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 r e c o n s i d e r a t i o 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 ) d a t e d 0 8 J a n u a r y 2 w i t h d i s a b i l i t i e s ( P W D ) . T h e m i n i s t r y d e t e r m i n e d t h a c r i t e r i a f o r P W D d e s i g n a t i o n s e t o u t i n t h e E m p l o y m A c t , s e c t i o n 2 . S p e c i f i c a l l y , t h e m i n i s t r y d e t e r m i n e d t h e a p p e l l a n t 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 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 h e r a b i l i t y t o 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 ( 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 , s h e r e q u i r e s h T h e m i n i s t r y d e t e r m i n e d t h a t t h e a p p e l l a n t s a t i s f i e d a g e a n d h e r 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 m e d i c a l y e a r s . 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 f o r P e r s o n s w i t h D i s a b E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )e c i s i o n o f t h e M i n i s t r y o f S o c i a l D e v e l o p m e n t a n d 0 1 4 d e n y i n g t h e a p p e l l a n t d e s i g n a t i o n a s a p e r s o n t t h e a p p e l l a n t d i d n o t m e e t a l l o f t h e r e q u i r e d e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b i l i t i e s t h a t t h e i n f o r m a t i o n p r o v i d e d d i d n o t e s t a b l i s h t h a t i r m e n t t h a t i n t h e o p i n i o n o f a p r e s c r i b e d p e rf o r m d a i l y l i v i n g a c t i v i t i e s ( D L A ) e i t h e r n d , 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 . t h e o t h e r 2 c r i t e r i a : s h e h a s r e a c h e d 1 8 y e a r s o f 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 i l i t i e s A c t ( E A P W D A ) s e c t i o n 2 i l i t i e s R e g u l a t i o n ( E A P W D R ) s e c t i o n 2
P A R T E S u m m a r o f F a c t s T h e m i n i s t r y d i d n o t a p p e a r a t t h e h e a r i n g . A ft e r c o h e a r i n g , t h e h e a r i n g p r o c e e d e d i n a c c o r d a n c e w i t h R e g u l a t i o 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 r e c o n s i d e r a t i o n 1 . T h e a p p e l l a n t ' s P W D D e s i g n a t i o n A p p l i c a t i o c o n t a i n e d : • A P h y s i c i a n R e p o r t ( P R ) d a t e d 1 7 A u g u s t 2 p r a c t i t i o n e r ( G P ) w h o h a s k n o w n t h e a p p e l l p a s t y e a r . • A n A s s e s s o r R e p o r t ( A R ) o f t h e s a m e d a t e 2 . T h e a p p e l l a n t ' 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 a t t a c h e d : • A S e l f A s s e s s m e n t ( S A ) f o r m c o m p l e t e d b y h a s i n d i c a t e d , w i t h h i s s i g n a t u r e d a t e d 1 7 D e a s s e s s m e n t o f h i s p a t i e n t ' s o v e r a l l c o n d i t i o n " c a n o n l y c o m m e n t o n m e n t a l a n d e m o t i o n a l • A S e l f R e p o r t ( S R ) p r e p a r e d b y t h e a p p e l l a n • A P s y c h i a t r i c C o n s u l t R e p o r t p r e p a r e d b y t h • A w r i t t e n s u b m i s s i o n p r e p a r e d b y t h e a p p e l l I n t h e P R , t h e G P d i a g n o s e s t h e a p p e l l a n t ' s i m p a i r m • s e v e r e p o s t t r a u m a t i c s t r e s s d i s o r d e r • s e v e r e e n d o g e n o u s d e p r e s s i o n • b r o n c h i a l e n v i r o n m e n t a l s p a s m • a r t h r i t i s h a n d s & f e e t • b r a i n i n j u r y a s s a u l t 1 9 9 6 • t h o r a c i c s c o l i o s i s . T h e p a n e l w i l l f i r s t s u m m a r i z e t h e e v i d e n c e f r o m t h e i m p a i r m e n t s a s i t r e l a t e s t o t h e P W D c r i t e r i a a t i s s u e S e v e r i t vl h e a l t h h i s t o ry T h e G P w r i t e s : " C o u g h s w i t h a n y c o n t a c t w i t h c i g a r e b a c k g r o u n d o f P T S D c o m b i n e d w i t h b r a i n i n j u r y f r o m a n d c o n c e n t r a t i o n a n d m o o d p r o b l e m s . H e r a r t h r i t i s T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t h a s n o t b e e n p r i n t e r f e r e w i t h h e r a b i l i t y t o p e r f o r m D L A . H e r e p o r t s t f o r h e r i m p a i r m e n t . P h y s i c a l i m p a i r m e n t E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )n f i r m i n g t h a t t h e m i n i s t r y w a s n o t i f i e d o f t h e s e c t i o n 8 6 ( b ) 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 c o n s i s t e d o f t h e f o l l o w i n g : n d a t e d 2 0 A u g u s t 2 0 1 3 . T h e A p p l i c a t i o n 0 1 3 , c o m p l e t e d b y t h e a p p e l l a n t ' s g e n e r a l a n t f o r 4 y e a r s a n d h a s s e e n h e r 2 -1 0 t i m e s i n t h e , c o m p l e t e d b y t h e a p p e l l a n t ' s G P . , d a t e d 2 0 D e c e m b e r 2 0 1 3 , t o w h i c h w a s t h e a p p e l l a n t , t o w h i c h 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 c e m b e r 2 0 1 3 , t h a t t h e a s s e s s m e n t i s a n a c c u r a t e a n d h e r c u r r e n t c i r c u m s t a n c e s , n o t i n g t h a t h e i m p a i r m e n t s , t h o u g h . " t . e a p p e l l a n t ' s p s y c h i a t r i s t d a t e d 2 8 A u g u s t 2 0 1 3 . a n t ' s a d v o c a t e . e n t s a s : P R a n d A R r e l a t i n g t o t h e a p p e l l a n t ' s . t t e s m o k e , s u f f e r s w i t h s e v e r e d e p r e s s i o n a n d a s s a u l t h a s a d d e d u p t o c o n f u s i o n , b r a i n f o g h a n d s f e e t c a u s e p r o b l e m s w a l k i n g o u t s i d e . " 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 t r e a t m e n t s t h a t h a t s h e d o e s n o t r e q u i r e a n y p r o s t h e s e s o r a i d s
PR: The GP reports that the appellant can walk 1 to 2 blocks unaided, climb 2 to 5 steps, lift 5 to 15 lbs. and remain seated for 1 to 2 hours. He reports no difficulties with communication. AR: Regarding mobility and physical ability, the GP assesses the appellant independent for walking indoors and requiring periodic assistance from another person for walking outdoors, climbing stairs, standing, lifting, and carrying and holding, commenting "back pain" for the functions where periodic assistance is required. Mental impairment PR: The GP reports that the appellant has no difficulties with communications. The GP reports that the appellant has significant deficits with cognitive and emotional function in the f o llowing areas: executive, memory, emotional disturbance, motivation, and attention or sustained concentration. AR: The GP assesses the appellant's communications abilities as satisfactory for speaking, reading, writing, and hearing. With respect to restrictions to cognitive and emotional functioning, the GP assesses a major impact for emotion (inappropriate anxiety, depression), and moderate impacts in the areas of bodily functions (sleep