PART C -Decision under Appeal The decision u nder appeal is the reconsideration decision of the Ministry of Social Development and Social Innovation (the ministry) dated December 24, 2013 denying the appellant designation as a person with disabilities (PWD). The ministry determined that the appellant did not meet three of the five criteria required for PWD designation as set out in the Employment and Assistance forP ersons with.DisabilitiesA ct(EAPWDA) section 2. The ministry found that the appellant meets the criteria of being 18 years of age or older and, that in the opinion of a medical practitioner, her impairment is likely to continue for two or more years. However, the ministry determined that, based on the information provided, the following criteria as set out in section 2(2)(b) of the EAPWDA were not met: • The minister is satisfied that the appellant has a severe mental or physical impairment; • In the opinion of a prescribed professional, the appellant's impairment significantly restricts her ability to perform daily living activities (DLA) either continuously or periodically for extended periods; and • As a result of the restrictions, the appellant requires the significant help or supeivision of another person to perform the DLA restricted by her impairment. PART D-Relevant Legislation Employment and Assistance forP ersons with Disabilities Act(EAPWDA) -section 2 Employment andA ssistance for Persons with Disabll!lies Regulation (EAPWDR) -section 2 EMT003(10/00I01)
. PART E -Summa of Facts Th 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. The appellant's PWD Designation Application, containing the following three parts: • The appellant's Self Report (SR) completed April 29, 2013; • The Physician Report (PR) dated July 3; 2013 completed by the appellant's family physician who has known the appellant since 2010 and indicated she had seen her 11 or more times in the previous year. Attached to the PR was a consultation report from the appellant's local hospital dated December 12, 2012 regarding the appellant's admission to hospital for injuries she sustained in a fall down stairs, as well as a letter from an occupational therapist to the appellant's f a mily physician dated June 19, therapist conducted of the appellant on May 10, 2013; • The Assessor Report (AR) dated July 9, 2013 completed by the appellant's chiropractor who has known the appellant since 2006 and had seen her 11 or more times 2. The appellant's request for reconsideration dated November 26, 2013, attached to which were a written submission prepared by her advocate report prepared and signed by the appellant on or about December 6, 2013, and revised pages of the PR and AR prepared by the appellant's family physician and chiropractor in early December 2013 (there are no dates on the revised pages, indicated at the hearing that they were prepared for the ministry's reconsideration in early December 2013). The revised PR and AR were not included in the appeal record. The ministry submitted these documents the day before the hearing. The appellant completed her notice of appeal on January 16, 2014, " n e v e r c o n s i d e r e d a G P f o r b a c k o r n e c k p r o b l e m s " a n y o f h e r d o c t o r s " i n 2 5 y e a r s " . S h e w r o t e t h a t h e r f o r a i d s a t h o m e " a s s h e h a s i t e m s d u e t o h a v i n g h e t h a t a s h e r f a t h e r w a s a d o c t o r , s h e w o u l d t a l k t o h i m have 2 boys and they do what I can't." I n h e r s u b m i s s i o n s a t t h e a p p e a l h e a r i n g , t h e a p p e l l h e r f a m i l y p h y s i c i a n a b o u t h e r b a c k p a i n a n d , a l t h o u fr o m h e r d o c t o r f o r t h e h e a r i n g , s h e s a i d s h e w o u l d h a d a l w a y s r e l i e d o n h e r c h i r o p r a c t o r fo r h e r b a c k i s f a m i l y p h y s i c i a n . S h e s a i d t h a t h e r c h i r o p r a c t o r k n o w h i c h h e r i m p a i r m e n t s a f f e c t h e r a b i l i t y t o p e r f o r m h following summary of the evidence. T h e f o l l o w i n g i s a s u m m a r y o f t h e e v i d e n c e f r o m t h e r e g a r d i n g t h e a p p e l l a n t ' s i m p a i r m e n t s a s t h e y r e l a t e h a s a l s o i n c l u d e d r e f e r e n c e t o t h e a p p e l l a n t ' s S R i n on reconsideration and on appeal and at the hearing. EMT003(10/06i01) APPEAL# I c o n s i s t e d o f t h e fo l l o w i n g : 7 I i I I 2013 regarding a home visit the occupational and in the previous year. (2 pages) on December 6, 2013, a 2-page self but the appellant's advocate and on it she wrote that she has a n d h a s n e v e r d i s c u s s e d t h e s e p r o b l e m s w i t h f a m i l y d o c t o r " n e v e r r e c e i v e d r e c o m m e n d a t i o n s r d i s a b l e d m o t h e r l i v e w i t h h e r . S h e a l s o w r o t e a b o u t h e r h e a l t h i s s u e s . S h e w r o t e , " a l s o I a n t t o l d t h e p a n e l t h a t s h e w i l l b e s p e a k i n g w i t h g h s h e d i d n o t h a v e a n y a d d i t i o n a l i n f o r m a t i o n b e g o i n g fo r a n x r a y s o o n . S h e s a i d t h a t s h e s u e s a n d h a d n o t t h o u g h t t o d i s c u s s i t w i t h h e r w s h e r b e s t . T h e a p p e l l a n t d e s c r i b e d t h e w a y s i n e r D LA a n d t h i s i s n o t e d w h e r e a p p l i c a b l e i n t h e P R a n d A R , i n c l u d i n g t h e r e v i s e d P R a n d A R t o t h e t h r e e P W D c r i t e r i a a t i s s u e . T h e p a n e l t h e P W D a p p l i c a t i o n , a s w e l l a s h e r s u b m i s s i o n s
I APPEAL# Severity of impairments {criteria set out in subs. 2(2) EAPWDA) . ! . In the PR completed July 3, 2013, the appellant's physician diagnosed her with a traumatic brain injury that occurred in December 2012; this is confirmed in the information in the consultation report i dated December 12, 2012 from the appellant's in patient record from her local hospital attached to ! the PR. In her comment regarding the severity of the appellant's conditions, the appellant's physician i wrote in the PR, "see attached copies of in-hospital stay & consultation report." In the consultation report, the reason for the appellant's referral to hospital is identified as "basal skull fracture which was felt to be nonsurgical" and that at the date of the consult, the appellant was hospitalized in the intensive care unit for observation and discharged 2 days later. The consultation reports also notes that . at the time of hospitalization, the appellant had "right flank and hip tenderness." In the functional skills assessment of the PR orig)nally completed by the appellant's physician in July 2013, the physician indicated that the appellant could walk 4+ blocks unaided on a flat surface, that she could climb 5+ steps unaided, that she had no limitations in lifting and no limitations in remaining seated. She also indicated that the appellant had no difficulties with communication. In the revised PR of early December 2013 prepared for the reconsideration, the appellant's physician changed all of her answers in the functional skills assessment. She check marked "unknown" in answer-to how far the appellant could walk unaided on a flat surface and wrote. "see chiropractic report." In the revised answer for how many stairs the appellant could climb unaided, the physician crossed out her previous answer (5+ steps) and wrote, "uses rails" but did not check any answers. In the revised answer for the appellant's limitations in lifting, the physician crossed out the original answer (no limitations), check marked "unknown• and wrote, "see [chiropractor's] report." The physician change_ d her answer