APPFAI # : PART C -Decision under Appeal The decision being appeal � is the Ministry of Social Development and Social Innovation (the "Ministry") June 11, 2014 reconsideration decision in which the Ministry determined that the Appellant was not eligible for Persons with Disabilities ("PWD") designation because she 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 her ability to perform daily living activities either continuously or periodically for extended periods; and, (ii) as a result of those restrictions she 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 her 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. EAA T003(10/06101)
P A RT E -Su mm arv of Fa ct s For its recon sid eration d ec i s i on, th e M i nistry had t he 1 . A pp e llant 's PWD a pplica tion c o nsi sting of : • Her sel f-repor t dated J a nuary 21, 2014. • A p hysici a n's re por t ("PR") and an asse ssor 201 4 by th e Ap pel lant' s family doct o r w ho indicated that he had k yea rs and had se en her 11 or m o re times in 2 . A ppellant's r eques t f or rec o nsi de r a tio n d ated May • Writt en submissions b y th e App ellan t 's advoca • A che ckl ist repor t com pleted by t he A ppe llant's s Di agn o ses I n t he PR, t h e doct or dia gnosed the Appe lla nt w it h rheuma knees, left shoulder, elbows; memor y impairment caused tr aum ati c str e s s disorder], f las hbacks, lea rning disorde maj or event; an d asplenic. I n the Ma y 2014 c h e ck li s t rep or t, the d oct or che cked and he adde d t hat t he Appe l lan t "a lso has u rin ary i ncont Phvs ica/ I m pairm ent I n her self-re po rt, t h e Ap pella n t d escri be d her di s abi • Deformed right foot m ake s it ha rd to w alk or s swells and b r ui ses t he a n k le . • Arthritis in thumbs was r emoved s urgically, but is com all her fingers. • Can't use h er ha nds for co nti nual , re p e tit ive • Can't sleep th rough the nig ht. • Can't w alk fast or ex ercise, diff i c ulty gettin g i In the PR, t he doc t o r descr i bed t he se v e ri ty of the Ap skill s as follows: • Su s ta ined injuries inc luding a ru p tured sp l e en, penetrated h er lung a nd pneumothor ax a fter • Severe bunion, impaired gait. • Chronic pain in her shoulde r, hips, back, knees -currently controll pain will likely persist; pain control requires medical treatment, psy • Can walk 1-2 blocks unaided on a flat surface, can climb 5+ stairs unaided, can lift 5-15 lbs., can remain seated less than 1 hour. • Add ed the following comment: "sev e re art hritis" In t he AR, the doctor reported the Appellant's mobility • Walking indoors -independent, uses assistive device, takes significantly longer -2x, must use orthotic shoes. • Walking outdoors -uses assistiv e device, take m etres, slower • Clim bina stairs -independent, uses assistive device, takes siqnificantlv lonaer -EM T003(10/06/01) AP PEAL# : f ol lowin g ev ide nce: ' s report (" A R") bo t h co mple ted on Jan u a ry 14, nown t he Appellan t for 3 t he 12 m o nt hs pre ceding th e r ep orts . 2 1, 201 4 w it h : te. a me fam il y doctor on M ay 24, 20 14. t oid art hritis of bilatera l thumbs , both hips , by a motor vehicle accident; PT S D [post r (unable to lea rn new skills ) after survi ving a of f t he same conditi ons as rep orted in the PR inence as an extra b arrier" . li ty as follows: tan d f or long p e r iod s, h as or th ot i cs, f o ot s till ing ba ck i n most jo in ts of h er bo dy and in work. n and o u t of veh ic l e s bec aus e of her k ne es. pe l lant 's c ond i tions an d her physic al f un cti o ning dislocated both h ips, a number of ribs a severe motor veh icle acc id e n t. ed with medications; the chological suppor t. an d phys ic al abili ty a s follows: s significa nt ly longer-2x, 5 min utes for 30 2x -but
I APPEAL# dizziness going down stairs. • Standing -independent, uses assistive device, takes significantly longer -2x, cannot stand for more than 5 minutes before must lean on something. • Lifting -independent, takes significantly longer -2x, cannot carry more than 5 lbs. for 5 minutes. • Carrying and holding -independent, cannot carry heavy items for long. In the checklist report, the doctor checked boxes beside the following statements: • Basic mobility: directly and significantly restricted from walking more than 1-2 blocks due to swelling in right foot, pain in left knee and right hip. • Climbing stairs: directly restricted from climbing stairs without holding onto railing for support. She takes 2x longer to climb