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 ry o f S o c i a l D " m i n i s t r y " ) r e c o n s i d e r a t i o n d e c i s i o n o f A p r i l 8 , 2 0 1 4 , o f 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 m D i s a b i l i t i e s A c t ( " E A P W D A " ) f o r d e s i g n a t i o n a s a p e t h a t t h e 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 a p p e l l a n t ' s i m p 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 a t i s f i e d t h a t : o t h e e v i d e n c e e s t a b l i s h e s t h a t t h e a p p e l l a n t h 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 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 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 , 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 , a n a s s i s t i v e d e v i c e , o r t h e s e 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 i E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P f= A L # 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 w h i c h f o u n d t h a t t h e a p p e l l a n t d i d n o t m e e t t h r e e 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 r s o n w i t h d i s a b i l i t i e s ( " P W D " ) . T h e m i n i s t r y f o u n d 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 t h e s t t w o y e a r s . 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 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 ; r e , 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 , 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 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 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 . i l i t i e s A c t ( " E A P W D A " ) , s e c t i o n 2 l i t i e s R e g u l a t i o n ( " E A P W D R " ) , s e c t i o n 2
�APPEAL# PART E -Summary of Facts The information before the ministry at the time of reconsideration included the following: • The appellant's PWD application form consisting of the appellant's self-report [dated November 10, 2013], and a physician's report ("PR") and assessor's report ("AR") signed by the appellant's psychiatrist [both dated November 27, 2013]. The panel reviewed the evidence as follows: Mental Impairment • In the PR the psychiatrist diagnosed the appellant with "psychotic depression, moderate", with onset in 2004. In the Health History portion of the PR the psychiatrist noted that the appellant hears voices from time to time most days, that his condition has improved with medication, that his motivation remains poor, and that he spends a lot of time at home. • The psychiatrist noted that "Increasing his medications will reduce his symptoms and improve his level of functioning. The patient is currently comfortable with the dosages and effects of his medications." • In the PR the psychiatrist noted that the appellant has "mild" cognitive deficits that cause difficulty with communication. He explained that the appellant is "easily distractable sometimes and focus can be poor." • In the PR the psychiatrist indicated that the appellant has significant deficits with cognitive and emotional functioning in terms of emotional disturbance (his depression is moderate), motivation (his motivation is somewhat low), and attention or sustained concentration (attention span notably impaired). • The psychiatrist commented that the appellant "will not do well with cognitive therapy as he is not well motivated." • In the AR the psychiatrist described the appellant's impairments as "He hears voices at night. He has depression and he shakes frequently." He reported the appellant's ability to communicate as "satisfactory" with respect to speaking and reading, and "good" with respect to writing and hearing. • In the AR the psychiatrist indicated the appellant's impairment causes moderate impacts to 2 of 14 categories of cognitive and emotional functioning: The remaining 12 categories had minimal or no impacts. The psychiatrist commented that "Because of his anxiety attacks he may behave in a polite manner in public by avoiding contact with people. He has not displayed aggressive behaviour." • In his self-report the appellant wrote that he always hears something speaking in his head, but he doesn't know what it means. He reported that he spends "most" of his time staring into the closet, feeling as though something very heavy is tying him down. • In his oral testimony the appellant stated that he takes 3 to 4 medications a day and that sometimes he doesn't know where he is after he takes his medications. • He sees his psychiatrist once a month for counselling. Physical Impairment • In terms of physical functional skills, the psychiatrist indicated in the PR that the appellant has no limitations with respect to walking unaided on a flat surface, climbing stairs, lifting, or remainina seated. EAA T003(10/06/01)
