P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n u n d e r a p p e a l i s t h e M i n i s t r y o f S o c i a l D r e c o n s i d e r a t i o n d e c i s i o n d a t e d M a r c h 2 7 , 2 0 1 4 w h i c t h e f i v e s t a t u t o r y r e q u i r e m e n t s o f S e c t i o n 2 o f t h e E D i s a b il i t i e s A c t f o r d e s i g n a t i o n a s a p e r s o n w i t h d i s a a p p e l l a n t m e t t h e a g e r e q u i r e m e n t a n d t h a t h e r i m p H o w e v e r , t h e m i n i s t r y w a s n o t s a t i s f i e d t h a t t h e e v i d • t h e a p p e l l a n t h a s a s e v e r e p h y s i c a l o r m e n t a • t h e a p p e l l a n t ' s d a i l y l i v i n g a c t i v i t i e s ( D L A ) a r e d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t e d e i t h e r c o n t • a s a r e s u l t o f t h e s e r e s t r i c t i o n s , t h e a p p e l l a n t a n o t h e r p e r s o n , t h e u s e o f a n a s s i s t i v e d e v i c p e r f o r m D L A . P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b A P P E A L # I e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ( t h e m i n i s t r y ) h f o u n d t h a t t h e a p p e l l a n t d i d n o t m e e t t h r e e o f 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 b i l i t i e s ( P W D ) . T h e m i n i s t r y f o u n d t h a t t h e a i r m e n t i s l i k e l y t o c o n t i n u e f o r a t l e a s t t w o y e a r s . e n c e e s t a b l i s h e s t h a t : l i m p a i r m e n t ; , . i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l , i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s ; a n d , r e q u i r e s t h e s i g n i f i c a n t h e l p o r s u p e r v i s i o n o f e , o r t h e s e r v i c e s o f a n a s s i s t a n c e a n i m a l t o i l i t i e s A c t ( E A P W D A ) , S e c t i o n 2 il i t i e s R e g u l a t i o n ( E A P W D R ) , S e c t i o n 2
P A R T E S u m m a r v o f F a c t s T h e m i n i s t r y d i d n o t a t t e n d t h e h e a r i n g . A f t e r c o n f i r p r o c e e d e d u n d e r 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 T h e e v i d e n c e b e f o r e t h e m i n i s t r y a t t h e t i m e o f t h e r D i s a b i l i t i e s ( P W D ) A p p l i c a t i o n c o m p r i s e d o f t h e a p p 6 , 2 0 1 3 , a p h y s i c i a n r e p o rt ( P R ) a n d a n a s s e s s o r r e c o m p l e t e d b y a g e n e r a l p r a c t i t i o n e r w h o h a s k n o w n i n c l u d e d t h e f o l l o w i n g : A R e q u e s t f o r R e c o n s i d e r a t i d a t e d M a r c h 2 0 , 2 0 1 4 w h i c h h a s b e e n c o m p l e t e d a n D i a g n o s e s I n t h e P R , t h e a p p e l l a n t w a s d i a g n o s e d b y t h e m e d i s h o u l d e r s / f i b r o m y a l g i a , c h r o n i c l o w b a c k a n d c h e s t t h e P R f o r a m e n t a l d i s o r d e r . P h y s i c a l I m p a i r m e n t I n t h e P R , t h e a p p e l l a n t ' s p h y s i c i a n r e p o r t e d t h a t : • I n t e r m s o f h e a l t h h i s t o r y , " a l l s y m p t o m s w o r s v a c u u m i n g , h a i r w a s h i n g , d r e s s i n g , o v e r h e a d d e c r e a s e d . " T h e a p p e l l a n t c o m p l a i n e d o f p o o • T h e a p p e l l a n t d o e s n o t r e q u i r e a n y p r o s t h e s i s • I n t e r m s o f f u n c t i o n a l s k i l l s , t h e a p p e l l a n t i s a s u r f a c e , c l i m b 2 t o 5 s t e p s u n a i d e d , c a n d o n • T h e a p p e l l a n t i s n o t r e s t r i c t e d w i t h m o b i l i t y i n I n t h e A R , t h e a p p e l l a n t ' s p h y s i c i a n i n d i c a t e d t h a t : • T h e a p p e l l a n t i s a s s e s s e d a s i n d e p e n d e n t w i a n d n o a s s e s s m e n t f o r c l i m b i n g s t a i r s w i t h t h 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 p e r s o n w t h a t t h e a p p e l l a n t " s t a t e s c a n n o t l i f t / c a r r y a n d • I n t h e s e c t i o n o f t h e A R r e l a t i n g t o a s s i s t a n c e t h e p h y s i c i a n m a r k e d a c a n e a n d n o t e d t h a t t 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 o t e t h a t : • S h e h a s l o t s o f p a i n i n h e r n e c k , b a c k , s h o u l d • T h e p a i n a f f e c t s e v e ry t h i n g s h e d o e s . I n t h e f o r m d a t e d M a r c h 2 0 , 2 0 1 4 , t h e p h y s i c i a n i n d i • T h e a p p e l l a n t " . . . h a s p a i n t h a t a f f e c t s h e r n e c d e c r e a s e R O M s h o u l d e r s . S h e i s u n a b l e t o l i s i g n i f i c a n t p a i n . " M e n t a l I m p a i r m e n t I n t h e P R , t h e a p p e l l a n t ' s p h y s i c i a n r e p o rt e d t h a t : • T h e a p p e l l a n t h a s n o d i f f i c u l t i e s w i t h c o m m u n • T h e r e a r e s i a n i f i c a n t d e f i c i t s w i t h t h e a p p e l l a n I I A P P E A L # I 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 , t h e h e a r i n g a n d A s s i s t a n c e R e g u l a t i o n . e c o n s i d e r a t i o n d e c i s i o n i n c l u d e d t h e P e r s o n W i t h l i c a n t i n f o r m a t i o n a n d s e l f r e p o r t d a t e d N o v e m b e r p o r t ( A R ) b o t h d a t e d N o v e m b e r 6 , 2 0 1 3 a n d t h e a p p e l l a n t f o r 8 y e a r s . T h e e v i d e n c e a l s o o n d a t e d M a r c h 2 0 , 2 0 1 3 w i t h a n a t t a c h e d F o r m d s i g n e d b y t h e a p p e l l a n t ' s f a m i l y p h y s i c i a n . c a l p r a c t i t i o n e r w i t h m y o f a s c i a l p a i n n e c k / l u m b a r / w a l l p a i n . T h e r e w a s n o d i a g n o s i s i n d i c a t e d i n e w i t h a c t i v i t i e s s u c h a s b e n d i n g , t w i s t i n g , l i f t i n g , a c t i v i t i e s ; R O M [ r a n g e o f m o t i o n ] s h o u l d e r s r v i s i o n a n d c a n n o t a f f o r d a n o p t o m e t r y e x a m . o r a i d f o r h e r i m p a i r m e n t . b l e t o w a l k l e s s t h a n 1 b l o c k u n a i d e d o n a f l a t o l i f t i n g , a n d r e m a i n s e a t e d l e s s t h a n 1 h o u r . s i d e t h e h o m e o r m o b i l i t y o u t s i d e t h e h o m e . t h w a l k i n g i n d o o r s a n d o u t d o o r s a n d s t a n d i n g , e n o t e " n o s t a i r s a t h o u s e . " S h e r e q u i r e s i t h l i f t i n g a n d c a r r y i n g a n d h o l d i n g , w i t h a n o t e n e e d s h e l p a l l t h e t i m e . " p r o v i d e d t h r o u g h t h e u s e o f a s s i s t i v e d e v i c e s , h e a p p e l l a n t " u s e s c a n e o n o c c a s i o n . " e r s a n d r i g h t h i p . c a t e d t h a t : k / t r a p e z i u s / c h e s t / s h o u l d e r s , w i t h s i g n i f i c a n t f t , d o a n y o v e r h e a d a c t i v i t i e s , p u s h / p u l l w i t h o u t i c a t i o n . t ' s c o a n i t i v e a n d e m o t i o n a l f u n c t i o n i n t h e a r e a s
APPEAL# I of consciousness, memory, emotional disturbance, motivation, motor activity and attention or sustained concentration. The physician noted that the appellant "complains of poor memory, concentration, motivation, [illegible] with anxiety for a few years. She complains of occasional disorientation/ confusion." • The appellant is not restricted with social functioning. In the AR, the physician indicated that: • The appellant has a good ability to communicate in all areas, including speaking, reading, writing and hearing. • There are major impacts to the appellant's cognitive and emotional functioning in the areas of emotion and motivation. • There are moderate impacts in the areas of consciousness, attention/concentration, executive, and memory. • There are no impacts in the areas of bodily functions, impulse control, insight and judgement, motor activity, language, psychotic symptoms, and other neuropsychological problems. The physician added comments that the appellant "complains of confusion/ disorientation at times only" and "poor mood, motivation, concentration and memory, appetite OK, for a few years." • The appellant is assessed as independent with all aspects of social functioning, including making appropriate social decisions, developing and maintaining relationships, interacting appropriately with others, dealing appropriately with unexpected demands, and securing assistance from others. • The appellant ha. s good functioning in both her immediate and extended social networks. Daily Living Activities (DLA) In the PR, the physician indicated that: • The appellant has not been prescribed any medication and/or treatment that interfere with her daily living activities. • The appellant is not restricted in performing a majority of her DLA, including personal self care, meal preparation, management of medications, mobility inside and outside the home, and social functioning. • The appellant is continuously restricted in performing the basic housework, daily shopping and management of finances DLA, and it is unknown whether the appellant is restricted with use of transportation. • In response to a question about assistance need with DLA, the physician wrote that the appellant "needs family help with housework/ finance such as bills, taxes, shopping. Needs help vacuuming, carrying, washing/cleaning house; needs help carrying groceries." In the AR, the physician reported that: • The appellant is independent with moving about indoors and outdoors. • The appellant is independent in 6 out of 8 tasks of the DLA personal care, including grooming, toileting, feeding self, regulating diet, transfers in/out of bed and transfers on/off chair. The appellant requires periodic assistance from another person with dressing, described by the physician as "need help putting pants on at times", and with bathing, with the note "pain shoulder-need help with bathing." • The appellant is independent with doing her laundry and requires continuous assistance from another person with basic housekeeping, with the comment added that "need help with housework due to pain [illeqible]."