more than 5 stairs. • Lifting/carrying/holding: significantly restricted from lifting, carrying or holding more than 5 lbs. for more than 5 minutes due to pain in shoulders and hands. • Sitting: directly restricted from sitting longer than 5 minutes without changing positions due to back pain and cramps in legs. Mental impairment In her self-report, the Appellant described her disability as follows: • Short term memory loss, getting worse, head injury in a car accident. • Can't hold a job that needs memory of prices or orders -waitress or cashier positions. • Forgets things that she is doing; e.g., leaves the room to get or do something and can't remember. Has left pot on the stove boiling eggs, they burnt, has to use a timer to alert herself. • Has difficulty learning because of memory (new career). In the PR, the doctor reported and described the Appellant's conditions as follows; • Traumatic brain injury from a motor vehicle accident, PTSD, amnesia, difficulties with communication, cognitive cause -short term memory loss. • Significant deficits with cognitive and emotional function in the areas of memory, emotional disturbance, attention or sustained concentration. • "Severe memory/learning disability"; "severe PTSD related to surviving [a major incident]". In the AR, the doctor described the Appellant's impairment affecting her ability to manage daily living activities as "severe memory deficit, cannot form episodic memory". He reported that her ability to speak, write and hear is good. Her ability to read is satisfactory -"will forget what she read before, after minutes". The doctor also reported the following impacts to cognitive and emotional functioning: • No impact in the areas of consciousness; impulse control; insight and judgment; executive; motor activity; other neuropsychological problems; other emotional or mental problems. • Minimal impact in psychotic symptoms. • Moderate impact in the area of language. • Major impact in the areas of bodily functions -sleep disturbance; emotion -anxiety; attention/concentration; memory -names, forgets over-learned facts; motivation. • Adding "[Appellant] reports she suffers from PTSD, depression and anxiety and has confusion, lack of motivation, language restrictions, and delusions/flashbacks". In the checklist report, after the statement "experiences the following symptoms daily as a result of her mental health conditions which further restrict her ability to complete her daily living activities", the doctor checked boxes by the following statements: • Sleep disturbances -major impact. EAAT 003(10/06/01)
I �PPEAL # • Anxiety -major impact. o Depression -major impact. • Poor concentration and short term memory issues -major impact. • Memory issues, learning new info, forgetting over-learned facts -major impact. • Lack of motivation -major impact. o Language restrictions, loses train of thought -moderate impact. • Delusions and flashbacks -moderate impact. Dailv Living Activities In the PR, the doctor reported that the Appellant has not been prescribed any medication and/or treatments that interfere with her ability to perform daily living activities. In the AR, the doctor reported the Appellant's ability to manage daily living activities as follows: • Independent in all areas of basic housekeeping and medications. • For personal care, needs periodic assistance with dressing, grooming, bathing and toileting takes significantly longer -2x, "often neglects 3x/month due to fatigue, chronic pain and depression, forgets to urinate once/day"; is independent feeding herself and regulating her diet; is independent with transfers in/out of bed and on/off a chair -takes significantly longer -2x, "due to pain and weakness is slower". • For shopping, is independent in all areas, but for going to and from stores uses an assistive device and takes significantly longer -2x, "uses cart with wheels, slower due to pain & fatigue and memory"; and, for carrying purchases home uses an assistive device and takes significantly longer -2x, "uses cart with wheels" • For meals, is independent in all areas but all take significantly longer -2x; for meal planning uses assistive device, "must use lists & reminders; slower"; for food preparation "must take breaks due to fatigue"; for cooking "must take breaks due to pain"; and, for safe storage of food "often forgets to refrigerate food." • For paying rent and bills is independent in all areas, but banking takes significantly longer -2x, "unable to stand in line for more