disturbance), consciousness, impulse control, insight and judgment, attention/concentration, executive, memory, and motivation. No impacts are reported for motor activity, language, psychotic symptoms, other neuropsychological problems, or other emotional or mental problems. Ability to perform DLA PR: The GP assesses the appellant's ability to perform DLA as restricted on a continuous basis for meal preparation, basic housework, daily shopping, mobility inside the home, mobility outside the home, management of finances, and social functioning. The GP reports that the appellant is not restricted in the areas of personal self care, management of medications, and use of transportation. With respect to social functioning, the GP comments: "isolated and energy loss, suspicious of contact." The GP comments regarding the degree of restrictions: "severe." AR: The GP provides the f o llowing assessments: • Personal care -independent in all aspects, takes significantly longer than typical for transfers in/out of bed and on/off of chair. • Basic housekee in -continuous assistance from another erson or unable and takes EAAT 003( 10106101)
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 f o r l a u n d r y a e S h o p p i n g i n d e p e n d e n t f o r r e a d i n g p r i c e s a p e r s o n o r u n a b l e a n d t a k e s s i g n i f i c a n t l y l o n g c a r r y i n g p u r c h a s e s h o m e ; p e r i o d i c a s s i s t a n c a p p r o p r i a t e c h o i c e s a n d p a y i n g f o r p u r c h a s e b a c k . " • M e a l s i n d e p e n d e n t f o r m e a l p l a n n i n g ; p e r i 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 f o r f o o d p r e p • P a y r e n t a n d b i l l s p e r i o d i c a s s i s t a n c e f r o m t y p i c a l f o r b a n k i n g , b u d g e t i n g a n d p a y i n g r e n • M e d i c a t i o n s i n d e p e n d e n t a n d t a k e s s i g n i f i c p r e s c r i p t i o n s ; i n d e p e n d e n t f o r t a k i n g a s d i r e c • T r a n s p o r t a t i o n p e r i o d i c a s s i s t a n c e f r o m a n t y p i c a l f o r g e t t i n g i n a n d o u t o f v e h i c l e ; c o n t i n a n d t a k e s 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 f o r 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 . R e g a r d i n g s o c i a l f u n c t i o n i n g , t h e G P r e p o r t s t h a t t h fo r a l l l i s t e d a r e a s : m a k i n g a p p r o p r i a t e s o c i a l d e c i s i i n t e r a c t i n g a p p r o p r i a t e l y w i t h o t h e r s , d e a l i n g a p p r o p a s s i s t a n c e f r o m o t h e r s . T h e G P d e s c r i b e s h o w t h e a p p e l l a n t ' s m e n t a l i m p a i i m m e d i a t e a n d e x t e n d e d s o c i a l n e t w o r k s a s m a r g i n H e l p p r o v i d e d /r e q u i r e d P R : T h e G P c o m m e n t s t h a t t h e a p p e l l a n t n e e d s " c o u n s e A R : R e g a r d i n g s o c i a l f u n c t i o n i n g , t h e G P c o m m e n t s : " i s t o m o t i v a t e . " T h e G P n o t e s t h a t a s s i s t a n c e i s p r o v i d e d b y f a m i l y a c o m m e n t s t h a t t h e a p p e l l a n t n e e d s " m o r e s o c i a l s u p T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t d o e s n o t r o u t i n e h a v e a n a s s i s t a n c e a n i m a l . D o c u m e n t s s u b m i t t e d a t r e c o n s i d e r a t i o n S e l f r e p o rt I n h e r s e l f r e p o r t , t h e a p p e l l a n t w r i t e s t h a t w h e n t h e a p p l i c a t i o n s h e f o u n d i t h a r d t o e x p l a i n t h e s e v e r i t y o a n d m e n t a l i m p a i r m e n t s t o h i m w h e n h e a s k e d q u e s E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )n d b a s i c h o u s e k e e p i n g . n d l a b e l 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 a n o t h e r e r t h a n t y p i c a l f o r g o i n g t o a n d f r o m s t o r e s a n d e f r o m a n o t h e r p e r s o n r e q u i r e d f o r m a k i n g s . T h e G P c o m m e n t s : " c o n f u s i o n , p a i n j o i n t s , o d i c a s s i s t a n c e f r o m a n o t h e r p e r s o n a n d t a k e s 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 o f f o o d . a n o t h e r p e r s o n a n d t a k e s s i g n i f i c a n t l y l o n g e r t h a n t a n d b i l l s . a n t l y l o n g e r t h a n t y p i c a l f o r f i l l i n g / r e f i l l i n g t e d a n d s a f e h a n d l i n g a n d s t o r a g e . o t h e r p e r s o n a n d t a k e s s i g n i f i c a n t l y l o n g e r t h a 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 o r u n a b l e 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 t r a n s i t s c h e d u l e s e a p p e l l a n t r e q u i r e s p e r i o d i c s u p p o r t / s u p e r v i s i o n o n s , d e v e l o p i n g a n d m a i n t a i n i n g r e l a t i o n s h i p s , 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 a n d s e c u r i n g r m e n t i m p a c t s h e r r e l a t i o n s h i p s w i t h h e r a l f u n c t i o n i n g . l i n g h e l p w i t h [ i l l e g i b l e ]" o l a t e d a n d n e e d s c o n t i n u i n g c o u n s e l i n g a n d h e l p n d b y o n e h e a l t h a u t h o r i t y c o u n s e l l o r . H e p o r t , $ . " l y u s e a n y a s s i s t i v e d e v i c e a n d t h a t s h e d o e s n o t p h y s i c i a n w a s f i l l i n g i n h i s p o r t i o n o f t h e P W D f h e r b o d y ' s p h y s i c a l d e c l i n e a n d t h e c o g n i t i v e t i o n s . S h e w o u l d l o s e t r a c k o f h e r t h o u r:i h t s , h e r
memory recall didn't seem to exist, she forgot information she had written down to bring to him, and she would get emotionally triggered and frustrated trying to cope with the inability to express herself. She is exhausted. She goes on to write: "I could not even do the self report when I sent to the PWD application in at the end of August 2013. This report (including the SA] has taken me two weeks to complete. (I] had to fill in the checklist four times, due to written mistakes and misunderstanding information required on the document. This document [the SR] was typed by someone else. The community support workers and clinical counsellor guided me through the paperwork daily or when I got emotionally triggered by what I need to express on paper. The psychiatrist explains the head injury to me in the office." Describing her disabilities, the appellant writes she has severe PTSD. She has been exposed to a minimum of thirty disasters, traumas or hostilities since she was young. She feels on edge all the time, stays at home more and more, has severe memory loss and f o rgetfulness and cannot concentrate on one thing for more than 30 seconds. She has severe depression and doesn't know a time when she was not depressed. She has a severe reaction to cigarette smoke and finds very few places to go in the environment