i APPFAI # • In the AR the psychiatrist reported that the appellant is independent in terms of walking indoors and outdoors, climbing stairs, standing, and lifting/carrying/holding. • In his self-report the appellant wrote that he experiences headaches, dizziness and muscle pain/stiffness which affect his ability to perform DLA. He reported feeling weak, tired, always shaking, and being very dehydrated. The appellant feels these physical impacts are side effects of his medications, but wrote that he is afraid to inform his psychiatrist because the psychiatrist will likely want to increase the dosages of the medications. • In his oral testimony the appellant stated that his medications have caused him to gain weight. They also give him headaches, and make him feel tired so that he can't do much all day. About 2 weeks ago his psychiatrist increased the dosages to help him sleep. His muscles ache and sometimes he can't put on his jacket because his shoulder hurts. DLA • In the PR the psychiatrist noted that the appellant's medications interfere with his ability to perform DLA. He noted that one medication may cause daytime drowsiness from time to time. • In the AR the psychiatrist indicated that the appellant independently manages all aspects of the DLA of personal care, basic housekeeping, daily shopping, managing medications, and use of transportation. • The psychiatrist reported that the appellant requires periodic assistance with two aspects of meal preparation (food preparation and cooking) and two aspects of managing personal finances (banking and budgeting). The appellant independently manages the other aspects of these DLA. • In terms of social functioning, the psychiatrist reported the appellant as being marginally functional with both immediate and extended social networks. He indicated the appellant independently makes appropriate social decisions, but that he needs periodic support/supervision with other aspects of social functioning. • In response to a question from the panel, the appellant said that the help he receives with banking and budgeting is that his friend or sister will give him a ride to the bank. His sister helps him to count his money. His mother and sister cook meals for him and do his laundry. Help • The psychiatrist indicated that the appellant requires no prostheses or aids for his impairment, and that he does not have an assistance animal. • The psychiatrist commented that the appellant's family helps him occasionally to perform complex DLA, and that they occasionally help "as needed e.g. meals and companionship". Admissibl'lity of New Information In his oral testimony the appellant provided new information regarding his impairment. This information provides additional detail with respect to issues addressed in the original PWD application. Accordingly, the panel has admitted this new information as being in support of information and records that were before the ministry at the time of reconsideration, in accordance withs. 22(4) of the Employment and Assistance Act. The ministrv relied on its reconsideration decision and submitted no new information. EMT 003(10/06/0I)
P ART F -Reaso n s for Panel De ci sion The iss u e on t h is a ppeal i s wh eth er the minist ry's deci PWD was re a s onab ly supp ort e d b y t he evide nc e or was a reaso e n actme n t in the c ircumstances of t he ap pella nt . In determi nin g that the appel lant does not have a se vere opini on o f a prescribed p rofessional th e app e l lant's res tric t him from per f orming DL A e ither continuously or p a result of th ose rest ri ct i o ns the appellant d oes not T h e relevan t l e gislation i s a s f o llows: EAP W DA: 2 ( 1 ) In this section : "ass ist ive devic e" mea n s a d e v ice d e sig ned acti vity that, b e ca us e of a sev ere m e nta perform ; "daily l i ving a c tiv ity" ha s t he pre "p re scribe d profess ional " h as t he (2 ) T he min ister m a y desi gna t e a person who d isabilit ies for t he purpo ses of this Act if the minist ment a l or phy sic al impairm en t that ( a) i n the opinion o f a medi c years, and (b ) in t h e opin ion of a p r esc (i) dire c t l y a n d sign if living ac ti v iti es eith er (A ) con t inuous (B) periodically for extended periods, and (ii) as a r esult of t h os those activities. (3) For the purposes of subse ction (2), (a) a person who has a severe mental im mental disorder, an d ( b) a p erson requires h elp in relation