PART C-Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (the ministry) reconsideration decision dated January 29, 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 r
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. The evidence before the ministry at the time of the reconsideration decision included the Person With Disabilities (PWD) Application comprised of the applicant information dated August 19, 2013, a physician report (PR) and an assessor report (AR) both dated August 25, 2013 and completed by a physician who has known the appellant for 2 years. In describing the approach and information sources used to complete the AR, the physician indicated only an office interview with the appellant and no review of his file or chart information or any other secondary source. The evidence also included the following: 1) Print out of visit records from the appellant's physician for the period April 16, 2013 through August 7, 2013; 2) Consultation Report dated September 15, 2013 for MRI of the appellant's lumbar spine; 3) Medical Certificate dated January 15, 2014; and, 4 ) Request for Reconsideration-Reasons dated January 15, 2014. Diagnoses In the PR, the appellant was diagnosed by the medical practitioner with hydronephrosis with nephrolithiasis and date of onset of August 2012, chronic back pain and depression with onset in July 2011. Physical Impairment In the PR, the appellant's physician reported that: • In terms of health history, the appellant's hydronephrosis "has resolved, stone has been taken care of but still persistent back pain. His back pain may or may not have been due to the long standing kidney stone. He says he is unable to work as ... prolonged standing more than 1 hour causes him pain." • The appellant requires a shower chair as an aid for his impairment " ... as he has pain on bending." • With respect to degree and course of impairment, the physician wrote that he " ... expected his back pain to improve after several of the surgeries for his kidney stone but he has not improved ... his back pain may not have been due to the kidney stone." • In terms of functional skills, the physician assessed the appellant as able to walk 2 to 4 blocks unaided on a flat surface, climb 2 to 5 steps unaided, lift 2 to 7 kg. (5 to 15 lbs.), and remain seated 1 to 2 hours. • In the additional comments, the physician wrote: "Initially had back pain; investigation revealed severe hydronephrosis from kidney stone; thought initially pain was due to this; subsequent urologic surgeries failed to resolve pain. Still being worked up." In the AR, the appellant's physician indicated that: • The appellant is assessed as taking significantly longer than typical with walking indoors and outdoors (note: "needs to rest 1 0 minutes after 2 blocks") and climbing stairs, with the note: "needs to rest after 1 0 steps." The appellant is independent with standing (note: "cannot stand more than ½ hour"), lifting, and carrying and holding, with the note: "maximum 10 lbs. of lifting and carrvinq."
In the appellant's self-report which was prepared with the assistance of an advocate, as part.of the PWD application, he wrote: • With hydronephrosis he experiences back pain, blood in stools, weakness, fatigue, nausea, muscle spasms, restricted mobility, restricted range of motion, unable to stand still longer than ½ hour, unable to sustain lifting more than 1 O lbs. for longer than 1 O min., unable to sit longer than 1 hour. • Regarding osteoarthritis of his back and hip, he experiences pain with usage, restricted mobility, restricted range of motion. • Every day is a bad day. In the print out of visit records from the appellant's physician for the period April 16, 2013 through August 7, 2013, the physician noted: • The left hip CT showed mild OA [osteoarthritis], with an assessment of hip osteoarthritis on April 16, 2013. • The medications help, but the appellant says he cannot stand for more than an hour without pain. "Says he is getting 10/10 pain. Chiro helped a bit." The assessment on August 7, 2013 is chronic back pain. In the Consultation Report dated September 15, 2013, the MRI of the appellant's lumbar spine showed findings of mild lumbar spondylosis. In the Medical Certificate dated January 15, 2014, the physician wrote: • The appellant continues to report being disabled by his low back pain. Surgery for his kidney swelling and stones has not relieved his pain. • He continues to have pain on standing and doing heavy lifting. In his Request for Reconsideration, the appellant wrote: • He is completely unable to work. He has serious back pain, blood in stool, weakness and muscle spasms. He is unable to stand longer than half an hour because it puts a lot of pressure on his back and it gives him a very serious back pain. • He is unable to sustain lifting more than 1 O lbs. for longer than 1 O minutes. • He had an ultra sound and it showed that his spine bone is dislocated. • He did three surgeries but it did not help at all. His pain is still the same. Mental Impairment In the PR, the appellant's physician reported that: • The appellant has a score of 16 on a PHQ-9 [Patient Health Questionnaire]. • There are no difficulties with communication other than a lack of fluency in English. • The appellant has significant deficits in cognitive and emotional functioning in the areas of executive, memory, emotional disturbance, motivation, and attention or sustained concentration, with a note: "depression due to pain." In the AR, the physician indicated that: • The appellant has a satisfactory ability to communicate in all areas, including speaking, reading, writing and hearing, with a note: "English is a second language." • There are moderate impacts to the aooellant's coqnitive and emotional functionina in the areas I