where this is not present. Her osteoarthritis has caused joint deterioration and inflammation, limited range of motion and flexibility and she cannot lift heavy objects anymore. She has functional impairment in her left foot as her left big toe does not move anymore. Her thoracic scoliosis causes instability; she tires easily and movement in between her shoulder blades and arms is restricted. She has extended times when she feels uncomfortable -3 out of 4 weeks. The medications she takes for mental illness cause her to be unsteady on her feet and have ringing in her ears; they also cause nausea, loss of appetite and unusual tiredness. The balance of the SR addresses how her disability affects her ability to take care of herself. This is also addressed in her Self-Assessment, as summarized below. Self-Assessment The appellant's SA is a 6 page advocate-prepared questionnaire in which the appellant checks boxes against aspects of DLA in which she is restricted and with which she requires assistance, providing hand-written detailed comments. The panel has summarized the salient points as follows: • Meal preparation -chops food for 2-3 minutes and then rests/resumes task/prep time 30-40 minutes; standing at sink or stove, rests one foot on stool f o r stability; understanding recipes and labels, reads through 2x/maybe understands/goes back again because does not recall information; remembering having food on the stove or in the oven, uses timer. • Managing money and paying bills -remembering to pay bills and budgeting, needs to keep track in a book and write everything down; therapist gives her strategies for impulse control and reasoning skills. 0 Eating -being motivated to eat, disinterested; chewing and swallowing, 3-4 minutes extra; therapist gives her tips to motivate her to eat. • Shopping -stops and sits every 5 minutes for 5 to 10 minutes; understanding labels and prices, needs to read a couple of times; moving groceries from shelves to cart, can only lift 1-2 lbs at the time; being able to be in a crowded store without feeling anxious or scared, very rare, uses self talk or doesn't go; therapy is the tool she uses for these issues of anxiety and fear. • Usina transportation -doesn't take the bus due to hypersensitivitv to ciaarette smoke; ridinq in EAAT 003( 10/06/01)
a car, front seat only, stops every 20-30 minutes to stretch, uses support cushion; getting in/out of vehicles, periodic support if stiff or inflamed, someone helps; takes elevators instead of stairs when available; therapy is needed because transportation is a huge trigger for her psychologically. • Housework -washing counters, cleaning bathrooms, washing dishes, vacuuming etc., restricted continuously because of depression and arthritis stiffness and inflammation; manages one task a day, works for 5-10 minutes/rests/resumes task/resumes task/rest again to complete; washing walls and windows, doesn't do it; therapy and a day planner are the tools she uses if she can. • Mobility inside the home -getting in/out of bed, restricted periodically 2-3x/week, depends on flexibility; walking from room to room, continuous restrictions, depends on inflammation in feet; sitting in chairs, only 20-30 minutes, uses a support cushion; climbing and descending stairs, slowly and deliberately 1-2 steps up and 3-4 steps down then rest, 5-10 minutes extra to get anywhere; uses hot packs and cold packs daily. • Mobility outside the home -climbing and descending stairs or ramps, same as inside the home; walking more than 1-2 blocks needs to rest; going out without being anxious, daily, severe, 1-2 hours extra to get out the door; needs therapy for anxiety and fear. • Personal hygiene and self care -remembering or having energy/motivation to bathe every day and to brush teeth and hair everyday, continuous daily restrictions, 20 minutes to think about it and prepare and focus to get these done; therapy needed for motivation. • Managing personal medication -taking the right amount of medication, compliance and motivation are issues; coping with side effects of medication, with difficulty; psychiatric support is needed. • Mental and emotional skills -coping with anxiety and agitation, self talk daily 5-6x for 5-10 minutes; coping with depression, stays in bed or isolates but mostly pushes herself; coping with stress, stays in bed, watches DVDs, checks in with therapist; planning ahead, doesn't do it; attending to the most important things first, does one task a day if she can manage it; never ending always coping and struggling daily; completing tasks, takes 2 hours to motivate herself to complete 1 task/day; never-ending, always coping and struggling daily; therapy and medication are the tools she uses. • Social skills -socializing without being anxious or scared, never; no interaction with friends and family, strangers; developing and maintaining relationships, doesn't do it; takes her days to ask for help; dealing with unexpected situations, anxiety goes through the roof and takes her 3x longer to process the inf o rmation and 2x longer to do something about the situation; therapy is the tool she uses. • Communication -making herself understood, gives several explanations and needs to search for the right words, gives up then gets mad; understanding others, has to ask people to talk slower; speaking or listening to people without becoming anxious and scared, never; medications and therapy are the tools she uses to help her. • Assistance/supervision required -17.5 to 20 hours per week. • Assistance received -from a counsellor, psychiatrist, community support workers and a charitable organization. Psychiatric Consult Report The psychiatrist summarizes the appellant's personal (including an assault with being knocked out, and the death of her son and em lo men! (communit service executive and health car_ e) hisJo_ry_ �, � EAA T003(1 0/06/01)
He then reviews the pre s e n ti n g co m plaints, which include: times , very angry and irritab le at oth er times; feels like her concentration a n d drive and p oor short t er m memor and mixes up her words; so let hargic oft en in the morn and get dress ed; has nightm a re s which are often very dis re l ating to her son's fatal accident; curren tly sleeps less than bef wh ere she sl e eps up to 18 hours a day; feels like he tim e ; admits to ele v at ed mood a t t imes, whe n she b periods when she descr ib e s as be ing "angry;" has had coming int o her mind passi vely; did s l as h h er wrists, o anything to herse l f since then; describes herse lf as feeli do no t know what ha p piness is." The psychiatrist a lso provid es the f o llo w ing Mental State Examination: "[The appel la n t] pres ent s as ve ry neat and well-kempt. S a nd fri endly . She seems to be a g o od his e dgy, "wor ri e d about th e o u t co m e of this admi ts to o ccasiona l v a g u e experien c es of in t ern al an d she se es this a s her "spiritual