perform it, the person requires (i) an ass istive de v i c e (ii) the significant help or supervision of another person, or (iii) the services of an assistance animal. EM T003(10/06/01) APPEAL # � sion to deny the appel lant d esi gn ation a s a nab le app licati o n of the ap pli cable partic ula r, wa s the minist r y rea sonable i n phys i cal or men tal i m p ai r ment, and that i n th e i m pa irmen ts do not di rectly and s i g nif icantly e r io dic ally for e xtende d pe riods , and that a s require he lp to perfo rm DLA? to e n ab l e a per son to p er form a dai ly living l or p h ysi c a l im pairm ent , the p ers o n is una bl e to scribe d meanin g ; p r esc r ib e d meanin g . has reach e d 18 years o f age as a pe r so n w i t h er i s s a tis fied t hat t he p e rs o n ha s a sev ere al pr a ct iti oner is li kely t o c ontin u e f o r at leas t 2 ri b ed p r o f essional icantly rest ric t s t he p er so n ' s ab i lity t o perf orm daily l y, o r e rest ric t ions, the p ers o n requires help to perf o rm pairment includes a person w i th a t o a da ily livi ng act ivity if, in order to ,
I APPEAL# EAPWDR section 2(1): 2 (1) For the purposes of the Act and this regulation, "daily living activities", (a) in relation to a person who has a severe physical impairment or a severe mental impairment, means the following activities: (i) prepare own meals; (ii) manage personal finances; (iii) shop for personal needs; (iv) use public or personal transportation facilities; (v) perform housework to maintain the person's place of residence in acceptable sanitary condition; (vi) move about indoors and outdoors; (vii) perform personal hygiene and self care; (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. (2) For the purposes of the Act, "prescribed professional" means a person who is (a) authorized under an enactment to practise the profession of (i) medical practitioner, (ii) registered psychologist, (iii) registered nurse or registered psychiatric nurse, (iv) occupational therapist, (v) physical therapist, (vi) social worker, (vii) chiropractor, or (viii) nurse practitioner, or (b) acting in the course of the person's employment as a school psychologist by (i) an authority, as that term is defined in section 1 (1) of the Independent School Act, or (ii) a board or a francophone education authority, as those terms are defined in section 1 (1) of the School Act, if qualifications in psychology are a condition of such employment. ******* Severe Mental Impairment The appellant's position is that his psychotic depression, with accompanying symptoms, constitutes a severe mental impairment. The ministry's position, as set out in its reconsideration decision, is that as the psychiatrist has re orted at most moderate im acts to co nitive and emotional functionin , the evidence does not EMT 003(10/06/01)
�APPEAL# establish a severe mental impairment. 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 psychiatrist. The psychiatrist has described the mental impairment as being "moderate" and its impacts on cognitive and emotional functioning as being "mild" or "moderate". In terms of functional skills the psychiatrist noted the appellant's communication skills as being "good" or "satisfactory", though he can be easily distracted and can lose focus. The psychiatrist indicates that the medications are causing an improvement in the appellant's symptoms. Section 2(1)(b) of the EAPWDR prescribes two DLA that are specific to mental impairment-make decisions about personal activities, care or finances (decision making), and relate to, communicate or interact with others effectively (social functioning). The evidence indicates that the appellant is not significantly restricted with respect to decision making in that he independently manages his finances (pay rent and bills -except for getting a ride to the bank from his friend or his sister) and his medications. Based on the evidence in the AR, he also independently manages the decision-making components of the DLA of daily shopping (making appropriate choices), meal preparation (meal planning and food storage), and social functioning (making appropriate social decisions). With respect to the DLA of social functioning, there is evidence to indicate that the appellant is isolating himself to some extent. However, there is no evidence before the panel as to what sort of support or supervision the appellant may require except that his family provides him with companionship. The psychiatrist's evidence indicates that the appellant remains functional (albeit marginally) in respect of his immediate and extended social networks. Considering the evidence as a whole, the panel concludes that the ministry reasonably determined that it does not demonstrate a severe mental impairment. Severe Physical Impairment The appellant's position is that the side effects of the medications he is taking constitute a severe physical impairment. The ministrv's position, as set out in its reconsideration decision, is that the assessments provided bv EMT003(10/06/01)
