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 r e c o n s i d e r a t i o n d S o c i a l I n n o v a t i o n ( t h e m i n i s t r y ) d a t e d 1 2 J u n e 2 0 1 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 d e t e r m i n e d t h c r i t e r i a f o r P W D d e s i g n a t i o n s e t o u t i n t h e E m p l o y m A c t , s e c t i o n 2 . S p e c i f i c a l l y , t h e m i n i s t r y d e t e r m i n e d t h e a p p e l l a n t h a s a s e v e r e m e n t a l o r p h y s i c a l i m p a p r o f e s s i o n a l ( i ) d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s h i s a b i l i t y t o c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s ; a ( i i ) a s a r e s u l t o f t h o s e r e s t r i c t i o n s , h e r e q u i r e s h T h e m i n i s t r y d e t e r m i n e d t h a t t h e a p p e l l a n t s a t i s f i e d a g e a n d h i s i m p a i r m e n t i n t h e o p i n i o n o f a m e d i c a l y e a r s . P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A i I e c i s i o n o f t h e M i n i s t r y o f S o c i a l D e v e l o p m e n t a n d 4 d e n y i n g 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 p e r s o n a t t h e a p p e l l a n t d i d n o t m e e t a l l o f t h e r e q u i r e d e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b ili t i e s 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 d i d n o t e s t a b l i s h t h a t i r m e n t t h a t i n t h e o p i n i o n o f a p r e s c r i b e d p e r f o r m d a i l y l i v i n g a c t i v i t i e s ( D L A ) e i t h e r n d , e l p t o p e r f o r m t h o s e a c t i v i t i e s . t h e o t h e r 2 c r i t e r i a : h e h a s r e a c h e d 1 8 y e a r s o f 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 i l i t i e s A c t ( E A P W D A ) s e c t i o n 2 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
PART E -S u mmarv o f Facts With the cons e nt of parties, thi s h ea ri ng was con ducte E mplo y ment and Assist a n ce A ct. The evidence b efore the m i nis tr y at rec o nsideratio n 1. Th e app e llan t' s PWD Des i gnation Ap plicati on not to co mplete a Self R ep o r t. The App l i c ation co • A P hy sician Re p or t (PR ) da ted 19 D ecember pra ctitione r/ hospita l is t ( G P) who h a d seen d u r ing hi s ho sp ital s t ay, caring fo r him si n ce • A n As sess or Report (AR) da te d 19 D e c e m w ho ha d met the ap pella nt o nc e; sh e w o r ked home uni t of the same hospita l . • A le t te r from a h o spit al social worke r da ted 2. T he ap pellan t 's Req ues t f or Reconsiderat ion, Physici a n Re p o tt In the P R, the G P d iag nos es the appell a nt's impairme t hat the a ppel la nt's impairme nt w ill l ikel y cont i n u e f or tran s plan t will take app rox i mately o ne y ear for t he b hepat i t is C treatment, whic h will l as t f o r ap proximately Und er hea lt h his t ory, the GP note s muscle wasting, bil ir ub in le vels can c aus e i tchines s, fati gue, and e n The a p pell a n t h as ha d to go to multipl e doctor ap po (rece ntly a p pro ved, 1 6 De cem be r 2013). O nce transplanted, he for l ife, with po tentia l side e ff e cts: tired , o ff b ala n ce , s ympto m s can inc l u d e b ut a re not limit ed to n a u se a, vomiting (20 October 2013) showed scarring of the liv er (ci rrhos gallbladd er w i th r elated s t on e s. Under addit ional comme nts, the GP writes that the appellant was admitted to the hospital on 28 October 2013 for a three month history of feelin g weak/unwell. During the admission, he has been treated for low sodium (hyponatremia). His INR value has be body's ability to clot blood and if the value is high the The G P noted that th e appellant's he ight and we ight are rele The GP indicated that the appellant had no t been pre interfere with his ability to perform DLA .. She also reports that the a prostheses or aids for his impairment. As to functional skills, the GP reports that the appellant can walk 4+ blocks unaided, climb 5+ steps, lift 15 to 35 lbs. and has no limitation as to remaining seated. The GP reports that the appellant has no difficulties with communication. EAA T003(10/06101) APPEAi I d in w r i ting purs u ant to sec t ion 22(3) (b} of the con si ste d of t he f oll o wing: d a ted 1 O December 2013. T he ap pellant chos e nta ine d: 20 1 3, comple ted b y a g e ner a l the ap pe llant m ult i pl e t im es on ho sp i tal r o unds 04 Nov emb er 2013. b er 2013, co mple ted by a nurse pra ct i tion er (NP) i n the patient assessme nt and transi tio n to 02 Decem ber 2013. dated 09 June 20 1 4, with no r ea so ns gi ven. nt as hepatitis C, onset 2009. The GP confirms two year s or more, com menti n g t hat a ody to reh a b ili t ate b efore he wi ll then sta rt 2 y ears. f at ig ue and mem or y lo ss explai ning th at total ce phalop athy (cha n ge in level of consciousn e ss). intment s whi le w aiting for a live r t ran s p l a nt -wil l h a ve to take anti-rejectio n d rugs not coherent . C h ronic hy po natrem ia (l o w sodi um) , f a t igue, weakness. Abd omen CT scan i s ), liver nod ule s, and l arge s plee n , di s tended en h igh. The IN R value i ndicates t he re is a greater risk for bleed ing. v an t : 5 ' 11" and 85 kg. s cr i b ed any medication and/ or treatments that ppellant does no t require any
T h e G P r e p o r t s t h a t t h e a p p e l l a n t h a s s i g n i f i c a n t d e a r e a s o f m e m o r y a n d a t t e n t i o n o r s u s t a i n e d c o n c e n 2 6 / 3 0 o n a n M M S E t e s t o n 1 9 D e c e m b e r 2 0 1 3 . [ P a A s c o r e o f 2 6 -3 0 i s c o n s i d e r e d n o r m a l i n t h e g e n e c o n s c i o u s n e s s w h e n i n i t i a l l y a d m i t t e d t o h o s p i t a l ( d R e g a r d i n g t h e a b i l i t y t o p e r f o r m D L A , t h e G P r e p o r h i s a b i l i t y t o p e r f o r m D L A . T h e G P i n d i c a t e s t h a t t h s e l f c a r e , m e a l p r e p a r a t i o n , m a n a g e m e n t o f m e d i c a i n s i d e a n d o u t s i d e t h e h o m e , u s e o f t r a n s p o rt a t i o n , A s s e s s o r R e p o rt I n t h e A R , t h e N P r e p o rt s t h a t t h e a p p e l l a n t i s c u r r e T h e N P a s s e s s e s t h e a p p e l l a n t ' s a b i l i t y t o c o m m u n w r i t i n g , a n d h e a r i n g . R e g a r d i n g m o b i l i t y a n d p h y s i c a l a b i l i t y , t h e N P a s s e 