'. APPEAi ii PART C -Decision under Appeal The decision being appealed is the reconsideration decision of the Ministry of Social Development and Social Innovation (the "Ministry") dated May 23, 2014 in which the Ministry determined that the Appellant was not eligible for Persons with Disabilities ("PWD") designation because he did not meet all the requirements for PWD designation in section 2(2) of the Employment and Assistance for Persons with Disabilities Act. Based on the information provided, the Ministry was not satisfied that the Appellant has a severe mental or physical impairment that in the opinion of a prescribed professional (i) directly and significantly restricts his ability to perform daily living activities either continuously or periodically for extended periods; and, (ii) as a result of those restrictions he requires help to perform those activities. The Ministry was satisfied that the Appellant has reached 18 years of age and in the opinion of a medical practitioner his impairment is likely to continue for at least 2 years. PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Act ("EAPWDA") Section 2(2) and 2(3). Employment and Assistance for Persons with Disabilities Regulation ("EAPWDR") Section 2. EAAT003(10/06/01)
P ART E -Su mm ary of F a cts For it s reco nsid erati on dec is io n, the M ini stry had the follo 1. A p pellan t's P WD a pp lic ation consi sting of t h • The Appe llant' s self repo r t ( "S R ") signed by him • A physician's rep ort ("PR" ) da ted D e cember 14, 2 ph y sician who in dicat ed tha t the A ppellan t had s een the App ell a n t 11 or m o re ti mes in the 12 • An a ssesso r ' s re port ("AR") da te d December 14 f ami ly physi cian. 2 . Ap pellan t's request for r econside rati on da te d 3 . A handwri tten le tt er from t he A ppellant's da ught dau ghter w rit e s that s h e sha res a hous e with her f has h i s be droo m o n the main l evel o f the ho use. all of t he house c leanin g and c ook i ng. S he a going up a nd do wn st airs." She writes that her father " as he compla i n s t hat his w rists h urt." 4 . A 4-pag e do c um en t "Dai ly Liv ing Ac t i vi t i es Check da te, s howing a series of ch eck m a rks be s ide da i ly l iving activi t y after t he w ord s "m y disab ility activiti es." At the h earing , the A p pellan t' s r e present comple ted this document wi th the A ppel lant, fo r the re c o nsid erati on. 5. A 2 p age document, S upp lem ental Medical Opin a nd da t e d M a y 15, 2 014. Th e Su pple men tal a nd the p hys ici a n has h and writ ten his ans wer The Appellant's daughter testified as a witness at the hea informa tion set out in her letter of April 6, 2014. The 22(4)(b ) of the Employment and Assistance Act as it is or was before the Ministry wh en the decision being appea The following is a summary of the relev ant evidence from the PW information before the Ministry at recon sideration, and the evidence provided at the hearing. Diagnoses In t h e P R, th e Appellant's physician diagno s ed the Appellant wi disease, COPD (chronic obstructive pulmonary disease), ischemic heart disease, "recent AAA [abdominal ao r tic an eurysm] repair and "limited e ducation/learning indicate the date of onset of any of the Appellant's medical conditions. that he believes he has a learnina disability, caus ed EAAT003(10/06/01) : ADDCAI # w in g eviden ce: e f ollowin g t hre e parts: on May 2 7, 20 13; 01 3 c o mpl et ed by the App el lan t's f amily b een a p atien t o f hi s fo r 1 O yea r s and h e'd mo nth s pr eced i n g the re por t; and , 20 13, a lso com pleted by th e Appe lla nt's April 7, 2 014. er d ate d April 6, 2 014. In this lett e r, th e ather and her three c h i ldren and her father Sh e writes t hat she i s the pers o n w ho does lso does the lau ndry as her fath er "has problems has a hard time with p eeli n g vegetables lis t" w i t h the Appe ll a nt's name o n it but no li st s of task s set out u nder h ead ings f or ea ch m akes it diff i cu l t for me t o d o the f ollow ing ative co n f i rmed t hat an advo c a te b as e d on th e Appel lant's a nswers, in p repa r a tio n ion, sig ned by the Appe ll a nt's f a mily ph ysician Med ical Op inio n se t s o ut a series o f q uest ion s s o n the form. ri n g on his beh alf, speaking to the panel admits her evidence under section al testimony in support of information that l ed was made. D a p plica tion, as we l l as t he t h lo w bac k pain/degenerative disc disorder?" Th e physician did not The Appellant told the panel by beina born or emat u relv, but that he has never