of emotion and memory, as well as minimal impacts to consciousness, attention/concentration and motivation. There are no impacts in the remaining 9 areas of functioning. • The appellant is independent in making appropriate social decisions and requires periodic support/ supervision in 4 of 5 aspects of social functioning, including developing and maintaining relationships (note: "states socially withdrawn, has only one friend"), interacting appropriately with others (note: "easily frustrated"), dealing appropriately with unexpected demands (note: "poor concentration") and securing assistance from others (note: "socially withdrawn"). • The appellant has marginal functioning in both his immediate and extended social networks. • Asked to describe the support/supervision required by the appellant, which would help to maintain him in the community, the physician wrote: "none." Additional comments, including identification of any safety issues, were also "none." • In the additional information, the physician wrote that the appellant scored 16 on a PHQ-9, "although score possibly higher as his English is poor and son may have mistranslated. Depression leads to poorer social interaction." In the appellant's self-report as part of the PWD application, he wrote: • As a result of depression, he experiences feelings of helplessness/ hopelessness/ worthlessness, lack of motivation, sleep disturbances, poor concentration, poor memory, and low stress tolerance. • For social/emotional functioning, he feels upset by his declining health. He is easily frustrated now. He just wants to sit alone and not talk to anyone. He no longer enjoys watching TV and has no concentration to read anything. He only has one friend who he may call every 1 to 2 months. • He depends on his family to remind him to do tasks or he will forget. In his Request for Reconsideration, the appellant did not refer to impacts from a mental health condition. Daily Living Activities (DLA) In the PR, the physician indicated that: • The appellant has not been prescribed any medication and/or treatment that interfere with his daily living activities. • The appellant's wife helps him with housework. In the AR, the physician reported that: • The appellant takes significantly longer than typical with moving about indoors and outdoors. • The appellant takes significantly longer than typical with all 8 tasks of the DLA personal care, including dressing, grooming, bathing, toileting, feeding self, regulating diet, transfers in/out of bed and transfers on/off chair, with a note: "takes longer than usual." • The appellant requires continuous assistance from another person with laundry (note: "too heavy; needs daughter to do laundry") and with basic housekeeping (note: "daughter cleans house"). • The appellant is independent in performing 3 of 5 tasks of the DLA shopping, while requiring continuous assistance with going to and from stores (note: "son or daughter shops") and carrying purchases home (note: "son or daughter shops"). • The aooellant is independent with 1 of 4 tasks of the DLA meals and requires oeriodic
assistance from another person with meal planning, food preparation, and cooking. The physician noted: "wife helps with cooking; poor memory-states forgot to turn off burner 1 to 2 times per week." • The appellant is independent with 2 of 3 tasks of the DLA paying rent and bills, including banking and budgeting, and requires continuous assistance from another person with paying rent and bills (note:"needs reminder from family"). • The appellant is independent in performing all 3 tasks of managing his medications, including filling/refilling prescriptions, taking as directed and safe handling and storage. • The appellant is independent with 1 of 3 tasks of managing transportation, namely using transit schedules and arranging transportation, and takes significantly longer than typical with using public transit (note: "needs to sit due to increased pain and increased fatigue"). The physician indicated that the task of getting in and out of a vehicle is not applicable and noted that the appellant does not have a license. • In the additional information, the physician wrote that "none of the AOL's listed are medically contraindicated but he may have pain doing them and may take an inordinate amount of time to do them." In the appellant's self-report as part of the PWD application, he wrote: • Every day is a bad day for him. Because of his medical conditions (hydronephrosis, osteoarthritis, and depression), he has ongoing, marked restrictions with a number of DLA. • For personal self care, he is unable to take baths due to increased pain when getting up/down and he prefers to take showers. He has fallen in the shower so he needs to be very slow and careful. He needs a shower chair, bathtub safety bar and grab bar. Due to fatigue, he needs to rest before and after dressing and needs to sit down to put on pants, socks, shoes. • For meal prf/paration/cooking, he depends on his wife due to his inability to stand up longer than a half hour. He forgets to turn the burner/oven [off] 1 to 2 times per week and will burn the food. • Due to painful bending, he depends on his wife and daughter to assist with vacuuming and cleaning toilets. • Due to his inability to carry more than 1 O lbs., he depends on his family to assist with carrying groceries. • For mobility inside and outside and use of transportation, he is 2 times slower than a healthy peer, and it will take him up to 15 minutes to painfully walk 2 blocks and he will need to rest for 1 O minutes afterwards. • He depends on his family and landlord to remind him to pay the bills/rent as he will forget. In his Request for Reconsideration, the appellant wrote: • He is unable to take a bath due to increased pain when getting up/down from the bathtub. He depends on his family to help him get up or help him to have a shower. • Since he is unable to work anymore, it is very difficult for him to pay bills and pay the rent. Need for Help The physician reported in the AR that the help required for DLA is provided by the appellant's family. In the section of the AR relating to assistance provided through the use of assistive devices, the physician has added a note: "does not use any equipment" and "may benefit from shower chair or grab bars due to painful bending."
