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 " 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 J u n e 1 2 , 2 0 t h r e e 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 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 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 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 s a t i s f i e d t h a t : • 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 • 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 " ) 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 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 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 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 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 E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # � l D 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 1 4 , 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 e 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 e 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 t 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 a 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 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 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 , 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 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 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 . b i l i t i e s A c t ( " E A P W D A " ) , s e c t i o n 2 b i l i t i e s R e g u l a t i o n ( " E A P W D R " ) , s e c t i o n 2
I 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 20, 2013) along with a physician's report ("PR") and assessor's report ("AR") completed by the appellant's physician of 5+ years -a general practitioner (both also dated November 20, 2013). • The appellant's 2-page typewritten reconsideration submission dated May 28, 2014. Admissibilitv of Additional Information 1. Prior to the hearing, the appellant sent a 5-page typewritten submission to the offices of the Employment and Assistance Appeal Tribunal. 2. At the hearing, the appellant submitted a 3 page handwritten document listing 19 symptoms of multiple sclerosis which she said she experiences. The ministry took no position on admissibility of these documents other than to express concern that some of the information in the documents was not before the ministry at the time of reconsideration. In reviewing the above-noted documents, as well as the appellant's oral testimony, the panel found that they provided additional detail about the appellant's condition and has admitted them as being in support of the information and records that were before the ministry at the time of reconsideration, in accordance with section 22(4) of the Employment and Assistance Act. The ministry relied on the reconsideration decision and provided no additional information. The panel reviewed the evidence as follows: Diagnosis • In the PR the physician diagnosed the appellant with multiple sclerosis ("MS"), which she described as "rapidly remitting/relapsing". • In response to the question 'What are the applicant's mental or physical impairments ..." in the AR, the physician wrote "If fatigue, acute episode MS -cannot work, concentrate etc." Phvsical Impairment • In terms of physical functioning, the physician reported in the PR that the appellant can walk 1 to 2 blocks unaided on a flat surface, climb 5+ steps unaided, lift 5 to 15 pounds, and has no limitations to how long she can remain seated. • In the AR the physician indicated that the appellant independently manages her walking indoors and outdoors and stair climbing, but that she needs periodic assistance with standing ("feels weak") and lifting/carrying/holding ("can't lift weak"). The physician commented "Often requires someone to help with above." • In her self-report the aooellant wrote that MS has severely impacted the left side of her bodv, EAAT 003(10/06/01)
c a u s ing numbness , slight v ision los s, inabi l d ress and bath e. She wro t e th at c old weat her probl ems with sho rt t e rm memory . o In her oral t es t imo ny the appel lan t s a id t ha t • In re spon se to a qu es ti o n from the ministry , the sy mpto ms s he'd subm itt e d at the hearing was d appl i ed to her. • In re spon se to a qu es ti o n from the pan el as to l o ng they last , t he appellant replied that they happen e da y) or ev er y two d ays, and t ha t th ey can last Me ntal I mpairmen t • In the PR a nd AR the physician ind icated t hat c om munic a ti o n, and th at her ability to communi • I n th e PR the physician rep o r ted that the appel catego ri e s of cognit ive a n d emotional functi a t tention/con c en t r at ion . • I n t he AR the physician in dicated th a t the ap 5 of 14 ca t e