gui danc e a n d sh e expe ri e n ce s them as " true h allucinat ions, ho wev er. T he re is no d elusions. As ment ion e d, she has no t re cent though ts. Her sl eep h a s bee n variabl e but her a The psy chia trist diagnose s t he ap pellant wi th Post T D isor der , not other w ise sp ecified, an d a p re viously dia curre nt concern i s around mood inst a b i li t y -woul d like Bor d erl ine Person a li t y D isord er tr aits. T h e psychia trist r e ports t hat he d i s cussed v a riou s medica agree d to go on a trial of a certa in med ication . H e su current therapy p r oc ess and th at a r efe rral to a health a future. Advo cate's written submission The submission reviewed the eviden ce set out in the PR and A reconsideration; the balance of the submis sion went to argument. Documents submitted on ap peal In her Notice of Appe al da ted 2 0 Ja nuary 2 0 1 4, the appellan ministry has erred in inte r p r e tation of the facts & the law." The appellant's advocate provided a written submission dated 24 January 2014. The submission went to argument (see Part F, Reasons for Panel Decision, below). EAAT003(10106/01) bein g very s ocially isolated; low mood at " m ind is not working properly;" d iminished y ; fe els l ike she cannot express herself proper ly ings that it t akes he r 2 hours to get o ut of b ed tressing and she also has "flashbacks" o r e but at times goes through perio ds r moo d is fluctuating a n d has b een fo r a lon g ec o m e s very irri table and verbally aggre s si v e , long-standing thoughts of suici de, o f t en n ce whe n she was 14 but has not done n g "empty in side" and then g oes o n t o say "I he i s cooperative , well spoken, to ria n, in g e n e ral . Her mood, s h e re ports i s a little con sul tat i on ." A f fec t is norma l. [Th e appell ant] hear ing voices b u t sh e describe s this as b ein g g ui de . " Sh e s ays t he voices alw ays g ive her s oft a nd gentle." This do es not seem to am ount to forma l t ho ugh t d i s order, n or a r e the r e any ly experienced any s i g nif ic ant sui c i d a l p petite, g en e ra lly , i s s ta ble." r au mati c S tress Disord er, on h i story, Mood gnose d Major Depressive Disorder. The to rul e out Bipolar Di so r der Ty p e I I and tion op tions with the a pp el la nt a nd she ggests tha t the appe l lant co ntin ue w ith her uth or ity sk ills group be considere d i n the R a nd the documents submitted at t gave as reasons for appeal: "The
The appellant also provided copies of he r Self Repo endorsed by t he a p pellant's GP with his signature and office s January 2014. On 04 Februar y 2014 t he appe l lant submitted a "To whom it ma GP da ted 0 1 Feb r ua r y 2 014. The no te r eads a s f o llows: [ The appellant] is totally disab l e d with s ever the he lp o f p s ych ia trist [n a me]. S he is on strong an This is chronic a n d p rev ents functioning in society a continuous and is not i mprovin g an d needs ye ars." At the hearin g , the appellant's advocate prese n ted a provi ded be f o re the hearing. In h e r r e marks and in answe r to q u est ions, the app • Sh e de scribed h o w, w i t h a me ntal il lnes s, whi appr eciate that a nything t h e pers on say s o r d es pecia lly the case given the sheer volu m e of • She exp la ined t ha t the esti mate o f 17.5 -20 hour d evel ope d with th e help of her cou n s el lor . Th counsellor ( a Regist ere d C l inical C oun s ell o r), per mon th, the help of community sup po rt workers otherwis e c o uld not manage), call s from her a nd the oc casional help o f a fr i end in he r a partme so me fo od for her. S he also st ate d t hat her sister to dr i ve her to h e r a ppointments with her GP o pp ort unity to bring h e r some f roz en pre pared vacuuming. • Th e a ppe lla nt exp lai ned t hat d ur i ng h e r vi sits and provides psychiatric therapy for her PTSD. He also provides guidance to the counse how she can bes t help the appe lla nt. The psychiatrist will also take phone calls from the appellant w hen s he feels it ne cessary to cal l him. • She explained that th e GP's assessments in the AR that stores) showing both "continu ous assistance from anothe significantly longer than ty p ical" refl ec t how sh motivated to do the task as well as how slowly she is able to complete the task because of her mental and p h ysical issues . As an example, she stated that if she was in the mid something outside the home and became confused or was confron si tua t ion she would text h er cou nsellor for support an ki n d o f the rapeutic a s sistan c e w as mentioned f Assessment. The panel finds that the new information provided by the appellant before the hearing and at the hear i ng is i n support of the in formation bef ore the minis appellant's SR and SA were before the ministry at reconsideration; the submission supports the information contained therein bv carrvinq the GP's siqned endorsement. The letter from the GP . ,_-E AA T003(10/06/01) rt and Self-Assess men t, as summariz ed above, tamp o n the 2 doc u men ts , and dated 24 y concern" note from the ap pel lant's e depression and PTSD and anx iety a l l r e quirin g t idepressant and mood stabilizer meds. nd in public at this t ime. This is we ekly c ounseling a nd psychi at r ist -1/mo f o r 2 rgument based o n th e written submissio n el lant pr ovid ed t he f o l lowing t es timony : le a person may look no rmal, i t is impor tant to oes takes a g r eat deal of e f fort. F or he r, t h is is mental an d physical issu es s h e fa ces. s/wee k in assi stance she re qu ir es wa s is amou n t o f t i m e inc lud es the time o f h er one or s ometimes tw o visits w ith h er psyc h ia t ri st (wh o as sist h e r with paperwork t hat s h e p h a rma ci s t t o rem i nd h e r about pr escr ipt i on r efil ls, n t who will drive her to the sto re o r pick up wi ll visit her o n ce or pe rhap s t wice a month i n anoth er ci t y. T he s i s ter wi ll al so ta ke that meal s and do s ome hou se work for her, s uc h as to hi m, h e r psy c hia trist reviews h e r med i ca ti o ns l lor on a DLA t as k ( e . g. going to an d from r pers on or un able" and "takes e requires d ail y help from her cou nsell o r to be dle o f doing t e d with a disturbing d advice. She noted that t h e need for this or 10 of the 13 areas covered in he r S elf t ry at the time of th e recons ideration. The '
s u p p o r t s a n d c l a r i f i e s h i s e a r l i e r a s s e s s m e n t s i n t h e c l a r i f i e s t h e n a t u r e o f t h e h e l p p r o v i d e d h e r i n m a n a a p p e l l a n t ' s t e s t i m o n y p u r s u a n t t o S e c t i o n 2 2 ( 4 ) ( b ) o E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )P R a n d A R . T h e t e s t i m o n y o f t h e a p p e l l a n t g i n g h e r D L A . T h e p a n e l t h e r e f o r e a d m i t s t h e 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 t .