b e e n d i a g n o s e d a s h a v i n g a l e a r n i n g d i s a b i l i t y . 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 p h y s i c i a n d e s c r i b e d t h e s e v e r i t y o f t h f o l l o w s : • H e h a s h a d l o w b a c k p a i n " f o r a p p r o x i m a t e l y c a n e f o r w a l k i n g . H e h a s d e g e n e r a t i v e d i s c j o i n t a r t h r i t i c . " • H e h a s u n d e r g o n e a r e c e n t a b d o m i n a l a o r t i c a b i l i t y t o l i f t o r s t r a i n . • T h e A p p e l l a n t b e c o m e s s h o r t o f b r e a t h w a l k i e m p h y s e m a t o u s c h a n g e s o n C T . " I n t h e f 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 , t h e A p p e l l a w a l k u n a i d e d 1 -2 b l o c k s , c l i m b 5 + s t a i r s u n a i d e d , l i f 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 d e s c r i b e d t h 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 ' s h e a r i n g i s s a t i s f a c t o r y p o o r a n d h i s s p e a k i n g i s g o o d . I n t h e m o b i l i t y a n d p 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 c o u l d i n d e p e n i n d o o r s , w a l k i n g o u t d o o r 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 y c o m m e n t a r y . 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 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 l e a r n i n g d i s o r d e r . " T h e p h y s i c i a n r e p o r t e d s i g n i f i c a t h e a r e a s o f e x e c u t i v e ( p l a n n i n g , o r g a n i z i n g , s e q u e n a u d i t o r y , w r i t t e n c o m p r e h e n s i o n o r e x p r e s s i o n ) a n d I n t h e s e c t i o n o f t h e A R r e g a r d i n g c o g n i t i v e a n d e m i n d i c a t e d a m o d e r a t e i m p a c t i n t h e a r e a o f b o d i l y f u n m i n i m a l i m p a c t i n t h e a r e a s o f l a n g u a g e , a n d o t h e r p r o b l e m s , p s y c h o m o t o r p r o b l e m s , l e a r n i n g d i s a b i l i t i 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 h e o t h e r a r e A p p e l l a n t ' s p h y s i c i a n w r o t e , " p o o r s l e e p , p o o r s h o r t c o m p r e h e n s i o n o f l a n g u a g e , a n d " p o s s i b l e l e a r n i n g p h y s i c i a n d o e s n o t d i a g n o s e t h e A p p e l l a n t w i t h a m e S e v e r i t y o f I m p a i r m e n t s I n t h e M a y 1 5 , 2 0 1 4 S u p p l e m e n t a l M e d i c a l O p i n i o n " 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 , " I n y o u r p r o f e s s i o n p h y s i c a l a n d / o r m e n t a l i m p a i r m e n t ? " T h e A p p e l l a n t e x p l a i n h i s a n s w e r . T h e A p p e l l a n t ' s p h y s i c i a n a l s o y o u r p r o f e s s i o n a l o p i n i o n , a s a r e s u l t o f [ t h e A p p e l l a p e r f o r m h i s [ D L A ] ? " A t t h e h e a r i n g , w h e n a s k e d a b t h e S u p p l e m e n t a l M e d i c a l O o i n i o n , t h e A o o e l l a n t s a E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # e A p p e l l a n t ' s m e d i c a l c o n d i t i o n s a n d i m p a c t s a s 1 0 y e a r s g e t t i n g g r a d u a l l y w o r s e . " H e u s e s a d i s e a s e a t h i s L 3 " [ s e e n ] o n C T a n d b i l a t e r a l S I a n e u r y s m r e p a i r t h i s l i m i t s t h e A p p e l l a n t ' s n g o n e b l o c k a n d h e h a s " c e n t r i l o b u l a r 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 c a n t 2 -7 k g , a n d c a n 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 . p p e l l a n t ' s i m p a i r m e n t s a s " b a c k p a i n " a n d a l s o ( h e a r i n g a i d i n r i g h t e a r ) , r e a d i n g a n d w r i t i n g a r e h y s i c a l a b i l i t y s e c t i o n o f t h e A R , t h e A p p e l l a n t ' s d e n t l y p e r f o r m a l l o f t h e l i s t e d a c t i v i t i e s ( w a l k i n g l i f t i n g , c a r r y i n g a n d h o l d i n g ) a n d d i d n o t p r o v i d e h a s l i m i t e d e d u c a t i o n a n d " s u s p e c t e d t o h a v e 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 e m o t i o n a l f u n c t i o n i n c i n g , c a l c u l a t i o n s , j u d g m e n t ) , l a n g u a g e ( o r a l , m e m o r y ( a b i l i t y t o l e a r n a n d r e c a l l i n f o r m a t i o n ) . o t i o n a l f u n c t i o n i n g , t h e A p p e l l a n t ' s p h y s i c i a n c t i o n s . H e a l s o i n d i c a t e d b o t h a m o d e r a t e a n d a 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 ( e . g . v i s u a l / s p a t i a l e s e t c . ) , a n d m i n i m a l i m p a c t i n t h e a r e a s o f a s l i s t e d w e r e c h e c k e d a s n o i m p a c t . T h e t e r m m e m o r y , c h r o n i c m e m o r y p r o b l e m s , p o o r d i s a b i l i t y ( b o r n p r e m a t u r e ) . " T h e A p p e l l a n t ' s n t a l i m p a i r m e n t o r m e n t a l h e a l t h c o n d i 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 h a s c i r c l e d t h e w o r d a l o p i n i o n , d o e s [ t h e A p p e l l a n t ] h a v e a s e v e r e ' s p h y s i c i a n d i d n o t p r o v i d e a n y c o m m e n t a r y t o c r o s s e d o u t t h e w o r d " s e v e r e " i n t h e q u e s t i o n , " I n n t ' s ] s e v e r e r e s t r i c t i o n s , d o e s h e r e q u i r e h e l p t o o u t t h e p h y s i c i a n ' s r e s p o n s e t o t h i s q u e s t i o n o n i d t h a t h e f e l t h i s i m o a i r m e n t s h a d b e c o m e m o r e