to the question how long the appellant could remain seated she crossed out "no limitation" and check marked "unknown." In the PR of July 2013, the appellant's physician indicated that she has significant deficits with cognitive and emotional function in the following areas: "memory (ability to learn and recall information)", "emotional disturbance (e.g. depression, anxiety)", "attention or sustained concentration", and "other'' noting "intermittent vertigo." In the comments section regarding these deficits, the physician wrote, "Patient is easily distracted and has difficulty staying focused." The appellant's physician did not change these answers on re-evaluation. In the AR completed July 9, 2013, the appellant's chiropractor wrote that the appellant's impairments are "short-term memoiy loss. Vertigo. Chronic intermittent mid and lower back pain" and.this answer was not revised In the early December 2013 re-evaluation. The chiropractor indicated that the appellant's levels of ability to communicate were good in all aspects and he did not revise this section on the December re-evaluation. In the original AR section regarding her mobility and physical ability, the chiropractor indicated that the appellant was able to independently perform walking indoors and outdoors and did not revise this answer on re-evaluation. In the original AR, the chiropractor indicated the appellant used rails for climbing stairs and did not change this answer on re-evaluation. In the original AR. the chjropractor indicated the appellant was independent for standing, with the comment "vertigo at times." On re-evaluation. the chiropractor crossed out the check mark f o r "independent" and checked "uses assistive device." The chiropractor originally check marked that the appellant required periodic assistance from another person for lifting and carrying and holding, but subsequently crossed out these check marks and checked "continuous assistance" on re-evaluation. In the ori inal AR, the chiro ractor wrote the comment, "Fre uent low and mid back EAAT003(10/06/01)
a s s i s t a n c e l i ft i n g / c a r r y i n g a t t i m e s . " I n t h e r e e v a l u a c r o s s e d o u t t h e w o r d " t i m e s " i n t h e c o m m e n t a n d w o v e r f o r p r o l o n g e d p e r i o d s . C a n n o t w e e d o r b e n d o v I n t h e A R s e c t i o n r e g a r d i n g t h e a p p e l l a n t ' s c o g n i t i v e o r i g i n a l l y c h e c k m a r k e d t h a t t h e a p p e l l a n t ' s m e n t a l i t h e a r e a s o f c o n s c i o u s n e s s , e x e c u t i v e a n d m o t i v a t i o e m o t i o n , a t t e n t i o n / c o n c e n t r a t i o n a n d m e m o r y . A l l o i m p a c t . I n t h e r e e v a l u a t i o n o f D e c e m b e r 2 0 1 3 , t h e c o n s c i o u s n e s s f r o m m i n i m a l i m p a c t t o m o d e r a t e i m e m o t i o n , a t t e n t i o n / c o n c e n t r a ti o n a n d m e m o r y f r o m m c h i r o p r a c t o r d i d n o t c h a n g e a n y o f t h e c h e c k m a r k s w a s n o I m p a c t . T h e c h i r o p r a c t o r d i d n o t p r o v i d e a n 2 0 1 3 o r o n t h e r e e v a l u a t i o n A R o f e a r l y D e c e m b e r I n t h e r e v i s e d A R o f e a r l y D e c e m b e r 2 0 1 3 , t h e c h i r o a p p e l l a n t ] i s i m p a i r e d b o t h b y h e r b r a i n i n j u r y a s w e g e n e r a l l y s p i n a l d e g e n e r a t i o n w h i c h m a k e s h e r j o i n t a n d m u s c l e s p a s m s . S h e m u s t t a k e c a r e w i t h p o s i t e p i s o d e s . T h i s I b e l i e v e , i n c o n j u n c t i o n w i t h h e r m e d i s a b i l i t y i n h e r l i f e . " I n h e r s u b m i s s i o n s o n r e c o n s i d e r a t i o n , t h e a p p e l l a n c a u s e s h e r d i zz i n e s s , a ff e c t s h e r m e m o r y a n d c o n c o v e r n e w s i t u a t i o n s " ( f o r e x a m p l e , s h e w r o t e t h a t s h b a l a n c e a n d c a n n o t s t a n d o n a c h a i r o r s t o o l w i t h o u t h e m o rn i n g , s h e w i l l b e d i z z y a n d m a y v o m i t ; s h e g · a n y w h e r e u n f a m i l i a r ; i f s h e d o e s n ' t s e t a l a r m s w h e n fo r g e t s t h a t s h e i s c o o k i n g , a n d s h e a l s o w r o t e t h a t s u b m i s s i o n s , t h e a p p e l l a n t a l s o d e s c r i b e d h o w s h e e x a m p l e , s h e l i e s d o w n t o w a t c h t e l e v i s i o n , h e r c h i l d b a c k , s h e d o e s n ' t b e n d o v e r t o c l e a n h e r t u b a s it w s o s h e d oe s n ' t h u r t h e r b a c k o r s h o u l d e r , a n d t h e c h s h o u l d e r . A t t h e h e a r i n g , t h e a p p e l l a n t t o l d t h e p a n e fr o m d i z z i n e s s a n d v e r t i g o a n d t h a t s h e f i n d s i t d i f fi c s h e c o u l d n o t f o l l o w t h e p a n e l c h a i r ' s o v e r v i e w o f t h s e c o n d s . " S h e t o l d t h e p a n e l t h a t s h e f r e q u e n t l y g e t d e c o r a ti o n s o n h e r C h ri s t m a s t r e e t h i s y e a r b e f o r e s s e v e r a l o f t h e e f f e c t s s e t o u t i n t h e s u b m i s s i o n s o n r A b i l i ty t o p e rf o r m D LA ( c r it e r i a s e t o u t i n s u b s . 2 ( 2 ) ( b I n t h e P R , t h e a p p e l l a n t ' s p h y s i c i a n c h e c k m a r k e d " i m p a i r m e n t d i r e c t l y r e s t r i c t t h e p e r s o n ' s a b i l i t y t o p e r e a r l y D e c e m b e r 2 0 1 3 r e e v a l u a t i o n . I n t h e s e c t i o n o f t h e A R i n d i c a t i n r e e o f r e s t EM T 0 0 3 ( 1 0 1 0 6 / 0 1 )I A P P � -E A L # --� i ! t i o n A R o f D e c e m b e r 2 0 1 3 , t h e c h i r o p r a c t o r r o t e " a l l t i m e s " a n d a d d e d , " C a n n o t s t a n d o r b e n d e r t o c l e a n . " a n d e m o t i o n a l fu n c t i o n i n g , t h e c h i r o p r a c t o r m p a i r m e n t ( b r a i n i n j u r y ) h a d a m i n i m a l i m p a c t i n n , a n d a m o d e r a t e i m p a ct i n t h e a r e a s o f f t h e o t h e r a r e a s w e r e c h e c k m a r k e d a s n o c h i r o p r a c t o r c h a n g e d t h e c h e c k m a r k b e s i d e p a c t , a n d c h a n g e d t h e c h e c k m a r k s b e s i d e o d e r a t e i m p a c t t o m a j o r i m p a c t . T h e f o r t h e o t h e r a r e a s w h e r e h e h a d i n d i c a t e d t h e r e y n a r r a t i v e o r c o m m e n t s o n t h e o r i g i n a l A R o f J u l y 2 0 1 3 . p r a c t o r w r o t e t h e f o l l o w i n g c o m m e n t , " [ t h e l l a s h e r c h r o n i c s p i n a l i s s u e s . H e r c o n d i t i o n i s s v e r y u n s t a b l e a n d s u s c e p t i b l e t o i m p i n g e m e n t i o n i n g a n d w e i g h t b e a r i n g t o a v o i d th e s e m o ry a n d e q u i l i b r i u m p r o b l e m s c o n s t i t u t e a m a j o r t d e s c r i b e d t h e e f f e c t s o f h e r b r a i n i n j u r y , w h i c h e n t r a t i o n , a n d c a u s e s " g r e a t s t r e s s a n d p a n i c e u s e s b o t h h a n d s t o g o u p a n d d o w n s t a i r s f o r t g e t t i n g d i z z y ; i f s h e g e t s o u t o f b e d t o o q u i c k l y i n e t s c o n f u s e d e a s i l y a n d w i l l g e t l o s t i f s h e d r i v e s s h e i s c o o k i n g , s h e w i l l b u r n d i n n e r a s s h e s h e fo r g e t s c o n v e r s a t i o n s w i t h p e o p l e ) . I n t h e s e c o m p e n s a t e s f o r h e r b a c k a n d n e c k p a i n ; f o r r e n v a c u u m fo r h e r a s i t h u r t s h e r s h o u l d e r a n d i l l s e i z e h e r b a c k , h e r c h i l d r e n c a r r y t h e g r o c e r i e s i l d r e n a l s o w a s h w i n d o w s s o s h e d o e s n ' t h u rt h e r l t h a t a s a r e s u l t o f h e r b r a i n i n j u r y , s h e s u f f e r s u l t t o c o n c e n t r a t e f o r e x a m p l e , s h e s a i d t h a t e a p p e a l p r o c e s s a n d w a s " l o s t w i t h i n t h e f i r s t 3 0 s v e r y d i z z y s h e s a i d s h e w a s o n l y a b l e t o p u t 3 h e g o t t o o d i z z y t o c o n t i n u e . S h e r e p e a t e d e c o n s i d e r a t i o n . ) E A P W D A ) n o " i n r e s p o n s e t o t h e q u e s t i o n " d o e s t h e f o r m [ D L A ] ? " T h i s a n s w e r w a s n o t r e v i s e d i n t h e r i c t i o n th e a e l l a n t ' s i m a i r m e n t s c a u s e o n h e r