gorie s of co gn i tive and emot i o nal at tentio n /concen tra tio n, m emor y , and m ot iva fatigue. Una b le t o sleep, conc entr a t e o r a mbula DLA • The physic ian i n d icat e d that the a p pellant has been pr wit h he r abili ty to perform DL A. • In th e PR t he p h y sic ia n r e p orted that t he appel DLA of pe r s o na l s el f-ca r e , meal pre p a ration, m a nagement of fin ances . The p h y sic ia n i ndicated th ind oo rs po r tio n of the DLA mo ve abo ut ind oors appell a nt req uires con tinuous ass is tance with the 3 use of transportation, and the outdoors aspect of move about indoors an s t a t ed that the a pp e l la n t requires periodic assistance w increa sed fatigue, difficulty concentration [illegible] ... must not get fatigued -will ppt recurrence acute episode MS." • I n the AR the physicia n ind icated that the appellant independently manages all aspects of the 4 DLA of personal self-care, meal preparation, manage personal finances (pay rent and bills), and manage personal medications. She reported that the appellant requires periodic assistance with some aspects of 4 DLA : basic housekeeping (when acute attack MS); daily shopping (going to and from stores when acute attack difficulty lifting); use of transportation, (difficult to access public transit when fatigu so c ial fu n c t ioning (dealing appropriately with un Further pertaining to social functioning, the physician reported that the appellant has marginal functioning with her immediate social network, and good functioning with her extended social network. • In her reconsideration submission the appellant indicated that she lives with her husband and 2 oun children. She wrote that: EMT 003(10/06/01) APPEAL# � i ty to move/ wal k withou t hel p, and requi ri n g he lp t o causes her t o fa tigue easily, and MS has caused she'd been seein g her phys icia n f o r 8 or 9 year s. appellant acknowled g ed that the l ist o f 19 erived f rom a n M S we b site, but that they all ho w often f lar e up s of her M S o c cur and ho w ve ry day (sometim e s m ore t han on ce a f o r d ay s o r w eek s . t he appellant ha s no d iff i cul t ies with cate is sa t isfactory in al l re spe cts. la n t expe ri e nces s ignifi c ant deficits in 3 o f 1 2 o n: memor y , e m oti on al d isturb a nc e, a nd pellant 's i m p airm e n t caus es moderat e imp a c ts to f unc tioning: bodily fun cti o n s, emotion , t ion . The physic ia n c o mm ente d " Mu st a v o id te when ac ute att a c k. escr ibed a me d icati o n tha t int e rferes la n t ha s n o r estr ictions with the 4 p rescr ibed man agemen t of per sonal me dic ations, and a t the a ppellant also is unrestr icted i n t he a nd outdoors. The phys ician stat ed that t he D LA of basi c hou s ew o rk, daily sh opping, d outdoors. She also ith social functioning, commenti n g "if MS; carrying purchases home ed) ; and e xpected dem a n d s -"n o t physical demands".)
I APPEAL# ► Too much heat or cold can trigger flare-ups of her MS. The flare-ups can last anywhere from a "minimum of a week to generally four weeks, the longest itself lasting over a six week time period. In that time span, my [DLA] are impaired. ► When flare-ups occur, her husband helps her to bath and wash her hair. ► When severe flare-ups occur "even driving becomes out of the question." ► She's had poor response to 2 MS medications, and will be trying a third, ► Her MS makes it difficult to find work because it affects her walking and sometimes slurs her speech. ► Her husband frequently has to remind her to take her mediations. o In her appeal submission, the appellant reported restrictions to virtually all DLA as follows: ► Personal self-care -Difficulty remembering to perform basic hygiene; husband has to help reach some parts of her body unless she sits down to do so; husband sometimes has to help her dress. ► Meal preparation -has to sway back and forth to shift weight while standing at counter to ease pain from hip to knee; generally understands recipes but sometimes has to ask for help; sometimes keeps food items too long till they go bad; only prepares one meal a day -husband or eldest son does the rest; sometimes forgets to eat for 2 or 3 days or is too fatigued to eat. ► Manage personal medications -she manages to remember to take her morning mediation but her husband has to remind her to take it at night; her husband and physician have to remind her to buy more probiotics. ► Basic housework -she can wash dishes but her husband does the rinsing and drying; she can't bend over far enough to clean the bath tub, at times she tries to vacuum the floors but has to stop; she can dust as long as she doesn't have to bend over too long; she forgets to do laundry and has to be reminded to do it; some days she is well motivated