s e v e r e i n t h e t i m e s i n c e h i s p h y s i c i a n c o m p l e t e d t h D a i l y L i v i n g A c t i v i t i e s I n t h e A R , t h e 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 e f o • I n d e p e n d e n t l y m a n a g e s a l l t a s k s o f t h e D L A • F o r t h e D L A o f b a s i c h o u s e k e e p i n g c a n i n d 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 t h e t a s k o f • F o r t h e D L A o f s h o p p i n g c a n i n d e p e n d e n t l a n d p a y i n g f o r p u r c h a s e s , b u t r e q u i r e s c o n t i n a n d l a b e l s , m a k i n g a p p r o p r i a t e c h o i c e s a n d p r o v i d e a n y c o m m e n t a r y . • F o r t h e D L A o f p a y r e n t a n d b i l l s c a n i n d e p r e n t a n d b i l l s , b u 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 b u d g e t i n g " ) . • F o r t h e D L A o f t r a n s p o rt a t i o n c a n i n d e p e n d v e h i c l e , b u t r e q u i r e s c o n t i n u o u s a s s i s t a n c e w t r a n s i t s c h e d u l e s a n d a r r a n g i n g t r a n s p o r t a t i o • F o r t h e D L A o f s o c i a l f u n c t i o n i n g i s i n d e p e n d e v e l o p a n d m a i n t a i n r e l a t i o n s h i p s , a n d a b l e p e r i o d i c s u p p o rt t o i n t e r a c t a p p r o p r i a t e l y w i t h u n e x p e c t e d d e m a n d s ( " f e e l s u n c o m f o r t a b l e i h a s a ' s h o r t f u s e "' ) . • H a s m a r g i n a l f u n c t i o n i n g w i t h h i s i m m e d i a t e c o m m e n t a r y w a s p r o v i d e d . I n t h e M a y 1 5 , 2 0 1 4 S u p p l e m e n t a l M e d i c a l O p i n i o n p r o f e s s i o n a l o p i n i o n , i 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 d u e t o h i s i m p a i r m e n t s ? I f s o , p l e a s e c h e c k t h e b o x b e y o n d t h a t o f a t y p i c a l h e a l t h y p e r s o n " a n d p r o v i d e a n y o f t h e b o x e s , h o w e v e r , h e d i d w r i t e c o m m e n t s . p h y s i c i a n w r o t e , " Y e s h e c a n . " B e s i d e t h e D L A o f s g e t s b a c k p a i n b e f o r e h e f i n i s h e s s h o p p i n g & h a s t o o r p e r s o n a l t r a n s p o rt a t i o n f a c i l i t i e s , t h e p h y s i c i a n w r h o u s e w o r k t o m a i n t a i n a c c e p t a b l e s a n i t a r y c o n d i t i o n h o u s e w o r k b u t o t h e r s d o m o s t . " T h e p h y s i c i a n w r o t o u t " b e s i d e t h e D L A o f m o v e a b o u t i n d o o r s a n d o u t d m e d i c a t i o n , t h e p h y s i c i a n w r o t e , " h e f o r g e t s t o t a k e " y e s " b e s i d e t h e D L A s o f " m a k e d e c i s i o n s a b o u t p e r 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 " w i t h o u t a n y c o I n t h e S u p p l e m e n t a l M e d i c a l O p i n i o n , t h e A p p e l l a n t ' o p i n i o n , i 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 r m t h e s e d r e s t r i c t e d ? " T h e p h y s i c i a n w r o t e , " D i r e c t l y y e s , S i g n M i n i s t r y r e p r e s e n t a t i v e e x p l a i n e d t h a t " D B 2 " w a s t h e P W D . T h e A p p e l l a n t ' s o h v s i c i a n c i r c l e d t h e w o r d s " E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P F A I # : e f o r m ( 5 w e e k s p r i o r t o t h e h e a r i n g ) . l l o w i n g i m p a c t s o n t h e A p p e l l a n t ' s D L A s : s o f p e r s o n a l c a r e , m e a l s , a n d m e d i c a t i o n s . e p e n d e n t l y p e r f o r m t h e t a s k o f l a u n d r y , b u t b a s i c h o u s e k e e p i n g ( " u n a b l e t o s w e e p o r m o p " ) . y p e r f o r m t h e t a s k s o f g o i n g t o a n d f r o m s t o r e s u o u s a s s i s t a n c e f o r t h e t a s k s o f r e a d i n g p r i c e s c a r r y i n g p u r c h a s e s h o m e . T h e p h y s i c i a n d i d n o t e n d e n t l y p e r f o r m t h e t a s k s o f b a n k i n g a n d p a y e w i t h t h e t a s k o f b u d g e t i n g ( " h a s n o t d o n e e n t l y p e r f o r m t h e t a s k o f g e t t i n g i n a n d o u