DLA, the appellant's chiropractor.o ri ginally i ndicat e d that the app lis t ed tasks of the DLA o f persona l care, writin g "ta k es h and on/o f f c hair, a nd check m ark i ng th at the a ppe ll ant u com me n t, "seat in shower ." The chiroprac t o r did not The c hi r o prac to r or ig inally check m ark ed th at the ap sign ificant l y longer tha n typica l in per f orm ing the 2 t a "occa si o n all y whe n dizz y ." In th e r evi setj AR, the c hirop in d e pen dent to c ontinuous as sistanc e and added the comm spasms . " For th e 5 li s t ed ta sk s under the D LA o f sho th e ap pellan t wa s independent for al l of th e task s. I n th e che ck m ark f or the t ask o f carrying purc h as es home an d w rote , "so n carries groceries." In the re-evalua t comm e n t, " [ the ap pel lan t's] chi l dren m u st con t inuous str ai n on her l ower and upp e r back." In the orig i nal AR, for the t a s ks list ed unde r the DLA m a rked t h at the ap p e llant was independe nt in per f o rmi of fo od, and that sh e takes s ig n ificant ly longer th an typ c ookin g, c ommenti ng, "for gets w hat's coo king." Th e re-eva lu at i on. F or t he DI.As of pa y r e nt and bi l ls, and m mar ke d i ndepe ndent and d id no t re vise thes e answe tr a nsporta t i on, th e chi roprac t or indi cate d in the AR that list ed t asks, but to ok s i gn i fican tly l o ng e r tha n t ypical is fla re d ." T he ch i r o pra cto r di d n o t chan g e a n y of these answers on I n the origina l A R. t h e c h iropractor check m ark ed that the listed aspects o f social f un c ti onin g and he di d not re v c h i r o p ractor ind ic ated i n th e or igina l AR that s he had g social networ ks, but revised h is an sw e r on the r e-evaluation ap pellant 's socia l netw o r ks wi t h t he c o m ment, " s he st In t h e letter from the occ u pa ti ona l therapist of June 19, 2013, the occupational therapist wrote that the appellant "reports b e ing large ly inde pendent with act were of vertigo, physical de-condition i n g and short term memory impairment." therapist con t i nued tha tt h e appellant "reports feeli ng on t o furnitur e or shoppin g carts for stability. Her bal walker. She is able to shower safely using a shower seat.' conver sation, [th e appellant] appears to · have sig ni ficant short term memory deficits and She ofte n loses her train of thought. She prepares basic meals but s forgets sh e is co oking rt distracted, thoug h s h e has not had any incide compensatory strategies (i.e., cooks on low or medium heat). lost in familiar places. [The appe l l ant] appears to become anxious and frustrated c o gnitive abi lit i es ( a tt ention, mem o ry, problem-solving) are worsened under stressful situations." In her submissions at the hearing, the appellant told the panel that.her children assist her wrth many of her daily living activities: they carry the laundry up and down stairs as balance; the load and unload the roceries for her so she doesn't lose her balance or h £MT 003(10/06101) I AP PEA L # e llan t was independent in 7 of the 8 I er tim e whe n diz zy" for transfers in/out o f bed se s a n assistive dev ice for bat hing with th e revise th ese answer s in th e re-eval ua tion AR. pel lan t was indep endent an d also tak e s sks o f t he DLA of b asic ho u s e keeping, w rt tin g racto r chang ed t he check ma r ks from e nt, "needs assis t a n ce i f gets b a ck p pin g, t he ch iropr actor or i ginall y ch e ck e d tha t the re-evaluation A R, the chiro p ract or ch a ng ed fr om i n d ep endent to cont inu o u s ass istanc e i on AR, the ch i rop r a c t or has also added th e ly ass ist h er in he r daily l i f e to preve n t exces si ve of meals, the ap pellan t's chiro pra c t o r che c k ng t he tasks of meal planning and s af e st or age ic al wi th the t a s ks of food preparation and chi r opract or d i d n o t revise these answers in the e dic ations, the chiroprac to r has check r s on re-evaluati o n. F or the DLA o f th e appel lant wa s independe n t for all o f th e for g e tting in a nd out o f a vehicle "longer if back re -ev a lu a t ion. app ellant w as independent fo r 4 of the i se the s e a nswer s on the re -eval u ation AR. The o od funct io ning i n her i m mediate a nd extended AR to marginal f unctioni ng fo r the a y s home to avoid confusing situat ions.? i v i t i es of da i ly living. H er main co m p la in ts The occupational dizzy o r vert iginous when mo b il izing; sh e ho ld s an ce is a deq u ate ... She does not require a The occupational therapist also wrote, "In distr a c ti b il it y. tates th a t s h e occasionally nts . .. and use s good She also reports incidents of getting ea s i l y; a nd her she needs both her hands to u r t he r back
a nd s h ould ers ; and th e y vacuu m and pi ck u p t h i n gs s he prepares the mea ls for the fa mily , but she sets alanns hea t as s h e is w orried s he w ill forget sh e is co oking sto re an d to ru n he r err a nd s, bu t her children help wit la te moth e r' s s c ooter when s h e has to walk the do g, being a ble t o se e wh er e s he i s walking and the dog is active, use this for ass istance whe n walking and if sh e stan m othe r 's wa lker. She said t hat wh e n she h a s gone hik fo r a s sistanc e w alki ng . She u s es a shower seat becau l o ng and w h en she c lean s her bathroo m, s he will just s ove r a n d scru b the tub . Ass i s tan c e required/provi de d (cr iteria se t out in subs. 2(2)(b I n the s e ction o f the AR d escribing th e assistance pr origi nally wro t e, ''Assis tance h as no t been uti lize d so requir e d but th ere is no ne a v a i lable, p l ease describe wh " Help for heavier ho u se-w ork would be necess ary at The chiropract o r che ck mark ed that the ap pell ant use of Dec ember 2013, th e chiro p ractor cros sed o ut the c far," c hec k ma r ked "fami ly" a n d w rote, "S on s c on tin uo his o rigin a l answer to, "H elp for all house-work w ou l u p or v ertig o e pis odes. " At th e hearing , t h e appellant t old t h e panel tha t her mo h o use has bee n equ i p pe d wit h g rab b ars and ra i ls , incl h el p he r a great deal. As se t ou t previousl y, t h e app gre at deal wit h carrying it e ms such as gr o ceries, lifting up a nd do w n stai r s. S he described set t ing t i mer s and co doesn't bum fo o d . The panel finds that the new info rmat ion . p rovid ed b y information before the ministry at the time of the recons clarifies the nature of her i mpa irments a n d t he help therefore admits the appellant's testimony purs uant Assist ance A ct. EAAT003(10/06/01) AP PEAL # I aro und t he h ouse. Th e ap pellant to ld th e panel a n d t ime rs and cooks on low to m edium a nd b um food. She said that she dri ves to th e h l ifti n g and carryi n g pu r c hase s. She u s es her but only if it is da rk as she's conce rn e d a bo ut S he has a cane and will s om etim es ds for more than ·30-60 mi n ute s she u ses her la t e ing o r camping, she has also us e d ski p oles se she l oses her ba lance when standin g too pray the tub with clea n e r as she can't be nd )(ii) EAPWDA) ov id ed for t he ap pellant, t h e chiro p ra c to r far" a nd in an s wer to t he que stion "i f h el p is a t a ssistance wo u ld be n e cessary", wrote , t i m es of sp i nal fla re-up or ver tig o ep isodes ." d a bath ing aid, "s eat." In the re-evaluation AR omment "A ssi stance has n o t b e en uti l i zed so us l y assis t her." Th e c hiro pra cto r a l so r ev i sed d be nece s sa r y at all times to a void spin a l flare-th er li ved w it h the m and the low er part o f th e uding in the ba thr oo m , a nd t hat the s e thing s el lant described h o w her c hil dren help h e r a thing s, va c uumin g, a nd c a rrying the la u ndry oking on lo w to mo dera te heat so she the appell a n t at the hearing is in supp o r t of the i d era tion. The testimony of the appellant pr ovided h er in m anaging her DLAs. 'Th e pa n el to section 22(4)(b) o f the Employment and