than 5 minutes". • For transportation is independent in all areas, but using public transit takes significantly longer -2x, "unable to stand on bus, very anxious with buses". • Adding: "Memory problems severe & inhibiting" and "PTSD, depression, anxiety are very inhibiting". • Independently manages all areas of social functioning; has good functioning with her immediate social network; has marginal functioning with her extended social network -after major incident now avoids interacting with neighbors. • Adding: "PTSD, depression, anxiety are significant barriers to daily activities"; "[Appellant] is often confused, lacking of motivation, problems with language due to losing train of thought, and delusions/flashbacks"; "PTSD related to [major incident] -thinks about it almost daily". In the checklist report, the doctor checked the box beside this statement: "[Appellant] is directly and significantly restricted in her ability to do her daily living activities continuously, as a result of the conditions noted above" , referring to a list of the diagnosed conditions. The doctor also checked boxes beside the following statements: • Dressing/grooming/bathing: directly restricted from personal care 2x per week due to de ressed moods and lack of motivation. She ex eriences anxiet when bathin as she is EAAT 003(10/06/01)
� APPEAL# afraid of falling or not being able to get out of the bathtub. • Toileting: direct restrictions due to memory issues. She gets the urge to urinate but will forget and end up rushing to the washroom (1x per day). She experiences accidents 2x per week because of this. • Feeding self: lack of appetite 2x per week due to depressed moods. • Transfers on/off bed: takes 2x longer due to pain, weakness and cramps in calves. • Laundry/housekeeping: significant restrictions due to lack of motivation, pain and depressed moods. These activities get frequently neglected. • Going to and from the store: significantly restricted from going to and from the store due to pain and fatigue. Takes 3x longer to complete. • Paying for purchases: direct restrictions with standing in line ups longer than 5 minutes due to pain and fatigue. Supports herself on the counter or shopping cart. • Carrying purchases home: significantly restricted from lifting, carrying or holding more than 5 lbs. due to pain in shoulders and hands. • Meal planning: significant restrictions with meal planning on a daily basis due to memory issues. Takes 3x longer to complete. • Food preparation/cooking: significant restrictions due to lack of motivation, fatigue and pain. Neglects 2 days per week due to lack of appetite. • Safe storage of food: memory issues Sx per week with putting food away into fridge. • Banking: significantly restricted from standing in line-ups at the bank longer than 5 minutes due to pain. • Using public transit: significant restrictions with taking the bus due to anxiety and unable to stand on the bus. Help with Dailv Living Activities In the PR, the doctor reported that the Appellant requires orthotics for her impairment. In the AR, the doctor wrote that the Appellant uses a cart with wheels to go to and from stores, and to carry purchases home. He also noted that family and friends provide assistance to the Appellant, but gave no details about the type or frequency of such assistance. The doctor also did not complete the sections for assistance provided with assistive devices or assistance provided by an assistance animal. In the checklist report the doctor checked boxes next to the following statements: • Basic mobility: requires transportation to access the community and would benefit from a cane. • Climbing stairs: needs railing. • Lifting/carrying/holding: continuous assistance from son with more than 5 lbs. • Dressing/grooming/bathing: would benefit from shower grab bar or stool. Needs son or daughter-in-law to be home when she is bathing in case she is unable to get out of the tube or has a fall. • Toileting: wears menstrual pads on a daily basis, especially if leaving her home. • Feeding self: encouragement from son to eat 2x per week. • Laundry/housekeeping: continuous assistance from son. • Going to and from the store: son goes for her 75% of the time. • Paying for purchases: uses counter or shopping cart for support when standing in line-ups. • Carrying purchases home: uses cart on wheels to transport groceries home. • Meal planning: continuously uses lists and reminders. Needs a timer when cooking. • Food preparation/ cookinq: continuous assistance from son with all meals. EMT 003(1 0/06/01)