I n h i s N o t i c e o f A p p e a l d a t e d F e b r u a r y 4 , 2 0 1 4 , t h e m i n i s t r y r e c o n s i d e r a t i o n d e c i s i o n b e c a u s e h e i s c o m m o r e t h a n 2 0 m i n u t e s b e c a u s e i t p u t s a l o t o f p r e s s u m a k i n g h i m f e e l b e t t e r , i t m a d e h i m f e e l w o r s e . H e t h e s h o w e r , a n d t h i s i s n o t e a s y f o r h i m . T h e a p p e l l a n t p r o v i d e d a w r i t t e n s u b m i s s i o n d a t e d F • H e i s c o m p l e t e l y u n a b l e t o w o r k o r e v e n t a k e • H e h a s s e r i o u s b a c k p a i n f o r m o r e t h a n o n e y m u s c l e s p a s m s . • H e c a n b a r e l y s t a n d f o r m o r e t h a n 2 0 m i n u t e i t g i v e s h i m s e r i o u s p a i n o n h i s l o w e r b a c k . • H e i s u n a b l e t o s u s t a i n l i f t i n g m o r e t h a n 1 0 l b • H e d i d a n u l t r a s o u n d a n d i t s h o w e d t h a t h i s s t o t a k e a b a t h d u e t o i n c r e a s e d p a i n w h e n g e . s h o w e r a c o u p l e o f t i m e s b e c a u s e i t i s h a r d f o • H i s w i f e a l w a y s h a s t o b e t h e r e f o r h i m t o h e l b e d a n d t o h o l d h i s h a n d w h e n h e w a l k s . • H e c a n n o t c o o k f o r h i m s e l f b e c a u s e i t i s h a r d • H e f e e l s d e p r e s s e d , h e l p l e s s , a n d h o p e l e s s b 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 . T h e m i n i s t r y d i d n o t r a i s e a n o b j e c t i o n t o t h e a d m i s s o f A p p e a l a n d w r i t t e n s u b m i s s i o n . T h e p a n e l r e v i e w r e g a r d i n g h i s b a c k p a i n a n d d e p r e s s i o n , a s r e l a t i n g c o n d i t i o n s a n d b e i n g i n s u p p o r t o f i n f o r m a t i o n b e f o r e S e c t i o n 2 2 ( 4 ) o f t h e E m p l o y m e n t a n d A s s i s t a n c e A c a p p e l l a n t w r o t e t h a t h e d i s a g r e e s w i t h t h e p l e t e l y u n a b l e t o w o r k . H e c a n b a r e l y s t a n d f o r r e o n h i s b a c k . H e d i d 3 s u r g e r i e s a n d i n s t e a d o f n e e d s h i s w i f e t o h e l p h i m g e t u p , t o h e l p h i m i n e b r u a r y 1 7 , 2 0 1 4 i n w h i c h h e w r o t e t h a t : c a r e o f h i m s e l f . e a r . H e a l s o h a s b l o o d i n s t o o l , w e a k n e s s a n d s b e c a u s e i t p u t s a l o t o f p r e s s u r e o n h i s b a c k a n d s . f o r l o n g e r t h a n 1 0 m i n u t e s . p i n e b o n e i s d i s l o c a t e d . T h e r e f o r e , h e i s u n a b l e t t i n g u p / d o w n f r o m t h e b a t h t u b . H e f e l l i n t h e r h i m t o s t a n d f o r m o r e t h a n 1 0 m i n u t e s . p h i m s h o w e r , m a k e h i s b e d , h e l p h i m g e t o u t o f f o r h i m t o s t a n d a n d h e a l w a y s h a s t o l i e d o w n . e c a u s e h e c a n n o t d o a n y t h i n g o n h i s o w n . i b i l i t y o f t h e i n f o r m a t i o n i n t h e a p p e l l a n t ' s N o t i c e e d t h e d o c u m e n t s a n d a d m i t t e d t h e i n f o r m a t i o n t o t h e a p p e l l a n t ' s p r e v i o u s l y d i a g n o s e d m e d i c a l t h e m i n i s t r y o n r e c o n s i d e r a t i o n , p u r s u a n t t o t .
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e o n t h e 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 ' s r e c o n s i d e r a t i o n d e c i s i o n , 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 i s n o t e l i g i b l e 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 b i l i t i e s ( P W D ) , w a s r e a s o n a b l y s u p p o rt e d b y t h e e v i d e n c e o r w a s a r e a s o n a b l e 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 c e s o f t h e a p p e l l a n t . T h e m i n i s t r y f o u 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 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 a n d t h a t 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 ) a r e n o 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 , 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 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 h a t , 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 , i t c o u l d 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 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 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 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 p e rf o r m D L A . T h e c r i t e r i a f o r b e i n g d e s i g n a t e d a s a p e r s o n w i t h d i s a b i l i t i e s ( P W D ) a r e s e t o u t i n S e c t i o n 2 o f t h e E A P W D A a s f o l l o w s : P e r s o n s w i t h d i s a b i l i t i e s 2 ( 1 } I n t h i s s e c t i o n : " a s s i s t i v e d e v i c e " m e a n s a d e v i c e d e s i g n e d t o e n a b l e a p e r s o n t o p e r f o r m a d a i l y l i v i n g a c t i v i t y t h a t , b e c a u s e o f a s e v e r e m e n t a l o r p h y s i c a l i m p a i r m e n t , t h e p e r s o n i s u n a b l e t o p e r f o r m ; " d a i l y l i v i n g a c t i v i t y " h a s t h e p r e s c r i b e d m e a n i n g ; " p r e s c r i b e d p r o f e s s i o n a l " h a s t h e p r e s c r i b e d m e a n i n g . ( 2 ) T h e m i n i s t e r m a y d e s i g n a t e a p e r s o n w h o h a s r e a c h e d 1 8 y e a r s o f a g e a s a p e r s o n w i t h d i s a b i l i t i e s f o r ! h e p u r p o s e s o f t h i s A c t i f t h e m i n i s t e r i s s a t i s f i e d t h a t t h e p e r s o n h a s a s e v e r e m e n t a l o r p h y s i c a l i m p a i r m e n t t h a t ( a } i n t h e o p i n i o n o f a m e d i c a l p r a c t i t i o n e r i s l