PART F -Reasons for Panel Decision The issue in this appeal is whether the ministry reasonably determined that the appellant is ineligible for PWD designation because she did not meet all the requirements in section 2 of the EAPWDA. Specifically the ministry determined that the information provided did not establish that the appellant has a severe mental or physical impairment that in the opinion of a prescribed professional (i) directly and significantly restricts her ability to perform daily living activities either continuously or periodically for extended periods; and, (ii) as a result of those restrictions she requires help to perform those activities. The ministry determined that she met the 2 other criteria in EAPWDA section 2(2) set out below. The following section of the EAPWDA applies to this appeal: 2 (1) In this section: "assistive device" means a device designed to enable a person to perform a daily living activity that, because of a severe mental or physical impairment, the person is unable to perform; "daily living activity" has the prescribed meaning; "prescribed professional" has the prescribed meaning. (2) The minister may designate a person who has reached 18 years of age as a person with disabilities for the purposes of this Act if the minister is satisfied that the person has a severe mental or physical impairment that (a) in the opinion of a medical practitioner is likely to continue for at least 2 years, and (b) in the opinion of a prescribed professional (i) directly and significantly restricts the person's ability to perform daily living activities either {A) continuously, or (8) periodically for extended periods, and (ii) as a result of those restrictions, the person requires help to perform those activities. (3) For the purposes of subsection (2), {a) a person who has a severe mental impairment includes a person with a mental disorder, and {b) a person requires help in relation to a daily living activity if, in order to perform it, the person requires (i) an assistive device, (ii) the significant help or supervision of another person, or (iii) the services of an assistance animal. The following section of the EAPWDR applies to this appeal: 2 (1)For the purposes of the Act and this regulation, "daily living activities", (a) in relation to a person who has a severe physical impairment or a severe mental impairment, means the following activities: (i) prepare own meals; (ii) manage personal finances; (iii) shop for personal needs; (iv) use public or personal transportation facilities; (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; EAAT 003( 10/06/01)
(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. Evidentiarv Considerations The appellant did not complete a Self Report to accompany her original PWD application. At reconsideration, she submitted her SR and SA (see Part E above); the latter was endorsed by her psychiatrist, not simply by signing it but adding the caveat "Can only comment on mental and emotional impairments, though." On appeal, the appellant submitted the same two documents, this time endorsed by her GP, with an accompanying letter providing his opinion on the severity of the appellant's disability. With the caveat provided by the psychiatrist and the letter provided by the GP, it is the view of the panel that both medical practitioners (who by definition are also prescribed professionals under the legislation) have turned their minds to the document(s) they endorsed and accept the appellant's comments as their own. Accordingly, the panel considers these documents to reflect their opinions on the materials contained in the documents. The panel will consider each party's position regarding the reasonableness of the ministry's decision under the applicable PWD criteria at issue in this appeal. Severity of impairment For PWD designation, the legislation requ_ires that a severe mental or physical impairment be established. The determination of the severity of impairment is at the discretion of the minister, taking into account all the evidence, including that of the applicant. However, the starting point must be medical evidence, with the legislation requiring that a medical practitioner (in this case, the appellant's GP) identify the impairment and confirm that impairment will continue for at least two years. In the discussion below concerning the information provided regarding the severity of the appellant's impairments, the panel has drawn upon the ministry's definition of "impairment." This definition consists of "cause" and "impact" components: "impairment is a loss or abnormality of psychological, anatomical or physiological structure or function [the cause] causing a restriction in the ability to function independently, effectively, appropriately or f o r a reasonable duration [impact]." This definition is not set out in legislation and is not binding on the panel, but in the panel's view it appropriately describes the legislative intent. The cause is usually set out as a disease, condition, syndrome, injury or even a symptom (e.g. pain or shortness of breath). A severe impairment requires the identified cause to have a significant impact on daily functioning. The panel also notes that the legislation requires that for PWD designation, the minister must be "satisfied" that the person has a severe mental or physical impairment. For the minister to be "satisfie d" that the person's impairment is severe, the panel considers it reasonable for the ministry to expect that the information provided presents a clear and complete picture of the nature and extent of the impacts of the person's medical conditions on daily functioning. EAA T003( 10/06/01)
Mental impairment In the reconsideration decision, the ministry refers to the GP's diagnoses of severe post traumatic stress disorder and severe endogenous depression and notes the GP's report of the appellant's "confusion, brain fog, concentration and mood problems," with several deficits to cognitive and emotional functioning. The ministry notes that there are no difficulties with communications and speaking/reading/writing/hearing as satisfactory. The ministry also notes that continuous restriction to social functioning is described as "isolated and energy loss, suspicious of contact." The ministry notes that of the impacts reported on daily functioning, most are moderate with one major impact on emotion and that periodic support/supervision is required with social functioning with the comment "isolated and needs continuing counseling and help to motivate." The ministry refers to the psychiatrist's consultation report and states that it does not establish a severe mental impairment: treatment recommendations are f o r medication, continuation of current counseling, and the possibility of referral to a skills group as well as follow-up with the psychiatrist f o r review in about a month. The ministry's position is that the information as a whole is not supportive of a severe mental condition that significantly restricts the appellant's ability to function either continuously or periodically for extended periods. The ministry also refers to the documents submitted at reconsideration, indicating that they have been reviewed and considered in conjunction with that presented with the original application. The