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 e D i s a b i l i 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 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 a 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 d • 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 e 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 • 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 t 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 f o 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 fo r P e r s o n s w i t h D i s a b A P P E A L # I 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 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 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 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 . 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 ; , 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 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 , 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 il 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 a p p e l l a n t c o n s e n t e d t o t h e a t t e n d a n c e o f a m i n T h e e v i d e n c e b e f o r e t h e m i n i s t r y a t t h e t i m e o f t h e r D i s a b i l i t i e s ( P W D ) A p p l i c a t i o n c o m p r i s e d o f t h e a p p n o t i n c l u d e a s e l f r e p o r t b y t h e a p p e l l a n t , a p h y s i c i a a s s e s s o r r e p o r t ( A R ) d a t e d J u n e 1 3 , 2 0 1 3 , b o t h c o m k n o w n t h e a p p e l l a n t f o r a p p r o x i m a t e l y 2 y e a r s . T h e 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 e r 2 3 , 2 0 1 3 . 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 p s y c h i a t r i o n s e t i n O c t o b e r 2 0 0 7 . T h e p s y c h i a t r i s t n o t e d s i g n i w a s n o d i a g n o s i s i n c l u d e d i n t h e P R o f a n y h e a l t h c 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 a p p e l l a n t ' s p s y c h i a t r i s t r e p o r 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 r e q u i r e a n y p r o s t h e s i s • I n t e r m s o f f u n c t i o n a l s k i l l s , t h e a p p e l l a n t c a n u n a i d e d a n d h a s n o l i m i t a t i o n s w i t h l i f t i n g a n d I n t h e A R , t h e a p p e l l a n t ' s p s y c h i a t r i s t 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 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 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 , c l i m b i n g s t a i r s • T h e s e c t i o n o f t h e A R r e l a t i n g t o a s s i s t a n c e p n o t a p p l i c a b l e t o t h e a p p e l l a n t . 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 a p p e l l a n t ' s p s y c h i a t r i s t 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 " . . . l o n g s t a n d i n g h i s t o r y o f a n d a g o r a p h o b i a s u c h t h a t p r i o r t o i n i t i a l a s s e H a s a l s o b e e n u n e m p l o y e d f o r s a m e t i m e . " • W i t h r e s p e c t t o t h e d e g r e e a n d c o u r s e o f i m p c o n s i d e r a b l y a n d c a n n o w l e a v e t h e h o u s e , a • T h e r e a r e 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 , w i t h " s o m e t i m e s w h e n d e p r e s s i o n w o r s e n s , t h e r e • T h e r e a r e 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 e m o t i o n a l d i s t u r b a n c e , m o t i v a t i o n , a n d i m p u l p s y c h i a t r i s t a d d e d : " M a i n d e f i c i t s r e l a t e t o d e m o o d m a i n t e n a n c e . " • I n t h e a d d i t i o n a l c o m m e n t s : " . . . p r i o r t o t h e i n i t D e p r e s s i v e s y m p t o m s c o m p l i c a t e d b y s o c i a l r e m a i n i n g d i f f i c u l t i e s w i t h s o c i a l p h o b i a , d e a l i a n x i e t y / m o o d ; h o w e v e r , h a s g e n e r a l l y b e e n I n t h e A R , t h e p s y c h i a t r i s t i n d i c a t e d t h a t : • T h e a o o e l l a n l h a s a q o o d a b i l i t v l o c o m m u n i c A P P E A L # I i s t r y o b s e r v e r a t t h e h e a r i n g . 