t o f a i t h t h e t a s k s o f u s i n g p u b l i c t r a n s i t a n d u s i n g n ( " d o e s n ' t u n d e r s t a n d s c h e d u l e s " ) . d e n t f o r a p p r o p r i a t e s o c i a l d e c i s i o n s , a b l e t o t o s e c u r e a s s i s t a n c e f r o m o t h e r s , b u t r e q u i r e s o t h e r s a n d a b l e t o d e a l a p p r o p r i a t e l y w i t h n s o c i a l s i t u a t i o n s . D o e s n ' t k n o w h o w t o i n t e r a c t a n d e x t e n d e d s o c i a l n e t w o r k s , b u t n o , 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 a s k e d " I n y o u r rf o r m h i s [ D L A ] c o n s i d e r e d s e v e r e l y r e s t r i c t e d b e s i d e t h e l i s t e d D L A i f t h e r e i s a r e s t r i c t i o n d e t a i l s . 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 c h e c k B e s i d e t h e D L A p r e p a r e o w n m e a l s , t h e h o p f o r p e r s o n a l n e e d s , t h e p h y s i c i a n w r o t e , " h e g o o u t t o c a r . " B e s i d e t h e D L A o f u s e o f p u b l i c o t e , " g e t s l o s t . " B e s i d e t h e D L A o f p e r f o r m s , t h e p h y s i c i a n w r o t e , " H e c a n d o a l i t t l e e , " h e n e e d s a c a n e [ a n d h i s r i g h t ] l e g w i l l g i v e o o r s . B e s i d e t h e D L A o f m a n a g e p e r s o n a l i t . " T h e A p p e l l a n t ' s p h y s i c i a n w r o t e t h e w o r d s o n a l a c t i v i t i e s , c a r e , o r f i n a n c e s " a n d " r e l a t e t o , m m e n t a r y o r e x p l a n a t i o n . s p h y s i c i a n w a s a s k e d , " I n y o u r p r o f e s s i o n a l a i l y l i v i n g a c t i v i t i e 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 i f i c a n t l y a s p e r D B 2 n o . " A t t h e h e a r i n g , t h e M i n i s t r y ' s p r e v i o u s d e s i g n a t i o n f o r w h a t i s n o w p e r i o d i c a l l y r e s t r i c t e d " i n r e s o o n s e t o t h e
q u e s t i o n , " i f t h e [ D L A ] l i s t e d o n t h e p r e v i o u s p a g e a t o p e r f o r m t h e s e D L A s r e s t r i c t e d c o n t i n u o u s l y o r p e w r o t e , " D i f f i c u l t t o s a y " a s h i s c o m m e n t o n t h e f r e q u A t t h e h e a r i n g , t h e A p p e l l a n t a n d h i s r e p r e s e n t a t i v e D a i l y L i v i n g A c t i v i t i e s C h e c k l i s t . T h e A p p e l l a n t i n d i c o m p l e t e t h e f o l l o w i n g a c t i v i t i e s f o r e a c h l i s t e d D L A P e r s o n a l C a r e : • g e t t i n g i n a n d o u t o f t h e b a t h t u b ; a p p l y i n g l o e n e r g y / m o t i v a t i o n t o b a t h e e v e r y d a y . P r e p a r i n g M e a l s : • p e e l i n g f r u i t o r v e g e t a b l e s ; s t a n d i n g a t t h e s i n u n d e r s t a n d i n g r e c i p e s ; u n d e r s t a n d i n g l a b e l s T a k i n g m e d i c a t i o n s : • R e m e m b e r i n g t o t a k e a l l m y m e d i c a t i o n s w h e H o u s e w o r k • C l e a n i n g t h e b a t h t u b ; c l e a n i n g t h e t o i l e t ; w a s w a s h i n g f l o o r s ; d u s t i n g ; c a r r y i n g l a u n d r y ; d o i S h o p p i n g • W a l k i n g a r o u n d s t o r e s ; c a r r y i n g g r o c e r i e s t o b e i n g a b l e t o w a i t i n l i n e w i t h o u t b e c o m i n g f r u M o v i n g a r o u n d i n s i d e t h e h o m e • G o i n g u p o r d o w n s t a i r s o r r a m p s ; g e t t i n g i n t o f r o m t h e f l o o r ; k n e e l i n g a n d g e t t i n g u p f r o m t h M o v i n g a r o u n d o u t s i d e t h e h o m e • W a l k i n g v e r y f a r ; g o i n g u p o r d o w n s t a i r s o r r U s i n g t r a n s p o r t a t i o n • S t a n d i n g a t t h e b u s s t o p ; s i t t i n g o n t h e b u s / S u n d e r s t a n d i n g b u s s c h e d u l e s . M a n a g i n g m o n e y a n d p a y i n g b i l l s • U n d e r s t a n d i n g b i l l s ; b u d g e t i n g f o r g r o c e r i e s o b u y i n g t h i n g s I d o n o t n e e d E a t i n g • R e m e m b e r i n g o r b e i n g m o t i v a t e d t o e a t r e g u h a s w r i t t e n , " I d o n ' t h a v e d e n t u r e s , m a k e s c h C o m m u n i c a t i o n • B e i n g a b l e t o m a k e m y s e l f u n d e r s t o o d ; u n d e r m o s t t h i n g s i n w r i t i n g ; h e a r i n g w h a t p e o p l e s a m e o n t h e t e l e p h o n e M e n t a l a n d e m o t i o n a l s k i l l s • C o p i n g w i t h s t r e s s , p l a n n i n g a h e a d , a t t e n d i n g i n f o r m a t i o n ; c o m p l e t i n g t a s k s S o c i a l s k i l l s • I n t e r a c t i n g w i t h f r i e n d s , f a m i l y , p a r t n e r ; i n t e r a m a i n t a i n i n g r e l a t i o n s h i p s ; b e i n g