i k e l y t o c o n t i n u e f o r a t l e a s t 2 y e a r s , a n d ( b } i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l ( i } d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s t h e p e r s o n ' s a b i l i t y t o p e r f o r m d a i l y l i v i n g a c t i v i t i e s e i t h e r ( A } c o n t i n u o u s l y , o r ( B } p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s , a n d ( i i } a s a r e s u l t o f t h o s e r e s t r i c t i o n s , t h e p e r s o n r e q u i r e s h e l p t o p e r f o r m t h o s e a c t i v i t i e s . ( 3 ) F o r t h e p u r p o s e s o f s u b s e c t i o n ( 2 ) , ( a ) a p e r s o n w h o h a s a s e v e r e m e n t a l i m p a i r m e n t i n c l u d e s a p e r s o n w i t h a m e n t a l d i s o r d e r , a n d { b ) a p e r s o n r e q u i r e s h e l p i n r e l a t i o n t o a d a i l y l i v i n g a c t i v i t y i f , i n o r d e r t o p e r f o r m i t , t h e p e r s o n r e q u i r e s ( i ) a n a s s i s t i v e d e v i c e , ( i i ) t h e s i g n i f i c a n t h e l p o r s u p e r v i s i o n o f a n o t h e r p e r s o n , o r ( i i i ) t h e s e r v i c e s o f a n a s s i s t a n c e a n i m a l . ( 4 ) T h e m i n i s t e r m a y r e s c i n d a d e s i g n a t i o n u n d e r s u b s e c t i o n ( 2 ) . S e c t i o n 2 ( 1 ) ( a ) o f t h e E A P W D R d e f i n e s D L A f o r 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 o r m e n t a l i m p a i r m e n t a s f o l l o w s : D e f i n i t i o n s f o r A c t 2 ( 1 ) F o r t h e p u r p o s e s o f t h e A c t a n d t h i s r e g u l a t i o n , " d a i l y l i v i n g a c t i v i t i e s " ( a } i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e p h y s i c a l i m p a i r m e n t o r a s e v e r e m e n t a l i m p a i r m e n t , m e a n s t h e f o l l o w i n g a c t i v i t i e s : ( i ) p r e p a r e o w n m e a l s ; ( i i ) m a n a g e p e r s o n a l f i n a n c e s ;
(iii ) shop for p er s onal n eed s ; ( iv ) u s e p u bl i c or p e rsona l transp o rt at i o n fac ilit i e s; (v ) pe rfor m housework to maintai n the . p erson' s place of resid (v i ) mo v e ab o ut indoo r s a n d outd oor s; (v i i) perform persona l hy gi e ne and s e lf ca re; (vi ii) m anage pers onal medication, a n d ( b) in relation to a pe r s on w ho has a seve re m e ntal impa (i ) make decisions a b out pe rs onal activit ie s , c are or f inances; (ii) rela t e to, commun icat e or inte ra ct w it h othe r s e ffec Se vere Phy sical Im pairment Th e app ell a nt' s p ositi o n is t hat a s eve r e p hys ical impairm s eriou s ba ck pa in, w eaknes s, fatigue , n ausea an d m nephrolit hiasis a nd chron i c back p ain. Th e ap pellant it d i d not help at al l, t ha t his pa in i s sti ll t h e same a nd T h e mi n i s tr y ' s po sit io n is that t he imp acts desc r ibed by wit h a mod era te de gree of imp airmen t and there i s no app ellant h as a seve r e ph ysic al i mpairm e nt . The minis in dicated tha t the ap pe llan t's hydr on ephro sis a nd kidne the appe llant ha s per sist ent back pai n whi ch m a y or s to ne s . The mini stry state d t hat, in ass es sing the appell in dicated tha t the appe llant i s able to w a l k 2 to 4 b loc lbs . and r e main seat ed 1 to 2 hour s. The minis t ry state the a ppe l lant takes sig nifican tly longer wit h w alking ind in f o r mation is provid ed on how m u ch longer i t tak es gener a l p r acti t i oner wrot e tha t t he appell ant st ates h a pplica t ion is not in t e nde d to a s sess e m p loya bilit y as P WD . Panel D e c isi on The diagnosis of a medical condition is not itself determinative of a severe impairmen the severity of an impairment one must consider the nature of the impairment and its impact on the appellant's ability to manage his DLA as evidenced by functional skill limita DLA, and the deg ree of independence in performing DLA. when it defines the word "impairmen t" in t he physici an psychological, anatomical or physio logical st ru ct u re or f function inde pendently, effe ctively, appropriately or f set out in legislation and is not binding on the pane l, describes the legislative intent. The legislation clearly provides that the determination of severity of impairment is at the discretion of the minister, taking i n to acc ou nt all o f the evide nce including that of the ap 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 e n ce i n acc ept abl e sa nita ry con d it ion ; irm en t , in clude s the f ollowi n g acti v i ties: t iv ely . ent is est abli shed by the e viden ce o f his uscl e s pasms due to h ydroneph r o sis wi t h wrote t h at h e ha s underg one thr e e su r g eries bu t he is comple tely unabl e t o work. the gen eral practit ioner are more in k eepin g t su ff ic ient information t o c onfirm tha t th e t ry stated th at t he gener al prac tit io ner y s tone s have been re solve d by surg eries but m a y not have been due to l ong-standi ng k idney ant's phy sical abili ty, t h e gen eral p r ac tit ion er ks a nd climb 2 to 5 stai rs u naide d, lift 5 to 1 5 d tha t the g e nera l prac t itione r indic ated that oo rs an d outdoors a nd cli mbi n g st a i rs but n o the ap pe ll a nt. Th e ministry s ta ted that t he e is u nable to work a nd pointed ou t tha t t he PWD it i s not a n e l ig ible crite rion fo r desi gnat i on as a t. To assess tions, th e rest r i ctions to The mini stry describes this approach report as be ing "a loss or abnormality of unction c a u sing a re striction i n the ab ility to or a reas onable d uration." This def i nition is not but in the panel's view it quite appropriately pellant. However, the act on dail functionin .