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 c a r r y i n g a n d h o l d i n g . I n t e r m s o f 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 g , t h e a p p e l l a n t ' s i m p a i r m e n t o n d a i l y f u n c t i o n i n g i n 6 a r e a a t t e n t i o n / c o n c e n t r a t i o n , e x e c u t i v e , m e m o r y a n d m o a r e a s o f b o d i l y f u n c t i o n s a n d m o t o r a c t i v i t y . N o i m p c o n t r o l , i n s i g h t a n d j u d g m e n t , l a n g u a g e , p s y c h o t i c s a n d o t h e r e m o t i o n a l o r m e n t a l p r o b l e m s . T h e N P r e A s t o a s s i s t a n c e r e q u i r e d i n p e r f o r m i n g D L A , t h e N P a s p e c t s o f p e r s o n a l c a r e , b a s i c h o u s e k e e p i n g , p a y i T h e N P a s s e s s e s t h e a p p e l l a n t r e q u i r i n g p e r i o d i c a s s h o p p i n g : g o i n g t o a n d f r o m s t o r e s , r e a d i n g p r i c e s a p u r c h a s e s , a n d c a r ry i n g p u r c h a s e s h o m e . R e g a r d i n p e r i o d i c a s s i s t a n c e f r o m a n o t h e r p e r s o n f o r s a f e s t o a s p e c t s : m e a l p l a n n i n g , f o o d p r e p a r a t i o n a n d c o o k i n 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 N P a s s e s s e s 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 i l i t y t o d e v e l o p a n d m w i t h o t h e r s , a n d a b i l i t y 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 s u p p o r t / s u p e r v i s i o n f o r a b i l i t y t o d e a l a p p r o p r i a t e l y w T h e N P d e s c r i b e s t h e a p p e l l a n t ' s r e l a t i o n s h i p w i t h b a s m a r g i n a l f u n c t i o n i n g . A p a r t f r o m t h e r e f e r e n c e t o t h e M M S E s c o r e , t h e N P E AA T 0 0 3 ( 1 0 l 0 6 / 0 1 )I A P P E A L 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 t h e t r a t i o n , c o m m e n t i n g t h a t t h e a p p e l l a n t s c o r e d n e l n o t e : M M S E = m i n i m e n t a l s t a t e e x a m i n a t i o n . r a l p o p u l a t i o n . ] H e d i d h a v e d e c r e a s e d l e v e l o f e l i r i u m ) . t s 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 d o e s n o t r e s t r i c t e a p p e l l a n t i s n o t r e s t r i c t e d i n a l l a r e a s : p e r s o n a l t i o n s , b a s i c h o u s e w o r k , d a i l y s h o p p i n g , m o b i l i t y m a n a g e m e n t o f f i n a n c e s a n d s o c i a l f u n c t i o n i n g . n t l y h o m e l e s s . i c a t e a s g o o d i n a l l a r e a s : s p e a k i n g , r e a d i n g , s s 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 f o r w a l k i n g a n d l i f t i n g . N o a s s e s s m e n t i s p r o v i d e d f o r N P a s s e s s e s a m o d e r a t e i m p a c t o f t h e s : c o n s c i o u s n e s s , e m o t i o n , t i v a t i o n . A m i n i m a l i m p a c t i s a s s e s s e d i n t h e a c t i s a s s e s s e d i n t h e f o l l o w i n g a r e a s : i m p u l s e y m p t o m s , o t h e r 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 , p o r t s t h e s a m e M M S E s c o r e ( 2 6 / 3 0 ) a s t h e G P . a s s e s s 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 i n a l l n g r e n t a n d b i l l s , m e d i c a t i o n s a n d t r a n s p o r t a t i o n . s i s t a n c e f r o m a n o t h e r p e r s o n f o r a l l a s p e c t s o f 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 , p a y i n g f o r g m e a l s , t h e N P a s s e s s e s t h e a p p e l l a n t r e q u i r i n g r a g e o f f o o d a n d i n d e p e n d e n t i n a l l o t h e r g . 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 f o r m a k i n g a i n t a i n r e l a t i o n s h i p s , i n t e r a c t i n g a p p r o p r i a t e l y e r s . T h e N P a s s e s s e s h i m a s r e q u i r i n g p e r i o d i c i t h u n e x p e c t e d d e m a n d s . o t h h i s i m m e d i a t e 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 p r o v i d e s n o o t h e r c o m m e n t a r v r e a a r d i n a t h e
APPEAi I above assessments. Social worker's letter The SW's letter predates the PWD designation application. The SW notes that the appellant's file is open with the ministry but he has been denied PWD designation. However, she believes he would qualify now as his health status is quite precarious and this can be verified by his physicians. He has been hospitalized since 28 October 2013 and cannot go back to his former living arrangements due to his former residence being incompatible with his current health status. Therefore he is currently homeless and looking for suitable accommodation. She seeks advice from her ministry contact as to how to proceed with PWD designation. Information submitted after reconsideration. The appellant submitted his Notice of Appeal on 23 June 2014, stating: "Please see psychiatrist's letter." Attached to the Notice of Appeal was a letter/consultation report from a health authority hospital psychiatrist dated 23 June 2014. This letter had the following attachments: • A mental health unit referral screening by the hospital intake and cognitive therapist dated 11 June 2014. • A letter from a specialist in internal medicine dated 27 May 2014. • 3 reports of visits to the hospital emergency room by the appellant. In her letter, the psychiatrist writes: "I will address this letter primarily to the Appeals Tribunal as the patient has recently been denied PWD and as I review the material, I can see readily that the person who filled out the application was not aware of the necessary essential components on an application form that will be considered successful." Later, the psychiatrist goes on to write: "This patient who has a life threatening illness is in most dire need of increased financial aids and some of the benefits the PWD status can provide him. Withholding this will likely cost this man his life. The most valuable thing I can do for this man's mental state is to have this appeal support letter sent immediately. I would also request that it be considered an emergency appeal as time is of the essence and I would hope that in future when people are turned down for PWD due to inadequate information, it might be sent back to the referring agency with clarification about paucity of information causing a negative decision." In a late submission dated 28 July 2014 to the written hearing, accepted by the panel chair, the ministry wrote: "At the time of the reconsideration decision was made the attached information was not provided. The Minister made the decision based on the evidence at the time. The Minister acknowledges the submission of the supplemental information as it was intended for the reconsideration decision and does not object to the supplemental information. If this information had been submitted at the time of the reconsideration decision, it may have resulted in an approval." The panel will summarize the relevant information from this "suoolemental information." EMT 003(10/06/01)
