PART C Decision under Ap peal The decision b eing appealed is the Ministry of Social Developmen "Ministry") May 28, 2014 reconsideration decision in which the Ministry denied the Appellant's request fo r a health supplement f or c usto m orthotics. T he the requirement s in section 67 or 76 of the Employment and A re quirements in se ction 62 of the Em p loyment Assi P A RT D -R elevan t Leg islati on Emplo y men t and A ss is tance Ac t ( "EAA") Sec tio n 4 Emplo y men t a nd A ss is tance Reg u lati o n ("EAR") Section Emplo ymen t a nd A ss is tance for Persons w ith Disabiliti Emplo ymen t a nd A ss is tance for Persons w ith Disabilities R EAAT 003(10/06/01) I APP E A L# t and So c i al Innovation (the M i nistry d e termined that th e App el lant d i d not meet ssistance Re gula tion, o r the stance for Per sons W ith D i sabiliti e s Regulati o n. . s 2, 6 7 and 76. e s Ac t (" EAPW D A") Secti on 2 a nd 5 . e g ulat ion ("EAPW D R") Sec tion 62.
APPEAL# : PART E -Summary of Facts With the consent of both parties, the hearing was conducted as a written hearing pursuant to section 22(3)(b) of the EAA. Because the Panel found it difficult to sort out what information the Ministry relied on in its reconsideration decision, the Panel will list the documents in the Ministry's records as follows: 1. Appellant's orthoses request and justification with the following information: o April 10, 2014 information from a doctor describing the Appellant's medical condition as left and right bunions and left ankle valgus. • A certified pedorthist occupational therapist's specification for standard functional orthotics and shoes with a stiff forefoot rocker. 2. Letter dated April 29, 2014 from the Ministry to the Appellant stating that the Appellant's request for foot orthotics and supportive shoes was denied because she did not meet the criteria in EAR section 67, Schedule C sections 3(1) and 3.10(1). The Ministry provided no explanation to the Appellant as to why she did not meet these criteria. 3. Appellant's request for reconsideration in which she stated that: • She meets the requirements in Schedule C section 3(1) because she has no other resources. • She meets the requirements in Schedule C section 3.10 (1) because the requested orthotics are not off the shelf. The items requested are specific to her feet and needs as prescribed by her physician and they are fitted by a certified pedorthist/occupational therapist. • The cost of her orthotics is $425, which is less than the amount allowed for orthotics and the requested footwear costs $125, which is the amount allowed for footwear. • She has a chronic, degenerative disease of the muscles -Fascioscaputohumeral muscular dystrophy ("FSH"). • Because of upper body weakness, she is unable to lift her arms over her shoulders, unable to lift normal household items like a skillet ,and is experiencing 'foot drop', another common symptom of the disease, which causes uneven gait. • The uneven gait can be helped by stabilizing her ankles with lightweight orthotics and exercise; the requested orthotics help her with the basics of walking; walking is essential to her health and physical wellbeing by trying to build her bone mass and lower body strength to help offset the degeneration of her upper body muscles. 4. Ministry's reconsideration decision in which it stated that it found that the Appellant: • Does not have qualification as a person with persistent multiple barriers to employment. • Does not receive income assistance under section 8 of Schedule A of the EAR. • Is not receiving disability assistance. The Panel reviewed the Appellant's appeal submissions and summarizes them as follows: • The Ministry's denial in its reconsideration decision was based on sections of legislation not cited in its original denial and this is patently unfair as she has to try to predict what legislation she will have to reply to. • As a person with muscular dystrophy, a chronic and degenerative disease, she has persistent multiple barriers to employment. The disease precludes her from having any retail or restaurant jobs, any jobs requiring lifting, or any jobs as an education assistant because she could not deal with a physically or behaviorally challenged child. • She received income assistance for at least 12 of the precedina 15 months. EAAT 003(10/06/01)