The medical practitioner, a physician who has known the appellant for a period of 2 years, diagnosed the appellant with hydronephrosis with nephrolithiasis and chronic back pain. The physician also noted in the health history that the appellant's hydronephrosis has resolved but he still has persistent back pain, which may or may not have been due to the long-standing kidney stone. In the additional comments to the PR, the physician wrote that he initially thought the appellant's back pain was due to his kidney stones but subsequent urologic surgeries failed to resolve pain and it is "still being worked up." In the print out of visit records, the appellant's physician noted that the left hip CT showed mild OA [osteoarthritis], with an assessment of hip osteoarthritis on April 16, 2013. In the Consultation Report dated September 15, 2013, the MRI of the appellant's lumbar spine showed findings of mild lumbar spondylosis. In the Medical Certificate dated January 15, 2014, the appellant's physician wrote that the appellant continues to report being disabled by his low back pain, that he continues to have pain on standing and doing heavy lifting. In terms of functional skills, the physician assessed the appellant as able to walk 2 to 4 blocks unaided on a flat surface, climb 2 to 5 steps unaided, lift 5 to 15 lbs., and remain seated 1 to 2 hours. In the AR, the appellant is assessed by the physician as taking significantly longer than typical with walking indoors and outdoors (note: "needs to rest 10 minutes after 2 blocks") and with climbing stairs. The physician added a note that the appellant "needs to rest after 1O steps", which indicates that the appellant is able to climb more than 5 steps unaided, and the panel finds that this is not consistent with the functional skill limitation of climbing 2 to 5 steps. The physician reported that the appellant " ...m ay benefit from shower chair or grab bars due to painful bending," but no assistive device is identified to aid with the appellant's mobility. In the AR, the appellant is assessed as independent with lifting, and carrying and holding, with the note: "maximum 10 lbs. of lifting and carrying." The appellant is also assessed as independent with standing with a note added that he " . ..c annot stand more than ½ hour''; however, there is a discrepancy in the PR as the physician wrote that the appellant " ... says he is unable to work as ... prolonged standing more than 1 hour causes him pain." In his written submission dated February 17, 2014, the appellant wrote that he can barely stand for more than 20 minutes because it puts a lot of pressure on his back and it gives him serious pain on his lower back. In his Request for Reconsideration, his Notice of Appeal, and his written submission, the appellant wrote that he is completely unable to work. 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. The panel finds that the ministry reasonably concluded that there is not sufficient information to confirm that the appellant has more than a moderate degree of impairment. The panel finds that it is difficult to obtain an accurate picture of the appellant's present physical limitations due to the indeterminate cause of the appellant's back pain as well as the inconsistencies and lack of detail in the evidence. In the absence of further detail, the panel finds that the ministrv reasonablv determined
th at there is not suffici en t evide n ce to establish that the appellan under section 2(2) of the EAPWDA. Severe Mental Impairment The appellan t ' s position is that a s evere menta l impairment feelings of helpl essness/ hope l e s sness/ wor thl es sness, concentration, poor memory, a nd l ow st ress toleran dated February 17, 2014, the a ppellant wrote that he feels depressed, h b ecause he cann ot do anything on his own. The minist ry's po s iti on is that there is insufficient evidence to establish that the appellan s evere me n tal im p a ir m e n t. T he min i s try stated that the physician indicated that the appel def icits with cognit ive and emotional functioning in the area disturbanc e, mot ivation, a nd a t te nti on or sust a ined concen due to p ai n." The ministry state d that wh en ass e s si i ndicat ed t h a t the a ppella nt h a s moder a te i m pacts to consc io u sness, a ttentio n/ co ncentr at i o n and moti v a tion cogniti v e a nd e moti onal f un ction ing. The minis t ry s t appell an t has no dif ficult i es with co mmun icat i o n a nd wri t i n g and h ear in g . Panel Decision The ph y sicia n d iagnosed depr es sion with onse t i n July 20 has a score of 16 on a PHQ-9 [Patient He a lth Ques ti the p hys ician w rote that t he appe l la nt scor ed 1 6 on Engl ish is p oor an d so n may have mis transl ated. D epression however , t her e are n o other det ails pr ovided to ex pla appell an t i s as sessed b y his phy sici a n as h aving signific fun c tioning in the a r eas of e xecut i ve, memory , em ot sust ain e d conce n tr ati on, wit h a note: "depres si o n due to pa f u nct ioning, h owever, a re assessed as mode rat e in the areas no impacts in the remaining 1 2 ar eas of f u n c ti o n ing, communication other than a lack of fluency in English. In terms of social