A P P E A L # I P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e i n t h i s a p p e a l i s w h e t h e r t h e m i n i s t r y r e a s o n a b l y d e t e r m i n e d t h a t t h e a p p e l l a n t i s i n e l i g i b l e f o r P W D d e s i g n a t i o n b e c a u s e s h e d i d n o t m e e t a l l t h e r e q u i r e m e n t s i n s e c t i o n 2 o f t h e EA P W D A . S p e c i fi 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 a t th 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 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 i rm e n t , t h a t h e r p h y s i c a l i m p a i n n 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 d i r e c t l y a n d s i g n i fi 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 p e rf o n n d a i l y l i v i n g a c t i v i t i e s e i t h e r c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e ri o d s , a n d , 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 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 fo l l o w i n g s e c t i o n o f t h e E A P W D A a p p l i e s t o t h i s a p p e a l : 2 ( 1 ) I n t h i s s e ct i o n : " a s s i s ti 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 n n a d a i l y l i v i n g a c t M t y t h a t , b e ca u s e o f a s e v e r e m e n la l o r p h y s i c a l i m p a i r m e n � th e p e r s o n i s u n a b l e t o p e rfo 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 ca 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 ti n u e fo 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 fi 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 . Th e f o l l o w i n g s e c t i o n o f t h e E A P W D R a p p l i e s t o t h i s a p p e a l : 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 i i ) s h o p f o r p e r s o n a l n e e d s ; ( i v ) u s e p u b l i c o r p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s ; ( v ) p e r f o r m h o u s e w o r k t o m a i n t a i n t h e p e r s o n ' s p l a c e o f r e s i d e n c e i n a c c e p t a b l e s a n i t a ry c o n d i t i o n ; ( v i ) m o v e a b o u t i n d o o r s a n d o u t d o o r s ; ( v i i ) p e r f o n n p e r s o n a l h y g i e n e a n d s e l f c a r e ; ( v i i i ) m a n a g e p e r s o n a l m e d i c a t i o n , a n d b · i n r e l a t i o n t o a 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 a i r m e n ! , i n c l u d e s th e f o l l o w i n a c t i v i t i e s : EM T 0 0 3 ( 1 0 / 0 6 / 0 1 )
( i ) m a k e d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e o ( i i ) r e l a t e t o , c o m m u n i c a t e o r i n t e r a c t w i t h o t h e r s e ff 2 ( 2 ) F o r t h e p u r p o s e o f t h e A ct , " p r e s c r i b e d p r o f e s s i o n a l ' e n a c t m e n t t o p r a ct i c e t h e p r o f e s s i o n o f ( a ) m e d i c a l p r a ct i t i o n e r ; ( b ) r e g i s t e r e d p s y ch o l o g i s t ; ( c ) r e g i s t e r e d n u r s e o r r e g i s t e r e d p s y c h i a tr i c n u r s e ; ( d ) o c c u p a t i o n a l t h e r a p i s t ; ( e ) p h y s i c a l t h e r a p i s t ; ( f} s o c i a l w o r k e r ; ( g ) c h i r o p r a c t o r ; o r ( h ) n u r s e p r a c t i t i o n e r . E x i s t e n c e a n d s e v e ritv o f 1 in p a l nn e n f s T h e a p p e l l a n t t o l d t h e p a n e l t h a t w h e n h e r d o c t o r c o a n d h e r d o c t o r f o c u s e d o n h e r b r a i n i n j u r y i m p a i rm e w n: h h e r d o c t o r , b u t h a d r e l i e d o n h e r c h i r o p r a c t o r w b a c k p r o b l e m s a n d h e r m e n t a l i m p a i r m e n t . A s s t a t e r e c o n s i d e r a t i o n , t h e a p p e l l a n t ' s p h y s i c i a n " w a s n o t f a f f e c t e d b y h e r m e n t a l a n d p h y s i c a l h e a l t h i m p a i r m e a p p e l l a n t ' s p h y s i c i a n . i n h e r r e v i s e d a n s w e rs t o t h e f e a r l y D e c e m b e r 2 0 1 3 h a d d e f e r r e d t o t h e a p p e l l a n t ' c h i r o p r a c t o r re p o r t . " T h e a d v o c a t e s a i d t h a t t h e P R e x i s t e n c e a n d s e v e r i t y o f t h e a p p e l l a n t ' s i m p a i r m e n t i n f o r m a ti o n p r o v i d e d b y t h e a p p e l l a n t ' s c h i r o p r a c t o r s e v e r e p h y s i c a l i m p a i r m e n t b a c k p a i n . T h e a p p e l l a a r e b o t h a b r a i n i n j u ry ( w h i c h w a s a c c e p t e d b y t h e m i m p a i r m e n t s a r e s e v e r e . T h e a p p e l l a n t t o l d t h e p a n e l t h a t s h e h a s fr e q u e n t d s h e h a s l e a rn e d " t r i c k s " t o c o m p e n s a t e f o r t h e e f f e c t a n d u s i n g a l a r m s a n d t i m e r s t o r e m i n d h e r s h e i s c o h e r b a l a n ce i n t h e s h o w e r , u s i n g b o t h h a n d s t o g o u h e r b a c k a n d n e c k / s h o u l d e r p a i n n e g a t i v e l y a ff e c t h e o n t h e a s s i s t a n c e o f h e r c h i l d r e n f o r ca r t y i n g a n d l i ft I n t h e r e c o n s i d e r a t i o n d e c i s i o n , t h e m i n i s t r y b a s e d t t w e r e n o t s e v e r e o n t h e i n fo r m a t i o n p r o v i d e d b y t h e a 2 0 1 3 a n d r e v i s e d i n D e c e m b e r 2 0 1 3 , a s w e l l a s t h e 2 0 1 3 , a n d t h e i n f o r m a t i o n p r o v i d e d b y t h e a p p e l l a n t ' r e v i s e d i n e a r l y D e c e m b e r 2 0 1 3 . T h e m i n i s t ry n o t e d h a d c h a n g e d h e r a n s w e r s i n t h e f u n c t i o n a l s k i l l s a s s c h i r o p r a c t o r ' s r e p o r t . H o w e v e r , t h e m i n i s t r y fo u n d t h n o t a d d r e s s [ 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 rm t h e s e t o d e t e r m i n e h i s e v a l u a t i o n . " T h e m i n i s t ry n o t e d t h a d i a n o s i s o f h s i c a l i m a i m , e n t , b a c k a i n , i n t h e r EM T 0 0 3 ( 1 0 / 00 / 0 1 )l A P P E A L # r fi n a n c e s ; e c t i v e l y . i m e a n s a p e r s o n w h o I s a u t h o r i z e d u n d e r a n m p l e t e d t h e P W D a p p l i c a t i o n i n J u l y 2 0 1 3 , s h e n t , a s s h e h a d n o t d i s c u s s e d h e r b a c k p r o b l e m s h o s h e s e e s f r e q u e n t l y a n d k n o w s a b o u t b o t h h e r d b y h e r a d v o c a t e i n t h e s u b m i s s i o n o n u l l y a w a r e o f t h e e x t e n t t o w h i c h ( t h e a p p e l l a n t ] i s n t s . " T h e a p p e l l a n t ' s a d v o c a t e n o t e d t h a t t h e u n c t i o n a l s k i l l s s e c t i o n o f t h e P R c o m p l e t e d i n s c h i r o p r a c t o r t h r o u g h t h e c o m m e n t " s e e a n d A R m u s t b e r e a d t o g e t h e r t o d e t e r m i n e t h e s a n d a r g u e d t h a t t h e m i n i s t ry h a d d i s c o u n t e d t h e i n t h e A R t h a t e s t a b l i s h e s t h e a p p e l l