P sychiatrist 's l e t te r T he psychia tr i st wr i tes: " P l ea se be a d vise d t hat thi s man suffers wit diagnoses include cirr h o s is of liver advance se c o n da ry t o hepat otoxicity, al co hol addict a ddiction / remot e, t ype II d iab etes, chol el l is t of diagnoses is not co mpl ete b ut it highl diagno ses at th is da te." A nd: " This pati ent a ls o upon today's ass essment d epressed and anxious mo od se c o ndary f ul f i ll c riterion f or dys t hym ic d isorder an d The p s ychiatri st wr ites th at the appellant is cur rent o bvio us fro m the co nsultatio n r e p orts t hat h e wi ll not procu r in g a transpla nt . C rit ica l t o that i s h is need t o po s t-o p re c o ver y. The a p pe ll ant and h i s father have p resides. H is extre me fi nancial distre ss is certa in l y may pre matu re ly end his l ife. In t e rms of mental statu s, the psych iatr is t w r i tes that e s lowl y and appears fa ti gu e d. He is or ie n ted. H e is c hi s li d s seem ed hea vy and he does seem fatigued but h Mood is asse ssed to b e a nx io us an d d ep r e s sed, n o intact. Int elligenc e is asse ssed to be av e rage w i t h w go od. Ju dg me n t is assessed to be fa i r. Mental health unit referral screening • Presenti ng problems -anxiety, medical/physical concerns, mood alterat substance misuse. • History of mental ill ness -"History of depression and anxiety in the cont misuse and life circumstanc es. Client reports he currently experiences lots of anxiety including automatic thoughts and negative appraisal, particularly at night that prevent him from sleeping well. He does report panic attacks but was n durat ion ot h e r th a n to s ay he has been having the anxious he reports overeating to comp ensate. secondary to anxiety but does experience depressive curr e nt financial and living circ u mstances and complications with IA due to hospitalization. Client states he has difficulty falling asleep due to an internal voice that won't stop when he is trying to sleep. Client states this is the automatic thoughts, n psychotic type voice. Client states his appetite is normal and weight is stable, as is his energy level most days. He reports some problems with short-term memory and concentration along with anhedonia. He is physically active, but does have some problems around ADLs." EAAT 003(10/06/01) I APPE A h a myr i ad o f dia gn o ses. His m u ltipl e d, hepa tit is C, c h roni c organic b r a in s yndrom e i on/rem ote, s ub s tan ce a b us e an d ithi asis a n d g astroesop hagea l ref l ux dise as e . This ights the be st o f my u n derst and ing o f this would c learly h ave adjust me n t d is or der with to his mult ip le medic al d i agno ses. He w ould also likely general iz e d a n xiety disorde r . ly be in g asse ssed for a liv er t ransplant and it i s ha ve lon g t o li ve if he is n ot s u cce ss fu l in be in a s af e and supportive e n v ironment fo r his a tte m pte d to f ind h im a ho me w here an RN a huge h in d rance and if n ot rect i f ied ver y quic kly, xam inatio n re veals a large man w ho m o ves o ope ra ti ve and co h e rent. A t times in th e intervi ew, e d oes stay on top i c and is loos e thr oughout. t acut e ly suic i da l, not psych o t ic, and co gnitively ide fluc tuation s. In sight is a ssess ed to be fai r t o ion and recovery from ext o f substan ce ot able to be specific r e gard ing f requency and m for year s . When he becomes very Client states dep res sion sym ptoms are symptoms espe cially regarding his hi s health a nd financ es from o t a
• Social history -" ... C l ien t a ppears to have mai e arly 1980 's ] , al t hough he reports being sober from alc c lea n from c o c a i n e f or 8 -1 0 m onth s." • Clinic al i mpressi ons -a djus tme nt di s order and • C urr e nt CGI [c linic a l gl o bal impress io n ] -"mo • Reco mmendations -referral to a r a pid ac cess Subseque n t ly, on 1 2 June 2014 th e a ppe llant wa s physici an, w ho wr ote u n der p rese ntin g i ssu es: "Depression h ospital because of hi s ci rrhosis of liver and fina ncial Le tt er from a special ist in int e rnal me dicine The sp ecia list w rites: (The appe l lant] is st ru gg li ng with his c irr hosis, e e nc ephalopat h y . He i s now l iving alone tempora altho u gh he ha s a community ph armacy to [na me of h ospit a l ] re peatedly, primarily s ome wha t a nd i s di s c harged. He doe s have periods of The sp eci a l ist list s t h e appell ant's me d icati ons , t hen " This man clearly requires a li v er tran splan a nd clearly he re q uires mo re c o m munity freq uently wh ich is ap prop r ia te here. He d susp ec t tha t he m igh t ul ti m atel y simply be ad of care whi le aw ai t i ng transplantat i on but h outpatient b asis . .. " "P. S . I h ave now rec e i ved [d octor's name] note stating that li v er transplantation as h e has ess enti a l ly Rep o rts o f visits t o the hos pital e mer g ency ro om (ER repo • Date: 25/26 May 201 4. Tr ea tme nt/ co urs e in hospi Emerge on M a y 25, 2014 as his fa ther told the ER physician that medications. The patient had some heartburn ov Upon me seeing him today, he is not confused all. His ammonia is 20. He is wanting to go home. I see no reason to keep h im here. He is m • Date: 04/05 May 2014. His t ory of presenting complaint: "[The appellant] emergency d epartment confu s e d yes t er day, 'looks well; he is confused.' Clear that became worse. It is unclear how he arrived at the emergency department. He has previously attended the emergency roo exacerbati o ns of hepatic encephalopathy relating to noncompliance with medications. I see that there were 2 admissions in March relating to this and 1 in April 2014 ... " Assessment and plan: "Confused -likely secondary to hepatic enc [medication]. We will provide (medication] for him and follow his ammonia • Date: 15/18 Aoril 2012. Historv of oresentina illness: "This is a [late 50'sl male, comina EAAT003(10/06/01) I A P PE A' ntai ned a m i nimal stand ar d o f life s i nce [th e o ho l fo r 2 5 ye a rs. C li e nt reports being anxie ty disorder . de r at ely ill . " cli nic . referred t o the r ap id a ccess cl i ni c by his family a nd anxiety. Frequent adm ission to diffic u l t y." n d-st a ge l iver d is ea s e, and ril y i n a hote l, and carin g f or himself deli vering his medicatio ns da il y. He h as re t urne d with s ympto m s of ence p halopathy , a nd i m proves some confusion. C h r o nic f at igue .. ." goes on to write: tation. He is rea l ly just barel y man aging now, s u p port. He retu r ns t o [the hospital] fairly oesn' t r e a l ly have any o t her bett er opti on s. I m itted to [the hospital] at a n alt ernat i ve level opefully he can continue to function on an they canno t consid er h im for n o so cial support s in th e communi ty ... " rts) t al: "The patient was brought to hospital to he was confuse d a bout his er night f or w hich he wa s given [med ica tio n] . e dically s tabl e." arrived in th e on May 4 , 2014. The triage nur se si mp ly states m c o nfused after epha l opathy secondary to possibly not t aking .. .'' with
I APPE/1 increasing weakness. Denied chest pain. No fever. No abdominal pain. No diarrhea. He is not really taking his [medication] properly, and this is his third admission in the past few months. He is very confused, and he is also drowsy. " Assessment: "We will admit him. We will start the [medication] again. I will speak with [name of physician] to find out the plan from him tomorrow and if he is still on the transplantation list ..." Admissibilitv of the supplemental information Since the ministry acknowledges the submission of the supplemental information as it was intended for the reconsideration decision and does not object to the supplemental information, the panel will admit this information, pursuant to section 22(4) of the Employment and Assistance Act, as evidence being in support of the records and information that were before the ministry at reconsideration. The panel will consider the psychiatrist's comments concerning the consequences for the appellant of not being designated as PWD only to the extent that it is relevant to the application of the legislation (see Part F, Reasons for Panel Decision, below). The panel will give no weight to the ministry's comment that If this information had been submitted at the time of the reconsideration decision, it may have resulted in an approval, as the ministry provided no reasons for this opinion. EAAT 003(10/06/01)
I APPEA PART F -Reasons for Panel Decision The issue in this appeal is whether the ministry reasonably determined that the appellant is ineligible for PWD designation because he did not meet all the requirements in section 2 of the EAPWDA. Specifically the ministry determined that the information provided did not establish 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 determined that he met the 2 other criteria in EAPWDA section 2(2) set out below. The following section of the EAPWDA applies to this appeal: 2 (1) In this section: "assistive device" means a device designed to enable a person to perform a daily living activity that, because of a severe mental or physical impairment, the person is unable to perform; "daily living activity" has the prescribed meaning; "prescribed professional" has the prescribed meaning. (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 following section of the EAPWDR applies to this appeal: 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 hvaiene and self care; EMT 003( 10/06/01)
I APPEi (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. The panel will consider each party's position regarding the reasonableness of the ministry's decision under the applicable PWD criteria at issue in this appeal. Severity of impairment For PWD designation, the legislation requires that a severe mental or physical impairment be established. The determination of the severity of impairment is at the discretion of the minister, taking into account all the evidence, including that of the applicant. However, the starting point must be medical evidence, with the legislation requiring that a medical practitioner identify the impairment and confirm that impairment will continue for at least two years. In the discussion below concerning the severity of the appellant's impairments, the panel has drawn upon the ministry's definition of "impairment" as provided in the PR. This definition consists of "cause" and "impact" components: "impairment is a loss or abnormality of psychological, anatomical or physiological structure or function [the cause] causing a restriction in the ability to function independently, effectively, appropriately or for a reasonable duration [impact]." The cause is usually set out as a disease, condition, syndrome, injury or even a symptom (e.g. pain or shortness of breath). A severe impairment requires the identified cause to have a significant impact on daily functioning. The legislation requires that for PWD designation, the minister must be "satisfied" that the person has a severe mental or physical impairment. For the minister to be "satisfied" that the person's impairment is severe, the panel considers it reasonable for the ministry to expect that the information provided presents a clear and complete picture of the nature and extent of the impacts of the person's medical conditions on daily functioning. Physical impairment In the reconsideration decision, the ministry reviewed the evidence regarding the appellant's physical functioning (able to walk 4+ blocks unaided, etc.), noting that he is independently able to do all aspects of mobility and physical abilities. No assistive devices are routinely used to help compensate for his impairment. The position of the ministry is that the functional skill limitations are not significantly restricted and that the ministry is not satisfied that the information provided is evidence of a severe physical impairment. The appellant's position, as argued by the hospital psychiatrist, is that the appellant suffers from a myriad of diagnoses including cirrhosis of the liver advanced, hepatitis C, chronic organic brain syndrome secondary to hepatotoxicity, type II diabetes, and cholelithiasis. He will not have long to live if he is not successful in procuring a liver transplant. The appellant, who has a life threatening illness, is in most dire need of increased financial aid and some of the benefits of PWD status. Withholding this will likely cost this man his life. In light of these considerations, it is clear that the appellant has a severe physical impairment as required for PWD designation. EAAT003(10/06/01)