functioni ng, the appella nt is assessed by the physician as independent in making approp ria te so c ial deci s i o n s a nd requiring periodic support/ su functioning, inclu d i ng developing and ma intaining relatio only one friend ") , inte racting appropriately with others with unexpected demands (note: "poor concentration") and securing assistance from others (note: "s ocial ly withdr aw n "). The ph ysician assessed the app immediate and ext ended social networks, but when asked to describe th required by the appellant, which would help to maintain him in the community, the physician wrote: "none." Additional comments, including identific a t ion physician as "none." In his self report, the appellant wrote that with respect to social/emotional functioning, he feels upset b his declinin health, that he is easil frustrated and he ·ust wants to sit alone and not talk to t has a seve re p h ys ical imp airment is estab l i shed by th e ev i den ce of his lack of motivation, sleep disturb ances, poor c e due to depress i on . In his written submissi on e l p less, and hopeless t has a lant has s of executive, memory, emoti onal t ra t ion wit h the explana t ion "depr ession ng the i m p act s on dai ly functi oni ng, the phys ician emot ion a nd memo ry, mi n i ma l impact s to , a nd no impacts to the remaind er of h is a t ed that th e phy si cian also in dicat e d t h a t the t ha t he i s sat isfact o r y with speak ing, readi ng , 11 a nd rep o rted i n the PR that the a p pel la nt onna ire ] . In the ad dit io n al i nf ormation t o t he AR , a PHQ-9, "a ltho u gh scor e possib ly higher a s h i s l eads to po orer social inter a c t i on ;" in t he si gni fican ce of t h e ap pell ant's sc o re. The an t d eficit s in c ognitiv e an d emo t ional io n al disturb a nce, m oti vat ion, a nd a tt enti o n or in." The impacts to t he app ell ant ' s daily of emotion and memory, and minimal or T he appellan t has no d i fficulties with per vision in 4 of 5 aspects of social ns hips (n o t e: " st a t es socially withdrawn, ha s (note: "easily frustrated"), dealing appropriately el lant with marginal functioning in both his e s u p port/supervision of any safety issue s, were also descr ibed by the
a n y o n e . I n h i s w r i t t e n s t a t e m e n t d a t e d F e b r u a r y 1 7 d e p r e s s e d , h e l p l e s s , a n d h o p e l e s s b e c a u s e h e c a n w i t h t h e p h y s i c i a n ' s n o t e t h a t t h e a p p e l l a n t ' s d e p r e s p a i 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 r e a s o n a b l y c s o c i a l a n d c o g n i t i v e / e m o t i o n a l f u n c t i o n i n g r e m a i n i n e v i d e n c e t o e s t a b l i s h a s e v e r e m e n t a l i m p a i r m e n t , p 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 r f o r m 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 i s p h y s i c a l a n d m e n h i s a b i l i t y t o p e r f o r m D L A o n a n o n g o i n g b a s i s t o t h e o f a n o t h e r p e r s o n , a s w e l l a s a s s i s t i v e d e v i c e s s u c h 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 t h e a p p e l l a n t c a n i n d e i n d e p e n d e n t l y a n d , f o r t h o s e t a s k s t h a t t a k e h i m l o n p h y s i c i a n h a s n o t e x p l a i n e d h o w m u c h l o n g e r i t t a k e a s s i s t a n c e r e q u i r e d t o i n d i c a t e r e s t r i c t i o n s f o r e x t e n 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 a p r e s a p p l i c a n t ' s s e v e r e i m p a i r m e n t d i r e c t l y a n d s i g n i f i c a n f o r e x t e n d e d p e r i o d s . I n t h i s c a s e , t h e a p p e l l a n t ' s p d e f i n e d i n s e c t i o n 2 ( 1 ) o f t h e E A P W D R a n d a r e a l s o t h e A R . T h e r e f o r e , a p r e s c r i b e d p r o f e s s i o n a l c o m p l w h i c h , i f a n y , D L A a r e 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 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 n t h e a p p e l l a n t ' s c i r c u m s t a n c e s , h i s p h y s i c i a n r e p o w i t h t h e D L A o f m a n a g i n g h i s m e d i c a t i o n s a n d w i t h o f m a n a g i n g m e a l s , 2 o f 3 t a s k s o f t h e D L A p a y i n g r t r a n s p o r t a t i o n D L A . T h e a p p e l l a n t i s a s s e s s e d a s t a a b o u t i n d o o r s a n d o u t d o o r s w i t h t h e c o m m e n t a d d e f o r 1 O m i n u t e s a f t e r 2 b l o c k s . W h i l e a l l t a s k s o f t h e b e i n g i n d e p e n d e n t , t h e p h y s i c i a n c h a n g e d h i s r e s p o a l l 8 t a s k s , d e s c r i b e d a s " t a k e s l o n g e r t h a n u s u a l . " a s t a k i n g s i g n i f i c a n t l y l o n g e r t h a n t y p i c a l , w h i c h i s d i n c r e a s e d p a i n a n d i n c r e a s e d f a t i g u e . " T h e p h y s i c i a n a l s o a s s e s s e d t h e a p p e l l a n t a s r e q u i r 3 o f 4 t a s k s o f t h e m e a l s D L A w i t h t h e c o m m e n t " w i f t o t u r n o f f b u r n e r 1 t o 2 t i m e s p e r w e e k . " T h e p a n e l t h e c o m m e n t s p r o v i d e d b y t h e p h y s i c i a n f o r t h o s e t a p e r i o d i c a s s i s t a n c e i s r