t h e p s y c h i a t r i s t c o n f i r m t h a t t h e a p p e l l a n t d o e s n o t h P a n e l D e c i s i o n T h e p s y c h i a t r i s t d i d n o t d i a g n o s e a p h y s i c a l i m p a i r m t h a t t h e a p p e l l a n t i s u n r e s t r i c t e d i n t e r m s o f w a l k i n g , e v i d e n c e i n t h e A R i s c o n s i s t e n t w i t h t h i s . T h e a p p e l l a n t r e p o rt s t h a t h e i s s i g n i f i c a n t l y i m p a i r e a n d a f e e l i n g o f h e a v i n e s s . H e f e e l s t h a t m a n y o f t h m e d i c a t i o n s . T h e a p p e l l a n t ' s e v i d e n c e i n d i c a t e s t h a s i d e e f f e c t s o f t h e m e d i c a t i o n s t o t h e p s y c h i a t r i s t f o r o f t h e m e d i c a t i o n s . W h i l e t h e p s y c h i a t r i s t h a s a c k n o i m p a c t o n t h e a p p e l l a n t ' s a b i l i t y t o m a n a g e D L A b y c c o n f i r m e d t h e o t h e r p h y s i c a l i m p a c t s i d e n t i f i e d b y t h t h e s e i m p a c t s , t h e y c a n n o t b e g i v e n s i g n i f i c a n t w e i g t o t h e i r s e v e r i t y . A s d i s c u s s e d i n m o r e d e t a i l i n t h e s u b s e q u e n t s e c t i o R e s t r i c t i o n s t o D L A , a n y p h y s i c a l l i m i t a t i o n s r e s u l t i n t o h a v e t r a n s l a t e d i n t o s i g n i f i c a n t r e s t r i c t i o n s i n h i s a f o r e g o i n g r e a s o n s , t h e p a n e l h a s c o n c l u d e d t h a t w h i s s u e s , 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 s e v e r e p h y s i c a l i m p a i r m e n t a s c o n t e m p l a t e d b y t h e S i g n i f i c a n t R e s t r i c t i o n s t o D L A T h e a p p e l l a n t ' s p o s i t i o n i s t h a t h i s D L A a r e s i g n i f i c a p h y s i c a l l y a n d m e n t a l l y a n d t h a t h e r e l i e s o n f r i e n d s T h e m i n i s t r y ' s p o s i t i o n i s t h a t t h e p s y c h i a t r i s t h a s p r o d u r a t i o n o f a n y a s s i s t a n c e r e q u i r e d b y t h e a p p e l l a n t e v i d e n c e t o c o n f i r m t h a t h i s i m p a i r m e n t s i g n i f i c a n t l y f o r e x t e n d e d p e r i o d s . P a n e l D e c i s i o n I n t h e p a n e l ' s v i e w , t h e e v i d e n c e i s c o n s i s t e n t i n i n d i r e s t r i c t e d w i t h r e s p e c t t o t h e f o l l o w i n g 7 o f t h e 1 O p r e s h o p p i n g , m a n a g e m e n t o f m e d i c a t i o n s , u s e o f t r a n s i n d o o r s a n d o u t d o o r s , a n d d e c i s i o n m a k i n g . W i t h r e s p e c t t o s o c i a l f u n c t i o n i n g , b a s e d o n t h e a n a s e v e r e m e n t a l i m p a i r m e n t , t h e p a n e l c o n c l u d e s t h a t r e s t r i c t i o n . R e q a r d i n q t h e D L A o f m a n a g e m e n t o f f i n a n c e s , t h e E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A i 1/ a v e a p h y s i c a l i m p a i r m e n t . e n t . T h e p s y c h i a t r i s t ' s e v i d e n c e f r o m t h e P R i s c l i m b i n g s t a i r s , s t a n d i n g , a n d s i t t i n g . H i s d b y h e a d a c h e s , f a t i g u e , s h a k i n g , m u s c l e p a i n , e s e p h y s i c a l s y m p t o m s a r e c a u s e d b y t h e t h e h a s b e e n r e l u c t a n t t o f u l l y r e p o r t t h e p h y s i c a l f e a r t h a t t h e p s y c h i a t r i s t w i l l i n c r e a s e t h e d o s a g e w l e d g e d t h a t t h e m e d i c a t i o n s d o h a v e s o m e a u s i n g d r o w s i n e s s f r o m t i m e t o t i m e , h e h a s n o t e a p p e l l a n t . W h i l e t h e p a n e l a c k n o w l e d g e s h t w i t h o u t s o m e e v i d e n c e f r o m t h e p s y c h i a t r i s t a s n o f t h i s d e c i s i o n u n d e r t h e h e a d i n g S i g n i f i c a n t g f r o m 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 o n o t a p p e a r b i l i t y t o m a n a g e h i s D L A i n d e p e n d e n t l y . F o r t h e i l e t h e a p p e l l a n t d o e s h a v e s o m e p h y s i c a l h e a l t h e v i d e n c e f a l l s s h o rt o f e s t a b l i s h i n g t h a t h e h a s a l e g i s l a t i o n . n t l y r e s t r i c t e d . H e s t a t e d t h a t h e i