• S afe sto rage of food: so n reminds he r to p ut f • U sing public tr an sit: needs a seat on the bus. The doc tor c hec ked o f f b oxes rep orti ng that the Ap on whe els, men s trual p ads " to catch uri ne l ea kage wh c ane, would be n e fit from sh o w e r gr a b bars or stoo l At the hearing, the A p pe l lant's adv o ca te submit ted th is deci sio n . He said t hat the May 201 4 check list report was r ev iew e d the docto r 's dia gn o sis of the Ap pel lant's medi impact the A ppellan t's ab ility to ma na g e her daily l i Ap pellant h a d a s k ed him to spe ak on her be h a l f. He a n d she f req u ent ly n eed s h er childr en to do dail y livin of her ch i ld ren present and she ne ed s her s on to d o Th e Appell ant said h e r foo t is g ett ing more and more de surgery to f ix it , surgery w hich w o uld involv e brea kin th a t she us es or t hot i cs if she w alks fa r and she u s e sh opping and she hold s on t o railing s w hen using stair Pursuant to s ectio n 22 ( 4) of the Em pl oyment and A provid ed by the App el lant a nd h er advocate at t he hearing b in su ppo rt o f t he evidence t hat the Min istry had at r e At th e h eari ng, the Ministry re l i ed on a n d re aff irme d i EAAT003(10/06/0 1 ) : AP P EAL# o od awa y -con tinuously. pe lla nt n e eds t he foll owing ass istive devic es: ca r t ich happen s al mos t d a il y" , would benefit fro m a s. o ral argu m ent which is summarized in P art F of p r e pa r e d by an other advoc at e. He also cal con d itio ns and how those cond i tions v i n g co n diti ons . T he advocate a lso said t hat t h e state d that the Ap pe llan t live$ wi th her c h il d r en g activiti es . She is u nab le to bathe w itho u t on e most of the s hoppin g; th at is, 3 out of 4 trip s . f o r m ed and she woul d need ex pensi v e g all the bon es in her fo ot . The Appella n t state d s a ca n e . She a lso has a whee led cart f or s. ss i s ta nc e A ct, th e Panel admits the inf ormation e cause it substan tiates a nd therefore is co nsi d eration. ts r e consideration deci sion.
PART F -Reas ons for P anel Decisi on The i ssue in this appeal is whether the Mini stry reasona e ligib le for PWD designati o n b eca u s e sh e did not me EAPWDA, and specifically, tha t th e Appel lant d oe s th at in the op in io n of a prescr ibe d profess ional (i) directly and perform da i ly l iving ac t ivi ti e s either c ont inuou sly or re s u lt of those restrictions she require s h elp t o per form T he el i gibility cr i teri a for PW D de sig nation a re set o 2 (2 ) T h e m i n ister m ay de sign ate a pers on w ho has di sab i lit ies f o r the pur poses of this Act if th e m in ister or physical impairment tha t (a) in the opini on of a med i c al practitio n e r is likel y to c (b) in the opinion of a prescribed pro fe ssional ( i ) d irectly and si gn i f i ca ntly restr i cts th e pers on's a bi (A) continuously, or ( B) peri odi call y for ex tended periods, and (ii ) as a result of those r estr i ct ions , t he per s on req uire ( 3 ) For the purposes of subsect io n (2), (a ) a person who h a s a seve r e mental imp a ir ment in (b) a p erson r equ i res help i n relatio n to a daily living re qui res (i) an assis t ive d e v ic e , (ii ) th e sig nificant h el (i ii ) t he services of a n as sistanc e anima l . The "d aily l ivi ng act iv it ies " refe r red to in EAP WDA s 2 (1) F o r t he purposes of t he Act and th i s r e g ula t i on, (a) i n relatio n to a p erson who ha s a sev ere phy s ical imp means the fol lowi n g activ ities: ( i) p rep are own meal s; ( ii) man age pe r sona l finan ces; p ers on al t ra ns p ortation fa cil itie s; (v) perform h o usew acceptab l e san itary c ond ition ; ( vi) mov e a bout ind oo and self-care; (viii) man age personal medi cat ion, and (b) i n relation to a person wh o has a s evere ment al i (i) m ake d e cisions about personal act i vities, c are o r with others effectively. Evidentiary Findings The Appellant's doctor completed the PR and AR parts of the PWD application on Januar With her request for reconsideration, the Appellant submitted a checklist report completed by the same doctor on May 24, 2014. This May 2014 form was prepared by an advocate. In tha r ather than a l lo w in g the d o ctor to p rovid e an a ssessment o exam p l e o ptions to ch o ose f rom or room for comments, the for each box. The following is an example: dressing/grooming/bathing: directly