a b l e t o a s k f o u n e x o e c t e d s i t u a t i o n s E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # : I r e c o n s i d e r e d r e s t r i c t e d , i s [ t h e A p p e l l a n t ' s ] a b i l i t y 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 e p h y s i c i a n e n c y a n d d u r a t i o n o f t h e p e r i o d i c r e s t r i c t i o n s . r e f e r r e d t h e p a n e l t o t h e i n f o r m a t i o n s e t o u t i n t h e c a t e d t h a t h i s d i s a b i l i t y m a k e s i t d i f f i c u l t f o r h i m t o , a s s e t o u t i n t h e d o c u m e n t : t i o n s a n d c r e a m s ; r e m e m b e r i n g o r h a v i n g t h e k a n d s t o v e ; u s i n g a c a n o p e n e r ; o p e n i n g j a r s ; ; k n o w i n g w h e n f o o d h a s g o n e b a d . n I a m s u p p o s e d t o . h i n g d i s h e s ; v a c u u m i n g o r s w e e p i n g f l o o r s ; n g l a u n d r y ; c l e a n i n g w i n d o w s t h e b u s o r c a r ; c a r r y i n g g r o c e r i e s i n t o t h e h o u s e ; s t r a t e d o r a n g r y . b e d a n d o u t o f b e d ; b e n d i n g t o p i c k u p t h i n g s e k n e e l i n g p o s i t i o n . a m p s k y t r a i n ; g o i n g u p o r d o w n s t a i r s o r r a m p s ; r o t h e r t h i n g s I n e e d ; s t o p p i n g m y s e l f f r o m l a r m e a l s ; e a t i n g h e a l t h y f o o d s . T h e A p p e l l a n t e w i n g d i f f i c u l t . " s t a n d i n g w h a t p e o p l e s a y t o m e ; u n d e r s t a n d i n g y t o m e f a c e t o f a c e ; h e a r i n g w h a t p e o p l e s a y t o t o t h e m o s t i m p o r t a n t t h i n g s f i r s t ; r e m e m b e r i n g c t i n g w i t h s t r a n g e r s i n p u b l i c ; d e v e l o p i n g a n d r h e l p w h e n I n e e d i t ; b e i n g a b l e t o d e a l w i t h
H e l p w i t h D a i l y L i v i n g A c t i v i t i e s T h e A p p e l l a n t ' s p h y s i c i a n n o t e d i n b o t h t h e P R a n d a n d t h a t h e l i v e s w i t h f a m i l y , b u t d i d n o t p r o v i d e a n S u p p l e m e n t a l M e d i c a l O p i n i o n , t h e A p p e l l a n t ' s p h y p r o f e s s i o n a l o p i n i o n , a s a r e s u l t o f [ t h e A p p e l l a n t ' s ] r e s t r i c t i o n s , d o e s h e r e q u i r e h e l p t o p e r f o r m h i s [ D L a n d o t h e r a c t i v i t i e s a s r e q u i r e d . " T h e p h y s i c i a n w r o p e r w e e k t h e A p p e l l a n t r e q u i r e d t h i s a s s i s t a n c e . I n h e r l e t t e r o f A p r i l 6 , 2 0 1 4 a n d i n h e r t e s t i m o n y a t t h a t s h e d o e s a l l o f t h e h o u s e w o r k a n d t h e m e a l p r e h e c a n n o t p e e l v e g e t a b l e s , f o r e x a m p l e ) , i n c l u d i n g a n d d o w n t h e s t a i r s . S h e a l s o t o l d t h e p a n e l t h a t s h r e m i n d s h i m t o t a k e h i s m e d i c a t i o n . A s i t i s h a r d f o A p p e l l a n t ' s d a u g h t e r t e s t i f i e d s h e w i l l h e l p h i m a n d S h e a l s o t e s t i f i e d t h a t s h e d o e s t h e f a m i l y ' s s h o p p i n f a t h e r w a s n o t l i v i n g w i t h h e r , s h e w o u l d r e g u l a r l y g I n t h e D a i l y L i v i n g A c t i v i t i e s C h e c k l i s t , t h e a p p e l l a n t e y e g l a s s e s , h e a r i n g a i d s a n d a c a n e . M i n i s t r y ' s P o s i t i o n F o r t h i s a p p e a l , t h e M i n i s t r y r e l i e d o n a n d r e a f f i r m e d E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )'. A P P E A L # t h e A R t h a t t h e A p p e l l a n t u s e s a c a n e t o w a l k y c o m m e n t a r y . I n t h e M a y 1 5 , 2 0 1 4 s i c i a n r e s p o n d e d " y e s " t o t h e q u e s t i o n , " I n y o u r s e v e r e [ w h i c h t h e p h y s i c i a n s t r o k e d o u t ] A ] ? " a n d a d d e d , " n e e d s h e l p t o g e t o u t o f b a t h t u b t e " d i f f i c u l t t o s a y ' ' r e g a r d i n g t h e n u m b e r o f t i m e s t h e h e a r i n g , t h e A p p e l l a n t ' s d a u g h t e r i n d i c a t e d p a r a t i o n f o r t h e f a m i l y ( h e r f a t h e r ' s w r i s t s h u r t s o h e r f a t h e r ' s l a u n d r y a s h e h a s d i f f i c u l t y g o i n g u p e r e m i n d s h e r f a t h e r t o t a k e s h o w e r s a n d s h e r h e r f a t h e r t o g e t i n a n d o u t o f t h e b a t h t u b , t h e w i l l g e t h e l p f r o m a m a l e f r i e n d o r r e l a t i v e a s w e l l . g . T h e A p p e l l a n t ' s d a u g h t e r s a i d t h a t w h e n h e r o t o h i s h o m e t o a s s i s t h i m . h a s i n d i c a t e d t h a t h e n e e d s t h e f o l l o w i n g i t e m s : i t s r e c o n s i d e r a t i o n d e c i s i o n .