to complete housework, other days she is not; she sometimes forgets to water the house plants. ► Daily shopping -generally has someone with her to help lift items; tends to buy the cheapest item rather than "stand in an [a]isle long enough to figure out what is best for my family"; son and daughter or husband usually go shopping with her; tends to get anxious and claustrophobic. ► Move about indoors and outdoors -lives in a two-story home and has trouble with stairs; has to use both arms to push herself out of a chair but sometimes requires her husband's help to get up; as long as she has something to pull herself up with she "tend[s] to get around some-what well"; on worse days has to lean against the walls and gets dizzy spells; can walk up to a block before her entire body starts to get tingly or numb. ► Use of transportation too claustrophobic to use public transportation. ► Managing personal finances -difficult to remember how much money she has when shopping; sometimes finds it difficult to remember to pay bills; ► Social functioning-suffers from depression, anxiety, confusion; difficult to interact with strangers; unable to maintain a healthy friendship or relationship; when in desperate need seeks out a family member, health professional or support group. • In her oral testimony the appellant stated that she has had to learn to compensate and to "work around" her MS to get things done. For example she sometimes crawls up the stairs at home or sits on the counter top while cooking. • In response to a question from the panel, the appellant confirmed that she had preoared the 5 EAAT 003(10/06/01)
I APPEAL# page appeal submission. Help o In the PR the physician reported that the appellant requires glasses as an aid for her impairment. In the AR the physician indicated that the appellant requires no other assistive devices, and she does not have an assistance animal. • The physician stated that the appellant receives assistance with DLA from her family, but that she requires help with "home care re: laundry, cleaning, meals and child care." EMT 003(10/06/01)
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 i s a p p e a l i s w h e t h e r t h e m i n i s t r y ' 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 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 . d e t e r m i n i n g 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 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 h e a p p e l l a n t ' r e s t r i c t h e r f r o m p e r f o r m i n g D L A e i t h e r c o n t i n u o u 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 d o e s n o T h e r e l e v a n t l e g i s l a t i o n i s a s f o l l o w s : E A P W D A : 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 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 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 " 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 ( 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 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 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 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 ( i ) d i r e c t l y a n d s i g n i l i v i n g a c t i v i t i e s e i t h e ( A ) c o n t i n u o u ( B ) p e r i o d i c a ( i i ) a s a r e s u l t o f t h o 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 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 p e r f o r m i t , t h e p e r s o n r e q u ( i ) a n a s s i s t i v e d e v i c ( i i ) t h e s i g n i f i c a n t h e ( i i i ) t h e s e r v i c e s o f a E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # d e c i s i o n t o d e n y t h e a p p e l l a n t d e s i g n a t i o n a s a 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 I n p a r t i c u l a r , w a s t h e m i n i s t r y r e a s o n a b l e i n 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 n d t h a t i n t h e s i m p a i r m e n t s d o n o 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 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 t r e q u i r e h e l p t o p e r f o r m D L A . 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 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 e s c r i b e d m e a n i n g ; h e p r e s c r i b e d m e a n i n g . 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 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 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 c r i b e d p r o f e s s i o n a l 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 r f o r m d a i l y r s l y , o r l l y f o r e x t e n d e d p e r i o d s , a n d s e r e s t r i c t i o n s , t h e p e r s o n r e q u i r e s h e l p t o p e r f o r m 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 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 i r e s 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 n a s s i s t a n c e a n i m a l .