APPEAL# I • The appellant is independent in performing 4 of 5 tasks of the DLA shopping, including going to and from stores, reading prices and labels, making appropriate choices, and paying for purchases. The appellant requires continuous assistance with carrying purchases home. • The appellant is independent with 3 out of 4 tasks of the DLA meals, including meal planning, food preparation, and safe storage of food. The appellant requires periodic assistance with cooking, with no explanation or description provided. • The appellant is independent with 2 of 3 tasks of the DLA paying rent and bills, including budgeting and paying rent and bills. She requires periodic assistance from another person with banking and the physician notes "needs assistance." • The appellant is independent in performing all 3 tasks of managing her medications: filling/refilling prescriptions, taking as directed and safe handling and storage. • The appellant is independent with using transit schedules and arranging transportation and requires periodic assistance with getting in and out of a vehicle. There is no assessment for using public transit as the physician notes that the appellant "doesn't use public transit." In her self-report, the appellant wrote that: • Her pain affects everything she does such as going to the toilet, getting dressed, making her bed, doing dishes, vacuuming, and bathing. It also affects activities such as golfing, fishing, bingo, and holding her grandchildren. In the form dated March 20, 2014, the physician indicated that: • The appellant has a severe mental or physical impairment that directly and significantly restricts her ability to perform DLA continuously or periodically for extended periods. • The DLA that are restricted continuously are basic housework and daily shopping. • The appellant " ...i s unable to lift, do any overhead activities, push/ pull without significant pain. She has had to stop ...s chool due to her symptoms. She will have difficulty lifting groceries." Need for Help The physician reported in the AR that the help required for DLA is provided by the appellant's family. In the section of the report indicating assistance provided through the use of assistive devices, the physician indicated that the appellant uses a cane "on occasions." In the form dated March 20, 2014, the physician indicated that, in his opinion, the appellant requires help to perform the activities in which she is restricted. In her Notice of Appeal dated March 10, 2014, the appellant expressed her disagreement with the ministry's reconsideration decision and wrote that she meets all the criteria in the legislation for PWD benefits as supported by her doctor. Prior to the hearing, the appellant provided the following additional documents: 1) Written submission on behalf of the appellant with excerpts from the decision in Hudson v. EAAT, 2009 BCSC 1461; and, 2) Note dated April 23, 2014 from the physician who completed the reports with the PWD application. The physician wrote that he confirms that the appellant has osteoarthritis and degenerative disc in her neck.
I APPEAL# At the hearing, the appellant stated: • She has a hard time with everything: with washing her hair, with getting dressed, vacuuming, and making beds. She cannot pick up her grandchildren. • She cannot drive because she cannot see properly. She also cannot turn to make a shoulder check. She has never taken public transit and would not know how to take it. • She has to get someone to wash her hair because of the pain in her shoulders and neck which makes it so she cannot lift up her arms. • The lack of sleep due to pain makes it worse and she becomes very emotional. She wakes up 6 or 8 times each night because of the pain. • She has no way to get her medications because she cannot afford to pick them up at the pharmacy. Her daughter supplies her with Tylenol #3 and Advil. Her doctor had given her some sample medications for the pain and for sleeping but they ran out. • The pain is in her hip, knee, right shoulder and her neck. Sometimes her hands become numb or "go to sleep" and it is hard to move them. • She has a problem with her bladder which leads to incontinence and her doctor has asked her to take some tests to find the problem. • All her activities are limited and they are becoming limited more and more every day. • She lives with a friend who helps her do everything throughout the day. He is retired so he is available to help her. • She cannot open a can or twist or turn to open a jar. She needs help to get dressed. • Her friend prepares the meals and does everything around the house. If it were not for him, she would be in the hospital. He does all the shopping, the cooking, and the laundry. She will sit and fold the laundry. • She can only stand for 10 minutes and sit for 10 minutes and then she has to walk. She cannot climb stairs very well. She climbs 4 stairs and then needs to rest. • She uses a cane "on and off" both in the house and outside. • Her doctor told her to walk 30 minutes every day but she has a bad knee and she can only walk for 10 minutes and then she needs to stop and rest. She has had an operation on her knee twice and if she overdoes her activity it "hurts so badly and gets swollen." • Her neck is sore all the time. She applies a heat pack which helps sometimes. She had an injection of cortisone in her back and 2 in her shoulders. • With her fibromyalgia, she "feels bruised all over." She took a course for specialized occupational training and she cannot do the work due to the pain in her shoulder and neck. • Her doctor thinks she is depressed. He gave her some questionnaires to complete but she could not understand his handwriting and did not know what to do. He gave her this information quite a long time ago but she has not done anything with it. The doctor will not give her pain killers because he is afraid she "will try to kill herself." • Her condition has gotten much worse than the time that the reports for the PWD application were prepared. Admissibility of New Information In the physician's note, new information was provided regarding the appellant's impairment. This information provides additional detail with respect to the pain in the appellant's neck, referred to in the original PWD application. The appellant also provided further detail of the impact of her conditions in her oral testimony. The panel admitted the physician's note and the appellant's oral testimony as new information in support of information and records that were before the ministry at the time of reconsideration, in accordance with Section 22(4) of the Emp!ovment and Assistance Act.