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 l i c a n t i n f o r m a t i o n d a t e d M a y 2 8 , 2 0 1 3 w h i c h d i d n r e p o r t ( P R ) d a t e d M a y 2 9 , 2 0 1 3 a n d a n p l e t e d b y t h e a p p e l l a n t ' s p s y c h i a t r i s t w h o h a s e v i d e n c e a l s o i n c l u d e d t h e a p p e l l a n t ' s R e q u e s t s t w i t h m o o d d i s o r d e r s a n d a n x i e t y d i s o r d e r s , w i t h f i c a n t f e a t u r e s o f s o c i a l a n d a g o r a p h o b i a . T h e r e o n d i t i o n s o t h e r t h a n t h e m e n t a l d i s o r d e r s . o r a i d f o r h i s i m p a i r m e n t . w a l k 4 o r m o r e b l o c k s a n d c l i m b 5 o r m o r e s t e p s r e m a i n i n g s e a t e d . t h a l l m o b i l i t y a n d p h y s i c a l a b i l i t y , i n c l u d i n g , s t a n d i n g , l i f t i n g , a n d c a r r y i n g a n d h o l d i n g . r o v i d e d t h r o u g h t h e u s e o f a s s i s t i v e d e v i c e s i s d e p r e s s i o n w i t h c o m p l i c a t i n g f e a t u r e s o f s o c i a l s s m e n t i n 2 0 1 1 , h a d r a r e l y l e f t h o m e f o r 4 y e a r s . a i r m e n t , t h e a p p e l l a n t " . . . h a s i m p r o v e d l t h o u g h h e r e m a i n s u n e m p l o y e d . " t h e c a u s e i n d i c a t e d a s " o t h e r " a n d a n o t e : i s d i f f i c u l t y c o m m u n i c a t i n g . " d e m o t i o n a l f u n c t i o n i n g i n t h e a r e a s o f e x e c u t i v e , s e c o n t r o l ( n o t e : " r a r e l y t h o u g h " ) . T h e c r e a s e d m o t i v a t i o n , d e c r e a s e d i n i t i a t i v e a n d i a l a s s e s s m e n t , w a s e s s e n t i a l l y h o u s e b o u n d . a n d a g o r a p h o b i a . I n s p i t e o f t r e a t m e n t t h e r e a r e n g w i t h c r o w d s , w a v e r i n g i n i t i a t i v e , p e r i o d s o f s t a b l e a n d i m p r o v e d . " a t e i n a l l a r e a s , i n c l u d i n a s o e a k i n a , r e a d i n q ,
w r i t i n g a n d h e a r i n g . • F o r 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 , t h e r f u n c t i o n i n g i n t h e a r e a o f " o t h e r e m o t i o n a l o m e d s a n d p s y c h o t h e r a p y a n d r e g u l a r t r e a t m • T h e r e a r e m o d e r a t e i m p a c t s t o c o g n i t i v e a n d m o t i v a t i o n a s w e l l a s m i n i m a l i m p a c t s t o b o d T h e r e a r e n o i m p a c t s i n d i c a t e d i n t h e r e m a i n • T h e a p p e l l a n t " s l e e p s w e l l w i t h m e d i c a t i o n . A a r e s t i l l p r o b l e m 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 ) I n t h e P R , t h e p s y c h i a t r i s t i n d i c a t e d t h a t t h e a p p e l l a t r e a t m e n t t h a t i n t e r f e r e w i t h h i s 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 p s y c h i a t r i s t r e p o r t e d t h a t : • T h e i m p a i r m e n t s t h a t i m p a c t t h e a p p e l l a n t ' s a d e p r e s s i o n a n d a n x i e t y i m p a i r i n g a b i l i t y t o b e • 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 i n a l l t a s k s o f s e o u t d o o r s , p e r s o n a l c a r e , s h o p p i n g , a n d m a n a • F o r b a s i c h o u s e k e e p i n g , n o a s s e s s m e n t i s p r l a u n d r y a n d h o u s e k e e p i n g : " s i s i n l a w d o e s • F o r m e a l s , 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 i n 3 o b u t a n o t e a d d e d : " p a r e n t s d o s h o p p i n g . " • F o r p a y i n g r e n t a b i l l s , t h e a p p e l l a n t i s i n d e p e a n d p a y i n g r e n t a n d b i l l s i s " n o t a p p l i c a b l e . " • F o r m a n a g i n g t r a n s p o r t a t i o n , t h e a p p e l l a n t i s w i t h n o a s s e s s m e n t f o r u s i n g p u b l i c t r a n s i t a t r a n s p o r t a t i o n w i t h t h e n o t e : " a v o i d s b e c a u s e • I n t e r m s o f s o c i a l f u n c t i o n i n g , t h e a p p e l l a n t i s a p p r o p r i a t e s o 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 a s s i s t a n c e f r o m o t h e r s . • T h e r e i s n o a s s e s s m e n t f o r i n t e r a c t i n g a p p r o p a n x i e t y i n s o c i a l c o n t e x t " a n d f o r d e a l i n g a p p " l i t t l e e x p e r i e n c e , u n l i k e l y . " • T h e a p p e l l a n t h a s g o o d f u n c t i o n i n g i n h i s i m m h i s e x t e n d e d s o c i a l n e t w o r k w i t h a n o t e a d d e N e e d fo r H e l p T h e p s y c h i a t r i s t r e p o r t e d t h a t t h e h e l p r e q u i r e d f o r D n o t e : " h a s m e a l s c o o k e d , i s d r i v e n t o a p p o i n t m e n t s , i n d i c a t i n g a s s i s t a n c e p r o v i d e d t h r o u g h t h e u s e o f a s I n h i s N o t i c e o f A p p e a l , t h e a p p e l l a n t w r o t e t h a t : • H e i s t o t a l l y i n h i b i t e d f r o m p e r f o r m i n g D L A . • T h e p s y c h i a t r i s t d i d n o t u n d e r s t a n d h o w t o c o i n t e r p r e t e d t h e q u e s t i o n s i n c o r r e c t l y . • T h e e v i d e n c e n o w a v a i l a b l e s u n n o r t s h i s a b i l i I A P P E A L # e i s a m a j o r i m p a c t t o t h e a p p e l l a n t ' s d a i l y r m e n t a l p r o b l e m s " d e s c r i b e d a s " p r i o r t o u s e o f e n t , w a s b a s i c a l l y h o u s e b o u n d f o r 3 t o 4 y e a r s . " e m o t i o n a l f u n c t i o n i n g i n t h e a r e a s o f e m o t