APPEAi I I Panel findings The evidence is that in the PR, the GP diagnosed the appellant with cirrhosis of liver, with a liver transplant in prospect. The hospital psychiatrist reported other internal medicine diagnoses -hepatitis C, chronic organic brain syndrome secondary to hepatotoxicity, type II diabetes, and cholelithiasis. On the appellant's visits to the ER, the ER physician reported hepatic encephalopathy, secondary to not taking medicine. The panel will consider chronic organic brain syndrome secondary to hepatotoxicity and hepatic encephalopathy to be similar and will address these conditions under mental impairment below. The panel notes that the diagnosis and treatment of a medical condition, even a life-threatening one, are not in themselves determinative of a severe impairment: as noted above, the severity of impairment must be assessed in terms of impact of the medical condition on daily functioning, including ability to perform DLA. The legislation is also clear that the minister must be satisfied that the person has [panel emphasis] a severe mental or physical impairment -the legislation speaks to the degree of impairment at the time when the decision is made, not to some time in the future. In the PR, the GP comments that after a liver transplant the appellant will have to take anti-rejection drugs for life, with possible side effects such as being tired, off balance, not coherent. The GP implies that there will also be significant side effects later with hepatitis C treatment. However, the legislation does not provide for the ministry to take into account future, possible restrictions in the appellant's ability to perform DLA: the ministry can reasonably be expected to assess only current restrictions. In the mental health referral screening, the therapist reports that the appellant is physically active, but does have some problems around ADLs. However, no description of the nature and extent of these problems is provided. In his letter, the specialist in internal medicine states that the appellant "is really just barely managing now. Clearly he requires more community support." The hospital psychiatrist refers to the appellant's "frequent hospital admission because of this advanced cirrhosis of the liver, and financial difficulties and difficulties obtaining the necessary supports to proceed with transplantation." She also notes that "his extreme financial distress is certainly a huge hindrance." She refers to the appellant and his father having attempted to find him a home where an RN presides. The panel notes that financial need is not a criterion for PWD designation. Help required, in the form of the significant help or supervision from another person (or the use of an assistive device or the services of an assistance animal), is a criterion for PWD designation, provided such help is necessary for the person to perform DLA which are directly and significantly restricted by a severe impairment, either continuously or periodically for extended periods. While the specialist in internal medicine and the psychiatrist both refer to the appellant's need for community support, no description is provided as to what such support entails and for what DLA this support would help the appellant perform. In addressing the impact the appellant's impairment on his ability to perform DLA requiring physical effort, both the GP and the NP have reported consistent assessments, with the GP reporting that the appellant is not restricted in all DLA, and the NP assessing the appellant as independent in all aspects of all DLA requiring physical effort, with the exception of shopping, where periodic help from another person is required (though no explanation is provided) and for one aspect of meals, namely safe storage of food (again no explanation is provided). In the original reports, the GP who treated the aooellant for close to two months in hosoital and the NP who also saw the aooellant in hosoital have EMT 003(1 0/06/01)
con si st e n tly assessed the appel lant as havi ng no limitations to his functional sk independent in all aspect s of mobility and phy s ical ability. On the basis of the foregoin g, a nd t a king a c co unt the evi information, th e panel fi nd s that the mini stry was reasonab impairment h ad not been established. Mental impairment. In the reconsideration d eci sion, t he ministry n o tes h ealth di ag n osis and states that MMSE is 26/30 on 19 Dec con s cio usness when i nitially admitted to hospital -d functioning are re ported -in th e areas of me mory and good w i th no difficulty. No r es triction to so c i al f unctioning i mode r at e impac ts on dail y funct io ning based on MM info rm ation and narrat i v e a re no t supportive of a sever limits the a p pell a n t ' s ability to fu nc tion eit her co n tinuousl m ini stry wa s ther efor e no t s atis f ied t hat the in for m atio impair ment. The a p pel lant's p o si tion, as put forw ard by t h e hosp anxiet y and d e pression, as wel l as a d just men t d isord anxiet y disorder. W ith t he s e di ag noses, i t is c le ar that the a Panel fin ding s In the PR, the G P did n o t diagn ose t he appellant w refer t o a his to ry of encephalop a thy (loss of g loba l w ith co g n itive and em o tio nal function in t h e area s of memory conc e n t ration. The NP, wi tho ut reference to any m enta o f a menta l impairme n t in six areas, i ncluding con s memory. The NP provided no commentary, except referring t The psychol ogist, drawi ng on th e ment al health unit i anxie ty and depress i o n , as well as adjustm ent disorder, dysthym anxi ety disorder. However, with the excepti on noted below, the panel cann supplemental information any description or assessment as to how and to what extan h ealth c onditions restric t t he ap pellant's ability to perform DLA, particularly with regard to making decisions about p ersonal ac tiv ities, c a re o r fina nce s or rel others effec ti v ely. In