e q u i r e d , d o n o t d e f i n e h o w m p e r i o d i c a s s i s t a n c e r e q u i r e d t o i n d i c a t e r e s t r i c t i o n s f p h y s i c i a n a l s o a s s e s s e d t h e a p p e l l a n t a s r e q u i r i n g c t h e D L A b a s i c h o u s e k e e p i n g , 2 o f 5 t a s k s o f s h o p p i n a n d c a r ry i n g p u r c h a s e s h o m e ) a n d w i t h t h e t a s k o f p f r o m h i s f a m i l ., 2 0 1 4 , t h e a p p e l l a n t w r o t e t h a t h e f e e l s n o t d o a n y t h i n g o n h i s o w n , w h i c h i s c o n s i s t e n t s i o n i s a r e a c t i o n t o h i s s i t u a t i o n a l e x p e r i e n c e o f o n c l u d e d t h a t , o v e r a l l , t h e i m p a c t s a s s e s s e d t o a m o d e r a t e r a n g e a n d t h e r e i s n o t s u f f i c i e n t u r s u a n t t o s e c t i o n 2 ( 2 ) o f t h e E A P W D A . t a l i m p a i r m e n t s d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t p o i n t t h a t h e r e q u i r e s t h e s i g n i f i c a n t a s s i s t a n c e a s a s h o w e r c h a i r o r g r a b b a r s . p e n d e n t l y m a n a g e t h e m a j o r i t y o f h i s D L A g e r o r w h e r e p e r i o d i c a s s i s t a n c e i s r e q u i r e d , t h e s t h e a p p e l l a n t o r t h e e x t e n t o f t h e p e r i o d i c d e d p e r i o d s o f t i m e . c r i b e d p r o f e s s i o n a l p r o v i d e a n o p i n i o n t h a t a n t l y r e s t r i c t s h i s D L A , 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 h y s i c i a n i s 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 . D L A a r e l i s t e d i n t h e P R a n d , w i t h a d d i t i o n a l d e t a i l s , i n e t i n g t h e s e f o r m s h a s t h e o p p o r t u n i t y t o i n d i c a t e a p p e l l a n t ' s i m p a i r m e n t s e i t h e r c o n t i n u o u s l y o r r t e d i n t h e A R , 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 3 o f 5 t a s k s o f s h o p p i n g , 1 o f 4 t a s k s o f t h e D L A e n t a n d b i l l s a n d 1 o f 2 a s s e s s e d t a s k s o f t h e k i n g s i g n i f i c a n t l y l o n g e r t h a n t y p i c a l w i t h m o v i n g d b y t h e p h y s i c i a n t h a t t h e a p p e l l a n t n e e d s t o r e s t D L A p e r s o n a l c a r e w e r e i n i t i a l l y a s s e s s e d a s n s e t o t a k i n g s i g n i f i c a n t l y l o n g e r t h a n t y p i c a l w i t h F o r u s i n g p u b l i c t r a n s i t , t h e a p p e l l a n t i s a s s e s s e d e s c r i b e d b y t h e p h y s i c i a n a s " n e e d s t o s i t d u e t o i n g 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 w i t h e h e l p s w i t h c o o k i n g , p o o r m e m o r y , s t a t e s f o r g o t f i n d s t h a t t h e m i n i s t r y r e a s o n a b l y d e t e r m i n e d t h a t s k s t h a t t a k e t h e a p p e l l a n t l o n g e r o r w h e r e u c h l o n g e r i t t a k e s h i m o r t h e e x t e n t o f t h e o r e x t e n d e d p e r i o d s o f t i m e . I n t h e A R , t h e o n t i n u o u s 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 w i t h g ( t h e p h y s i c a l t a s k s o f g o i n g t o a n d f r o m s t o r e s a y i n g r e n t a n d b i l l s s i n c e h e n e e d s r e m i n d e r s
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 , 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 i t i e s , c a r e o r f i n s u p e r v i s i o n w i t h 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 , d T h e a p p e l l a n t h a s n o d i f f i c u l t i e s w i t h c o m m u n i c a t i o n e v i d e n c e o f t h e p h y s i c i a n d e m o n s t r a t e s t h a t t h e a p p m a n a g i n g h i s b a n k i n g a n d b u d g e t i n g , f i l l i n g / r e f i l l i n g s a f e h a n d l i n g a n d s t o r a g e o f m e d i c a t i o n s a s w e l l a s 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 . T h e a p p e l l a n t w i t h r e m i n d e r s t o p a y h i s r e n t a n d b i l l s . I n t h e a p p e l l a n t ' s s e l f r e p o rt a s p a r t o f t h e P W D a p p d a y " a n d b e c a u s e o f h i s m e d i c a l c o n d i t i o n s o f h y d r o o n g o i n g , m a r k e d r e s t r i c t i o n s w i t h a n u m b e r o f D L A . t h e a p p e l l a n t ' s h y d r o n e p h r o s i s h a s r e s o l v e d a n d t h e i s l i m i t e d i n f o r m a t i o n p r o v i d e d r e g a r d i n g o s t e o a rt h r i t h a t t h e l e f t h i p C T s h o w e d m i l d o s t e o a rt h r i t i s . T h e a d e p r e s s i o n a s f o r g e t t i n g t o t u r n t h e b u r n e r / o v e n [ o f f ] f a m i l y a n d l a n d l o r d t o r e m i n d h i m t o p a y t h e b i l l s / r e n a p p e l l a n t w r o t e t h a t s i n c e h e i s u n a b l e t o w o r k a n y m t h e r e n t , w h i c h s u g g e s t s a r e s t r i c t i o n r e l a t e d t o f i n a n a d d i t i o n a l i n f o r m a t i o n p r o v i d e d i n t h e A R , t h e p h y s i c m e d i c a l l y c o n t r a i n d i c a t e d b u t h e m a y h a v e p a i n d o i n t i m e t o d o t h e m . " I n t h e a b s e n c e o f n a r r a t i v e o r n o t e s b y t h e p h y s i c i a n m u c h l o n g e r i t t a k e s t h e a p p e l l a n t w i t h t h e t a s k s o f i n c o n s i s t e n c y b e t w e e n t h e r e s t r i c t i o n s i d e n t i f i e d a n d a r e m e d i c a l l y c o n t r a i n d i c a t e d , t h e p a n e l f i n d s t h a t t h e n o u g h 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 s i g n i f i c a n t l y 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 p e r i o d s , 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 H e l p t o p e r fo r m 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 t h e s i g n i f d e v i c e t o p e r f o r m D L A . 