ministry took the position that the new information did not demonstrate either a severe impairment or a significant restriction in the appellant's ability to perform DLA. The position of the appellant, as set out in her advocate's submission on appeal, is that the ministry appears to discount the opinions of the GP and the psychiatrist as to the severity of the appellant's disabi lity. Both have provided opinions, in the application and in the psychiatric consult report, and endorsed the Self-Assessment. Taken together this inf o rmation demonstrates that the appellant has a severe mental impairment that directly and significantly restricts her ability to perform DLA both continuously and periodically and that she requires help to perform activities. Panel findings The evidence is that the appellant's psychiatrist has diagnosed the appellant with post traumatic stress disorder, mood disorder not otherwise specified and a previously diagnosed major depressive disorder. What is at issue here is how significantly these mental health conditions directly and sign ificantly restrict the appellant's daily functioning. To the panel, it appears that the ministry based its determination that a severe mental impairment had not been established on the check marks in the PR and AR relating to ability to communicate, cognitive and emotional deficits, the number of major and moderate impacts of these deficits on daily functioning, the periodic support/supervision required for the listed areas of social functioning, and marginal functioning assessed for relationships with immediate and extended social networks. The panel notes that there is not much further commentary provided by the GP that might support a different decision based on the original application. On further examination of the reconsideration decision, however, the panel notes the following: • The ministry refers to the psychiatric consult report and states that this did not establish a severe mental impairment. Strictly speaking, this may be the case, as the psychiatrist did not directly assess and report on the impacts of her mental health condition on her daily functionin . However, based on the a ellant's histo and resentin com laints and even EAAT 003( 10/06/01)
with the relatively positive Mental State Examination (quoted in its entirety in Part D above), the psychiatrist diagnosed the appellant with PTSD, major depressive disorder and mood disorder not otherwise specified. If he did not consider the impacts of these conditions on her daily functioning to be significant, he would not have recommended the comprehensive treatment regime he did -not only strong anti-depressant and mood stabilizer medication, but also weekly therapy. • The ministry also notes that of the reported impacts on daily functioning, most are moderate with only one major impact -on emotion (inappropriate anxiety, depression). The panel notes that the prescribed professional providing these impact assessments is asked to do so on a relative basis -from no impact, minimal impact, moderate impact to major impact. Considering the psychiatrist's diagnoses of mood disorders, it is not surprising that the GP would give the highest relative impact rating to emotion as this is the one of overwhelming importance and the one f o r which treatment has been prescribed. The panel does not consider it reasonable to minimize the impacts of the 8 other areas -bodily functions, consciousness, impulse control, insight and judgment, attention/concentration, executive, memory, and motivation -just because, in relative terms, they are assessed as "moderate." Moreover, at reconsideration the ministry had available to it the SR and SA, the latter endorsed by the psychiatrist with the caveat noted above. On review of the SA in particular, the panel notes that the ministry did not take into account many significant impacts on daily functioning resulting from her mental health conditions for which the appellant requires ongoing assistance from her therapist. Some examples: eating -she is disinterested in eating and her therapist gives her tips to motivate her; managing money and paying bills -therapist gives her strategies for impulse control; shopping --therapist gives her the tools to use for the issues of anxiety and fear while shopping; using transportation -therapy is needed because transportation is a huge trigger f o r her psychologically; mobility outside the home -going outside without being anxious or scared, takes 1-2 hours to get out the door, needs therapy for anxiety and fear; personal self care -bathing every day and brushing teeth and hair, needs 20 minutes to think about it and prepare to do it, needs therapy f o r motivation; social skills -asking for help, takes her days to ask; dealing with unexpected situations, anxiety goes through the roof; therapy is needed for these issues. The panel notes that the SR and SA are coherent and comprehensive. This is not surprising given the executive and health care background of the appellant. The panel would estimate that a person in good mental health with her background would have been able to put together these documents independently in a couple of hours. In fact, she reports in the SR that it took her 2 weeks to complete them, and only with the assistance of her therapist and community service workers. To the panel, this speaks to the extent to which the appellant requires assistance to complete the simplest of tasks. The panel recognizes that there are some inconsistencies between the psychiatrist's consult report as to how the appellant "presents" and some information in the SA, such as regarding her appetite vs. difficulty eating, and being "well spoken" vs. her account of difficulties expressing herself. This may be explained by the difference between how a person "presents" in a doctor's office and how she is actual ly able to manage her life. Also, the psychiatrist prepared his consult report after a first appointment in August 2013 and endorsed the SA 4 months later, in December 2013, when he would have had the opportunity to get to know her better. There are also some difficulties reconciling the evidence that the appellant is able to go out in public, meeting with her therapist and shopping, while the GP states that her condition "prevents functioninq in society or in public at this time." It may be EAAT 003(10/06/01)