E A P W D R s e c t i o n 2 ( 1 ) : 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 ( a ) i n r e l a t i o n t o a p e r s o m e n t a l i m p a i r m e n t , m e a ( i ) p r e p a r e o w n m ( i i ) m a n a g e p e r s o ( i i i ) s h o p f o r p e r s ( i v ) u s e p u b l i c o r ( v ) p e r f o r m h o u s e a c c e p t a b l e s a n i t a ( v i ) m o v e a b o u t i ( v i i ) p e r f o r m p e r s ( v i i i ) m a n a g e p e r s ( b ) i n r e l a t i o n t o a p e r s o f o l l o w i n g a c t i v i t i e s : ( i ) m a k e d e c i s i o n s ( i i ) r e l a t e t o , c o m m ( 2 ) F o r t h e p u r p o s e s o f t h e A c t , " p r e s c r ( a ) a u t h o r i z e d u n d e r a n e ( i ) m e d i c a l p r a c t i ( i i ) r e g i s t e r e d p s y ( i i i ) r e g i s t e r e d n u ( i v ) o c c u p a t i o n a l ( v ) p h y s i c a l t h e r a ( v i ) s o c i a l w o r k e r ( v i i ) c h i r o p r a c t o r , ( v i i i ) n u r s e p r a c t i ( b ) a c t i n g i n t h e c o u r s e o b y ( i ) a n a u t h o r i t y , a I n d e p e n d e n t S c h o ( i i ) a b o a r d o r a f d e f i n e d i n s e c t i o n i f q u a l i f i c a t i o n s i n p s y c h o l o g y a r e a c o n d i S e v e r e P h y s i c a l I m p a i r m e n t 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 t h e f a t i g u e a n d p a i n 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 . S h e s a i d t h a t h e r M S v i r t u a l l y a l l a c t i v i t i e s a r e r e s t r i c t e d b y h e r d i s e a s e . S m u c h t i m e p r e s s u r e a n d d i d n ' t p r o v i d e e n o u g h d e t a E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # � 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 " , 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 n s t h e f o l l o w i n g a c t i v i t i e s : e a l s ; n a l f i n a n c e s ; o n a l n e e d s ; p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s ; w o r k t o m a i n t a i n t h e p e r s o n ' s p l a c e o f r e s i d e n c e i n r y c o n d i t i o n ; n d o o r s a n d o u t d o o r s ; o n a l h y g i e n e a n d s e l f c a r e ; o n a l m e d i c a t i o n , a n d 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 t h e a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r f i n a n c e s ; u n i c a t e o r i n t e r a c t w i t h o t h e r s e f f e c t i v e l y . i b e d p r o f e s s i o n a l " m e a n s a p e r s o n w h o i s n a c t m e n t t o p r a c t i s e t h e p r o f e s s i o n o f t i o n e r , c h o l o g i s t , r s e o r r e g i s t e r e d p s y c h i a t r i c n u r s e , t h e r a p i s t , p i s t , , o r t i o n e r , o r f t h e p e r s o n ' s e m p l o y m e n t a s a s c h o o l p s y c h o l o g i s t s t h a t t e r m i s d e f i n e d i n s e c t i o n 1 ( 1 ) o f t h e o l A c t , o r r a n c o p h o n e e d u c a t i o n a u t h o r i t y , a s t h o s e t e r m s a r e 1 ( 1 ) o f t h e S c h o o l A c t , t i o n o f s u c h e m p l o y m e n t . * * * * * * * s h e e x p e r i e n c e s a s a r e s u l t o f h e r M S c o n s t i t u t e s h a s n o t b e e n r e s p o n s i v e t o m e d i c a t i o n a n d t h a t h e a r g u e d t h a t t h e p h y s i c i a n w a s u n d e r t o o i l a b o u t h e r i m p a i r m e n t .
T h e m i n i s t r y ' s p o s i t i o n , a s s e t o u t i n i t s r e c o n s i d e r t o e s t a b l i s h a s e v e r e p h y s i c a l i m p a i r m e n t . T h e m a r e m o r e i n k e e p i n g w i t h a m o d e r a t e d e g r e e o f i m P a n e l D e c i s i o n A d i a g n o s i s o f a s e r i o u s m e d i c a l c o n d i t i o n d o e s n o s e v e r e i m p a i r m e n t . A n " i m p a i r m e n t " i s a m e d i c a l a b i l i t y t o f u n c t i o n i n d e p e n d e n t l y o r e f f e c t i v e l y . T o a s s e s s t h e s e v e r i t y o f a n i m p a i r m e n t o n e m u s t e x t e n t o f i t s i m p a c t o n d a i l y f u n c t i o n i n g a s e v i d e n c w h i c h p e r f o r m i n g D L A i s r e s t r i c t e d . A m e d i c a l b a r e m p l o y m e n t i s n o t a l e g i s l a t e d c r i t e r i o n f o r s e v e r i t y c o n s i d e r a l l t h e r e l e v a n t e v i d e n c e , i n c l u d i n g t h a t o t h a t t h e f u n d a m e n t a l b a s i s f o r t h e a n a l y s i s i s t h e e e x e r c i s i n g i t s d e c i s i o n m a k i n g p o w e r t h e m i n i s t r y c p r o f e s s i o n a l s w i t h r e s p e c t t o w h e t h e r t h e s t a t u t o r y a m o u n t t o a n i m p r o p e r f e t t e r i n g o f d i s c r e t i o n . T h e a s s e s s e d l i k e a n y o t h e r e v i d e n c e . I n t h e a p p e