i o n a n d i l y f u n c t i o n s , i m p u l s e c o n t r o l , a n d e x e c u t i v e . i n g 8 a r e a s o f f u n c t i o n i n g . n x i e t y a n d d e p r e s s i o n b e t t e r w i t h m e d s b u t t h e r e 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 e d i c a t i o n a n d / o r . b i l i t y t o m a n a g e D L A a r e : " D i f f i c u l t i e s w i t h w i t h p e o p l e o r s e e k w o r k . " v e r a l D L A , i n c l u d i n g m o v i n g a b o u t i n d o o r s a n d g i n g h i s m e d i c a t i o n s . o v i d e d b u t a n o t e p r o v i d e d w i t h r e s p e c t t o i t . " f 4 t a s k s w i t h n o a s s e s s m e n t f o r m e a l p l a n n i n g n d e n t w i t h b a n k i n g b u t h e " d o e s n ' t d o " b u d g e t i n g i n d e p e n d e n t w i t h g e t t i n g i n a n d o u t o f a v e h i c l e , n d u s i n g t r a n s i t s c h e d u l e s a n d a r r a n g i n g o f a n x i e t y . " i n d e p e n d e n t i n 3 o f 5 a s p e c t s , n a m e l y m a k i n g m a i n t a i n i n g r e l a t i o n s h i p s , a n d s e c u r i n g r i a t e l y w i t h o t h e r s w i t h a n o t e : " e x p e r i e n c e s r o p r i a t e l y w i t h u n e x p e c t e d d e m a n d s , w i t h a n o t e : e d i a t e s o c i a l n e t w o r k a n d m a r g i n a l f u n c t i o n i n g i n d : " p r e s e n t l y v e r y d e p e n d e n t o n p a r e n t s . " L A i s 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 w i t h a h a s l a u n d r y d o n e . " T h e s e c t i o n o f t h e r e p o r t s i s t i v e d e v i c e s i s m a r k e d " n o t a p p l i c a b l e . " m p l e t e t h e o r i g i n a l a p p l i c a t i o n f o r m a n d t h e r e f o r e t v t o p e r f o r m D L A i s e x t r e m e l v a f f e c t e d b y h i s
I APPEAL# mental condition. Prior to the hearing, the appellant provided additional documents as follows: 1) Note dated January 16, 2014 from the psychiatrist who completed the reports for the PWD application, in which he wrote that: • The level of assistance required with laundry, housekeeping, grocery shopping or finances is related to apathy and agoraphobia, i.e. a functional impairment from a diagnosed medical condition. • His restriction in mobility is secondary to agoraphobia. • With respect to making social decisions and maintaining relationships, he remains very socially isolated secondary to his psychiatric condition. • He remains quite handicapped by his agoraphobic state. • It will be important that there be telephone communication with the ministry regarding the appellant. 2) Memo dated January 29, 2014 from a psychologist who has treated the appellant since 2010 and has seen him for a total of 14 sessions, in which he wrote that: • The appellant stated that he feels extremely anxious whenever he leaves his house and he often cannot leave his room for days at a time. • The appellant reported that he requires significant support with most AOL's [activities of daily living] and that he tends to stay up all night (in his room) and sleep during the day. • With respect to diagnosis, the appellant easily meets the DSM-V diagnostic criteria for both Agoraphobia and Panic Disorder. • The psychologist concurs with the psychiatrist's assessment that the appellant's functional impairment relating to DLA (e.g. laundry, housekeeping, groceries, finances) and restriction to mobility are secondary to apathy and agoraphobia. • He also agrees with the psychiatrist's opinion that this disorder profoundly affects the appellant's ability to make social decisions and maintain relationships, resulting in chronic social isolation. • The appellant is profoundly handicapped by his disorder and has been unable to make any real progress despite abundant support from his parents. • In his clinical opinion, the appellant's prognosis is unclear but with extensive treatment he may be able to acquire some rudimentary life skills. • It is his clinical opinion that the appellant displays a long-standing pattern of severe anxiety related to Agoraphobia and Panic Disorder and f o r that reason he [is] severely disabled with respect to his ability to lead a normal, independent life. At the hearing, the psychiatrist stated that: • He already completed the reports included with the PWD application, and he did so to the best of his ability. He answered the questions as best as he could. • The appellant's parents met with him and expressed that they felt the questions in the forms were not understood. • The appellant was referred to him by his general practitioner (GP) in 2011 and, at that time, the appellant was severely debilitated by mental illness and he had been housebound for 4 years. • He wrote a letter to the appellant's GP on December 5, 2011 and had diagnosed significant depression. He recommended that the appellant continue psychiatric treatment and also see a psychologist, who the appellant is still seeing for help. • The annellant has aained some benefit from the medications that he orescribed. His