I A P P E A L # � � --� -----P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e o n t h e a p p e a l i s w h e t h e r t h e m i n i s t r y ' s r e c o n s i d e r a t i o n d e c i s i o n , w h i c h f o u n d t h a t t h e a p p e l l a n t i s n o t e l i g i b l e f o r d e s i g n a t i o n a s a p e r s o n w i t h d i s a b i l i t i e s ( P W D ) , w a s r e a s o n a b l y s u p p o r t e d b y t h e e v i d e n c e o r w a s a r e a s o n a b l e a p p l i c a t i o n o f t h e a p p l i c a b l e e n a c t m e n t i n t h e c i r c u m s t a n c e s o f t h e a p p e l l a n t . T h e m i n i s t r y f o u n d t h a t t h e a p p e l l a n t d o e s n o t h a v e a s e v e r e m e n t a l o r p h y s i c a l i m p a i r m e n t a n d t h a t h e r d a i l y l i v i n g a c t i v i t i e s ( D L A ) a r e n o t , i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l , d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t e d e i t h e r c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s a n d t h a t , a s a r e s u l t o f t h o s e r e s t r i c t i o n s , i t c o u l d n o t b e d e t e r m i n e d t h a t t h e a p p e l l a n t r e q u i r e s t h e s i g n i f i c a n t h e l p o r s u p e r v i s i o n o f a n o t h e r p e r s o n , t h e u s e o f a n a s s i s t i v e d e v i c e , o r t h e s e r v i c e s o f a n a s s i s t a n c e a n i m a l t o p e r f o r m D L A . T h e c r i t e r i a f o r b e i n g d e s i g n a t e d a s a p e r s o n w i t h d i s a b i l i t i e s ( P W D ) a r e s e t o u t i n S e c t i o n 2 o f t h e E A P W D A a s f o l l o w s : P e r s o n s w i t h d i s a b i l i t i e s 2 ( 1 ) I n t h i s s e c t i o n : " a s s i s t i v e d e v i c e " m e a n s a d e v i c e d e s i g n e d t o e n a b l e a p e r s o n t o p e r f o r m a d a i l y l i v i n g a c t i v i t y t h a t , b e c a u s e o f a s e v e r e m e n t a l o r p h y s i c a l i m p a i r m e n t , t h e p e r s o n i s u n a b l e t o p e r f o r m ; " d a i l y l i v i n g a c t i v i t y " h a s t h e p r e s c r i b e d m e a n i n g ; " p r e s c r i b e d p r o f e s s i o n a l " h a s t h e p r e s c r i b e d m e a n i n g . { 2 ) T h e m i n i s t e r m a y d e s i g n a t e a p e r s o n w h o h a s r e a c h e d 1 8 y e a r s o f a g e a s a p e r s o n w i t h d i s a b i l i t i e s f o r t h e p u r p o s e s o f t h i s A c t i f t h e m i n i s t e r i s s a t i s f i e d t h a t t h e p e r s o n h a s a s e v e r e m e n t a l o r p h y s i c a l i m p a i r m e n t t h a t ( a ) i n t h e o p i n i o n o f a m e d i c a l p r a c t i t i o n e r i s l i k e l y t o c o n t i n u e f o r a t l e a s t 2 y e a r s , a n d { b ) i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l ( i ) d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s t h e p e r s o n ' s a b i l i t y t o p e 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 e i t h e r { A ) c o n t i n u o u s l y , o r ( 8 ) 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 rf 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 rf o r m i t , t h e p e r s o n r e q u i r e s ( i ) a n a s s i s t i v e d e v i c e , ( i i ) t h e s i g n i f i c a n t h e l p o r s u p e r v i s i o n o f a n o t h e r p e r s o n , o r ( i i i ) t h e s e r v i c e s o f a n a s s i s t a n c e a n i m a l . ( 4 ) T h e m i n i s t e r m a y r e s c i n d a d e s i g n a t i o n u n d e r s u b s e c t i o n ( 2 ) . S e c t i o n 2 ( 1 ) ( a ) o f t h e E A P W D R d e f i n e s D L A f o r a p e r s o n w h o h a s a s e v e r e p h y s i c a l o r m e n t a l i m p a i r m e n t a s f o l l o w s : D e f i n i t i o n s f o r A c t 2 ( 1 ) F o r t h e p u r p o s e s o f t h e A c t a n d t h i s r e g u l a t i o n , " d a i l y l i v i n g a c t i v i t i e s " , ( a ) i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e p h y s i c a l i m p a i r m e n t o r a s e v e r e m e n t a l i m p a i r m e n t , m e a n s t h e f o l l o w i n g a c t i v i t i e s : ( i ) p r e p a r e o w n m e a l s ; ( i i ) m a n a g e p e r s o n a l f i n a n c e s ;
APPEAL# I (iii) shop for personal needs; (iv) use public or personal transportation facilities; (v) perform housework to maintain the person's place of residence in acceptable sanitary condition; (vi) move about indoors and outdoors; (vii) perform personal hygiene and self care; (viii) manage personal medication, and (b) in relation to a person who has a severe mental impairment, includes the following activities: (i) make decisions about personal activities, care or finances; (ii) relate to, communicate or interact with others effectively. Severe Phvsical Impairment The appellant's position is that a severe physical impairment is established by the evidence of her constant pain due to myofascial pain neck/ lumbar/ shoulders/ fibromyalgia, chronic low back and chest wall pain. In the written submission, the