th e AR, the NP assesses the a for dealing appropriately with unexpe c te d demands; he is assessed as independe decision-making areas. The NP describes t he appella extended social networks as marginal functioning, but provides no explanation and no description of any support/supervision required which w o u ld help t The one exception is with regard to the appellant's bouts of hepatic encephalopathy. The evidence from the ER re orts su ests that this medical condition, when the a EAA T003( 10/06/01) A PPEA I ills and as being d en c e pro v i ded, includ in g the supplemental le in determini ng that a se v er e physical t hat i n t he P R the GP did no t c onfir m a mental em b e r 201 3 (de c r eased lev el of elirium). T wo defi c i t s t o co gnitiv e and emotional a t tention/conc entration. Comm u ni ca ti on is s reported . Th e NP indicated mi nimal to SE. The p osi t i on of th e minist ry i s t h a t the e m ent al he alth co n d i tion that sign ific antly y or pe rio dica l ly for e xtended pe rio ds. T he n provid e d is evide n ce of a se v e re mental it al p sychiat ri st, i s that the appe l lant su ffe rs fr om e r, dy s th ymic disor der and l i k ely ge neralized p pe llant has a s e ve re me n t al impairment i th an y menta l hea l th conditions , a l thoug h she d id c onsci ou s ne s s) and i d entif ie d si g n ifi cant deficits and a tt ention o r susta i ne d l health cond itio n, a ss ess ed m od erat e i m p a cts cio us n es s, e motio n, attention / co ncentration and o the appell a n t 's MMSE score. ntake report, diagnoses the appellant with ic dis order and likely gene ralized o t find anywhere in th e t these mental at ing to, communicating or int er a cting wit h ppellant a s requiring p eriodic suppor t/ sup ervision nt in all other nt's relationship wit h his immediate and o maintain him in the community. ellant does not take his
m e d i c a t i o n , l e a d s t o c o n f u s i o n o r d e l i r i u m . T h i s i n d d i f f i c u l t y w i t h t h e D L A o f m a n a g i n g p e r s o n a l m e d i c w h e r e t h e p r e s e n t i n g s i t u a t i o n q u i c k l y r e s o l v e s w i t h i d e n t i f i e d i n t h e P R o r A R , a n d t h e s u p p l e m e n t a r y i t h e a p p e l l a n t ' s a b i l i t y t o m a n a g e h i s m e d i c a t i o n , e x a n d t h e s p e c i a l i s t i n t e r n a l m e d i c i n e t h a t h e r e q u i r e s G i v e n t h e l a c k o f i n f o r m a t i o n , b o t h i n t h e P R a n d A t h e i m p a c t s o f t h e a p p e l l a n t ' s m e n t a l h e a l t h c o n d i t i m i 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 a s e v e 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 t h e a b i l i t y t o p e r fo r m T h e p o s i t i o n o f t h e m i n i s t r y i s t h a t , a s t h e m a j o r i t y o l i t t l e h e l p f r o m o t h e r s , t h e i n f o r m a t i o n f r o m t h e p r e s 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 D L A e i t h e r c o n t i n u 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 s p e c i a l i s t i n i n t e b a r e l y f u n c t i o n o n h i s o w n a n d t h e p s y c h i a t r i s t h a s e n v i r o n m e n t . T h i s e v i d e n c e c l e a r l y s h o w s t h a t i t i s p r a c t i t i o n e r s / p r e s c r i b e d p r o f e s s i o n a l s t h e a p p e l l a n t s i g n i f i c a n t l 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 D L A , b o t h a f t e r w a r d s a s h e r e c o v e r s a n d b e g i n s h e p a t i t i s C t r P a n e l f i n d i n g s T h e p a n e l n o t e s t h a t , a c c o r d i n g t o t h e l e g i s l a t i o n , t h p e r f o r m D L A m u s t b e a r e s u l t o f a s e v e r e i m p a i r m e t h i s a p p e a l . T h i s D L A c r i t e r i o n m u s t a l s o b e c o n s i d e o f s e c t i o n 2 o f t h e E A P W D A , w h i c h p r o v i d e s t h a t t h w i t h d i s a b i l i t i e s " i f t h e m i n i s t e r i s s a t i s f i e d t h a t " t h e c t h e d i s c r e t i o n c o n f e r r e d b y t h e l e g i s l a t i o n , i t i s r e a s o 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 b e s u b s t a n t i a t e t h a t w o u l d s a t i s f y t h e m i n i s t e r t h a t t h e r e a r e d i r e c t a 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 e x t e n d e d p i c t u r e o f t h e n a t u r e a n d e x t e n t o f t h e s e r e s t r i c t i o n s T h e p a n e l h a s r e v i e w e d i n d e t a i l a b o v e , u n d e r s e v e i m p a c t s o f t h e a p p e l l a n t ' s p h y s i c a l a n d m e n t a l i m p a s u p p l e m e n t a l i n f o r m a t i o n . T o s u m m a r i z e : t h e G P h a D L A ; t h e N P h a s a s s e s s e d h i m i n d e p e n d e n t i n a l l D a s s i s t a n c e f r o m a n o t h e r p e r s o n f o r a l l a s p e c t s o f s h a s p e c t o f t h e s o c i a l f u n c t i o n i n g D L A o f m a k i n g d e c i s m a r g i n a l f u n c t i o n i n g w i t h i m m e d i a t e a n d e x t e n d e d s p r o v i d e a n y c o m m e n t a r y a s t o t h e n a t u r e o r e x t e n t o T h e G P r e o r t s t h e a e l l a n t h a v i n s i n i f i c a n t d e f i c E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L i c a t e s t o t h e p a n e l t h a t t h e a p p e l l a n t h a s s o m e a t i o n . T h i s h a s l e d t o r e p e a t e d h o s p i t a l v i s i t s , m e d i c a t i o n . N o r e s t r i c t i o n s f o r t h i s D L A w e r e n f o r m a t i o n c o n t a i n s n o f u r t h e r i n f o r m a t i o n a s t o c e p t f o r t h e g e n e r a l c o m m e n t s b y t h e p h y s i c i a n s u p p o r t o r a s u p p o r t i v e e n v i r o n m e n t . R a n d i n t h e s u p p l e m e n t a l i n f o r m a t i o n , r e g a r d i n g o n s o n d a i l y f u n c t i o n i n g , t h e p a n e l f i n d s t h e r e m e n t a l i m p a i r m e n t h a d n o t b e e n e s t a b l i s h e d . D L A . f h i s D L A a r e p e r f o r m e d i n d e p e n d e n t l y o r r e q u i r e c r i b e d p r o f e s s i o n a l s d o e s n o t e s t a b l i s h t h a t 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 . r n a l m e d i c i n e h a s s t a t e d t h a t t h e a p p e l l a n t c a n i n d i c a t e d t h a t h e m u s t l i v e i n a s u p p o r t i v e t h e o p i n i o n o f t h e s e m e d i c a l ' s p h