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 b e c a u s e i t h a s n o t b e e 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 f i c a n t h e p h y s i c i a n i n d i c a t e d t h a t t h e a p p e l l a n t d o e s n o t u s e a b e n e f i t f r o m a s h o w e r c h a i r o r g r a b b a r s . 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 b i l i t y t o 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 r s u b s e c t i o n ( 3 ) a s t h e r e q u i r e m e n t f o r a n a s s i s t i v e d e a n o t h e r p e r s o n , 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 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 t w i t h a n c e s , a n d r e q u i r i n g p e r i o d i c s u p p o r t o r e s c r i b e d b y t h e p h y s i c i a n a s " e a s i l y f r u s t r a t e d . " o t h e r t h a n a l a c k o f f l u e n c y i n E n g l i s h . T h e 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 " m e n t a l " t a s k s o f p r e s c r i p t i o n s , t a k i n g m e d i c a t i o n s a s d i r e c t e d , w i t h w i t h 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 m a k i n g r e q u i r e s c o n t i n u o u s a s s i s t a n c e f r o m h i s f a m i l y l i c a t i o n , h e w r o t e t h a t e v e r y d a y f o r h i m i s a " b a d n e p h r o s i s , o s t e o a r t h r i t i s , a n d d e p r e s s i o n , h e h a s H o w e v e r , t h e p h y s i c i a n r e p o r t e d i n t h e P R t h a t k i d n e y s t o n e h a s b e e n t a k e n c a r e o f , a n d t h e r e t i s o t h e r t h a n t h e p h y s i c i a n ' s v i s i t r e c o r d n o t i n g p p e l l a n t d e s c r i b e d t h e i m p a c t s t o D L A f r o m h i s 1 t o 2 t i m e s p e r w e e k a n d d e p e n d i n g o n h i s t . I n h i s 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 , t h e o r e , i t i s v e ry d i f f i c u l t f o r h i m t o p a y b i l l s a n d p a y c e s r a t h e r t h a n t o a m e n t a l i m p a i r m e n t . I n t h e i a n w r o t e t h a t " . . . n o n e o f t h e A O L ' s l i s t e d a r e g t h e m a n d m a y t a k e a n i n o r d i n a t e a m o u n t o f , a s 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 d e s c r i b e h o w D L A t h a t t a k e h i m l o n g e r o r t o r e s o l v e t h e t h e p h y s i c i a n ' s c o m m e n t t h a t n o n e o f t h e D L A e m i n i s t r y r e a s o n a b l y c o n c l u d e d t h a t t h e r e i 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 ' s i m p a i r m e n t 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 n o f s e c t i o n 2 ( 2 ) ( b ) ( i ) o f t h e E A P W D A . i c a n t a s s i s t a n c e o f a n o t h e r p e r s o n o r a n a s s i s t i v e n e s t a b l i s h e d t h a t D L A a r e s i g n i f i c a n t l y l p i s r e q u i r e d . T h e m i n i s t r y s t a t e d t h a t t h e n y e q u i p m e n t a t t h i s t i m e a n d t h a t h e m a y a r e 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 f o r m t h o s e a c t i v i t i e s . H e l p i s d e f i n e d i n v i c e , 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 m a l i n o r d e r t o p e r f o r m a D L A .
T h e e v i d e n c e o f t h e p h y s i c i a n , a s a p r e s c r i b e d p r o f e p r o v i d e d b y t h e a p p e l l a n t ' s f a m i l y . T h e p h y s i c i a n r e i m p a i r m e n t b u t t h a t h e m a y b e n e f i t f r o m a s h o w e r c p a n e l f i n d s t h a t t h e m i n i s t r y r e a s o n a b l y d e t e r m i n e d 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 s t a p p e l l a n t 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 o f t h e E A P W D A . 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 m i n i s t r y ' s r e c o n s i d e r a t i o n d e c i s i o n w h i c h d e t e r m i n e d d e s i g n a t i o n w a s r e a s o n a b l y s u p p o r t e d b y t h e e v i d e n s s i o n a l , i s t h a t t h e h e l p r e q u i r e d w i t h D L A i s p o r t e d t h a t t h e a p p e l l a n t r e q u i r e s n o a i d s f o r h i s h a i r o r g r a b b a r s d u e t o p a i n f u l b e n d i n g . T h e 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 i n t h e 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 f t h o s e r e s t r i c t i o n s , a s d e f i n e d b y s e c t i o n 2 ( 3 ) ( b ) a n d 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 t h a t t h e a p p e l l a n t w a s n o t e l i g i b l e f o r P W D c e , a n d t h e r e f o r e c o n f i r m s t h e d e c i s i o n .
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.