a n t h a s a n t a n d h e r a d v o c a t e s u b m i t t h a t h e r i m p a i r m e n t s i n i s t r y ) a n d b a c k p a i n , a n d t h a t b o t h o f t h e s e i z z i n e s s a n d v e r ti g o w h i c h a ff e c t s h e r d a i l y a n d o f h e r b r a i n i n j u r y ( s u c h a s c o o k i n g o n l o w h e a t o k i n g , u s i n g a s h o w e r s e a t s o s h e d o e s n ' t l o s e p a n d d o w n t h e s t a i rs ) . S h e a l s o d e s c r i b e d t h a t r d a i l y l i v i n g a c ti v i t i e s a n d a s a r e s u l t , s h e r e l i e s i n g . s d e t e r m i n a t i o n t h a t t h e a p p e l l a n t ' s i m p a i r m e n ts p p e l l a n t ' s p h y s i c i a n i n t h e P R c o m p l e t e d J u l y 3 , l e t t e r f r o m t h e o c c u p a t i o n a l t h e r a p i s t o f J u n e 1 9 , s c h i r o p r a c t o r i n t h e A R o f J u l y 9 , 2 0 1 3 , a n d t h a t t h e a p p e l l a n t ' s p h y s i c i a n o n r e e v a l u a t i o n e s s m e n t o f t h e P R a n d r e f e r r e d t o t h e a t i n t h e A R , t h e a p p e l l a n t ' s c h i r o p r a c t o r " d o e s s p e c i fi c p h y s i c a l f u n c t i o n a l i t i e s , m a k i n g r t d i f f i c u l t t t h e a p p e l l a n t ' s p h y s i c i a n d i d n o t a d d a e e v a l u a t i o n P R o f e a r l D e c e m b e r 2 0 1 3 . T h e
m i n i s t r y a l s o r e fe r r e d t o t h e o c c u p a t i o n a l t h e r a p i s t ' s t h a t i n n e i t h e r o f t h e s e w a s t h e r e r e f e r e n c e t o b a c k i m p a i r m e n t . F o r t h e s e r e a s o n s , t h e m i n i s t r y d e t e r m e s t a b l i s h t h e a p p e l l a n t h a s a s e v e r e l) h y s i c a l i m p a i r I n t e r m s o f t h e a p p e l l a n t ' s m e n t a l i m p a i r m e n t , i n i t s a n s w e r s o f t h e a p p e l l a n t ' s p h y s i c i a n I n t h e P R t h a t e m o t i o n a l fu n c t i o n i n g a n d i s e a s i l y d i s t r a c t e d a n d h n o t e d t h a t t h e a p p e l l a n t ' s c h i r o p r a c t o r i n t h e A R h a d a s p e c t s o f s o c i a l fu n c t i o n i n g . T h e m i n i s t r y n o t e d t h e A R r e g a r d i n g t h e i m p a c t o f t h e a p p e l l a n t ' s m e n t a l i m i n e m o ti o n , a t t e n t i o n / c o n c e n t r a t i o n a n d m e m o r y t o m c o n s c i o u s n e s s t o m o d e r a t e . H o w e v e r , t h e m i n i s t r y i n t h i s s e c t i o n t o e x p l a i n t h e d e g r e e o f [ t h e a p p e l l a n t i m e o f t h e o r i g i n a l P W D a p p l i c a t i o n . " T h e m i n i s t ry i n f o r m a t i o n i n c o m b i n a t i o n w r t h t h e c o n s i d e r a t i o n o f d e s c r i b e s h i s s e N i c e s t o [ t h e a p p e l l a n t ] a s e p i s o d i c r e f e r e n c e . m e n t a l h e a l t h " t h e m i n i s t r y w a s n o t s a t i s f i severe mental impairment. Analysis and decision The legislation provides that the minister may designate a person that the person has a severe mental or physical impairment that in the opinion of a medical practrtioner is likely to continue f o r at least 2 years (subs. 2(2)(a) of the EAPWDA). physician confinned in the PWD application that her is a condition that is likely to continue for at least 2 years. physical impairment of chronic back pain and that rt is severe. the information provided confirms both that the appellant has a physical impairment of chronic back pain (in addition to the recognized mental impairment) and the severity of the impairment(s). In the PWD application form, the ministry has provided a definition of "impairment" which, although it is not set out in the applicable legislation, offers guidance in considering the existence and severity of an applicant's impairment. The ministry states, "impairment" is a "loss or abnormality of psychological, anatomical or physiological structure or functioning causing a restriction in the ability to function independently, effectively, appropriately or for a reasonable duration." To determine the severity of an impairment, there is both a cause -the impairment itself -and an effect -the to which it restricts the ability to function independently, effectively, appropriately orfor a reasonable duration. PhysicalimpaillTJen/ In this case, the appellant's physician has diagnosed her with a brain injury and the ministry has accepted this as her impairment. The panel understands that the impact of a brain injury may have b o t h m e n t a l a n d / o r p h y s i c a l c o m p o n e n t s . T h e p a n e physician has not diagnosed her with a back injury and, as noted by the ministry, has not commented on the a ellant's back, neck and shoulder ain in the PR E/v\1003(10/06/01} '--I A _ P_ P _ E _ A L _ # _ _ _ _ _ _ _ _ j l e tt e r a n d t h e a p p e l l a n t ' s o w n s e l f r e p o rt s a n d 7 p a i n o r " p h y s i c a l i s s u e s " r e g a r d i n g a p h y s i c a l i n e d 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 m e n t . r e c o n s i d e r a t i o n d e c i s i o n , t h e m i n i s t r y n o t e d t h e s h e h a d s i g n i f i c a n t d e f i c i t s w i t h c o g n i t i v e a n d a s d i ffi c u l t y s t a y i n g fo c u s e d . T h e m i n i s t ry a l s o i n d i c a t e d t h e a p p e l l a n t w a s i n d e p e n d e n t i n a l l c h i r o p r a c t o r h a d c h a n g e d t h e a n s w e r s o n t h e p a i r m e n t c h a n g i n g t h e t h r e e m o d e r a t e i m p a c t s a j o r , a n d c h a n g i n g t h e m i n i m a l i m p a c t i n n o t e d t h a t t h e c h i r o p r a c t o r " m a d e n o c o m m e n t s t ' s ] r e s t r i c t i o n s , o r e x p l a i n w h a t c h a n g e d fr o m t h e · m a d e t h e c o m m e n t t h a t " g i v e n t h i s l a c k o f [ t h e d o c t o r ' s ] c h i r o p r a c t i c p r o f e s s i o n , a s [ h e ] v i s i t s f o r b a c k a n d n e c k p a i n . a n d d o e s n o t e d t h e i n f o r m a t i o n p r o v i d e d w a s e v i d e n c e o f a as a PWD if the minister is satisfied The appellant's impairment is a traumatic brain injury and that rt The appellant also asserts that she has a The issue bef o re this panel is whether i degree l w i l l a d d r e s s t h e p h y s i c a l c o m p o n e n t h e r e . T h e both in the ori inal and on re-evaluation .
I APPEAL# The appellant told the panel she had not discussed her back, neck and shoulder pain with her doctor, but would do this in future visits and obtain an x-ray. The appellant asserts that her chiropractor has diagnosed her with back and neck pain, and argues that the ministry should consider this evidence of physical impairment and its severity in assessing her for PWD designation. In the AR, the appellant's chiropractor indicated her physical impairment was "chronic intermittent mid and lower back pain" but does not articulate the cause of the appellant's back pain, other than to write the comment "her pondition is generally spinal degeneration which makes her joints very unstable and susceptible to impingement and muscle spasm." The appellant told the panel that she has suffered from back pain "for years" and recalled visits to a previous chiropractor when she lived in another city. The chiropractor indicates in the AR that he has been treating her for seven years (since April 25, 2006), I describing his services as "episodic visits for care of mid or [lower back pain] also occasional ! problems with neck strain -was treated for this issue after her fall." The appellant's advocate pointed to the hospital consultation report of December 2012 where "right flank and hip tenderness" is I noted as part of the physical examination as evidence of the appellant's