y s i c a l a n d m e n t a l i m p a i r m e n t s d i r e c t l y a n d n o w w h i l e h e i s a w a i t i n g a l i v e r t r a n s p l a n t a n d e a t m e n t . e d i r e c t a n d s i g n i f i c a n t r e s t r i c t i o n i n t h e a b i l i t y t o n t , a c r i t e r i o n w h i c h h a s n o t b e e n e s t a b l i s h e d i n r e d i n t e r m s o f t h e p r e c e d i n g l e g i s l a t i v e l a n g u a g e e m i n i s t e r m a y d e s i g n a t e a p e r s o n a s a p e r s o n r i t e r i a a r e m e t , i n c l u d i n g t h i s o n e . I n e x e r c i s i n g n a b l e t h a t t h e m i n i s t e r w o u l d e x p e c t t h a t t h e d b y i n f o r m a t i o n f r o m t h e p r e s c r i b e d p r o f e s s i o n a l n d 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 t h e a b i l i t y t o p e r f o r m p e r i o d s , b y p r e s e n t i n g a c l e a r a n d c o m p l e t e . r i t y o f i m p a i r m e n t , t h e e v i d e n c e r e l a t i n g t o t h e i r m e n t s a s p r e s e n t e d i n t h e P R a n d A R a n d i n t h e s a s s e s s e d 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 f o r a l l L A , w i t h t h e e x c e p t i o n o f r e q u i r i n g p e r i o d i c o p p i n g , o n e a s p e c t o f m e a l p r e p a r a t i o n a n d o n e 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 s ; o c i a l n e t w o r k s i s a l s o r e p o r t e d . T h e N P d o e s n o t f h e l p r e q u i r e d f o r t h e s e r e p o r t e d r e s t r i c t i o n s . i t s i n c o n i t i v e a n d e m o t i o n a l f u n c t i o n i n t w o
a r e a s m e m o r y a n d a t t e n t i o n o r s u s t a i n e d c o n c e n i m p a c t o f m e n t a l i m p a i r m e n t o n d a i l y f u n c t i o n i n g ; i n t h a t w o u l d p r o v i d e a c l e a r e r p i c t u r e o f t h e s e i m p a c b o t t o m o f t h e " n o r m a l " r a n g e . T h e p s y c h i a t r i s t h a s a d d e d r e p o r t e d d i a g n o s e s r e l a a n d h i s m e n t a l h e a l t h d i s o r d e r s . W i t h p a r t i c u l a r r e f n e i t h e r t h e p s y c h i a t r i s t n o r t h e m e n t a l h e a l t h r e f e r r o f t h e s e d i s o r d e r s o n 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 m a k i n g 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 i n t e r a c t i n g w i t h o t h e r s e f f e c t i v e l y . T h e r e i s s o m e i n f e r e n t i a l e v i d e n c e , f r o m t h e E R r e p a p p e l l a n t ' s e n c e p h a l o p a t h y a n d h i s a b i l i t y t o m a n a g t h a t t h e r e i s a r e s t r i c t i o n i n t h e a p p e l l a n t ' s a b i l i t y t o t h e s u p p l e m e n t a l i n f o r m a t i o n , w h i l e i n t h e P R a n d A w h o t r e a t e d h i m i n h o s p i t a l a s i n d e p e n d e n t f o r t h i s A s a s e v e r e i m p a i r m e n t h a s n o t b e e n e s t a b l i s h e d a e v i d e n c e , t h e p a n e l f i n d s t h a t t h e m i n i s t r y w a s r e a s t h e p r e s c r i b e d p r o f e s s i o n a l s d o e s n o t e s t a b l i s h t h a c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s . H e l p w i t h D L A T h e m i n i s t r y ' s p o s i t i o n i s t h a t a s i t h a s n o t b e e n e s t c a n n o t b e d e t e r m i n e d t h a t s i g n i f i c a n t h e l p i s r e q u i r e T h e p o s i t i o n o f t h e a p p e l l a n t i s t h a t h e n e e d s t h e h e e n v i r o n m e n t . P a n e l f i n d i n g s T h e p a n e l n o t e s t h a t t h e l e g i s l a t i o n r e q u i r e s t h a t i n f o r h e l p m u s t a r i s e f r o m d i r e c t a n d s i g n i f i c a n t r e s t r i c c o n t i n u o u s o r p e r i o d i c f o r e x t e n d e d p e r i o d s . W h i l e t f r o m l i v i n g i n a s u p p o r t i v e e n v i r o n m e n t , t h e p a n e l f i s i n c e i t h a s n o t b e e n e s t a b l i s h e d t h a t D L A a r e d i r e c d e t e r m i n e d t h a t h e l p i s r e q u i r e d a s p r o v i d e d u n d e r C o n c l u s i o n H a v i n g r e v i e w e d a n d c o n s i d e r e d a l l o f t h e e v i d e n c e t h e m i n i s t r y ' s d e c i s i o n t h a t t h e a p p e l l a n t w a s n o t e l i s u p p o r t e d b y t h e e v i d e n c e . T h e p a n e l t h e r e f o r e c o n E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A i t r a t i o n a n d t h e N P i d e n t i f i e s s i x a r e a s o f m o d e r a t e e a c h c a s e h o w e v e r , n o c o m m e n t a r y i s p r o v i d e d t s , e x c e p t n o t e s r e l a t i n g t o a n M M S E s c o r e a t t h e t i n g t o t h e a p p e l l a n t ' s i n t e r n a l m e d i c i n e c o n d i t i o n s e r e n c e t o t h e d i a g n o s e d m e n t a l h e a l t h d i s o r d e r s , a l t h e r a p i s t p r o v i d e s a n y i n f o r m a t i o n o n t h e i m p a c t r m D L A a n d i n p a r t i c u l a r r e g a r d i n g t h e D L A o f f i n a n c e s a n d r e l a t i n g t o , c o m m u n i c a t i n g o r o r t s , t h a t t h e r e i s a n i n t e r a c t i o n b e t w e e n e p e r s o n a l m e d i c a t i o n . H o w e v e r , t o t h e e x t e n t m a n a g e t h i s D L A , i t i s n o t d i r e c t l y a d d r e s s e d i n R , t h e a p p e l l a n t i s a s s e s s e d b y t h e G P a n d N P D L A . n d o n t h e b a s i s o f c a r e f u l r e v i e w o f a l l t h e 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 i n f o r m a t i o n f r o m t 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 D L A e i t h e r a b l i s h e d t h a t D L A a r e s i g n i f i c a n t l y r e s t r i c t e d , i t d f r o m o t h e r p e r s o n s . l p t h a t w o u l d c o m e f r o m l i v i n g i n a s u p p o r t i v e t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l t h e n e e d t i o n s i n t h e a b i l i t y t o p e rf o r m D L A t h a t a r e e i t h e r h e e v i d e n c e i s t h a t t h e a p p e l l a n t w o u l d b e n e f i t n d 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 i n e d t h a t 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 , i t c a n n o t b e s e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A . a n d t h e r e l e v a n t l e g i s l a t i o n , t h e p a n e l f i n d s t h a t g i b l e f o r P W D d e s i g n a t i o n w a s r e a s o n a b l y f i r m s t h e m i n i s t r y ' s d e c i s i o n .