restricted from personal care 2x per week due to depressed moods and lack of motivation. whether the doctor saw the Appellant between January 2014 and May 2014 and no explanation from the doctor about some of the discrepancies between the information in the PR and AR, and in the Mav 2014 report. EM T003{10/06/01) � APPEAL# b ly det ermined that the App ell a nt was not et al l of t he requ ir e ment s in se ct io n 2( 2) o f th e not h av e a s ev e re men ta l or p hysic a l impa ir me nt signific a n t ly r e s tric t s her a b il ity to p eriodical ly for ex t ende d periods ; and, (ii ) a s a th o se ac t ivities. u t in th e fo l low ing sectio ns of t he EA PWDA: reac hed 18 years of ag e as a person w ith is sat is fie d th at t he pe rson has a s e vere mental ontin u e f o r a t l east 2 years, and l i ty to pe r form d a i ly livi ng act i vit ies eith e r s help t o per f or m th os e activities. clu d e s a p er son wi th a me ntal disorder, and act ivit y i f, i n ord er to perform it, t he person p or supervision of another person, or ec tion 2( 2) ( b) ar e def in ed in t he EAPW DR as: "d ai l y l i ving ac tivitie s" , airmen t o r a sever e ment al impa i rmen t, (iii) shop f or pers on al needs ; (iv ) use public or or k to maintain th e person's p lace o f resid ence in r s an d ou tdoor s ; ( vii ) pe rfo rm pe r sona l hygiene mp airm e nt, i n c lu des th e foll owing act i vi t i es: finances; ( i i) r e late to, communicate or interact y 14, 2014. t for m, f the Appellant's impairme nts with, for m uses very specific language beside Also, there is no information as to
APPEAL# � The Panel notes that there is some information in the May 2014 report that is consistent with information in the PR and AR. Therefore, where the May 2014 report is consistent with the PR and the AR, the Panel gives the May 2014 report the same weight as the information in the PR and the AR. However, with respect to the sections in the May 2014 report that are not consistent with the PR and the AR, the Panel gives the evidence in the PR and the AR more weight. The Panel will review such evidence under the applicable PWD criteria at issue in this appeal. The Appellant's advocate submitted that the Appellant's physical and mental conditions are connected and her impairments affect her both mentally and physically. Therefore, the advocate argues that based on the evidence the Ministry unreasonably determined that the Appellant does not have a severe impairment. The Panel notes that section 2(2) of the EAPWDA states that the minister must be satisfied that the person has a severe mental or physical impairment that directly and significantly restricts the person's ability to perform daily living activities. Also, the PWD application forms separate physical and mental impairments for a medical and prescribed professional's assessments. Therefore, the Panel will consider the reasonableness of the Ministry's decision first regarding the Appellant's physical impairment and then her mental impairment. Severe Physical Impairment The advocate referred to the doctor's reports regarding the diagnoses of the Appellant's conditions and how those conditions impact the Appellant's functioning. The advocate reviewed the physical functioning limitations reported by the doctor as well as the Appellant's descriptions of how her physical conditions impact her functioning. The advocate also stated that the Appellant lives with her children and relies on them to help her with daily living activities. In its reconsideration decision, the Ministry reviewed the doctor's reports in the PWD application and determined that the information indicated that functional skill limitations are more in keeping with a moderate degree of impairment. The Ministry also considered the May 2014 report and noted that it is essentially what is in the original application. The Ministry determined that the information provided does not demonstrate either a severe physical impairment or significant restriction in the Appellant's ability to perform daily living activities. 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. As for finding work and/or working, the Panel notes that employability is not a criterion for PWD designation in section 2(2) of the EAPWDA nor is it listed among the prescribed daily living activities in section 2 of the EAPWDR. The Panel finds that the diagnoses of the Appellant's health conditions in the AR, the PR and the May 2014 report are the same: arthritis of bilateral thumbs, both hips, knees, left shoulder, elbows and knees; and, asplenic. In the May 2014 report, the doctor added urinary incontinence. In the PR, the doctor also noted that the Appellant has chronic pain in her shoulder, hips, back knees which is currently controlled with medication. The Panel finds that the descriptions of the Aooellant's physical EMT 003(10/06/01)