advocate argued that the functional skill limitations indicated by the doctor in the PR suggest a significant deficit and imply that some DLA would require assistance or the appellant would be unable to do things. The ministry's position is that there is not enough information from the general practitioner to confirm that the appellant has a severe physical impairment. The ministry argued that, in terms of functional assessment, the general practitioner indicated that the appellant can walk less than 1 block and climb 2 to 5 stairs, she can remain seated for less than 1 hour and she cannot lift. The ministry argued that no assistive devices are routinely used to help compensate for impairment (a cane is used on occasion). The ministry argued that the appellant is independently able to do most aspects of mobility and physical abilities with continuous help to lift/ carry/ hold. Panel Decision A diagnosis of a serious medical condition does not in itself determine PWD eligibility or establish a severe impairment. An "impairment" is a medical condition that results in restrictions to a person's ability to function independently or effectively. To assess the severity of an impairment one must consider the nature of the impairment and the extent of its impact on daily functioning as evidenced by functional skill limitations and the degree to which performing DLA is restricted. In making its determination the ministry must consider all the relevant evidence, including that of the appellant. However, the legislation is clear.that the fundamental basis for the analysis is the evidence from a prescribed professional -in this case, the appellant's physician. The medical practitioner, a physician who has known the appellant for a period of 8 years, diagnosed the appellant with myofascial pain neck/ lumbar/ shoulders/ fibromyalgia, chronic low back and chest wall pain. In the Note dated April 23, 2014, the same physician wrote that he confirms that the appellant has osteoarthritis and degenerative disc in her neck. There were no further reports provided to indicate the progress of the condition or the degree of degeneration. In terms of functional skills, the appellant is able to walk less than 1 block unaided on a flat surface, climb 2 to 5 steps unaided, can do no lifting, and remain seated less than 1 hour. However, the physician also re orted in the PR that the a ellant is not restricted with mobilit inside the home or mobilit outside
I APPEAL# the home and she does not require any prosthesis or aid for her impairment. In the section of the AR relating to assistance provided through the use of assistive devices, the physician marked a cane and noted that the appellant "uses cane on occasion." At the hearing, the appellant stated that she uses a cane "on and off" both inside and outdoors. The appellant stated that her doctor told her to walk 30 minutes each day but she finds that her knee starts to get sore and she has to rest after walking 10 minutes. In the AR, the physician reported that the appellant is independent with walking indoors and outdoors and standing, and no assessment for climbing stairs with the note "no stairs at house." At the hearing, the appellant stated that she does not climb stairs very well, that she needs to rest after climbing 4 stairs. She requires continuous assistance from another person with lifting and carrying and holding, with a note that the appellant "states cannot lift/ carry and needs help all the time." The appellant stated at the hearing that her condition has deteriorated and become much worse than the time that the reports were completed for her PWD application. Given an opportunity to provide further comment and updated information in the form dated March 20, 2014, the physician indicated that the appellant " ... has pain that affects her neck/ trapezius/ chest/ shoulders, with significant decrease ROM shoulders. She is unable to lift, do any overhead activities, push/ pull without significant pain. She has had to stop ...s chool due to her symptoms. She will have difficulty lifting groceries." The appellant stated at the hearing that she cannot afford the pain medications that have been prescribed to her, and it is therefore unknown whether these medications may alleviate some of the pain symptoms experienced by the appellant. The panel finds that the ministry reasonably concluded that the evidence of the appellant's physician, who has known the appellant for 8 years, together with the appellant's testimony at the hearing including that her doctor is encouraging her to walk and she can walk for up to 1 O minutes, demonstrates that the appellant remains largely independent with her mobility and physical abilities, except with lifting and carrying/holding. The panel, therefore, finds that the ministry reasonably determined that there is not sufficient evidence to establish that the appellant has a severe physical impairment under section 2(2) of