that the GP was referring to employment, not a relevant consideration here, or to a more active social life but this does not negate his statement that her condition is not improving and she needs weekly counseling and continuing monitoring and therapy from the psychologist. Similarly, in the AR the GP has assessed the appellant requiring periodic, not continuous, support/supervision in the 5 areas of social functioning and has not explained the change in assessment implied in his letter submitted on appeal. Despite these inconsistencies, the panel views the evidence as demonstrating the degree to which the appellant's mental health conditions restrict her ability to function independently and effectively, to the extent that she requires ongoing weekly, and often more frequent, support from her therapist. Although the ministry did not have the benefit at reconsideration of being advised of the GP's endorsement of the appellant's SR and SA and his letter submitted on appeal, the panel finds that, considering the evidence in its entirety, the ministry was not reasonable in determining that a severe mental impairment had not been established. Phvsica/ impairment The position of the ministry is that it is not satisfied that the information provided is evidence of a severe physical impairment. In reaching this determination, the ministry reviewed the GP's assessment of functional skills (able to walk 1-2 blocks, etc) and noted that while periodic help is required-to do most aspects of mobility and physical abilities, no frequency or duration is provided to determine the significance of such help from other people. These tasks take longer to perform, but no further information is provided. No assistive devices are required. While pain from arthritic joints causes problems, remedial measures such as analgesics are available to ameliorate the pain and allow for better functionality. The functional skill limitations are not significantly restricted. The position of the appellant, as set out in her advocate's submission on appeal, is that the ministry appears to discount the opinions of the GP and the psychiatrist as to the severity of the appellant's disability. Both have provided opinions in the application and in the psychiatric consult report and endorsed the Self-Assessment. These indicate that the appellant has a severe physical impairment that directly and significantly restricts her ability to perform DLA both continuously and periodically and that she requires help to perform activities. Panel findings The evidence is that the appellant has been diagnosed with the following physical conditions: bronchial environmental spasm, arthritis in her hands and feet and thoracic scoliosis. For the determination of a severe physical impairment, the issue is the extent to which these conditions restrict her daily functioning. As the ministry noted, the GP reports that the appellant can walk 1 to 2 blocks unaided, climb 2 to 5 steps, lift 5 to 15 lbs. and remain seated for 1 to 2 hours. In the AR the GP assesses the appellant independent for walking indoors and requiring periodic assistance from another person for walking outdoors, climbing stairs, standing, lifting, and carrying and holding, commenting "back pain" for the functions where periodic assistance is required. As to restrictions to DLA where physical effort is required, the GP assesses the appellant as both requiring assistance from another person or unable and taking significantly longer than typical for housekeeoinq and laundry and for aoing to and from stores and carrying purchases home. At the EAAT 003( 10/06/01)
hearing, the appellant explained this "double assessment" as how she requires daily help from her counsellor to be motivated to do the task as well as how slowly she is able to complete the task because of her mental and physical issues. In her SA, the appellant explains that f o r most cleaning tasks she is restricted continuously because of depression and arthritis stiffness and inflammation. She reports that she can manage one task a day, working for 5-10 minutes then resting. Similarly for mobility inside and outside the home she walks more than 1-2 blocks without resting, climbs stairs slowly and deliberately, resting after 1-2 steps. While the reconsideration decision did not review the material in the SA, the panel's overall impression is that while the appellant's physical conditions contribute to her restrictions in managing DLA, given her explanation of the "double assessments," she can manage most tasks requiring physical effort, albeit slowly, once she has motivated herself to do so and drawn on the support and advice of her counsellor to face the anxiety and fear that goes with the task, particularly those outside the home. On this basis, the panel therefore finds the ministry was reasonable in determining that a severe physical impairment had not been established. Significant restrictions in the ability to perform DLA. In the reconsideration decision, the ministry notes that a severe impairment has not been established. The ministry refers to the PR, wherein the GP reported continuous restrictions to 7 of 10 DLA and to the AR where the GP assesses continuous assistance from another person required with basic housekeeping, going to/from stores, carrying purchases home, using public transit and using transit schedules. The ministry notes, however, that the appellant in her SA reported walking independently and shopping with the use of a metal carry cart. When she reads labels a couple of times, she is able to assimilate the information. The ministry asserts that pain medication will ease her pain and allow for better functionality. The ministry states that as the appellant is sensitive to cigarette smoke, transit is limited for this reason -not that she is unable to use transit or unable to manage transit schedules. For these reasons, the need for help from another person is not considered to be continuous or periodic for extended periods. The ministry notes that periodic help from another person is reported for several tasks but there is no inf o rmation on the frequency or duration of help from another person, and her SA establishes that she is able to perform these tasks with modifications in activity (rest breaks etc.) A number of tasks take longer to perform. The ministry further notes that periodic support/supervision is reported with all aspects of social functioning and continued counseling with the appellant's clinical counsellor is recommended. The ministry, taking into consideration the appellant's self report and explanation of performance of DLA, and as the inf o rmation from the GP does not establish a significant restriction in her ability to perform the majority of DLA, the global information including that from her prescribed professional does not establish that impairment significantly restricts DLA either continuously or periodically for extended periods. The position of the appellant is that the GP has indicated that the appellant takes significantly longer and requires periodic or continuous assistance with meal preparation, basic housework, daily shoooinQ, mobility inside the home, mobility outside the home, manaQement of finances and social EAAT 003( 10/06/01)