f u n c t i o n i n g s k i l l s i n t h e P R , t h e A R a n d t h e M a y 2 0 i n d i c a t e t h a t t h e A p p e l l a n t i s r e s t r i c t e d t o w a l k i n g 1 s t a i r s a n d t a k e s s i g n i f i c a n t l y l o n g e r w i t h l i f t i n g t h i n g i n c l u d i n g i n c r e a s e d d i f f i c u l t y w i t h w a l k i n g b e c a u s e A l t h o u g h t h e d o c t o r n o t e d l i m i t a t i o n s i n t h e A p p e l l a a l s o r e p o r t e d t h a t s h e i s i n d e p e n d e n t i n a l l a r e a s o a s s i s t i v e d e v i c e s , w h i c h t h e A p p e l l a n t s a i d w a s a c d o c t o r i n d i c a t e d t h a t t h e A p p e l l a n t i s i n d e p e n d e n t i s u c h a s b a s i c h o u s e k e e p i n g , i n m o s t a r e a s o f s h o p t a k e s s i g n i f i c a n t l y l o n g e r w i t h s o m e a c t i v i t i e s , s u c h a n d p a i n . I n t h e A R a n d t h e M a y 2 0 1 4 r e p o rt , t h e A w i t h t r a n s f e r s o n / o f f a b e d , b u t i n t h e A R t h e d o c t o r m a n a g e t h i s p a r t o f p e r s o n a l c a r e a s w e l l a s t r a n s f e v i d e n c e i s c o n s i d e r e d , t h e P a n e l f i n d s t h a t t h e M i n p r o v i d e d 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 p h y s i c a l i m 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 a d v o c a t e s u b m i t t e d t h a t t h e A p p e l l f r o m h e r p h y s i c a l c o n d i t i o n s , a n d t h e r e f o r e , t h e c o m f u n c t i o n i n g a m o u n t s t o a s e v e r e i m p a i r m e n t . T h e a d o c t o r a n d t h e d o c t o r ' s r e p o r t s a b o u t h o w P T S D , d a b i l i t y t o f u n c t i o n , i n c l u d i n g e x p e r i e n c i n g a l a c k o f m m e m o r y i s s u e s . T h e M i n i s t r y i n d i c a t e d t h a t i t r e v i e w e d t h e i n f o r m a t i h i s r e p o rt s o f d e f i c i t s t o t h e A p p e l l a n t ' s c o g n i t i v e a n m a n a g e p e r s o n a l c a r e a n d f i n a n c e s a n d h e r a b i l i t y p r o v i d e d , t h e M i n i s t ry w a s n o t s a t i s f i e d t h a t t h e i n f o T h e P a n e l ' s F i n d i n g s T h e d o c t o r d e s c r i b e d t h e A p p e l l a n t ' s c o n d i t i o n s a s h e r e p o r t e d m a j o r i m p a c t s i n t h e a r e a s o f s l e e p d i s t m e m o r y a n d m o t i v a t i o n , a s w e l l a s m o d e r a t e i m p a c d e l u s i o n s / f l a s h b a c k s . T h e s a m e i n f o r m a t i o n i s r e p o i m p a c t f o r d e l u s i o n s / f l a s h b a c k s . O t h e r i n f o r m a t i o n t h e P R a n d t h e A R ; f o r e x a m p l e , i n t h e d o c t o r ' s d e s m a n a g i n g p e r s o n a l c a r e a n d m e a l s . H o w e v e r , t h a t A p p e l l a n t m a n a g e s l a u n d r y / h o u s e k e e p i n g , s t a t i n g t m o t i v a t i o n , p a i n a n d d e p r e s s e d m o o d s w i t h n o r e a s F o r t h e r e a s o n s s t a t e d e a r l i e r , t h e P a n e l g i v e s l e s s w h i c h d i f f e r s f r o m t h e P R a n d t h e A R . I n t h e A R , t h e d o c t o r w r o t e t h a t P T S D , d e p r e s s i o n a a c t i v i t i e s a n d t h a t t h e A p p e l l a n t i s o f t e n c o n f u s e d a n h e r d i s a b i l i t y a s s h o rt t e r m m e m o r v l o s s . H o w e v e r , E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # 1 4 r e p o r t a r e c o n s i s t e n t . F o r e x a m p l e , t h e r e p o rt s -2 b l o c k s , t a k e s s i g n i f i c a n t l y l o n g e r g o i n g u p t h e s . T h e A p p e l l a n t d e s c r i b e d s i m i l a r l i m i t a t i o n s , o f h e r f o o t a n d h i p s . n t ' s p h y s i c a l a n d m o b i l i t y a b i l i t i e s i n t h e A R , h e f p h y s i c a l a n d m o b i l i t y a b i l i t i e s . S h e d o e s u s e a n e a n d o r t h o t i c s . I n a d d i t i o n , i n t h e A R t h e n d a i l y l i v i n g a c t i v i t i e s r e q u i r i n g p h y s i c a l a b i l i t i e s , p i n g a n d w i t h r e s p e c t t o m e a l s , a l t h o u g h s h e a s