the EAPWDA. Severe Mental Impairment The appellant did not maintain a position that she has a severe mental impairment, although she stated at the hearing that her doctor believes she may be depressed and he will not prescribe pain medication because he is afraid she may commit suicide. The ministry's position is that the physician did not report a mental health diagnosis and does not provide sufficient evidence to confirm a severe mental impairment. The ministry argued that the appellant is assessed as having a good ability to communicate in all areas with no restriction to social functioning. The ministry argued that although the physician reported the appellant has significant deficits with her cognitive and emotional function in several areas, the impacts on daily functioning are mostly moderate with two major impacts on emotion and motivation, and a number of aspects with no impact at all. Panel Decision The general practitioner did not diagnose a mental health condition in the PR and reported that the a ellant is not restricted in her social functionin . The a ellant is assessed as havin a ood
a b i l i t y t o c o m m u n i c a t e i n a l l a r e a s . T h e p h y s i c i a n r c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n t h e a r e a s o f c o n m o t i v a t i o n , m o t o r a c t i v i t y a n d a t t e n t i o n o r s u s t a i n e d a p p e l l a n t " c o m p l a i n s o f p o o r m e m o r y , c o n c e n t r a t i o n y e a r s . S h e c o m p l a i n s o f o c c a s i o n a l d i s o r i e n t a t i o n / a r e a s , t h e i m p a c t t o d a i l y f u n c t i o n i n g i s a s s e s s e d b e m o t i o n a n d m o t i v a t i o n , m o d e r a t e i n c o n s c i o u s n e s s a n d n o i m p a c t i n t h e r e m a i n i n g 7 a r e a s o f f u n c t i o n i n w i t h a l l a s p e c t s o f s o c i a l f u n c t i o n i n g a n d s h e h a s g o e x t e n d e d s o c i a l n e t w o r k s . G i v e n t h e a b s e n c e o f a i m p a c t s t o m e n t a l f u n c t i o n i n g , a n d n o i m p a c t t o c o m t h a t t h e m i n i s t ry r e a s o n a b l y d e t e r m i n e d t h a t a s e v e s e c t i o n 2 ( 2 ) o f t h e E A P W D A . R e s t r i c t i o n s i n t h e a b i l i t y t o p e r f o r m D L A T h e a p p e l l a n t ' s p o s i t i o n i s t h a t h e r p h y s i c a l i m p a i r m p e r f o r m D L A o n a n o n g o i n g b a s i s t o t h e e x t e n t t h a t p e r s o n a n d t h e u s e o f a c a n e a s a n a s s i s t i v e d e v i c e d e c i s i o n i n H u d s o n w h i c h s t a t e s t h a t t h e r e m u s t b e i n d i c a t i n g a d i r e c t a n d s i g n i f i c a n t r e s t r i c t i o n o n a t l e a t h a t m o r e t h a n t w o D L A b e r e s t r i c t e d i n o r d e r t o m e T h e m i n i s t r y ' s p o s i t i o n i s t h a t t h e a p p e l l a n t c a n i n d e f o r t h o s e t a s k s w h e r e p e r i o d i c a s s i s t a n c e i s r e q u i r e t h e p e r i o d i c a s s i s t a n c e r e q u i r e d t o i n d i c a t e r e s t r i c t i o P a n e l D e c i s i o n S e c t i o n 2 ( 2 ) ( b ) o f t h e E A P W D A r e q u i r e s t h a t a p r e s a p p l i c a n t ' s s e v e r e i m p a i r m e n t d i r e c t l y a n d s i g n i f i c a n e x t e n d e d p e r i o d s . I n t h i s c a s e , t h e a p p e l l a n t ' s p h y s d e f i n e d i n s e c t i o n 2 ( 1 ) o f t h e E A P W D R a n d a r e a l s o t h e A R . T h e r e f o r e , a p r e s c r i b e d p r o f e s s i o n a l c o m p l w h i c h , i f a n y , D L A a r e s i g n i f i c a n t l y r e s t r i c t e d b y t h e p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s . I n t h e a p p e l l a n t ' s c i r c u m s t a n c e s , h e r p h y s i c i a n r e p o i n p e r f o r m i n g a m a j o r i t y o f h e r D L A , i n c l u d i n g p e r s o m e d i c a t i o n s , m o b i l i t y i n s i d e a n d o u t s i d e t h e h o m e , a r e p o r t e d t h a t t h e a p p e l l a n t i s i n d e p e n d e n t i n 6 o u t o p e r i o d i c a s s i s t a n c e f r o m a n o t h e r p e r s o n w i t h d r e s s i n p u t t i n g p a n t s o n a t t i m e s " , a n d w i t h b a t h i n g , w i t h t h e t h e h e a r i n g , t h e a p p e l l a n t s t a t e d t h a t s h e c a n n o t l i f t h e l p h e r w a s h h e r h a i r . T h e a p p e l l a n t i s i n d e p e n d e n r e q u i r e s p e r i o d i c a s s i s t a n c e w i t h c o o k i n g , w i t h n o e x i s i n d e p e n d e n t i n p e r f o r m i n g a l l 3 t a s k s o f m a n a g i n g t a k i n g a s d i r e c 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 . T i s i n d e e n d e n t w i t h m o v i n a b o u t i n d o o r s a n d o u t d o A P P E A L # I e p o r t e d s i g n i f i c a n t d e f i c i t s w i t h t h e a p p e l l a n t ' s s c i o u s n e s s , m e m o ry , e m o t i o n a l d i s t u r b a n c e , c o n c e n t r a t i o n . T h e p h y s i c i a n n o t e d t h a t t h e , m o t i v a t i o n , [ i l l e g i b l e ] w i t h a n x i e t y f o r a f e w c o n f u s i o n . " D e s p i t e i d e n t i f y i n g d e f i c i t s i n t h e s e y t h e p h y s i c i a n a s m a j o r i n t h e t w o a r e a s o f , a t t e n t i o n / c o n c e n t r a t i o n , e x e c u t i v e , a n d m e m o r y , g . T h e a p p e l l a n t i s a s s e s s e d a s i n d e p e n d e n t o d f u n c t i o n i n g i n b o t h h e r i m m e d i a t e a n d m e n t a l d i s o r d e r d i a g n o s i s , t h e l a r g e l y m o d e r a t e m u n i c a t i o n o r s o c i a l f u n c t i o n i n g , t h e p a n e l f i n d s r e m e n t a l 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 u n d e r e n t d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s h e r a b i l i t y t o s h e r e q u i r e s t h e s i g n i f i c a n t a s s i s t a n c e o f a n o t h e r . T h e a d v o c a t e p r o v i d e d e x c e r p t s f r o m t h e c o u r t e v i d e n c e f r o m a p r e s c r i b e d p r o f e s s i o n a l s t t w o D L A , b u t t h e r e i s n o s t a t u t o r y r e q u i r e m e n t e t t h e P W D e l i g i b i l i t y r e q u i r e m e n t s . p e n d e n t l y m a n a g e t h e m a j o r i t y o f h e r D L A a n d , d , t h e p h y s i c i a n h a s n o t e x p l a i n e d t h e e x t e n t o f n s f o r e x t e n d e d p e r i o d s o f t i m e . c r i b e d p r o f e s s i o n a l p r o v i d e a n o p i n i o n t h a t a n t l y r e s t r i c t s D L A , c o n t i n u o u s l y o r p e r i o d i c a l l y f o r i c i a n i s t h e p r e s c r i b e d p r o f e s s i o n a l . D L A a r e l i s t e d i n t h e P R a n d , w i t h a d d i t i o n a l d e t a i l s , i n e t i n g t h e s e f o r m s h a s t h e o p p o r t u n i t y t o i n d i c a t e a p p e l l a n t ' s i m p a i r m e n t s e i t h e r c o n t i n u o u s l y o r r t e d i n t h e P R t h a t t h e a p p e l l a n t i s n o t r e s t r i c t e d n a l s e l f c a r e , m e a l p r e p a r a t i o n , m a n a g e m e n t o f n d s o c i a l f u n c t i o n i n g . I n t h e A R , t h e p h y s i c i a n f 8 t a s k s o f t h e D L A p e r s o n a l c a r e , a n d r e q u i r e s g , d e s c r i b e d b y t h e p h y s i c i a n a s " n e e d h e l p n o t e " p a i n s h o u l d e r n e e d h e l p w i t h b a t h i n g . " A t h e r a r m s u p a n d s h e n e e d s t o g e t s o m e o n e t o t w i t h 3 o u t o f 4 t a s k s o f t h e D L A m e a l s a n d p l a n a t i o n o r d e s c r i p t i o n p r o v i d e d . T h e a p p e l l a n t h e r m e d i c a t i o n s : f i l l i n g / r e f i l l i n g p r e s c r i p t i o n s , h e p h y s i c i a n r e p o rt e d i n t h e A R t h a t t h e a p p e l l a n t o r s .
In the PR, the physician indi cated that it i s unknown whether the appellant's u r estricted. In the AR, the physician reported that the appellant is independ sched ules and arra ng i ng tr ans portat ion a n d requires periodic vehicle. There is no a ss essment fo r u sing pub l i c transit as "d oesn ' t use public tran sit." At the hearing the appellant stated a n d would not know h ow t o u se i t. In the PR, continuous restrictions are indicated w ith the m anagemen t of finances. The physician commented tha housework/ finance such as bills , tax e s, shopping. c lean i n g house; needs he lp carry ing groceries." In the AR is independent with doi n g her laundry and requires conti b asic housek eeping, w ith t he comment add ed t hat "need help with housework due t Fo r shop ping, th e app ella nt is assessed in t he AR as indepe DLA shop ping , includ i n g going t o and fr o m s t ores, read choi ces , and p aying f or purc ha se s a n d r e qu irin g con h o m e. I n the AR the a ppe lla n t is as se ss e d by t he phy DLA pay ing ren t a nd b ills, i n cl u ding budgeting a n d paying a ss i stance f r o m an other per s on wi th ban k in g and the The appellant stated at the hearing t h a t her frie n d who si nc e she ne eds he lp to do e v e rythi ng , including ge tti prepares th e me als and does ever ything a r ound the house. hospit a l . He does all t he s h opp i ng, th e cooking, an d The app e ll a nt st a t e d that he r c ond i tion has deteriorated since t r eports were complete d. However, given a n opport u ph ysi cian i ndicate d in the f orm d a ted Mar c h 20 , 2014, that conti nu ously are b asic hou sework a n d da ily s hopp in unable to lift, do an y ov er head activities, push/ pull wit ...s c hool due to he r symp toms. She wi l l have dif fi c ulty The co u rt he ld in H u dson that there m us t be evidence from a pr direct and significant restricti on on at least two DLA, and the panel finds that section 2 of the EAPWDA stipulates that th e minis try must be sati sf ied in each case professio nal establishes direct and significant restrictions to the person's ov DLA. T he