i m p a c t o f m e n t a l i m p a i r m e n t o n d a i l y f u n c t i o n i n g ; i n t h a t w o u l d p r o v i d e a c l e a r e r p i c t u r e o f t h e s e i m p a c b o t t o m o f t h e " n o r m a l " r a n g e . T h e p s y c h i a t r i s t h a s a d d e d r e p o r t e d d i a g n o s e s r e l a a n d h i s m e n t a l h e a l t h d i s o r d e r s . W i t h p a r t i c u l a r r e f e n e i t h e r t h e p s y c h i a t r i s t n o r t h e m e n t a l h e a l t h r e f e r r a o f t h e s e d i s o r d e r s o n 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 m a k i n g 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 i n t e r a c t i n g w i t h o t h e r s e f f e c t i v e l y . T h e r e i s s o m e i n f e r e n t i a l e v i d e n c e , f r o m t h e E R r e p a p p e l l a n t ' s e n c e p h a l o p a t h y a n d h i s a b i l i t y t o m a n a g t h a t t h e r e i s a r e s t r i c t i o n i n t h e a p p e l l a n t ' s a b i l i t y t o t h e s u p p l e m e n t a l i n f o r m a t i o n , w h i l e i n t h e P R a n d A w h o t r e a t e d h i m i n h o s p i t a l a s i n d e p e n d e n t f o r t h i s A s a s e v e r e i m p a i r m e n t h a s n o t b e e n e s t a b l i s h e d a e v i d e n c e , t h e p a n e l f i n d s t h a t t h e m i n i s t r y w a s r e a s t h e p r e s c r i b e d p r o f e s s i o n a l s d o e s n o t e s t a b l i s h t h a c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s . H e l p w i t h D L A T h e m i n i s t r y ' s p o s i t i o n i s t h a t a s i t h a s n o t b e e n e s t c a n n o t b e d e t e r m i n e d t h a t s i g n i f i c a n t h e l p i s r e q u i r e T h e p o s i t i o n o f t h e a p p e l l a n t i s t h a t h e n e e d s t h e h e e n v i r o n m e n t . P a n e l f i n d i n g s T h e p a n e l n o t e s t h a t t h e l e g i s l a t i o n r e q u i r e s t h a t i n f o r h e l p m u s t a r i s e f r o m d i r e c t a n d s i g n i f i c a n t r e s t r i c c o n t i n u o u s o r p e r i o d i c f o r e x t e n d e d p e r i o d s . W h i l e t f r o m l i v i n g i n a s u p p o r t i v e e n v i r o n m e n t , t h e p a n e l f i n s i n c e i t h a s n o t b e e n e s t a b l i s h e d t h a t D L A a r e d i r e c d e t e r m i n e d t h a t h e l p i s r e q u i r e d a s p r o v i d e d u n d e r s C o n c l u s i o n H a v i n g r e v i e w e d a n d c o n s i d e r e d a l l o f t h e e v i d e n c e t h e m i n i s t r y ' s d e c i s i o n t h a t t h e a p p e l l a n t w a s n o t e l i g s u p p o r t e d b y t h e e v i d e n c e . T h e p a n e l t h e r e f o r e c o n E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A e a c h c a s e h o w e v e r , n o c o m m e n t a r y i s p r o v i d e d t s , e x c e p t n o t e s r e l a t i n g t o a n M M S E s c o r e a t t h e t i n g t o t h e a p p e l l a n t ' s i n t e r n a l m e d i c i n e c o n d i t i o n s r e n c e t o t h e d i a g n o s e d m e n t a l h e a l t h d i s o r d e r s , l t h e r a p i s t p r o v i d e s a n y i n f o r m a t i o n o n t h e i m p a c t r m D L A a n d i n p a r t i c u l a r r e g a r d i n g t h e D L A o f f i n a n c e s a n d r e l a t i n g t o , c o m m u n i c a t i n g o r o r t s , t h a t t h e r e i s a n i n t e r a c t i o n b e t w e e n e p e r s o n a l m e d i c a t i o n . H o w e v e r , t o t h e e x t e n t m a n a g e t h i s D L A , i t i s n o t d i r e c t l y a d d r e s s e d i n R , t h e a p p e l l a n t i s a s s e s s e d b y t h e G P a n d N P D L A . n d o n t h e b a s i s o f c a r e f u l r e v i e w o f a l l t h e 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 i n f o r m a t i o n f r o m t 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 D L A e i t h e r a b l i s h e d t h a t D L A a r e s i g n i f i c a n t l y r e s t r i c t e d , i t d f r o m o t h e r p e r s o n s . l p t h a t w o u l d c o m e f r o m l i v i n g i n a s u p p o r t i v e t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l t h e n e e d t i o n s i n t h e a b i l i t y t o p e r f o r m D L A t h a t a r e e i t h e r h e e v i d e n c e i s t h a t t h e a p p e l l a n t w o u l d b e n e f i t d 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 i n e d t h a t 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 , i t c a n n o t b e e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A . a n d t h e r e l e v a n t l e g i s l a t i o n , t h e p a n e l f i n d s t h a t i b l e f o r P W D d e s i g n a t i o n w a s r e a s o n a b l y f i r m s t h e m i n i s t r y ' s d e c i s i o n .
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.