m e a l p r e p a r a t i o n a n d c o o k i n g d u e t o f a t i g u e p p e l l a n t i s d e s c r i b e d a s t a k i n g s i g n i f i c a n t l y l o n g e r d e s c r i b e s t h e A p p e l l a n t a s i n d e p e n d e n t l y a b l e t o e r s i n / o u t o f a c h a i r . T h e r e f o r e , w h e n a l l o f t h e 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 n f o r m a t i o n p a i r m e n t . a n t ' s m e n t a l h e a l t h c o n d i t i o n s a r e n o t s e p a r a t e b i n a t i o n o f h e r c o n d i t i o n s a n d t h e i r e f f e c t s o n h e r d v o c a t e r e v i e w e d t h e d i a g n o s e s p r o v i d e d b y t h e e p r e s s i o n a n d a n x i e t y i m p a c t t h e A p p e l l a n t ' s o t i v a t i o n , p o o r c o n c e n t r a t i o n a n d s h o r t t e r m o n p r o v i d e d , i n c l u d i n g t h e d o c t o r ' s d i a g n o s e s a n d d e m 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 a b i l i t y t o t o f u n c t i o n s o c i a l l y . B a s e d o n t h e i n f o r m a t i o n r m a t i o n e s t a b l i s h e d a s e v e r e m e n t a l i m p a i r m e n t . P T S D a n d a m e m o r y / l e a r n i n g d i s a b i l i t y . I n t h e P R , u r b a n c e , e m o t i o n , a t t e n t i o n / c o n c e n t r a t i o n , t i n l a n g u a g e a n d m i n i m a l i m p a c t f r o m r t e d i n t h e 2 0 1 4 r e p o r t , e x c e p t f o r m o d e r a t e i n t h e M a y 2 0 1 4 r e p o r t i s g e n e r a l l y t h e s a m e a s i n c r i p t i o n 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 w i t h M a y 2 0 1 4 r e p o r t d i f f e r s i n d e s c r i b i n g h o w t h e h a t s h e h a s s i g n i f i c a n t r e s t r i c t i o n s d u e t o l a c k o f o n s g i v e n f o r t h i s c h a n g e f r o m t h e e a r l i e r r e p o r t s . w e i g h t t o t h e i n f o r m a t i o n i n t h e M a y 2 0 1 4 r e p o r t n d a n x i e t y a r e s i g n i f i c a n t b a r r i e r s t o d a i l y d l a c k i n g i n m o t i v a t i o n . T h e A p p e l l a n t d e s c r i b e d i n t h e A R , t h e d o c t o r a l s o i n d i c a t e s t h a t t h e
A ppellant independen tly mana ges areas of daily living activities wh impairment, such as, making shopping cho i ces, mea b ills, m edications and all aspects of social functioning as meal plann i n g, but the Ap pellant neverthel ess functions independently. the evidence provided, t h e P an el fin d s that the Ministry reason did not establish a severe mental imp airment. R e str ic t ions to Daily Li v ing Activities The Appellant's advocate submitt e d that the Appellant's severe impairment restricts her a manage daily living acti vities as reported by her d o a d v oc a te also s ub mitted t ha t the A p pell an t lives with he with daily li ving a c tiviti e s. The Ministr y deter mined that be c a use the m a jor ity of da requi re lit tle h elp fr o m othe r s, the info r matio n f rom t h e Appellan t ' s im pair m ent sign ificantly r e s trict s daily living periodic a l ly for e xtende d pe ri od s . The P anel' s Fi ndings Sec ti on 2(2)(b} of t h e EAPWD A requir es a p resc ribed App ellant's seve r e ph y s ic al or men t al im p a irm e nt directly a ctivi t ies, c o nti n uou s l y or peri o di call y for e xtended sectio n 2(1) of the EAPWDR, an d a re also li ste d i n do ctor i s the pre sc rib ed p ro fe s sion al. I n t h e M ay 20 14 r eport, the docto r ch e cked the bo x dir e ct ly an d significa ntly restr i ct ed in h er abi lity to do h of t h e conditions note d abov e [re f e r rin g to th e App ell sta tement , wh ic h par aphrases t h e PWD leg is lat i on, P W D ap plication. Th e d o c tor prov ided no ex planation be twee n th is a nd the i nforma tion in the application. statement little weight. With respect to the rest of the May 2014 report, the information about the Appellant's ability to man age daily living activities is generally consistent with the wi th respect to perso na l care, meals and shopping. Where there are dif note d for laundry/basic housekee ping, t h e Panel giv In th e PR, the doctor reported that the App ellant has n treatments that interfere with her ability to perform daily living activities. In the AR, the doctor indicated that the Appellant independently manages all areas of basic housekeepi meals, p aying rent and bills, medications, transpor t atio these activities take si gnificantly longer, su c h as m ea care does the Appellant need periodic