physician r eported t ha t o nly some of the tasks of the housework and shop co nt inuously restricted, in parti cu lar thos e tasks requiring lifting or For those tasks of other DLA that require periodic assistance (dressing, bathing, cooking, banking, getting in/out of vehicle) there is no narrative to explain how often the assista long; therefore , the panel finds that the ministry reasonably concluded that it cannot be determined that the appellant is restricted periodically for extended periods of time. the ministry rea son a b ly conclu d e d that there is not enough evid to estab lish that the a pp e lla nt' s impairment significantly restricts her ability to manage DLA either continuously or periodically for extended periods, thereby not satisfying the legislative criterion of section 2(2)(b)(i) of the EAPWDA. A P PEAL# I se of transportat ion is ent with us ing transit assistance w ith ge t ting in and out of a t h e physici an notes that t h e ap pellant th a t she has never taken public transit DLA basic housework, dai ly shopping and t the appel lant "n eeds family help w ith Needs help v a c u uming, ca rrying, was h i ng/ , th e physici an r e ported t h at the a p pellant n u ous assistance from another person with o pain [ille gi bl e]." nd e n t in pe rf ormi n g 4 of 5 tasks of th e ing p r ic es and la bels, making appr o pri a t e t inuou s ass i stan c e wit h c ar rying purchas e s s i cian a s in dep endent wi th 2 of 3 tas k s of the ren t and bi l ls a n d r equiring periodic ph ysician notes " n eeds a s sistance. " live s with her help s her thro u gho u t the da y ng d ress ed. The app ella nt state d t h a t her fr ien d I f it were not fo r him , she w ould be in the th e la un dry. Sh e will sit and fold th e laundr y . he time that th e PWD appl icati on n i ty to u p d at e the i n formation provided, th e th e a p pellan t's DLA that a r e restric ted g . T h e phy sician wr o te t h a t the appe llant " ... is hout signific an t pain. She has ha d to st o p lifting grocer i es." es c ribed prof essional indicating a t h at the opin i on of a prescribed erall ability to pe rform ping DLA are ov erhead activities. nc e is needed or for how Overall, the panel finds that en ce from the prescribed professional
H el p t o per form DLA The appel lan t 's po s i tio n is that she requ ires the s i gnif ass i s t ive de vice t o perfo rm DLA . The ministry 's po s i tio n is t hat because i t h as n o t bee restrict ed, it c annot be deter min e d tha t signi ficant help is ap pell a n t uses a cane a:s an ass istiv e d evic e "on occas P anel Dec is ion S ectio n 2(2 )(b ) (ii) of th e E A PWDA requir es t hat, as a ability to p e rform DL A, a pers o n r eq u ir es h e l p to perf subsection (3) as the requ irement f or an ass istive dev anothe r pers on, or t he se rvices of an assistanc e a n imal Th e evidence of t he physician, a s a p r escribed profes pr ovided by t he app el lant' s family. I n th e fo rm dated March his opini on, the ap pell ant re qu ires hel p to per f o rm the p h ysician reporte d t hat th e a pp ellant require s th e use of a oc casion s . " A t the he a r ing, th e app e llant state d tha her DLA, i nc ludin g pre p ari ng the meals, sh op ping, co that i f it we re not for h er fr iend's ass istance s he woul t hat t he e viden ce o f th e pres c r i bed pro fession a l estab ass i s t a nc e from her family , the panel also finds that and significa nt restri c t ions in the appell a n t's abili ty t o per ca n no t be de t er mi n ed t hat th e ap pe llant r equires help to perform a s defined by secti o n 2(3) (b ) of the EAPWD A. Conc l u s io n Havin g reviewed and considered all of the ev i de n ce and relev ministry's r ec onsi d eration d ecision whi ch determined that th des i g na t i o n was reasonabl y supported b y t h e e vidence, and therefor APPEAL# I ic a nt ass i stan ce of anothe r pe rson or an n establ is h e d that DLA are s ig nificantly re q u ired. The ministr y s ta t ed th a t the io n." r e sult of dire c t a nd signi fi c ant re strictions in the orm those ac tiv ities. Help is defined in ic e , th e s ig nifica nt help o r supervi sion of in o rder t o perfo rm a D LA . sional , is t hat th e h elp required wit h DLA is 20 , 2 014, the phys i cian i ndicat e d that, i n acti v i ties i n w h ic h s he is restri c t ed . T he ca n e a s an a s sis tive d evi ce "o n t her f riend w ho l ive s wit h her helps her wit h all of oking, a n d the l a u nd r y. T he app el lant stated d like l y b e in the hospital. W hile th e pa n el fi nd s li s hes th at the ap pe l lant o btains some t he m inistry re a son ably deter m ine d t hat, a s direc t for m DLA have not bee n esta blishe d , i t D LA as a result of t hose r estric tions, an t legislation, the panel finds that the e appell ant w as not eligible f or P WD e confirms the d ecis ion.
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