existing back impairment. However, the panel finds that it is more likely than not that this note in the hospital consultation report of December 2012 was in reference to pain arising from the appellant's f a ll down the stairs which caused her brain injury and is not evidence of a back injury as there is no other reference to back pain o r back injury in the hospital consultation report. The panel notes that the legislation provides that the determination of the severity of an impairment is at the discretion of the minister, taking into account all of the evidence, including that of the appellant. However, the starting point must be the medical evidence, with the legislation requiring that a medical practitioner identify the impairment and confirm that it will continue for at least two years. Although a I chiropractor is a prescribed professional for the purposes of completing the AR, a chiropractor is not a medical practitioner for the purposes of diagnosing a physical impairment that is likely to continue for at least 2 years -the first required criteria to determine if an applicant qualifies for PWD designation. The panel places weight on the information provided by the appellant's physician in the PR (both the ·original and revised) as she is the appellant's treating medical practitioner who has known her for 3 years and, although the panel accepts that the appellant has relied on treatment by her chiropractor for back pain, finds that the diagnosis of an impairment related to back , shoulder and neck pain is not set out in the information. Although the appellant accommodates for her back, neck and shoulder pain by limiting several of her activities -for example, she does not bend over to clean her bathtub, she relies on her children to carry laundry up and down the stairs and to carry groceries and vacuum -she also said that she restricts these activities because she loses her balance. In the revised PR, the physician did not change her answer of "no" to the question whether the appellant's impainnent of a brain injury directly restricts her ability to perform DLA. In the revised PR, the physician referred to the chiropractor's report (in the AR) in her changed answers to the assessment of the appellant's ability to walk unaided on a flat surface (changed from 4+ blocks to unknown) and limitations in lifting (changed from no limitations to unknown) in the functional skills assessment. In the AR (both original and revised), the chiropractor indicated the appellant was independent walking indoors and outdoors and used rails to climb stairs. In the original AR, the chiropractor wrote "vertigo at limes" beside standing, but changed the answer from independent to uses assistive device in the revised AR. At the hearing, the appellant said she occasionally uses a cane when she walks and ski poles when she hikes, but did not say she needed these devices all the time, and can walk without the cane. In the revised AR in the section addressing tile impact of the a ellant's brain in"u on her co nitive and emotional functionin where the effects of verti o and EMT003(10/06/01)
d i zz i n e s s c o u l d b e a s s e s s e d , t h e c h i r o p r a c t o r h a s i n m o . t o r a c t i v i ty o r o t h e r n e u r o p s y c h o l o g i c a l p r o b l e m s p r o b l e m s ) . . 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 ' s d e t e rm i n a t i o n t h 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 i s r e a s o n a b l e . M e n / a / I m p a i rm e n t I t i s e s t a b l i s h e d t h a t t h e a p p e l l a n t h a s a t r a u m a t i c b i m p a c t s o f t h i s i m p a i rm e n t i n t h i s s e c t i o n . T h e a p p e b e fo r e t h e m i n i s t ry , p a r t i c u l a r l y a s s e t o u t b y t h e c h i s u p p o r t s t h a t t h e a p p e l l a n t ' s b r a i n i n j u r y i s a s e v e r e t a k e i s s u e w i t h t h e m i n i s t r y ' s c o m m e n t i n t h e r e c o n s i n f o r m a t i o n i n c o m b . i n a ti o n w i t h t h e c o n s i d e r a t i o n o f a s s e r t i n g t h a t t h e m i n i s t ry g a v e l e s s w e i g h t t h a n i t s a p p e l l a n t d e s c r i b e d t o t h e p a n e l ( a n d i n h e r e a r l i e r s i m p a i rm e n t c a u s e s b o t h p h y s i c a l e f f e c t s ( d i zz i n e s s a m e n t a l e f f e c t s · ( i n a b i l i t y t o c o n c e n t r a t e a n d r e m e m b e A s s t a t e d p r e v i o u s l y , t h e p a n e l n o t e s t h a t t h e d e t e r m d i s c r e t i o n o f t h e m i n i s t e r , t a k i n g i n t o a c c o u n t a l l o f t h t h a t t h e s t a r t i n g p o i n t m u s t b e t h e m e d i c a l e v i d e n c e t h e a p p e l l a n t h a s s i g n i fi 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 e m o t i o n a l d i s t u r b a n c e a n d a t t e n t i o n o r s u s t a i n e d c o t h e c o m m e n t " [ t h e a p p e l l a n t ] i s e a s i l y d i s t r a c t e d a n d w e r e n o t c h a n g e d o n r e e v a l u a t i o n i n D e c e m b e r 2 0 r e g a r d i n g t h e i m p a c t o f t h e a p p e l l a n t ' s m e n t a l i m p a i c h a n g i n g t h e t h r e e m o d e r a t e i m p a c t s i n e m o t i o n , a t t i m p a c t , a n d c h a n g i n g t h e m i n i m a l i m p a c t i n c o n s c i o m i n i s t r y , t h a t t h e c h i r o p r a c t o r h a s n o t p r o v i d e d a n y n t h e d e g r e e o r s e v e r i t y o f t h e s e r e s t r i c t i o n s . A s w e l l , i n d e p e n d e n t i n a l l a s p e c t s o f s o c i a l fu n c t i o n i n g , w i t h n e t w o r k , a n d d i d n o t c h a n g e t h e s e a n s w e r s o n r e e v t h e A R o n r e e v a l u a t i o n w r i t i n g t h a t s h e h a s m a r g i n a a d d i n g t h e c o m m e n t , " s h e s t a y s h o m e t o a v o i d c o n f p a n e l fi n d s t h a t w i t h o u t f u r t h e r i n fo r m a t i o n f r o m t h e e x p l a i n i n g t h e s e v e r i t y o r r e s t r i c t i o n o f h e r b r a i n i n j u e f f e c t i v e l y , a p p r o p r i a t e l y o r f o r a r e a s o n a b l e d u r a t i o b e e n e s t a b l i s h e d t h a t t h e a p p e l l a n t h a s a s e v e r e m e D i r e c t a n d s i g n i fi c a n t 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 rf T h e a p p e l l a n t t o l d t h e p a n e l t h a t b e c a u s e o f h e r b r a p e r f o r m h e r D L A . A s s e t o u t p r e v i o u s l y , t h e a p p e l l a fr o m v e r t i g o a n d s o s h e m u s t u s e b o t h h a n d s w h e n b a l a n c e , a n d s h e m u s t t a k e h e r t i m e e t t i n i n t o a n d EM T 00 3 ( 1 0 / 06/ 0 1 )1 . A P P E A L # d i c a t e d t h a t i t h a s n o i m p a c t o n t h e a p p e l l a n t ' s ( e g . V i s u a l / s p a t i a l p r o b l e m s , p s y c h o m o t o r 7 . t th e i n f o r m a t i o n p r o v i d e d d o e s n o t e s t a b l i s h a r a i n i n j u r y . T h e p a n e l w i l l a d d r e s s t h e m e n t a l l l a n t a n d h e r a d v o c a t e a r g u e t h a t t h e i n fo r m a t i o n r o p r a c t o r i n t h e A R b o t h o ri g i n a l a n d r e v i s e d , i m p a i r m e n t . T h e a p p e l l a n t a n d h e r a d v o c a t e i d e r a t i o n d e c i s i o n t h a t " g i v e n t h i s l a c k o f [ t h e d o c t o r ' s n a m e ] c h i r o p r a c t i c p r o fe s s i o n " , h o u l d h a v e t o t h e c h i r o p r a c t o r ' s i n fo r m a t i o n . T h e u b m i s s i o n s t o t h e m i n i s t r y ) t h a t h e r m e n t a l n d / o r v e r t i g o a n d b a l a n ce p r o b l e m s ) a s w e l l a s r ) . i n a t i o n o f t h e s e v e r i t y o f a n i m p a i r m e n t i s a t t h e e e v i d e n c