APPEAL# I energy and mood improved and his anxiety diminished but it did not disappear. His irritability went down, he became more motivated, and he went on the occasional trip with a small group of people. He started going out of the house. • In May of 2012, the appellant went to his cabin for a couple of weeks by himself and he said that he was talking to people. In June 2012 he was looking at a job possibility. At that time, the appellant said he thought he was 95% improved since the previous year. • In June 2012 another medication was added along with the anti-depressants that the appellant takes. He takes his medications regularly. • He has been resistant to treatment in some ways. Over time, his medications have been increased and he has improved but he is still highly agoraphobic. He still has symptoms of anxiety. He could not take public transit, f o r example. • The appellant's activity level is still very limited as he only goes to his doctor appointments or to his cabin or, in the company of his parents, on various trips. He does not get out of the house in a way that one would expect f o r someone his age. He is still anxious and depressed. • Looking at the impacts to cognitive and emotional functioning, some of the impacts would be worse when the appellant is experiencing increased depression or anxiety, which happens at least once per month and, at times, once per week, or "fairly often." • For impulse control, in the last year the appellant has had two violent outbursts of hostility where he was out of control from an anger point of view, to the point where his mother was fearful. At these times, the impact would be moderate to major. Depending on his mood stale, the appellant's insight and judgment would also have a moderate to major impact. • For consciousness, for example, although he does not lose consciousness, he may be confused in his thinking when he is more depressed. Emotion would have more of a major impact than a moderate impact during these times. His executive functioning has either a minimal impact or moderate when his mood is lower. Likewise, his motivation has a moderate impact but sometimes there would be a major impact. • On the other hand, he was applying for a job in June 2012, so his attention/ concentration was good at that time. It would be poor if he was depressed. There have been no problems with the appellant's memory, motor activity, language, and no psychotic symptoms. • For his assessment of the appellant's ability with daily living activities, he asked the appellant about basic housekeeping and he said that his sister-in-law does it. The impact is related to the appellant's apathy and agoraphobia when he is very depressed. • Regarding the frequency of help needed by the appellant, it must be kept in mind that he does go for two weeks on his own to his cabin and he manages on his own. He is not sure how often the appellant is alone at his cabin. • In January 2013, the appellant still had anxiety in large groups. He sometimes gets nightmares from traumatic experiences in his childhood and was having difficulty sleeping. • In March 2013, he prescribed sleeping pills and the appellant stopped taking them because he felt too drugged and his mood was "up and down." He found that he was fine one moment and then irritable the next. • In April 2013 the appellant said he had gone to his cabin for two weeks on his own, that he was not as irritable. He complained of exhaustion. He did not see the appellant over the summer of 2013 because the annellant was awav at his cabin over this time.
• L o o k i n g a t s o c i a l f u n c t i o n i n g , t h e d e g r p e r i o d i c a s h e n e e d s a c o m p a n i o n , w h a l s o g o e s o n t r i p s i n a s m a l l g r o u p a n w i t h a l i m i t e d n u m b e r o f p e o p l e , a s l o n A t t h e h e a r i n g , t h e a p p e l l a n t a n d h i s a d v o c a t e s t a t e • T h e " c a b i n " i s a p r o p e rt y o n a l a k e w h w h o a r e " l i f e l o n g " f r i e n d s o f t h e f a m i l y T h e a p p e l l a n t a n d h i s p a r e n t s w i l l g o u s o m e t i m e s w h e n t h e a p p e l l a n t d e c i d e t o t r a v e l t o t h e c a b i n c a n t a k e a w h i l e a p p e l l a n t i s t h e r e , h e s e e m s t o h a v e " • H e c a n s e e m " f i n e " a t t h e c a b i n a n d f e t h e p l a c e c l e a n . H i s p a r e n t s s e e e a c h G e t t i n g o u t t h e f r o n t d o o r c a n s o m e t i m f r e e z e s t h e m s o t h a t t h e a p p e l l a n t o n l t h