s l i m i t e d b o t h a n d f a m i l y t o a s s i s t w i t h m a n y o f h i s D L A . v i d e d n o e v i d e n c e a s t o t h e t y p e , f r e q u e n c y , o r . T h e m i n i s t r y a r g u e d t h a t t h e r e i s n o t e n o u g h r e s t r i c t s D L A e i t h e r c o n t i n u o u s l y o r p e r i o d i c a l l y c a t i n g t h a t t h e a p p e l l a n t i s n o t s i g n i f i c a n t l y s c r i b e d D L A p e r s o n a l s e l f c a r e , d a i l y p o r t a t i o n , b a s i c h o u s e k e e p i n g , m o v i n g a b o u t l y s i s p r o v i d e d a b o v e u n d e r t h e d i s c u s s i o n o f t h e e v i d e n c e d o e s n o t d e m o n s t r a t e a s i g n i f i c a n t a p p e l l a n t ' s e v i d e n c e i s t h a t t h e h e l p h e r e c e i v e s
i n t h i s a r e a i s p r i m a r i l y w i t h r e s p e c t t o g e t t i n g a r i d e a p p e l l a n t r e q u i r e s p e r i o d i c a s s i s t a n c e w i t h b u d g e t i n d e s c r i b i n g t h e f r e q u e n c y , d u r a t i o n , o r e x t e n t o f s u c h W i t h r e s p e c t t o t h e D L A o f m e a l p r e p a r a t i o n , t h e e v p e r i o d i c a s s i s t a n c e f r o m h i s f a m i l y " a s n e e d e d " w i t h e v i d e n c e t o d e s c r i b e t h e f r e q u e n c y , d u r a t i o n , o r e x t I n t h e p a n e l ' s v i e w , t h e e v i d e n c e d o e s n o t e s t a b l i s h a p p e l l a n t ' s a b i l i t y t o m a n a g e h i s D L A i s s i g n i f i c a n t l y s c h e m e . A c c o r d i n g l y , t h e p a n e l c o n c l u d e s t h a t t h e a p p e l l a n t ' s a b i l i t y t o m a n a g e h i s D L A i n d e p e n d e n t 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 . H e l p w i t h D L A T h e a p p e l l a n t ' s p o s i t i o n i s t h a t h e r e l i e s o n h e l p f r o m 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 s i n c e i t h a s n o t b e e n e s i g n i f i c a n t l y r e s t r i c t e d , i t c a n n o t b e d e t e r m i n e d t h a t P a n e l D e c i s i o n O n t h e e v i d e n c e , t h e p a n e l c a n n o t c o n c l u d e t h a t t h e f a m i l y c o n s t i t u t 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 2 ( 3 ) ( b ) ( i i ) o f t h e E A P W D A . T h e r e i s n o e v i d e n c e t o i n d i c a t e t h a t t h e a p p e l l a n t r e a s s i s t a n c e a n i m a l . F o r t h e s e r e a s o n 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 r t h a t t h e a p p e l l a n t r e q u i r e s h e l p w i t h D L A a s d e f i n e d C o n c l u s i o n T h e p a n e l a c k n o w l e d g e s t h a t t h e a p p e l l a n t ' s m e d i c a f u n c t i o n . H o w e v e r , h a v i n g r e v i e w e d a n d c o n s i d e r e d t h e p a n e l c o n c l u d e s t h a t t h e m i n i s t r y ' s d e c i s i o n f i n d i 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 l e g i s l a t i o n i n t h e c i r c c o n f i r m s t h e m i n i s t r y ' s d e c i s i o n . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # t o t h e b a n k . W h i l e t h e A R i n d i c a t e s t h a t t h e g , t h e r e i s n o e v i d e n c e b e f o r e t h e p a n e l a s s i s t a n c e . i d e n c e 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 r e c e i v e s f o o d p r e p a r a t i o n a n d c o o k i n g , b u t t h e r e i s n o e n t o f s u c h a s s i s t a n c e . o n t h e b a l a n c e o f p r o b a b i l i t i e s t h a t t h e r e s t r i c t e d a s c o n t e m p l a t e d b y t h e l e g i s l a t i v 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 i s n o t 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 f r i e n d s a n d f a m i l y t o p e r f o r m h i s D L A . 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 ' s D L A a r e s i g n i f i c a n t h e l p i s r e q u i r e d f r o m o t h e r p e r s o n s . h e l p p r o v i d e d t o t h e a p p e l l a n t b y h i s f r i e n d s o r o f a n o t h e r p e r s o n " t h a t i s r e q u i r e d b y s . q u i r e s a n a s s i s t i v e d e v i c e , o r t h a t h e h a s a n e a s o n a b l y c o n c l u d e d i t c o u l d n o t b e d e t e r m i n e d b y s . 2 ( 3 ) ( b ) o f t h e E A P W D A . l c o n d i t i o n s h a v e s o m e i m p a c t o n h i s a b i l i t y t o a l l o f t h e e v i d e n c e a n d t h e r e l e v a n t l e g i s l a t i o n , n g t h e a p p e l l a n t 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 i s 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 p a n e l t h e r e f o r e
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.