I APPEAL# PART F -Reasons for Panel Decision The issue in this appeal is whether the Ministry reasonably determined that the Appellant was not eligible for PWD designation because he did not meet all of the requirements in section 2(2) of the EAPWDA, and specifically, that the Appellant does not have a severe mental or physical impairment that in the opinion of a prescribed professional (i) directly and significantly restricts his ability to perform daily living activities either continuously or periodically for extended periods; and, (ii) as a result of those restrictions he requires help to perform those activities. The eligibility criteria for PWD designation are set out in the following sections of the EAPWDA: 2 (2) The minister may designate a person who has reached 18 years of age as a person with disabilities for the purposes of this Act if the minister is satisfied that the person has a severe mental or physical impairment that (a) in the opinion of a medical practitioner is likely to continue for at least 2 years, and (b) in the opinion of a prescribed professional (i) directly and significantly restricts the person's ability to perform daily living activities either (A) continuously, or (B) periodically for extended periods, and (ii) as a result of those restrictions, the person requires help to perform those activities. (3) For the purposes of subsection (2), (a) a person who has a severe mental impairment includes a person with a mental disorder, and (b) a person requires help in relation to a daily living activity if, in order to perform it, the person requires (i) an assistive device, (ii) the significant help or supervision of another person, or (iii) the services of an assistance animal. The "daily living activities" referred to in EAPWDA section 2(2)(b) are defined in the EAPWDR as: 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. Panel's decision The panel will now consider each party's position regarding the reasonableness of the Ministry's decision under the applicable PWD criteria at issue in this appeal. Severe Physical Impairment The Appellant submitted that he suffers from severe physical impairments which significantly impair his ability to manage his daily tasks, namely: his crushed disc and resulting back pain for which he uses a cane to walk and which prohibits him from standing or sitting for extended periods; his heart condition which prevents him from walking very far, driving too long, or getting up from a laying position and in and out of the bathtub (this is also hindered by his back pain); his emphysema, which EAA T003(10/06/01)
I APPEAL# causes him trouble breathing, particularly in hot weather; and his recent surgery for abdominal aortic aneurysm, which limits his ability to lift or strain. The Ministry, in its reconsideration decision, considered the information in the Appellant's PWD application, the Daily Living Activities Checklist and in the physician's May 15, 2014 Supplemental Medical Opinion. It determined that the Appellant is independently able to manage all mobility and physical activities, based on the information provided by the Appellant's physician in the PR and AR. It concluded that the information provided did not establish a severe impairment of the Appellant's physical functioning, rather that it speaks to a moderate level of impairment. The Panel's Findings The diagnosis of a medical condition is not in and of itself evidence of the severity of impairment. To satisfy the requirements in section 2(2) of the EAPWDA, evidence of how and the extent to which a medical condition restricts daily functioning must be considered. This includes the evidence from the Appellant and from a prescribed professional regarding the nature of the impairment and its impact on the Appellant's ability to manage the daily living activities listed in section 2( 1) of the EAPWDR. In this case, information about the Appellant's circumstances was provided by the Appellant's family physician (the prescribed professional), who has known the Appellant for 10 years, in the PR and AR completed December 14, 2013 and in the recent Supplemental Medical Opinion of May 15, 2014. While the Appellant's physician has noted some restriction to the Appellant's functional skills in the PR (can walk unaided 1-2 blocks, lift 2-7 kg, sit less than an hour), in the AR, the physician indicated that the Appellant could perform all areas of mobility and physical ability. As well, the panel notes that the Appellant's physician expressly circled the word "no" in answer to the question whether, in his professional opinion, the Appellant has a severe physical and/or mental impairment as requested in the Supplemental Medical Opinion of May 15, 2014. The physician also crossed out the word "severe" in the question whether, as a result of the Appellant's "severe restrictions, does he require help to perform his DLA" on the same document. The information provided by the Appellant's physician in the Supplemental Medical Opinion of May 15, 2014 is consistent with the information provided by the physician in the PR and AR completed in December 2013, which speaks to its reliability. Although the Appellant told the panel that his conditions have become more severe since the May 15, 2014 Supplemental Medical Opinion, there was no evidence of this from the Appellant's physician. Therefore, when the professional assessment of the Appellant's physician is considered, especially the Supplemental Medical Opinion of May 15, 2014, the panel finds that it was reasonable for the Ministry to determine that the information provided did not establish that the Appellant has a severe physical impairment. Severe Mental Impairment The Appellant submitted that he has deficits to his cognitive and emotional functioning; that is, poor sleep, poor short-term memory, chronic memory problems, poor comprehension of language and a possible learning disability because he was born prematurely. The Appellant's physician in the PR indicated that the Appellant has a limited education and a "suspected" learning disability. In the PR, the Aooellant's physician indicated that the Aooellant has deficits with coQnitive and emotional EAAT003(10/06/01)