e s e m e a l s f o r h i m , t h e a p p e l l a n t w o u • T h e a p p e l l a n t c a n g o d a y s w i t h o u t s h o b i t b e t t e r t h a n h e u s e d t o b e , b u t " i t i s • H i s p a r e n t s r e a l i z e d t h a t t h e a p p e l l a n t h a d b e e n s e e i n g t h e p s y c h o l o g i s t o n a h i s m e a l s i n h i s b e d r o o m . • T h e a p p e l l a n t h a s a h a r d t i m e g e t t i n g w a i t i n g r o o m a t t h e d o c t o r ' s o f f i c e o r f o • A g o r a p h o b i a i s a f e a r o f g o i n g o u t s i d e f u n c t i o n . H e m i g h t b e a b l e t o r e h e a t a t h e g r o c e r y s t o r e t o g e t m o r e f o o d a n d • T h e j o b t h a t t h e a p p e l l a n t a p p l i e d f o r i n g r o u p o f f r i e n d s w h o h a s a b u s i n e s s . e x a m s . H e t o o k a n o n l i n e t r a i n i n g c o u i n t e r v i e w b u t h e w a s n o t o f f e r e d a j o b d e p r e s s a n t m e d i c a t i o n s . • T h e a p p e l l a n t w i l l g o t o t h e h o m e s o f t • T h e e p i s o d e s o f i n c r e a s e d a n x i e t y a n d p o t e n t i a l t o o c c u r e v e r y d a y . I t c a n b e a w a y , s i n c e h e i s v e r y a t t a c h e d t o h i s d • T h e a p p e l l a n t f e e l s h e h a s n o s k i l l s a n p a r e n t s . H i s s i b l i n g s a r e n o t d e p e n d a b g o " , h e h a s n o t h i n g t o f a l l b a c k o n . H e h e m i g h t h a v e s o m e t h i n g . T h e m i n i s t r y d i d n o t o b j e c t t o t h e a d m i s s i b i l i t y o f t h e o r a l t e s t i m o n y , o r t h e p s y c h o l o g i s t ' s M e m o d a t e d J a a d d i t i o n a l d o c u m e n t a r y a n d o r a l e v i d e n c e a s f u r t h e r a n d , t h e r e f o r e , i n s u p p o r t o f t h e i n f o r m a t i o n a n d r e c o p u r s u a n t t o s e c t i o n 2 2 ( 4 ) ( b ) o f t h e E m p l o y m e n t a n d T h e m i n i s t r v 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 .I A P P E A L # e e o f s u p e r v i s i o n r e q u i r e d b y t h e a p p e l l a n t i s i c h i s o f t e n h i s p a r e n t s , m o s t o f t h e t i m e b u t h e d t o h i s c a b i n w h e r e h e s t a y s a l o n e . H e i s O K g a s t h e y a r e p e o p l e h e i s c o m f o r t a b l e w i t h . d t h a t : i c h i s v e r y i s o l a t e d e x c e p t f o r s o m e n e i g h b o u r s , w i t h w h o m t h e a p p e l l a n t i s v e r y c o m f o r t a b l e . p t o t h e p r o p e r t y t o g e t h e r a n d t h e r e h a v e b e e n s t o s t a y t h e r e a l o n e . E v e n g e t t i n g i n t h e v e h i c l e b u t , o n c e h e i s t h e r e h e r e l a x e s . W h e n t h e n o r m a l b e h a v i o r " b u t t h e r e i s n o o n e e l s e a r o u n d . e d h i m s e l f b u t h e m a y n o t d o t h e l a u n d r y o r k e e p a c t i v i t y a s " s m a l l s t e p s " a n d d o n o t p u s h . e s b e a " b i g d e a l . " H i s m o t h e r c o o k s m e a l s a n d y n e e d s t o r e h e a t t h e m . I f s h e d i d n o t l e a v e l d n o t e a t . w e r i n g o r b r u s h i n g h i s t e e t h . H e f e e l s t h a t h e i s a s t i l l h a r d . " m i g h t h a v e m a d e m u c h m o r e i m p r o v e m e n t i f h e r e g u l a r b a s i s . A t l e a s t h e n o l o n g e r e a t s a l l o f o u t i n t h e c o m m u n i t y a n d e v e n s i t t i n g i n t h e r o t h e r a p p o i n t m e n t s i s " a b i g t h i n g . " , w h i c h m a k e s i t v e r y d i f f i c u l t f o r t h e a p p e l l a n t t o m e a l a n d f e e d h i m s e l f b u t h e c a n n o t g e t o u t t o , t h e r e f o r e , c a n n o t t a k e c a r e o f h i m s e l f . J u n e 2 0 1 2 w a s w i t h o n e o f t h e m e n i n t h e s m a l l T h e a p p e l l a n t i s v e r y i n t e l l i g e n t a n d e x c e l s i n h i s r s e f o r t h e j o b a n d d i d w e l l . T h e a p p e l l a n t h a d a n a f t e r i t w a s d i s c o v e r e d t h a t h e i s t a k i n g a n t i  h e m e n f r o m a s m a l l s o c i a l g r o u p . d e p r e s s i o n a r e u n p r e d i c t a b l e . I t h a s t h e t r i g g e r e d b y s o m e t h i n g l i k e h i s d o g r u n n i n g o g . d n o a b i l i t y a n d h e i s h i g h l y d e p e n d e n t o n h i s l e a n d h e h a s c o n s i d e r e d t h a t i f h i s p a r e n t s " b o t h h a s t r i e d s o h a r d t o g e t a s s i s t a n c e b e c a u s e t h e n p s y c h i a t r i s t ' s N o t e d a t e d J a n u a r y 1 6 , 2 0 1 4 o r h i s n u a r y 2 9 , 2 0 1 4 . T h e p a n e l a d m i t t e d t h e d e t a i l o f t h e a p p e l l a n t ' s d i a g n o s e d c o n d i t i o n s r d s b e f o r e 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 , A s s i s t a n c e A c t .
