findings The diagnosis of a medical condition is not in and of itself evidence of the severity of impairment. To satisfy the requirements in section 2(2) of the EAPWDA, evidence of how and the extent to which a medical condition restricts daily functioning must be considered. This includes the evidence from the Appellant and from a prescribed professional regarding the nature of the impairment and its impact on the Appellant's ability to manage the daily living activities listed in section 2(1) of the EAPWDR. As for the ability to find and/or retain employment, the Panel notes that employability is not a criterion in section 2(2) of the EAPWDA, nor is it listed among the prescribed daily living activities in section 2 of the EAPWDR. The doctor diagnosed the Appellant's condition as rheumatoid arthritis and he described her impairment as permanent flexion deformities of the hands due to the arthritis. The Appellant wrote that the arthritis affects most parts of her body; that is, her wrist, hands, knees, ankles and shoulders. The arthritis also affects her ability to lift things, walk long distances and she is totally unable to stand for long periods of time. The Appellant wrote that her arthritis is getting worse. The Panel notes that the doctor's reports do not describe the same level of impairment as the Appellant describes. The doctor only reported impairment in the Appellant's hands. He also indicated that she can walk 4 + blocks unaided, climb stairs and stand unaided. She needs help only when doing heavy lifting. In all aspects of mobility and physical ability, the doctor indicated that the Appellant is independent. Therefore, the Panel finds that the Ministry reasonably determined that there is not enough evidence to establish a severe physical impairment. Severe Mental Impairment The Appellant submitted that the doctor's reports of deficits with cognitive and emotional functions should be considered in conjunction with her efforts to deal with her physical impairment. The Ministry noted the doctor's reports of the level of deficits with cognitive and emotional functions, as well as difficulties with communicating. Based on this information, the Ministry determined that there was not enough evidence to establish a severe mental impairment. The Panel's Findings The doctor reported that the Appellant has an intellectual impairment and that she has difficulties in areas of communication from cognitive difficulties, often needing to have things repeated to her. The Appellant submitted that she has difficulties managing her daily living activities because of a combination of severe physical and mental impairments. In terms of impacts to daily functioning from cognitive/emotional deficits, the doctor reported moderate impacts to only 3 areas of such functioning, minimal impacts to 4 areas and no impacts to the other 7 areas of such functioning. The doctor provided no narrative about how the moderate or minimal impacts affect the Appellant's functioning and in fact reported that the Appellant is independent in all areas of social functioning. Therefore, based on the information provided, especially the doctor's reports, the Panel finds that the Ministry reasonably determined that there was not enouah evidence to establish a severe mental imoairment. EM T003(10/06/01)
Restric t ion s to Daily L i ving Activi ties The A ppell ant submit ted that becaus e of he r sev ere perf orming da i ly living act ivit ies, s uc h as cleaning h er she t a kes a lot of med i c ation to cope wit h suc h a cti vities an The M inistr y noted t ha t it relies o n the medic al o pinion on the inf or m ati o n from the doctor i n the PR an d the AR inf orma t io n demo nstr a ted that a s ev ere m ental or physical im Appel lant ' s abili ty to perfo rm d ail y living a c tivi ties , eithe per iod s. The P anel's Fi ndings S ection 2(2)( b) of t h e EAPWDA requi re s t ha t a pr escr a pp lica n t's severe impa irme nt direct l y and signific antly o r periodic a l ly for ext ended p eriods . In this case the doct a ct ivi ties are defined in sect ion 2( 1) o f t he EAPW DR A p pe lla n t wrote th a t s he h as di f fi culty m an aging h e r conf irmed by t h e doct o r . I n his rep orts, he indi cat ed daily l i v i ng activ iti es defi ned n section 2(1 ) of t he E APWD needs h el p w it h he av y lifting . T heref ore, based on the ev the Minist ry rea sona bly de t e r min ed that t he i nfo r matio me ntal or p h y si ca l i mpairment signif icantl y res tricts the Appe ac tiv iti es, ei the r c ontinu ously or per io di cal ly f or ext end Help wi t h Daily Liv i ng Ac tivities The A ppel lant submi tted that s h e depend s on frie nd s a rides , clean ing he r apartme nt a n d any li fting o r car rying. The M i nistr y's posi t io n is that becaus e the e vid en ce d sign if ica n tly restri cted, it ca n not determi ne that sign ificant Mini s t ry also no ted t hat no assistive de vice s are required. Th e Pan e l's Findings Section 2(2)(b)(ii) of the EAPWDA also requires the opinion of a prescri t h a t, bec a use o f direct and signific an t r e stri ctions in her ability to manage daily Appellant requires help with those activities. The doctor did not confirm the Ap about needing or receiving help. Instead he reported that she independe activities. He also wrote that she lives independently and does not receive help other than social ass istance. I n addition he reported that she does not use any assistance device or equipment. Therefore, based on the opinion of the doctor, the Panel finds that the Ministry reasonably concluded that it could not determine that the Appellant needs significant help from other persons to manage daily living activities. Conclusion Having reviewed and co nsidere d all of the evidence and the relevant legislation, the Panel finds that the Ministry's reconsider ation decision, which determined that the Appella desianation, was reasonab l y suooorted by the evidence. Therefore the Panel confirms that decision. EAAT003(10/06/01) physic al an d mental i m pairme nt she has d i fficu l t y apa r tme nt, lif ting and c arryi n g. She wr ote that d house hol d c h or e s. a nd ex pert i se of the Appel lant ' s doc tor. Bas ed , the Min i stry wa s n ot sat isfied t h at the pa i rme nt sig n ificantly re str i c ts t h e r con t in u o u sly or periodi cally for ext e nde d i bed prof es siona l provide an opi n i on t h a t an res t ricts he r dail y livin g a ct i vi t i es , continuousl y o r is the p res cri b ed p rofess ional. Da il y livin g and a lso are lis ted in t he PR and t h e AR. The daily li vin g activities; ho w ev er, th is wa s n ot that the A p pell ant in d e pendent ly ma nages a ll the R , wi t h the exc epti on tha t the App ella nt id e nce from the doctor, the Panel fin d s t ha t n provi ded did n ot demonstrate that a seve re llan t 's abi lity to perf orm da i l y l i v i n g e d per io d s. n d fa mily t o hel p he r wi t h daily l iv ing; e .g., oe s no t est a blish th a t da i l y living ac tivit ies a r e help i s r e qu i r e d from other pers o ns. The b e d professional confirming living ac tivities, th e pel la n t ' s information ntly manages all daily living nt was not eligible for PWD
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