functi oning. The psychiatrist h as re vi ewe d and endorse There is suff ic ie n t e vidence to e stablis h t ha t this crit Panel findings The pa nel not es t ha t , according to the legislation, the direct and significant restriction in the abilit perform DLA must be a res ult of a severe impairm e establ is he d in th is appeal. T h i s DL A c riterion m u st also the legislat ion, which start s with the pr ovision that th with disa bilities "i f th e minister i s sat isfied that" the cr the discretion conferred by the legislation, it is re as o pi nion of a pre scribed prof essi o nal be substantia ted that there are d irect and si g ni f i ca nt re st r i c t ions in t h pe riod ical ly fo r an ex t e nd e d per i od. As dis cussed ab has found tha t t he informati on provided in the SA an be conside red as re fl ecting t he opinion of a prescribed As a se ve re mental, tho ugh no t a severe p hy si cal, t he pan e l will consider how s ignif i cantly the appe ll a h e alth cond itions . Turning first to tho se DLA a pplica ble to a person with d ecis ions a b ou t pe rs onal acti vitie s, care or f inances and others e f fectively, as n o ted under sever it y o f i m pai r re quiring per i o di c s u ppo rt/super visio n in the s e a r eas ass ess men t, in his letter on app eal he ha s given h is appellan t' s condit ion "is chron i c ... an d i s no t impro vi -1 /mo for 2 years," thus impl ying t h a t continu o u s s f u n c tioning D L A. In terms o f relati ng to oth ers, the SA, end makes plain t h a t the a p pell a nt's f ea r , a nxiety an d dep From the summ ary of t h e SA i n Part E above : Social scared, never; no interaction wit h f ri ends a n d family, rel ationsh ips, d o esn' t d o it. R e garding decisi on m a k such ar eas a s managing finances (pay rent and bills), making dealing with unexpected demands and securing assistan "periodic assistance" actually means weekly, sometimes daily, support and guidan app ellant's counselor: Takes h e r da y s to as k f or he goes through the roof and takes her 3x longer to process the information and 2x longer to do something about the situation; therapy is the tool she uses. More generally, the panel considers it reasonable to read paragraphs the EAPWDA together: 2(2) T he minister may desig n ate a person .. . as a person with disabilities ... if the minis the person has a severe mental or physical impairment that b) in the opinion of a prescribed professional (i) directly and significantly restricts the person's ability lo perform daily living activities either A con t inuous! , or �----���=���---------·--EAAT 003(10/06/01) d the appellant's SA of re strictions in DLA. erion has been met. y to nt, with a s evere mental impairment having been be consider ed in t e rms of t he framewo rk o f e minister may d es i gnate a perso n as a perso n i ter i a are met, including this one. In exe rcisi n g o nabl e that the minister woul d exp ect that the by inf o rm a tion that w ould sati sf y t he mi nister e ability to per form DLA , either c on tinuous ly or o ve u nder evidentiary co nsiderations, the pa n e l d endorsed by th e GP and the psychi a trist can pro f es sional. impa i rm ent has bee n established in this a ppeal, nt's D LA ar e re stricte d as a re sult of he r menta l a se ver e m e ntal impairment , namel y make re late t o, co mmuni cate or interact w ith ment above , t he GP ass ess ed the appe lla nt . Althou g h the GP d id n o t e xplain his chang e in cle ar and uneq uivocal o pinion t hat the ng and nee ds weekly counseli n g and psychia trist up port/supervision is req uire d for th ese s o ci al orsed by both th e GP an d the psychiat r is t, ressio n signifi c antly restricts her s ocial li fe. skill s -soci a li zing wit hout be ing anx i ous or strang e rs; de ve l o ping a nd mai n ta in i n g in g, th e GP assessed pe riodic help re quired i n appropriate c h oices whil e s hopping, ce from others. From the SA, it is cl e ar that c e from the l p ; dea li ng with un e xp ected s itu atio n s , anxiety (i) and (ii) of subsection 2(b) of t er is satisfied that -------·---. ---· ----· _ _ ___,
(B) p eriodi c all y for e xt en d e d pe rio d s, and (ii) as a r esult of t hose res tr i ct i on s, the person Taki ng t hi s approa ch, t he pan el consider s i t r e aso nab an i n di c at o r of how s i g nifican tl y the pers on' s ab ili ty In the r econsid erati on d ecisi on, the ministr y h as note conti n uous or per i od i c ass istan ce fro m another per interpret s to su gge st t hat t he a pp ella nt man ages to he lp from a nothe r perso n for su ch DL A as hous ework o f an as sisti ve devi ce. The m in istry us es as an example that the ap has to re ad lab els a co uple of times, with the i mplie entry, alo ng with ot hers ab out r e adin g recipes twi ce t he ap pe llan t is se lf-a w a re o f how her s hor t-te rm memo da ily fu nct io ning . And while the minis try has given weig t he fr e que nt ref ere nce s i n t he SA to t he ap pellan t's too l s and strategies ac ross the who le ran ge of DLA of herself, do her h ousework and go out the doo r to and th e p s yc h iatrist ha v e str essed the ne ed for ongoing coun deal ing w ith her mental hea lth c o nd ition s and l iv in g her life a t h is ne ed for he lp, as pr e scribed by h er p hy sicia ns, ap pe llant's abi lit y to perform DLA is c onti nuo usl y r es For these r e asons , t he pan el finds th at t he ministry was not re . .. criterio n h ad no t.b een . me!. Help wit h DLA T h e mi nistry's positi on is t ha t as it has n ot been es t a canno t be de termin ed t ha t s i g nif ican t h elp is requ i red T he ap pe llan t's posi tion is that she r e quires ongoing help from as well a s fro m he r s ister and her friend. Panel findings The pa nel notes that the legis lation requires that in the opinion of a prescribe for help must arise from direct and signifi cant restricti continuous or periodic for ex tended periods. The help her friend (driving, picki n g up groceries, bringing f ood) needs arising from her physical impairment and not so much from her severe mental impairment. For the reasons set ou t above regarding significant restrictions in the abili finds that the ministry was not rea sonable in considerin the appellant's counselor and others as significant help sign i fica nt restrictions in her a bi lity t o perform DLA. The panel th unreasonably determined that this criterion had n ot been m EAAT003(10/06/01) require s help to p erf orm tho se ac tiviti e s. l e to r ely on t he in forma tion of hel p p rovi ded as to pe rform D L A is res tricte d. d tho se task s f o r which the GP ind i ca t es son , t he n refe rs to t h e SA, which t he ministry "ge t by ," as ther e is no inf o rmation p rov i de d ab out , sh oppin g, cookin g or p er s ona l care o r the us e pe llan t r eport s in th e SA that she d q ues t ion " Doesn' t everyo ne?" M a ybe so , b ut this o r us ing a timer on the st ove, also indi cates t h at r y is deter i or at ing a nd how thi s a f fects her ht to thi s e x a mple , it ha s giv en n o weight t o r elianc e on her th er ap ist f o r o ngoin g s upp ort , to g et he r m ot ivated to get out of bed, ta ke care do he r sh opping and othe r er rands . Both the GP s e l ing, and the t h erap y pr o vided in s be s t she is a ble. T h e pa ne l con side r s a s a r eliable ind ica tor of t h e degree to which the tr icted. ason able in deter mining t h at th is blish ed that DLA a r e signi fi cantly restrict ed, it from oth er p er so ns. other s , p ar ti cularl y from h er co uns el lor d professional the need o ns in the a bility to perform DLA that are either p r o vided to the appellant from her sis ter and is, i n th e panel's view, to meet the appellan t's ty to perform DLA, the pan el g the 17 .5 -2 0 hours/week of help provided by or supervisio n provided as a result of erefore finds that the m inistry et .
Conclusion Having reviewed and considered all of the evidence and the relevant legislation, the panel finds that the ministry's decision that the appellant was not eligible for PWD designation was not reasonably supported by the evidence. The panel therefore rescinds the ministry's decision. EAAT003(10/06/01)
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.