I A P P E A L # 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 , 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 r t 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 r f 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 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 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 ;
I APPEAL# (iii) shop for personal needs; (iv) use public or personal transportation facilities; (v) perform housework to maintain the person's place of residence in acceptable sanitary condition; (vi) move about indoors and outdoors; (vii) perform personal hygiene and self care; (viii) manage personal medication, and {b) in relation to a person who has a severe mental impairment, includes the following activities: (i) make decisions about personal activities, care or finances; (ii) relate to, communicate or interact with others effectively. Severe Physical Impairment The appellant did not maintain a position that he has a severe physical impairment. The ministry's position is that the medical practitioner does not provide a diagnosis of a physical condition contributing to the appellant's impairment. The ministry argued that, in terms of physical functioning, the psychiatrist indicated that the appellant can walk 4 or more blocks unaided on a flat surface, climb 5 or more steps unaided, with no limitations with lifting or remaining seated. The ministry argued that, in the AR, the psychiatrist indicated that the appellant is independently able to manage all areas of mobility and physical ability. Panel Decision The medical practitioner, the appellant's psychiatrist of approximately 2 years, did not diagnose a physical health condition. In terms of functional skills, the appellant is assessed by the psychiatrist as able to walk 4 or more blocks and climb 5 or more steps unaided and as having no limitations with lifting and remaining seated. The appellant is assessed as independent with all mobility and physical ability, including walking indoors and outdoors, climbing stairs, standing, lifting, and carrying and holding. The section of the AR relating to assistance provided through the use of assistive devices is not applicable to the appellant. Given the absence of a diagnosis and there being no restrictions reported to the appellant's physical functioning, the panel finds that the ministry reasonably determined that the evidence does not establish that the appellant has a severe physical impairment under section 2(2) of the EAPWDA. Severe Mental Impairment The appellant's position is that a severe mental impairment is established by the evidence of the impacts from his depression and anxiety, including social and agoraphobia and panic attacks. The advocate argued that these conditions are affecting the appellant's day-to-day functioning significantly. The ministry's position is that there is insufficient evidence to establish that the appellant has a severe mental impairment. The psychiatrist reported that the appellant has improved with treatment and is now able to leave the house, although he remains unemployed, and the ministry argued that employability is not a criterion for assessing eligibility for the PWD designation. The ministry argued that the psychiatrist reported significant deficits to cognitive and emotional functioning in the areas of _E'l_xecutive, emotional disturbance, motivation and im ulse control and, when assessin related
I APPEAL# impacts indicated one major impact relating to a period of 3 to 4 years which occurred in the past. The ministry argued that the psychiatrist identified moderate impacts in the areas of emotion and memory, and minimal impacts in the areas of bodily functions (with the comment "sleeps well with medications"), impulse control and executive, with no impacts to the remaining areas. The ministry argued that the psychiatrist noted that the appellant experiences anxiety when interacting with others and that he has little experience and is unlikely to deal appropriately with unexpected demands but otherwise does not require support/supervision with making appropriate social decisions, developing and maintaining relationships, and securing assistance from others. The ministry argued that the information provided by the medical practitioner in the PWD application does not establish that the appellant has a mental disorder that causes a severe impairment to his emotional and cognitive functioning. Panel Decision The legislation clearly provides that the determination of severity of impairment is at the discretion of the minister, taking into account all of the evidence including that of the appellant. However, the legislation is also clear that the fundamental basis for the analysis is the evidence from a prescribed professional respecting the nature of the impairment and its impact on daily functioning. The psychiatrist diagnosed mood disorders and anxiety disorders, with onset in October 2007, and noted significant features of social and agoraphobia. The psychiatrist reported in the PR that the appellant has " ... long standing history of depression with complicating features of social and agoraphobia such that prior to initial assessment in 2011, had rarely left home for 4 years. Has also been unemployed for same time." With respect to the degree and course of impairment, the psychiatrist again commented that the appellant has improved considerably and can now leave the house, although he remains unemployed. In the AR, the impairments that impact the appellant's ability to manage DLA are: "Difficulties with depression and anxiety impairing ability to be with people or seek 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 psychiatrist reported in the PR that there are significant deficits with cognitive and emotional functioning in the areas of executive, emotional disturbance, motivation, and impulse control (note: "rarely though") and added: " ...m ain deficits relate to decreased motivation, decreased initiative and mood maintenance." In the AR, the psychiatrist indicated a major impact to the appellant's cognitive and emotional functioning in the area of "other emotional or mental problems" described as "prior to use of meds and psychotherapy and regular treatment, was basically housebound for 3 to 4 years." Moderate impacts were reported in the areas of emotion and motivation, as well as minimal impacts to bodily functions, impulse control, and executive, and no impacts in the remaining 8 areas of functioning. The psychiatrist noted that the appellant "sleeps well with medication. Anxiety and depression better with meds but there are still problems."
APPEAL# I At the hearing, the psychiatrist stated that he had answered the questions in the PR and AR to the best of his ability. He stated that the appellant experiences periods of lowered mood and increased anxiety at least once per month and sometimes once per week and, at these times, the impacts to his cognitive and emotional functioning are greater. During the periods of exacerbated mood and/ or anxiety, the appellant is assessed with major impacts in emotion, impulse control, insight and judgment, and motivation, and a moderate impact in executive functioning. The psychiatrist also stated that the appellant applied for a job in June 2012, so his attention/ concentration was good at that time but would be "poor" when depressed, and he confirmed that there have been no problems with the appellant's memory, motor activity, language, and no psychotic symptoms. In terms of the frequency of the exacerbations to the appellant's mood and anxiety, the appellant's mother stated that they are unpredictable and could potentially occur every day. Regarding impulse control, the psychiatrist stated that there have been two outbursts in the past year and, in the AR, noted that these occur "rarely." In the additional comments to the PR, the psychiatrist reported that " ... in spite of treatment there are remaining difficulties with social phobia, dealing with crowds, wavering initiative, periods of anxiety/ mood; however, has generally been stable and improved." The psychiatrist reported in the PR that the appellant has difficulties with communication, with the cause indicated as "other" and a note: "sometimes when depression worsens, there is difficulty communicating." In terms of social functioning, the psychiatrist assessed the appellant in the AR as being independent in 3 of 5 aspects, namely making appropriate social decisions, developing and maintaining relationships, and securing assistance from others. In his Note dated January 16, 2014, the psychiatrist commented that, with respect to making social decisions and maintaining relationships, the appellant " . . .r emains very socially isolated secondary to his psychiatric condition." In the Memo dated January 29, 2014, the psychologist who has also been treating the appellant wrote that he agrees with the psychiatrist's opinion that the appellant's disorder profoundly affects his ability to make social decisions and maintain relationships, resulting in chronic social isolation. The psychologist also wrote that the appellant is profoundly handicapped by his disorder and has been unable to make any real progress despite abundant support from his parents. As the psychiatrist assessed the appellant as independent in these areas of social functioning and is of the opinion that the appellant is generally stable and improved, the panel has placed less weight on the evidence from the psychologist as possibly not being fully aware of the psychiatrist's opinion in these areas. While there was no assessment provided in the AR for interacting appropriately with others and for dealing appropriately with unexpected demands, the psychiatrist stated on the hearing that the appellant requires periodic support or supervision in these areas. The psychiatrist assessed the appellant with good functioning in his immediate social network and marginal functioning in his extended social network, with a note that the appellant is "presently very dependent on parents." The psychiatrist stated at the hearing that, with treatment, the appellant has gr eatly improved from the time of his initial assessment, the appellant considers that he has improved by 95% over the period of a year, and the appellant is able to go out of the house and interact in small groups, albeit with long-time friends of the family. The panel finds that the evidence demonstrates that the appellant's condition is generally stable and improved with "periods of anxiety/ mood" at least once per month at which times the impacts to cognitive and emotional functioning are exacerbated. The panel finds that the ministry reasonably concluded that, overall, the impacts assessed to social and cognitive/emotional functioning remain in a moderate range and there is not sufficient evidence to establish a severe mental impairment, pursuant to section 2(2) of the EAPWDA.