assistance and that is with dres toileting. Thus, the Panel finds that the Ministry reasonably determined that the evidence from the doctor demonstrates that the Appellant manages the majority of her daily living act independently. Therefore, the Panel further finds that the Ministry reasonably determined that the information from the prescri bed professional does not EAAT 003( 1010 610 1) � APPEAL# ich would be impacted by a mental l p lanning, safe storage of food, paying rent and . Som e activities take signif icantly longer, such Therefore, based o n a ll of ably determ ined that the information bi lity t o c tor, especially in t he May 2014 r epo r t. The r child ren and frequently nee d s them to help i ly a c t iviti es ar e perform ed i ndepe n dentl y or th e p resc ribed prof es sion d o es not esta bli sh that ac t iviti es eit h er co nt in uou s l y o r pr o f es sional t o provide a n opi n i on that th e and s i g nif icantly restric ts h er dail y liv ing p eriods . Daily liv ing acti v i ti es ar e d efined in the PR a n d i n th e AR. In t his c a s e the App ell a n t's be s ide the followi ng statem en t : [T he A pp ellant] is e r d a i ly livin g ac t iviti es conti nuously, a s a result a nt' s con d itions]. T he Pa n e l fin ds that this is not c onsi stent wi th the d octor 's rep ort s i n t h e f or t h is sta te m e nt or w hy th e re is a d i ff er enc e Therefore, the Panel gives th is May 2 014 A R; fo r example, ferences, suc h as restrictions es more wei ght to the AR in formation. ot been prescribed any me dication and/ or ng, shopping, n and social functionin g , although some of l pl ann ing a nd preparation. O n ly for personal sing, grooming, bathing and i v i t i es es tablish t h at the Aooellant's impair ments
r I APPEAL# directly and significantly restrict her daily living activities, either continuously or periodically for extended periods. Help with Daily Living Activities The Appellant's advocate submitted that the Appellant's children live with her and help her with daily living activities. She also uses a cane and orthotics for her disability. The Ministry's position is that because the evidence does not establish that daily living activities are significantly restricted, it cannot determine that significant help is required from other persons. The Panel's Findings Section 2(2)(b)(ii) of the EAPWDA also requires the opinion of a prescribed professional confirming that because of direct and significant restrictions in her ability to manage daily living activities, the Appellant requires help with those activities. Section 3 of the EAPWDA states that for the purposes of section 2(2) of the EAPWDA, a person requires help in relation to a daily living activity if, in order to perform it, the person requires an assistive device, the significant help or supervision of another person or the services of an assistance animal. In the May 2014 report, there is information that someone needs to be home when the Appellant is bathing and that her son goes to the store for her 75% of the time. There is also a check mark beside the box stating that for laundry/housekeeping there is continuous assistance from the son. This information is not consistent with what the doctor reported in the AR and as noted earlier there is no explanation for the change. Therefore, the Panel gives this part of the May 2014 report little weight. In the AR, the doctor reported that the Appellant does not use an assistance animal. He did report that she uses assistive devices for walking, which the Appellant said was a cane and her orthotics. In the AR, the doctor also noted that the Appellant gets assistance from family and friends, but he provided no details about the type or frequency of such help. Based on the evidence from the doctor and because the Ministry reasonably determined that the evidence does not establish that daily living activities are directly and significantly restricted either continuously or periodically for extended periods, the Panel finds that the Ministry reasonably found that the requirements in section 2(2)(b)(ii) were not met. Conclusion Having reviewed and considered all of the evidence and the relevant legislation, the Panel finds that the Ministry's reconsideration decision, which determined that the Appellant was not eligible for PWD designation, was reasonably supported by the evidence. Therefore the Panel confirms that decision. EAAT003(10106101)
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