e . i n c l u d i n g t h a t o f t h e a p p e l l a n t , b u t . I n t h e o r i g i n a l P R , t h e p h y s i c i a n c o n f i r m e d t h a t n d e m o t i o n a l f u n c t i o n i n t h e a r e a s o f m e m o ry , n c e n t r a t i o n , a s w e l l a s " i n t e r m i t t e n t v e r t i g o " w i t h h a s d rrfi c u l t y s t a y i n g fo c u s e d . " T h e s e a n s w e r s 1 3 . T h e c h i r o p r a c t o r r e v i s e d h i s a n s w e r s r m e n t fr o m t h e o r i g i n a l A R t o t h e r e v i s e d A R e n t i o n / c o n c e n t r a t i o n a n d m e m o r y t o m a j o r u s n e s s t o m o d e r a t e . T h e p a n e l n o t e s , a s d i d t h e a r r a t i v e o r c o m m e n t a r y i n t h i s s e c t i o n t o e x p l a i n i n t h e A R t h e c h i r o p r a c t o r i n d i c a t e d t h a t s h e w a s g o o d f u n c t i o n i n g w i t h h e r i m m e d i a t e s o c i a l a l u a t i o n . T h e c h i r o p r a c t o r r e v i s e d t h e a n s w e r i n l f u n c t i o n i n g w i t h e x t e n d e d s o c i a l n e t w o r k s a n d u s i n g s i t u a t i o n s . " B a s e d o n t h i s e v i d e n c e , t h e a p p e l l a n t ' s p h y s i c i a n o r f r o m h e r c h i r o p r a c t o r , r y o n h e r " a b i l i t y t o fu n c t i o n i n d e p e n d e n t l y , n , " t h e m i n i s t r y ' s d e t e rm i n a t i o n t h a t i t h a s n o t n t a l i m p a i r m e n t i s r e a s o n a b l e . o rm D LA . i n i n j u r y a n d h e r b a c k p a i n , s h e fi n d s i t d rffi c u l t t o n t d e s c r i b e d t h a t s h e i s o ft e n d i zz y a n d s u ff e r i n g g o i n g u p a n d d o w n s t a i r s t o m a i n t a i n h e r o u t o f b e d a n d i n t o a n d o u t o f a c h a i r s o s h e
d o e s n ' t f a l l . S h e s a i d t h a t s h e o f t e n fe e l s d i z z y i n h e c e r t a i n t e l e v i s i o n s h o w s a s i t w i l l m a k e h e r fe e l d i z z y h e r b a c k d o e s n ' t s e i z e , w h i c h s h e s a y s i t w i l l d o a ft e l a u n d ry u p a n d d o w n s t a i r s , b o t h s o s h e c a n b a l a n c e a n d s h o u l d e r t o l i f t F o r t h e s a m e r e a s o n , h e r c h i l d r t o l d th e p a n e l s h e c a n n o t b e n d o v e r t o c l e a n h e r b a t h e r c h i l d r e n t o v a c u u m a n d h e l p w i t h h o u s e w o r k . T s u c h a s s e t t i n g t i m e r s a n d u s i n g l o w o r m e d i u m h e a t o l d t h e p a n e l s h e h a s d i f f i c u l t y c o n c e n t r a t i n g a n d o f I n t h e r e c o n s i d e r a t i o n d e c i s i o n , t h e m i n i s t i y n o t e d t h fo u n d t h a t a l t h o u g h t h e a p p e l l a n t " h a s c e r t a i n l i m i t a t i n fo r m a t i o n p r o v i d e d " d o e s n o t e s t a b l i s h t h a t a n i m p 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 fo r e x t e n d e d p e r i o d s . " T i n t h e P R i n d i c a t e d t h a t t h e a p p e l l a n t ' s i m p a i rm e n t d D LA , a n d t h a t h e r p h y s i c i a n d i d n o t c h a n g e t h i s a n s w r e c o n s i d e r a t i o n d e c i s i o n n o t e d t h a t i n t h e A R , t h e c h c o u l d i n d e p e n d e n t l y p e r f o n m " 3 2 o u t o f 3 8 " o f t h e D L o n t h e A R a f t e r r e e v a l u a t i o n , i n d i c a t i n g t h a t t h e a p p D L A s . T h e m i n i s t ry n o t e d t h a t , w h e n e v a l u a t i n g t h e i n d i c a t e d a s i n d e p e n d e n t , t h e n a r r a t i v e o f t h e a p p e l l . ' t a k e s h e r t i m e w h e n d i zzy ' , ' o c c a s i o n a l l y w h e n d i z z T h e s e c o m m e n t s i n d i c a t e t h a t [ t h e a p p e l l a n t ' s ) a b i l i ty n a t u r e , a n d t h e f r e q u e n c y a n d l e n g t h o f t i m e i n a d a a f f e c t e d i s n o t c l e a r . " T h e m i n i s t ry a l s o n o t e d t h e s t 1 9 , 2 0 1 3 l e t t e r t h a t t h e a p p e l l a n t r e p o r t s b e i n g l a r g e A n a ly s i s a n d d e c is i o n T h e l e g i s l a t i o n r e q u i r es i n s u b s . 2 ( 2 ) ( b ) o f t h e E A P W t h e a p p e l l a n t ' s i m p a i r m e n t s d i r e c t l y a n d s i g n i f i c a n t l y 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 . T h p r o f e s s i o n a l m a y i n d i c a t e t h a t , b e c a u s e o f a r e s t r i c t 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 fo r e x t e n d e d p e r i o d s . t h i b e i n g a " d i r e c t a n d s i g n i fi c a n t r e s t r i c t i o n . " T h e D LA i m p a i rm e n t a r e , a s s e t o u t i n s u b s . 2 ( 1 ) o f t h e E A P W • P r e p a r e o w n m e a l s ; • M a n a g e p e r s o n a l fi n a n c e s ; • S h o p fo r p e r s o n a l n e e d s ; • U s e p u b l i c o r p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s • P e r f o rm h o u s e w o r k ; • M o v e a b o u t i n d o o r s a n d o u t d o o r s ; • P e r f o r m p e r s o n a l h y g i e n e a n d s e l f c a r e ; • M a n a g e p e r s o n a l m e d i c a t i o n ; • M a k e d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e • R e l a t e t o , c o m m u n i c a t e o r i n t e r a c t w i t h o t h e r EM T 0 0 3 ( 1 0 1 06 / 0 1 )I A P P EA L # r b e d w h e n s h e r o l l s o v e r , s h e c a n n o t w a t c h . S h e l i e s o n t h e f l o o r t o w a t c h t e l e v i s i o n s o t h a t r 1 0 m i n u t e s . S h e r e l i e s o n h e r c h i l d r e n t o c a r r y o n t h e s t a i r s a n d b e c a u s e i t c o u l d h u r t h e r b a c k e n h e l p h e r c a r r y g r o c e r i e s a n d s h o p p i n g . S h e h t u b b e c a u s e i t h u rt s h e r b a c k , a n d s h e r e l i e s o n h e a p p e l l a n t h a s d e v e l o p e d c o p i n g m e c h a n i s m s t w h e n s h e c o o k s s o s h e d o e s n ' t b u r n fo o d . T h e t e n f o r g e t s t h i n g s . a t a s e v e r e i m p a i r m e n t w a s n o t e s t a b l i s h e d , a n d i o n s a s a r e s u l t ' ' o f h e r m e d i c a l c o n d i t i o n ( s ) , t h e a i r m e n t s i g n i f i c a n t l y r es t r i c t s d a i l y l i v i n g a c t i v i t i e s h e m i n i s t r y r e f e r r e d t o t h e f a c t t h a t t h e p h y s i c i a n o e s n o t d i r e c t l y r e s t r i c t h e r a b i l i t y t o p e r f o r m e r i n t h e P R o n t h e r e e v a l u a t i o n . T h e i r o p r a c t o r o r i g i n a l l y 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 A s , b u t t h a t t h e c h i r o p r a c t o r r e v i s e d t h i s a n s w e r e l l a n t w a s i n d e p e n d e n t i n " 2 8 o u t o f 3 8 " o f t h e a p p e l l a n t ' s a b i l i ty t o p e r f o r m D L A s t h a t a r e n o t a n t ' s c h i r o p r a c t o r i n c l u d e s " c o m m e n t s s u c h a s y ' , ' v e r t i g o a t t i m e s ' . ' l o n g e r i f b a c k i s f l a r e d . t o p e r f o r m s o m e o f [ h e r ] D LA s i s e p i s o d i c i n y / w e e k / m o n t h t h a t [ t h e a p p e l l a n t ' s ] D L A s a r e a t e m e n t o f t h e o c c u p a t i o n a l t h e r a p i s t i n t h e J u n e l y i n d e p e n d e n t w i t h h e r a c t i v i t i e s o f d a i l y l i v i n g . D A t h a t 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 n fi rm t h a t r e s t r i c t h e r a b i l i t y t o p e r f o n m h e r D L A e p a n e l n o t e s t h a t a l t h o u g h a p r e s c r i b e d i o n , a n i n d i v i d u a l r e q u i r e s a s s i s t a n c e e i t h e r s d o e s n o t n e c e s s a r i l y m e e t t h e l e g i s l a t i v e t e s t o f t o b e c o n s i d e r e d f o r a p e r s o n w i t h a m e n t a l D R , a s f o l l o w s : ; o r fi n a n c e s ; a n d s e f f e c t i v e l v .