�APPEAL# function in the areas of executive, language and memory. The physician indicated in the AR that the Appellant's mental impairment has a moderate impact in the area of bodily functions, a minimal to moderate impact in areas of language and other neuropsychological problems, and a minimal impact on memory and attention/concentration. The Appellant is noted as feeling uncomfortable in social situations and doesn't know how to interact with others (marginal functioning in his immediate and extended social networks) and has a "short fuse." The Ministry found that the information provided by the Appellant's physician did not establish a severe mental impairment. The Ministry noted the information provided in the PR and AR (as recited above) and found that the information provided in the PWD application demonstrates that the Appellant has some cognitive and emotional deficits resulting in moderate to minimal impacts to his daily functioning, but the assessment does not establish the presence of a severe mental impairment. The Ministry also noted that the Appellant's physician had circled the word "no" in response to the question whether the Appellant has, in the physician's professional opinion, a severe mental or physical impairment in the May 15, 2014 Supplemental Medical Opinion. The Panel's Findings The panel finds that there is no diagnosis of a mental health condition or mental impairment, only the physician's note in the PR that the Appellant has a "limited education/suspected learning disability." In the AR, the Appellant's physician has indicated a minimal to moderate impact on those areas related to bodily function, attention/concentration, memory, language and other neuropsychological problems. The physician's commentary about the impact on these areas is, "poor sleep, poor short term memory, chronic memory problems, poor comprehension of language and possible learning disability (born premature)." Further, in the May 15, 2014 Supplemental Medical Opinion, the Appellant's physician expressly circled the word "no" in responding to the question whether the Appellant has a severe mental or physical impairment and crossed out the word "severe" in responding to the question whether as a result of the Appellant's "severe impairment, he requires help to perform" his DLA. Based on all of this information from the Appellant's physician, the panel finds that the Ministry reasonably determined that the evidence does not establish a severe mental impairment. Restrictions to Daily Living Activities The Appellant submitted that his ability to manage daily living activities is significantly restricted, pointing to the information provided by him in the Daily Living Activities Checklist. The Appellant's physician (the prescribed professional) reported in the AR that he is periodically restricted with the tasks of basic housekeeping ("unable to sweep or mop") and budgeting ("has not done budgeting"). The Appellant's physician also reported in the AR that the Appellant is continuously restricted with the tasks of reading prices and labels, making appropriate choices and carrying purchases home (but did not provide any commentary) and the tasks of using public transit and using transit schedules and arranging transportation ("doesn't understand schedules"). In the May 15, 2014 Supplemental Medical Opinion, the Appellant's physician indicated that the Appellant can prepare his own meals, gets back pain before he finishes shopping and has to go out to a car, gets lost using public or personal transportation, can perform a little housework but others do most, needs a cane and his right leg will give out when moving about indoors and outdoors and forgets to take his medication. The physician wrote that the Aooellant's ability to perform these DLAs is directly, but not siqnificantly EAAT003(10/06/01)
r e s t r i c t e d , a n d t h a t t h i s r e s t r i c t i o n i s p e r i o d i c b u t t h o f t h e r e s t r i c t i o n . T h e M i n i s t r y d e t e r m i n e d i n i t s r e c o n s i d e r a t i o n d e c i A p p e l l a n t ' s p h y s i c i a n d o e s n o t e s t a b l i s h t h a t a s e v p e r f o r m D L A e i t h e r c o n t i n u o u s l y o r p e r i o d i c a l l y f o r i 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 ' s d a u g h t e r a A p p e l l a n t i s u n a b l e t o p e r f o r m a n y a s p e c t s o f b a s i c p r i n c i p a l l y p e r f o r m e d b y h i s d a u g h t e r " a s p a r t o f a l i v i n g t o g e t h e r . T h e M i n i s t r y a l s o f o u n d t h a t t h e i n f O p i n i o n d o e s n o t e s t a b l i s h t h a t d u e t o a s e v e r e i m h i s D L A i 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 r e s t r i c t e d e i t h e r T h e P a n e l ' s F i n d i n g s 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 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 o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s . I n t h i s c a s e , t h p r o f e s s i o n a l . D a i l y l i v i n g a c t i v i t i e s a r e d e f i n e d i n s e t h e P R a n d i n t h e A R . I n t h e A R c o m p l e t e d i n D e c e m b e r 2 0 1 3 , t h e A p p e l i n d e p e n d e n t l y p e r f o r m t h e m a j o r i t y o f t h e l i s t e d t a s t h a t t h e A p p e l l a n t w a s p e r i o d i c a l l y r e s t r i c t e d w i t h t h " u n a b l e t o s w e e p a n d m o p " a n d b u d g e t i n g b e c a u s e p h y s i c i a n r e p o r t e d t h a t t h e A p p e l l a n t w a s c o n t i n u o u l a b e l s , m a k i n g a p p r o p r i a t e c h o i c e s , c a r r y i n g p u r c h a t r a n s i t , t r a n s i t s c h e d u l e s ( h e d o e s n ' t u n d e r s t a n d s c S u p p l e m e n t a l M e d i c a l O p i n i o n c o m p l e t e d M a y 1 5 , A p p e l l a n t ' s a b i l i t y t o p e r f o r m c e r t a i n D L A ( s h o p f o r 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 , a n d r e s t r i c t e d b u t t h a t i t w a s " d i f f i c u l t t o s a y " t h e f r e q u e n p h y s i c i a n ' s c o m m e n t s , s u c h a s " h e c a n d o a l i t t l e h w h e n u s i n g p u b l i c t r a n s i t c l a r i f y t h e n a t u r e o f t h e A p D L A . A s w e l l , t h e A p p e l l a n t ' s p h y s i c i a