l l a n t ' s c a s e , t h e e v i d e n c e p r o v i d e d b y t a p p e l l a n t ' s p h y s i c a l f u n c t i o n a l s k i l l s i n d i c a t e s t h a t c o n s i s t e n t w i t h h e r e v i d e n c e i n t h e A R t h a t t h e a p p c l i m b i n g s t a i r s , a n d t h a t s h e n e e d s p e r i o d i c a s s i s t a I t ' s a p p a r e n t f r o m t h e e v i d e n c e o f t h e p h y s i c i a n a n e x p e r i e n c e s i s v a r i a b l e w o r s e n i n g w h e n s h e i s h r e f e r r e d t o r e s t r i c t i o n s e x p e r i e n c e d b y t h e a p p e l l a n p r o v i d e d n o e v i d e n c e o f h o w f r e q u e n t l y t h e s e a c u t 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 R e s t r i c t i o n s t o D L A , t h e 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 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 e r 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 i s s u e s w h i c h a r e l i k e l y t o p r o g r e s s o v e r t i m e , t h e m f a l l s s h o r t o f e s t a b l i s h i n g t h a t s h e h a s a s e v e r e p h y l e g i s l a t i o n . 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 a p p e l l a n t ' s p o s i t i o n i s t h a t t h e c o g n i t i v e e f f e c t s 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 m i n i s t r y ' s p o s i t i o n , a s s e t o u t i n i t s r e c o n s i d e r a d e m o n s t r a t e 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 m i n w i t h c o m m u n i c a t i o n a n d t h e i m o a c t s t o c o g n i t i v e a n E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # a t i o n d e c i s i o n , i s t h a t t h e r e i s n o t e n o u g h e v i d e n c e i n i s t r y s t a t e d t h a t t h e a p p e l l a n t ' s f u n c t i o n a l s k i l l s p a i r m e n t . t i n i t s e l f d e t e r m i n e P W D e l i g i b i l i t y o r e s t a b l i s h a c o n d i t i o n t h a t r e s u l t s i n r e s t r i c t i o n s t o a p e r s o n ' s c o n s i d e r t h e n a t u r e o f t h e i m p a i r m e n t a n d t h e e d b y f u n c t i o n a l s k i l l l i m i t a t i o n s a n d t h e d e g r e e t o r i e r t o t h e a p p e l l a n t ' s a b i l i t y t o e n g a g e i n p a i d . I n m a k i n g i t s d e t e r m i n a t i o n t h e m i n i s t r y m u s t f t h e a p p e l l a n t . H o w e v e r , t h e l e g i s l a t i o n i s c l e a r v i d e n c e f r o m p r e s c r i b e d p r o f e s s i o n a l s . I n a n n o t m e r e l y d e f e r t o t h e o p i n i o n o f t h e r e q u i r e m e n t s a r e m e t a s t h a t a p p r o a c h w o u l d p r o f e s s i o n a l e v i d e n c e h a s t o b e w e i g h e d a n d h e p h y s i c i a n i n t h e P R w i t h r e s p e c t t o t h e s h e i s i n t h e m i d r a n g e o f f u n c t i o n a l i t y . T h i s i s e l l a n t i n d e p e n d e n t l y m a n a g e s w a l k i n g a n d n c e w i t h s t a n d i n g a n d l i f t i n g / c a r r y i n g / h o l d i n g . d t h e a p p e l l a n t t h a t t h e d e g r e e o f r e s t r i c t i o n s h e a v i n g a f l a r e u p . S e v e r a l t i m e s t h e p h y s i c i a n t d u r i n g a n " a c u t e e p i s o d e . " T h e p h y s i c i a n h a s e e p i s o d e s o c c u r o r h o w l o n g t h e y l a s t . i o 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 n 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 a b i l i t y t o m a n a g e h e r D L A i n d e p e n d e n t l y . F o r t h e h 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 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 e v i d e n c e 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 o f h e r M S i m p a c t m a n y o f h e r D L A a n d c o n s t i t u t e t i o n d e c i s i o n , i s t h a t t h e e v i d e n c e d o e s n o t i s t r y a r g u e s 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 y d e m o t i o n a l f u n c t i o n i n a , a s a s s e s s e d b v t h e
a p p e l l a n t ' s p h y s i c i a n , a r e a t m o s t m o d e r a t e . P a n e l D e c i s i o n S e c t i o n 2 ( 1 ) ( b ) o f t h e E A P W D R p r e s c r i b e s t w o D L d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r f i n a n c e i n t e r a c t w i t h o t h e r s e f f e c t i v e l y ( s o c i a l f u n c t i o n i n g ) . T h e e v 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 i s n o t s i g i n t h a t a c c o r d i n g t o t h e p h y s i c i a n ' s e v i d e n c e s h f i n a n c e s a n d m a n a g i n g p e r s o n m e d i c a t i o n s . W h i l e t h e s e D L A c o n f u s i n g , a n d t h a t s h e r e q u i r e s r e m i n d i s n o t s u f f i c i e n t l y c o n v i n c i n g t o o u t w e i g h t h e p h y s i c i n d e p e n d e n t l y