, APPEAL# '. o She described the effects of FSH as she did in her request for reconsideration, and she provided an abstract regarding FSH and the effects of custom lower limb orthoses and an article about FSH, including treatments available. Pursuant to section 22(4) of the EAA, the Panel admits the information in the Appellant's appeal statements and supporting documents because that information is consistent with and theref o re in support of the evidence the Ministry had at reconsideration. The Ministry made no submissions for this appeal and indicated that it relied on its reconsideration decision. The Panel makes the following findings of fact: 1. There is no information in the record that the Appellant has qualified as a "person with persistent multiple barriers to employment" under provincial legislation. 2. There is no information in the record that the Appellant has been designated as "person with disabilities" under provincial legislation. 3. There is no information in the record that the Appellant receives a federal spouse's allowance or guaranteed income supplement benefits. 4. There is no information in the record that the Appellant receives income assistance under section 8 of Schedule A of the EAR. EAAT003(10/06/01)
A PP E A L # - � _ _ � _ ---� ' _ _ ---PART F -Reasons for Panel Decision The issue in this appeal is whether the Ministry reasonably denied the Appellant's request for a health supplement for custom orthotics on the basis that the Appellant did not meet the requirements in section 67 or 76 of the EAR, or section 62 of the EAPWDR. The following legislation applies to the Appellant's circumstances in this appeal. EAA Income assistance and supplements 4. Subject to the regulations, the minister may provide income assistance or a supplement to or for a family unit that is eligible for it. EAR Persons who have persistent multiple barriers to employment 2 (1) To qualify as a person who has persistent multiple barriers to employment, a person must meet the requirements set out in (a) subsection (2) and (b) subsection (3) or (4). General health supplements 67 (1) Subject to subsection (1.1 ), the minister may provide any health supplement set out in section 2 [general health supplements] or 3 [medical equipment and devices] of Schedule C to or for a family unit if the health supplement is provided to or for a person in the family unit who (a) is a recipient of income assistance under section 2 [monthly support allowance], 4 [monthly shelter allowance], 6 [people receiving room and board] or 9 [people in emergency shelters and transition houses] of Schedule A if (i) any person in the family unit is a person who has persistent multiple barriers to employment, and (ii) the recipient does not receive a federal spouse's allowance or guaranteed income supplement benefits. (b) is a recipient of income assistance under section B [people receiving special care] of Schedule A. 76 The minister may provide to a family unit any health supplement set out in sections 2 (1) (a) and (f) [general heal/h supplements] and 3 [medical equipment and devices] of Schedule C, if the health supplement is provided to or for a person in the family unit who is otherwise not eligible for the health supplement under this regulation, and if the minister is satisfied that (a) the person faces a direct and imminent life threatening need and there are no resources available to the person's family unit with which to meet that need, (b) the health supplement is necessary to meet that need. Schedule A People receiving special care 8 (1) For a person who receives accommodation and care in a special care facility or a private hospital or who is admitted to a hospital because he or she requires extended care, the amount referred to in section 28 .. (2) If the special care facility is an alcohol or drug treatment centre, the minister may, in addition, pay either or both of the following while the applicant or recipient is in the alcohol or drug treatment centre. EAPWDA Person with disabilities 2(2) The minister may designate a person who has reached 18 years of age as a person with disabilities for the purposes of this Act if the minister is satisfied that the person has a severe mental or physical impairment. .. EAAT003(10/06/01)
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e Faces a direct and imminent lif e thr e atening no reso urc es available t o her m eet t hat need. Theref ore , t h e P anel finds that the Minist ry re asonab fo r a heal t h supp l e m e n t fo r the requested orthotic it in se c tion 67 o r 76 o f the EAR, o r in se c tion 62 of Havi ng con s id er ed all of the ev i dence an d t h e ap t he Pa nel fi nds t hat the M inis tr y' s recons i dera t ion evi dence . Therefore, the Panel c onfirms tha t decision. EMT 003(10/06/01) APP EAL# : n eed for t h e requested i tems and t hat t h e re a r e l y d e t e rmined that t he Appella nt wa s not e l igible e ms because she di d no t meet the req uire ments t h e EAPWDR. pli cable l egislati on in t h e App el lan t 's circum stan ces , d eci sion wa s re asonably s u pport ed by the
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