n h a s i n d i c a t 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 t s d o n o t " s i g n i f i c a n t l T h e P a n e l f i n d s t h a t w h e n r e a d i n g t o g e t h e r t h e M a i n f o r m a t i o n w i t h 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 i m p a i r m e n t p e r i o d i c a l l y r e s t r i c t s h i s a b i l i t y t o p e r f o r m a n d f r e q u e n c y o f t h e r e s t r i c t i o n i s n o t c l e a r , t h e M i n 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 s i g n i f i c a n t l y r e s t r i c t 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 a i l y L i v i n g A c t i v i t i e s T h e A n n e l l a n t s u b m i t s t h a t b e c a u s e o f h i s i m o a i r m e E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # � a t i t i s " d i f f i c u l t t o s a y " t h e f r e q u e n c y a n d d u r a t i o n s i o n 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 b y t h e e r e i m p a i r m e n t s i g n i f i c a n t l y r e s t r i c t s h i s a b i l i t y t o e x t e n d e d p e r i o d s . T h e M i n i s t r y c o n s i d e r e d t h e n d f o u n d t h a t i t w a s n o t c l e a r w h e t h e r t h e h o u s e k e e p i n g o r w h e t h e r t h e s e d u t i e s a r e c o m m o n d i v i s i o n o f l a b o u r ' ' a m o n g f a m i l y m e m b e r s o r m a t i o n p r o v i d e d i n t h e S u p p l e m e n t a l M e d i c a l p a i r m e n t , t h e A p p e l l a n t ' s o v e r a l l a b i l i t y t o m a n a g e 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 . s c r i b e d p r o f e s s i o n a l p r o v i d e a n o p i n i o n t h a t a n n t l y r e s t r i c t s h i s d a i l y l i v i n g a c t i v i t i e s , c o n t i n u o u s l y e A p p e l l a n t ' s p h y s i c i a n i s t h e p r e s c r i b e d 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 l i s t e d i n 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 t h e A p p e l l a n t c o u l d k s o f t h e D L A s . I n t h e A R , t h e p h y s i c i a n r e p o r t e d e t a s k s o f b a s i c h o u s e k e e p i n g b e c a u s e h e ' s h e " h a s n o t d o n e b u d g e t i n g . " I n t h e A R , t h e s l y r e s t r i c t e d w i t h t h e t a s k s o f r e a d i n g p r i c e s a n d s e s h o m e w h e n s h o p p i n g a n d u s i n g p u b l i c h e d u l e s ) a n d a r r a n g i n g t r a n s p o r t a t i o n . I n t h e 2 0 1 4 , 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 p e r s o n a l n e e d s , u s e p u b l i c t r a n s i t , p e r f o r m m a n a g e p e r s o n a l m e d i c a t i o n s ) w a s p e r i o d i c a l l y c y a n d d u r a t i o n o f t h e r e s t r i c t i o n s . T h e o u s e w o r k b u t o t h e r s d o m o s t " a n d " g e t s l o s t " p e l l a n t ' s r e s t r i c t i o n s i n t h e p e r f o r m a n c e o f t h e s e e d i n t h e M a y 2 0 1 4 S u p p l e m e n t a l M e d i c a l O p i n i o n y ' ' r e s t r i c t h i s a b i l i t y t o p e r f o r m t h e D L A s . y 1 5 , 2 0 1 4 S u p p l e m e n t a l M e d i c a l O p i n i o n p e l l a n t ' s p h y s i c i a n i n t h e A R t h a t t h e A p p e l l a n t ' s s o m e o f h i s d a i l y l i v i n g a c t i v i t i e s t h e d u r a t i o n i s t r y w a s r e a s o n a b l e i n d e t e r m i n i n g t h a t t h e 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 n t s , h e n e e d s a n d r e c e i v e s c o n t i n u o u s h e l o f r o m
his d a u ghter with hou se w ork, meals and shoppi ng his cane for walkin g. I n the Supplemental M edi c al c o nf i rmed that the Appellant needs help to get out of the bath tub and other but that it is " difficult to say " how often this help is required. p hysician referred t o t he A p pel lant's use of a cane t T he M i n i st r y 's position is that because the evidence does not establish that si gnificantly restric ted, it can no t be determi ned that signi The Ministry notes in the reconsider ation dec ision that the u a can e does not e stablish the existence of a s ev e re im th e Appellant's ability to perlorm DLA suc h that he requi The Panel's Findings Section 2(2)(b)(ii) of the EAPWDA also requi res the opinion of a t hat becau se of r estri c t ions in hi s a bility t o mana g e daily wit h those activities. In the Ma y 15 2 01 4 Su p pleme App ella nt req ui res help to get out of th e bat h tu b "and other a "dif ficu lt to say" ho w m any tim e s per w eek help i s requ A ppella nt r e q uir e s a ca ne to a ssist with his mobi l i ty. p erl orms th e hous ework for he r fat h er, as well a s meal professional (th e App ellant 's phys ician ) has not p r ovid b y the A ppellan t. Th e r e fo re, the pa nel f i nds tha t the Mi d etermi ne w hether th e A ppel lan t need s si gn ifican t h ac tiviti e s. Conclu si o n Havin g review ed and con s i dered al l of the ev i de nc e t h e M i nistry ' s reco n sid erat io n d e cisi on , w h ic h deter mined de si gnation, was re asonably s uppo r ted b y the evidence. The EAAT 003(10/06/01) I APPEAi # a nd to re m ind h im to take h i s med ication. He uses O pi nion of May 201 4, the Appe l la nt's physician acti v i ties " as re q uire d" In the P R and A R, th e Appellant's o a s sist h i m with his mobil ity . dail y living activities are ficant help is req u ired f ro m other perso ns. se of a "simple assis t ive device" such as pairment that d irectly an d significantly restricts res th e significant help of another person. prescribed professio n al confi rming living a c t ivi ties , the Appella nt requir es help n ta l Medic al Opinio n, there is in forma tion th at t he c ti vities a s required" but t h a t i t is ired. There i s a lso infor mati on that the Whil e the A p pella nt's daug hter testif ie d th at she p r e par atio n a nd la undry, the pre sc ribed e d i nfor m a t i on tha t thi s assi stanc e is req uir ed ni str y re a sona bl y c onc lu ded that i t could n o t elp fro m other person s to m a nage dail y livin g and t h e relev an t legislat ion , the pan el f inds t h a t that the Appellant w as n o t eli gib l e for PWD r efor e th e panel c onf irms t h a t d e cisi on.
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