m a n a g e s t h e s e D L A . T h e p h y s i c i a n ' s e v 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 m a k i n g t a s k s r e l a t e d t o s o c i a l f u n c t i o n i n g ( m a k e s a a n d d a i l y s h o p p i n g . O n b a l a n c e t h e e v i d e n c e i n d i h e r a b i l i t y t o m a n a g e h e r o w n 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 , t h e e v i d e n c e i n d l e v e l r e g a r d i n g h e r i m m e d i a t e s o c i a l n e t w o r k , a n d e x t e n d e d s o c i a l n e t w o r k . T h e a p p e l l a n t s a i d t h a t w a n d m a k i n g a n d m a i n t a i n i n g r e l a t i o n s h i p s , s h e s e e O n b a l a n c e t h e p a n e l c o n c l u d e s t h a t t h e e v i d e n c e 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 . W i t h r e s p e c t t o f u n c t i o n a l s k i l l s , t h e p h y s i c i a n ' s e v i c o m m u n i c a t e i s s a t i s f a c t o r y i n a l l r e s p e c t s . T h i s v i a c k n o w l e d g e m e n t t h a t s h e p r e p a r e d t h e a r t i c u l a t e 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 R e s t r i c t i o n s t o D L A , a n y l i m i t a t i o n s r e s u l t i n g f r o m 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 e r a b i l i t y t o C o n s i d e r i n g t h e e v i d e n c e a s a w h o l e , i n c l u d i n g t h e r e s t r i c t e d i n h e r a b i l i t y t o m a n a g e t h e 2 p r e s c r i b e d 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 r e a s o n a b l y d e t e r m m e n t a l i m p a i r m e n t . 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 e r a b i l i t y t o p e r f o r m f a t i g u e a n d c o g n i t i v e e f f e c t s o f M S . S h e s a i d t h a t s h e r h u s b a n d a n d c h i l d r e n t o h e l p h e r w i t h D L A . T h e m i n i s t r y ' s o o s i t i o n i s t h a t t h e r e i s n o t e n o u q h e E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )'. A P P E A L # A t h a t a r e s p e c i f i c t o m e n t a l i m p a i r m e n t m a k e s ( d e c i s i o n m a k i n g ) , a n d r e l a t e t o , c o m m u n i c a t e o r n i f i c a n t l y r e s t r i c t e d w i t h r e s p e c t t o d e c i s i o n m a k i n g e i s n o t r e s t r i c t e d i n t h e D L A o f m a n a g i n g p e r s o n a l t h e a p p e l l a n t h a s s a i d t h a t s h e f i n d s a s p e c t s o f e r s t o p e r f o r m t h e m , h e r e v i d e n c e o n t h e s e p o i n t s i a n ' s o b s e r v a t i o n s t h a t t h e a p p e l l a n t n t a l s o i n d e p e n d e n t l y m a n a g e s t h e d e c i s i o n  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 ) , m e a l p r e p a r a t i o n , c a t e s 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 r e s t r i c t e d i n i c a t e s t h a t t h e a p p e l l a n t f u n c t i o n s a t a m a r g i n a l t h a t s h e h a s g o o d f u n c t i o n i n g i n t e r m s o f h e r h i l e s h e h a s d i f f i c u l t y i n t e r a c t i n g w i t h s t r a n g e r s k s o u t f a m i l y m e m b e r s w h e n s h e n e e d s s u p p o r t . i n d i c a t e s t h e a p p e l l a n t i n d e p e n d e n t l y m a n a g e s 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 ' s a b i l i t y t o e w i s s u p p o r t e d b y t h e a p p e l l a n t ' s 5 p a g e w r i t t e n a p p e a l s u b m i s s i o n . i o 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 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 t o h a v e m a n a g e h e r D L A i n d e p e n d e n t l y . e v i d e n c e 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 D L A t h a t a r e s p e c i f i c t o m e n t a l i m p a i r m e n t , t h e i n e d t h a t i t d o e s n o t d e m o n s t r a t e a s e v e r e v i r t u a l l y a l l D L A i s 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 p a i n , h e w o u l d n o t b e a b l e t o f u n c t i o n i f s h e d i d n ' t h a v e v i d e n c e t o c o n f i r m t h a t t h e a n n e l l a n t ' s
I APPEAL# impairments significantly restrict her ability to perform DLA either continuously or periodically for extended periods. The ministry argued that as the physician indicated in the PR that the appellant requires continuous assistance with some DLA, then in the AR indicated that she needs periodic assistance for those DLA when she is having a flare up, it is difficult to develop a clear and cohesive picture of the degree of restrictions. Panel Decision The legislation -s. 2(2)(b)(i) of the EAPWDA-requires the minister to substantially assess direct and significant restrictions of DLA in consideration of the opinion of a prescribed professional, in this case the appellant's general practitioner. This doesn't mean that