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 m e n t a l i m p a i r m e 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 p o i n t t h a t h p e r s o n , n a m e l y h i s p a r e n t s . 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 i s a b l e t o o r w i t h l i t t l e h e l p f r o m o t h e r s a n d t h e i n f o r m a t i o n f r o t h a t h i s i m p a i r m e n t s i g n i f i c a n t l y r e s t r i c t s D L A e i t h e r T h e m i n i s t r y a r g u e d t h a t t h e p s y c h i a t r i s t i n d i c a t e d t h a n d h o u s e k e e p i n g , h i s p a r e n t s d o t h e g r o c e r y s h o p p a y i n g r e n t o r b i l l s ; h o w e v e r , t h e r e i s n o e x p l a n a t i o n t o a f u n c t i o n a l i m p a i r m e n t a r i s i n g f r o m t h e a p p e l l a 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 a r e 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 i n 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 d i r e c t l y i n d i c a t e 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 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 . 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 , t h e p s y c h i a t r i s t r e p t a s k s o f s e v e r a l D L A , i n c l u d i n g p e r s o n a l c a r e , s h o p p p s y c h i a t r i s t i n d i c a 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 a n d o u t d o o r s , i n t h e n o t e d a t e d J a n u a r y 1 6 , 2 0 1 4 , h m o b i l i t y s e c o n d a r y t o a g o r a p h o b i a . T h e a p p e l l a n t s b r u s h i n g h i s t e e t h ; h o w e v e r , t h e r e w e r e n o r e s t r i c t i o 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 h e a p p e l l a n t ' s m o t s t o r e t o g e t m o r e f o o d ; h o w e v e r , t h e r e w e r e n o r e s t r p s y c h i a t r i s t e x c e p t a n o t e u n d e r t h e D L A m e a l s t h a t I n t h e A R , t h e r e i s n o a s s e s s m e n t p r o v i d e d f o r t h e D s t a t e d o n t h e h e a r i n g t h a t h e a s k e d t h e a p p e l l a n t w h 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 i n 3 o f 4 t a s k s w i t h n o a a p p e l l a n t s t a t e d t h a t h e o n l y r e h e a t s m e a l s p r e p a r e a s s e s s e d 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 w i t h t h e t a s k o f f o o d . F o r p a y i n g r e n t a b i l l s , t h e a p p e l l a n t i s i n d e b u d g e t i n g a n d p a y i n g r e n t a n d b i l l s i s " n o t a p p l i c a b l e i n d e p e n d e n t w i t h g e t t i n g i n a n d o u t o f a v e h i c l e , w i t h t r a n s i t s c h e d u l e s a n d a r r a n g i n g t r a n s p o r t a t i o n w i t h t p s y c h i a t r i s t s t a t e d a t t h e h e a r i n g t h a t t h e a p p e l l a n t c a n x i e t y a n d a g o r a p h o b i a . I n h i s n o t e d a t e d J a n u a r y l e v e l o f a s s i s t a n c e r e q u i r e d w i t h l a u n d r y , h o u s e k e e p a p a t h y a n d a g o r a p h o b i a , i . e . a f u n c t i o n a l i m p a i r m e n I A P P E A L # n t d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s h i s a b i l i t y t o 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 o f a n o t h e r 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 i n d e p e n d e n t l y 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 d o e s n o t e s t a b l i s h 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 t t h e a p p e l l a n t ' s s i s t e r i n l a w d o e s h i s l a u n d r y p i n g , a n d t h e a p p e l l a n t d o e s n o t d o b u d g e t i n g o r a b o u t w h e t h e r t h i s l e v e l o f a s s i s t a n c e i s r e l a t e d t ' s d i a g n o s e d m e d i c a l c o n d i t i o n s . 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 s y c h i a t r i s t 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 l s o 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 , p l e t i n g a n y o f 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 e s t r i c t e d b y t h e a p p e l l a n t ' s i m p a i r m e n t s , 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 i n a l l i n g , a n d m a n a g i n g m e d i c a t i o n s . A l t h o u g h t h e i n d e p e n d e n t a s w e l l w i t h m o v i n g a b o u t i n d o o r s e c l a r i f i e d t h a t t h e r e i s a r e s t r i c t i o n i n o u t d o o r t a t e d t h a t h e c a n g o d a y s w i t h o u t s h o w e r i n g o r n s t o p e r s o n a l c a r e r e p o r t e d b y t h e p s y c h i a t r i s t h e r s t a t e d t h a t t h e a p p e l l a n t c o u l d n o t g o t o t h e i c t i o n s t o t h e t a s k s o f s h o p p i n g r e p o r t e d b y t h e h i s p a r e n t s d o t h e s h o p p i n g . L A o f b a s i c h