I n t h e a p p e l l a n t ' s c a s e , w h i l e h e r p h y s i c i a n i n d i c a t e d d i ffi c u l t y s t a y i n g f o c u s e d , h e r p h y s i c i a n d e f e r r e d t o t fu n c t i o n a l s k i l l s a n d 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 ' s i m T h e a p p e l l a · n t ' s c h i r o p r a ct o r ( a p r e s c r i b e d p r o f e s s i o a p p e l l a n t ' s a b i l i ty t o p e r f o r m h e r D L A i n t h e A R ( b o t 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 i s i n d e p e n d e n t i n 2 o f t h p r e p a r a t i o n , b u t t a k e s s i g n ifi c a n t l y l o n g e r w i t h c o o k i I n t h i s r e s p e c t , t h e a p p e l l a n t t o l d t h e p a n e l t h a t s h e l o w f o m o d e r a t e h e a t a n d s e t s t i m e r s t o r e m i n d h e r T h e a p p e l l a n t ' s c h i r o p r a c t o r i n d i c a t e d t h a t s h e w a s t h e D L A o f m a n a g e p e r s o n a l f i n a n c e s a s w e l l a s D L A o f m a n a g i n g p e r s o n a l m e d i ca t i o n . T h e a p p e l l a T h e c h i r o p r a c t o r i n d i ca t e d t h a t s h e w a s i n d e p e n d e n p e r s o n a l n e e d s , n o t i n g t h a t " s o n c a r r i e s g r o c e r i e s " a c o n t i n u o u s l y a s s i s t h e r i n h e r d a i l y l i f e t o p r e v e n t e x h e r e v i d e n c e , t h e a p p e l l a n t a g r e e d s h e d o e s t h e s h o t h e l o a d i n g a n d u n l o a d i n g o f t h e c a rt a n d c a r r y i n g p 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 w a s i n d e p e n d e n t i n t h e p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s , b u t g e t t i n g i n t o a n d b a c k i s f l a r e d . " T h e a p p e l l a n t t o l d t h e p a n e l s h e i s a r e v i s e d A R i n d i c a t e d t h a t t h e a p p e l l a n t r e q u i r e d c o n D L A o f h o u s e w o r k , b u t w r o t e t h e fo l l o w i n g c o m m e n t a s s i s t a n c e , " o c c a s i o n a l l y w h e n d i zz y . N e e d s a s s i s t a p a n e l t h a t h e r s o n v a c u u m s a s i t h u r t s h e r s h o u l d e r , d o w n t h e s t a i r s b e c a u s e s h e r e q u i r e s b o t h h a n d s f o b a t h r o o m , b u t o n l y s p r a y s t h e b a t h t u b w i t h c l e a n e r b F o r t h e D L A o f m o v i n g a b o u t i n d o o r s a n d o u t d o o r s , w a l k i n g i n d o o r s a n d o u t d o o rs , u s e s r a i l s t o c l i m b s t a a p p e l l a n t t o l d t h e p a n e l t h a t s h e o c c a s i o n a l l y u s e s a F o r t h e D L A o f p e r s o n a l h y g i e n e a n d s e l f c a r e , t h e c i n d e p e n d e n t i n 7 o f t h e 8 l i s t e d t a s k s , b u t u s e s a s e a w h e n d i zzy " g e t t i n g i n a n d o u t o f b e d a n d o n a n d o f f i n h e r t e s t i m o n y . F o r t h e D L A s p e c i f i c a l l y r e l a t e d t o p e r s o n s w i t h a m b y h e r c h i r o p r a c t o r i n t h e A R o r b y h e r p h y s i c i a n i n t a d i r e c t a n d s i g n i f i c a n t i m p a c t o n h e r p e r f o r m a n c e o a c t i v i t i e s , c a r e o r f i n a n c e s ( t h e c h i r o p r a c t o r i n d i c a t e d h e r p e r s o n a l f i n a n c e s a n d m e d i c a t i o n s ) . F o r t h e D LA o t h e r s e f f e c t i v e l y , t h e c h i r o p r a c t o r i n d i c a t e d i n t h e A s o c i a l fu n c t i o n i n g a n d h a d g o o d f u n c t i o n i n g w i t h h e r d i d n o t r e v i s e t h e s e a n s w e r s o n r e e v a l u a t i o n ) . T h e m a r g i n a l fu n c t i o n i n g w i t h e x t e n d e d s o c i a l n e t w o r k s , c o n f u s i n g s i t u a t i o n s . " EM T 00 3 ( 1 0/ {)6/() 1 )A P P E A L # I i n t h e P R t h a t s h e w a s e a s i l y d i s t r a c t e d a n d h a s I h e a p p e l l a n t ' s c h i r o p r a c t o r i n t h e a s s e s s m e n t o f i p a i r m e n t d i d n o t a f f e c t h e r a b i l i ly t o p e r f o rm D L A . l n a l ) p r o v i d e d t h e i n f o r m a t i o n r e g a r d i n g t h e h t h e o r i g i n a l a n d r e e v a l u a t i o n ) . T h e c h i r o p r a c t o r e 4 t a s k s a s s o c i a t e d w i t h t h e D L A o f m e a l n g a n d f o o d p r e p a r a t i o n " fo r g e t s w h a t ' s c o o k i n g . " p r e p a r e s t h e m e a l s fo r h e r f a m i l y . b u t c o o k s o n t h a t s h e i s c o o k i n g s o t h a t s h e d o e s n ' t b u r n fo o d . i n d e p e n d e n t i n a l l a s p e c t s o f p a y i n g r e n t a n d b i l l s i n d e p e n d e n t i n a l l 3 o f t h e l i s t e d t a s k s f o r t h e n t d i d n o t c h a l l e n g e t h i s i n f o r m a t i o n . t i n 4 o f t h e 5 t a s k s o f t h e D L A o f s h o p p i n g f o r n d t h a t t h e a p p e l l a n t ' s c h i l d r e n " m u s t c e s s i v e s t r a i n o n h e r l o w e r a n d u p p e r b a c k . " I n p p i n g f o r t h e f a m i l y , b u t h e r c h i l d r e n h e l p w i t h u r c h a s e s i n s i d e t h e h o m e . H e r c h i r o p r a c t o r 3 l i s t e d a s p e c t s o f t h e D LA o f u s i n g p u b l i c o r o u t o f a v e h i c l e t a k e s h e r s i g n i f i c a n t l y l o n g e r " i f b l e t o d r i v e h e r v e h i c l e . T h e c h i r o p r a c t o r i n t h e t i n u o u s a s s i s t a n c e t o p e r f o r m t h e 2 t a s k s o f t h e , w h i c h q u a l i f i e s t h e c h e c k m a r k o f c o n t i n u o u s n c e i f g e t s b a c k s p a s m . " T h e a p p e l l a n t t o l d t h e a n d t h a t h e r c h i l d r e n ca r r y t h e l a u n d ry u p a n d r b a l a n c e . S h e a l s o s a i d t h a t s h e c l e a n s t h e e c a u s e s h e c a n ' t b e n d d o w n t o s c r u b t h e t u b . t h e c h i r o p r a c t o r i n d i ca t e d t h a t s h e i s i n d e p e n d e n t i r s , a n d h a s v e rti g o a t t i m e s w h e n s t a n d i n g . T h e ca n e t o w a l k o r s k i p o l e s w h e n s h e i s h i k i n g . i h i r o p r a c t o r i n d i c a t e d t h a t t h e a p p e l l a n t i s i t i n t h e s h o w e r w h e n b a t h i n g a n d " t a k e s h e r t i m e a c h a i r . T h e a p p e l l a n t c o n f i r m e d t h i s e v i d e n c e l e n t a l i m p a i r m e n t , t h e r e i s n o i n fo r m a t i o n p r o v i d e d h e P R t o i n d i c a t e t h a t h e r m e n t a l i m p a i r m e n t h a s f t h e D L A o f m a k i n g d e c i s i o n s a b o u t p e r s o n a l s h e w a s i n d e p e n d e n t i n a l l t a s k s o f m a n a g i n g o f r e l a t i n g t o , c o m m u n i c a t i n g o r i n t e r a c t i n g w i t h R t h a t s h e w a s i n d e p e n d e n t i n a l l a s p e c t s o f i m m e d i a t e s o c i a l n e tw o r k ( a n d t h e c h i r o p r a c t o r c h i r o p r a c t o r i n d i c a t e d t h a t t h e a p p e l l a n t h a s w r i t i n g t h e c o m m e n t , " s h e s t a y s h o m e t o a v o i d
APPEAL# I The chiropractor has indicated that she takes significantly longer than typical to perform two of the four tasks of the DLA of meal preparation, and one of the tasks of using public and personal \ transportation (if her back is flared ) . The chiropractor has also indicated that she requires continuous assistance -albeit only if she is dizzy or if her back spasms to perform the DLA of housework. However, the appellant has confirmed that she is able to perform the tasks of these DLA, with some assistance if she is dizzy or if her back hurts. The panel concurs with the ministry's comments ! regar ding the lack of information surrounding the frequency and duration of the appellant's dizziness episodes. Nor has the appellant's chiropractor provided any narrative to support his cognitive and ! · emotiorial impact assessments. Wrthout such information, and based on the evidence provided, the panel finds that the ministry's determination that -although the appellant has certain limitations as a result of her medical conditions -the information provided does not establish that her brain injury significantly restricts her DLA continuously or periodically for extended periods is reasonable. Help with DLA The appellant told the panel that she needs help from her" children to perform her DLA -that because of her back pain, dizziness and vertigo, she needs their help carrying laundry, carrying groceries, and vacuuming. The appellant described how she sets alarms and timers and cooks on low to medium heat so that she won't forget things on the stove, and how she has restricted herself to stores that are familiar. The appellant also said that she had several assistive devices in her house from when her mother lived with them, such as bath rails and bath chair, and that she did not discuss her use of these things with her doctor because they were from her mother. In its reconsideration, the ministry noted that the appellant's physician said she uses a bath chair and stair rails, but determined that as it "had not been established that [DLA] are significantly restricted ... it cannot be determined that significant help is required from other persons." The legislation requires in subs. 2(b){iii) that in the opinion of a prescribed professional, as a result of the appellant's restrictions, the appellant requires help to perform DLA. The panel notes the evidence before the ministry at the reconsideration as set out by the chiropractor in the AR was that the appellant needs assistance with carrying purchases home, housework, and going to and from stores. The chiropractor has also written in the AR that the appellant's sons "continuously assist her" and that "help for all house-work would be necessary at all times to avoid spinal flare-up or vertigo episodes." Ho wever, the chiropractor does not indicate that the appellant's need for assistance is as a direct result of her brain injury, but rather is to prevent "spinal flare up or vertigo episodes" and the panel finds that the ministry's determination that because it has not been established that DLA are directly and significantly restricted, it cannot be determined that help is required as provided under section 2(2)(b)(ii) of the EAPWDA, is reasonable. 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 is reasonably supported by the evidence. The panel therefore confirms the ministry's decision. EAAT003{10/06/0t)
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.