other evidence shouldn't be factored in as required to provide clarification of the professional evidence, but the legislative language makes it clear that the prescribed professional's opinion is fundamental to the ministry's determination as to whether it is "satisfied". The legislation requires that a severe impairment directly and significantly restricts the appellant's ability to perform DLA either continuously or periodically for extended periods. The term "directly" means that there must be a causal link between the severe impairment and the restriction. The direct restriction must also be significant. Finally, there is a component related to time or duration. The di rect and significant restriction may be either continuous or periodic. If it is periodic it must be for an extended time. Inherently, any analysis of periodicity must also include consideration of the frequency. All other things being equal, a restriction that only arises once a year is less likely to be significant than one which occurs several times a week. Accordingly, in circumstances where the evidence indicates that a restriction arises periodically, it is appropriate for the ministry to require evidence of the duration and frequency of the restriction in order to be "satisfied" that this legislative criterion is met. In the appellant's case there is a degree of inconsistency in the physician's evidence on restrictions in that in the PR she identified 4 DLA for which the appellant requires continuous assistance (basic housework, daily shopping, using transportation, and the outside portion of moving about indoors and outdoors. In the AR in describing restrictions to those 4 DLA she described them as being "periodic", linking them to times when the appellant was having an acute episode or flare up. In the PR and AR the physician made several references to acute episodes or acute attacks, but she has provided no evidence as to the frequency or duration of these acute episodes. The appellant's evidence with respect to flare ups is that she gets them daily or every other day, that she can get more than one flare up in a day, and that flare ups can last for weeks. This degree of acute activity can't be reconciled with the physician's evidence of periodicity. The panel notes also that the appellant has said that she is restricted in virtually all DLA, including those which the physician indicated the appellant can manage independently. Many of the restrictions identified by the appellant are related to cognitive and emotional functioning. For example: forgetting basic hygiene, misunderstanding recipes, forgetting to eat, forgetting to do laundry, getting claustrophobic in stores or on public transit, and forgetting to pay bills. The physician has described the cognitive and emotional impacts as being at most "moderate". On this evidence it would be difficult to conclude that these cognitive impacts result in significant restrictions to the appellant's ability to perform DLA. EAAT003(10/06/01)
I APPEAL# Based on the inconsistency in the physician's evidence and the lack of any evidence from the physician on the frequency and duration of acute episodes, the panel finds that the ministry reasonably concluded that the evidence does not establish that the appellant's impairments directly and significantly restrict her DLA either continuously or periodically for extended periods. Help with DLA The appellant's position is that she requires help from her family to perform aspects of virtually all DLA. The ministry's position is that since it has not been established that the appellant's DLA are significantly restricted, it cannot be determined that significant help is required from other persons. Panel Decision A finding that a severe impairment directly and significantly restricts a person's ability to manage her DLA either continuously or periodically for an extended period is a precondition to a person requiring "help" as defined by section 2(3)(b) of the EAPWDA. For the reasons provided above, that precondition has not been satisfied on the balance of probabilities in this case. Accordingly, the panel finds that the ministry reasonably concluded it could not be determined that the appellant requires help with DLA as defined by section 2(3)(b) of the EAPWDA. Conclusion The panel acknowledges that the appellant's medical conditions affect her ability to function. However, having reviewed and considered all of the evidence and the relevant legislation, the panel finds that the ministry's decision finding the appellant ineligible for PWD designation is a reasonable application of the legislation in the circumstances of the appellant. The panel therefore confirms the ministry's decision. EAA T003(10/06/01)
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.