o u s e k e e p i n g a n d t h e p s y c h i a t r i s t o s t a t e d t h a t h i s s i s t e r i n l a w d o e s i t . F o r m e a l s , s s e s s m e n t p r o v i d e d f o r m e a l p l a n n i n g . T h e d f o r h i m b y h i s m o t h e r , w h i l e t h e p s y c h i a t r i s t s o f f o o d p r e p a r a t i o n , c o o k i n g a n d s a f e s t o r a g e p e n d e n t w i t h b a n k i n g b u t h e " d o e s n ' t d o " . " F o r m a n a g i n g t r a n s p o r t a t i o n , t h e a p p e l l a n t i s n o a s s e s s m e n t f o r u s i n g p u b l i c t r a n s i t a n d u s i n g h e n o t e : " a v o i d s b e c a u s e o f a n x i e t y . " T h e o u l d n o t t a k e p u b l i c t r a n s i t a s a r e s u l t o f h i s 1 6 , 2 0 1 4 , t h e p s y c h i a t r i s t c o n f i r m e d t h a t t h e i n g , g r o c e r y s h o p p i n g a n d f i n a n c e s i s r e l a t e d t o t f r o m a d i a g n o s e d m e d i c a l c o n d i t i o 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 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 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 . t h e a p p e l l a n t h a s a c o m p a n i o n w i t h h i m m o s t o f t h e s m a l l g r o u p s . 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 p s y " s o m e t i m e s w h e n d e p r e s s i o n w o r s e n s . " T h e p a n e l " p e r i o d s o f a n x i e t y / m o o d " o c c u r a t l e a s t o n c e p e r m g e n e r a l l y s t a b l e a n d i m p r o v e d a n d h e i s a s s e s s e d a a r e a s , i n c l u d i n g 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 T h e e v i d e n c e o f t h e p s y c h i a t r i s t a l s o d e m o n s t r a t e s " m e n t a l " t a s k s o f m a n a g i n g h i s b a n k i n g a n d f i l l i n g / r e d i r e c t e d , w i t h 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 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 . T h e p t h a t t h e r e i s n o t 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 i m p a i r m e n t 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 x t e n d e d 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 H e l p t o p e rf 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 e r e q u i r e s t h e s i g n i 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 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 e v i d e n c e o f t h e p s y c h i a t r i s t , a s a p r e s c r i b e d p r o p r o v i d e d b y f a m i l y , s p e c i f i c a l l y t h e a p p e l l a n t ' s p a r e n m e a l s c o o k e d , i s d r i v e n t o a p p o i n t m e n t s , h a s l a u n d r a s s i s t a n c e p r o v i d e d t h r o u g h t h e u s e o f a s s i s t i v e d e v 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 d e t e r m i t h e a p p e l l a n t ' s a b i l i t y t o p e r f o r m D L A h a v e n o t b e e n 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 I A P P E A L # , 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 n 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 A t t h e h e a r i n g , t h e p s y c h i a t r i s t c l a r i f i e d t h a t w h i l e t i m e , h e a l s o i n t e r a c t s b y h i m s e l f a t t i m e s i n c h i a t r i s t a s h a v i n g 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 o n f i n d s t h a t t h e e v i d e n c e d e m o n s t r a t e s t h a t t h e o n t h , b u t o t h e r w i s e t h e a p p e l l a n t ' s c o n d i t i o n i s s h a v i n g a g o o d a b i l i t y t o c o m m u n i c a t e i n a l l i n g . 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 f i l l i n g 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 i o n s a s w e l l a s 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 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 o n c l u d e d d p r o f e s s i o n a l t o 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 e h i s D L A e i t h e r c o n t i n u o u s l y o r p e r i o d i c a l l y f o r i v e c r i t e r i o 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 . f 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 t o p e r f o r m 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 . 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 . f e 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 t s . T h e p s y c h i a t r i s t w r o t e t h a t t h e a p p e l l a n t : " h a s y d o n e . " T h e s e c t i o n o f t h e r e p o r t i n d i c a t i n g i c e s i s m a r k e d " n o t a p p l i c a b l e " t o t h e a p p e l l a n t . n e d t h a t a s d i r e c t a n d s i g n i f i c a n t r e s t r i c t i o n s i n e s t a b l i s h e d , i t c a n n o t b e d e t e r m i n e d t h a t t h e 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.