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 2 7 M a y 2 0 1 4 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 )I A P P E A 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 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 il i 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 -Summarv of Facts With t he consent of p ar ties, t his h earing was conducted in writi Emplo ym e n t an d Ass istance A ct. T h e ev i dence before the ministry at reconside r ati on 1. The appel lant 's PWD D e signation App lication contained: • A Phy s ician Report (PR) dated 2 0 J anuary 201 p r act itioner (G P) who has k n own the appellant for 27 years and has se times in the past year. o An Assessor Report (AR ) of the same date comp • A Self Repo r t (SR) com pleted by t he appellant. 2. The appe llant's Requ e st fo r Recons ideratio undated page from a c ons ult r e por t fro m a sp I n the PR, the GP d iagnose s the a p pel la n t's impairment 20 09 ) , neuro log ical disor de r s other (o n set Jul y 20 The G P i nd i cates that t he ap pellant's impair m e nt is li "It is now a p pr oximat e ly 4.5 ye a rs s in ce w orsenin g with a cti vity and a d diti o n al c o so c i a l an xie t y d isord er." Th e pa nel w ill firs t summ ari z e the e vid ence f rom th im pai rm ents as it rel at e s to t he PWD cr iteri a at iss ue. Seve ritv/h e alt h h istory Physical impairm e nt PR: Unde r health history, the GP writes: "Thi s p a tie n t w as "i n v olved" in a mot or v ehicle acc between 2 cars in July of 2009. He sustained injury to the knee and perinea! nerve on the R side. The surgical intervent ion on the knee has symptoms, which have persisted and, if anything, have become rather worse with time despite some initial i mpro vement. The problem s with pain, cramps and giving way have increased and are exacerbated by being in one position for any length of time. He ha pain & frequency of giving way. He has cramps and aches of the R foot and calf as well as numbness in the foot and toes, progres sively Unde r addition com men ts , the GP writ e s : "This patient has been seen by several specialists over time incl specialists as well as having nerve co n ductio d emo nstrated any perinea! nerve injur y but he does have some significant arthritis medial comoartment of the affected knee. He also has some svmotoms of complex EMT 0 03( 10/06/01 ) APP E A L I ng pursuan t to se cti on 22(3) (b) of the consisted of the foll ow i ng: dated 09 Decembe r 2013 . Th e Applica t io n 4 , c om plete d by the appellant's general en him 11 or more leted by t he same GP. n, da t ed 16 May 2014, to which was attached an ecial ist physic ian. a s injury & po is o n ing -o ther ( o nset Jul y 0 9) and anxie t y dis order s (o ns et Au g u st 20 13) . kely to contin ue fo r two y ears or more, s tatin g: the acci d e nt with pe rsist i ng s ym ptom a t ology m p licatio n s o f d e pre ssi on, pan i c at tac ks and e PR, the AR rel at i ng to the appellant's i dent where his R le g was crushed subse quently ma de n o d iffer ence t o s s l eep diff i cu lt ies as well as increased with activity." ud in g orthopedic n studies pe rf ormed which is no t in the
r e g i o n a l p a i n s y n d r o m e w h i c h o f t e n g o e r e s u l t s . " T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t h a s n o t b e e n p i n t e r f e r e w i t h 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 e a p p e l l a n t d o e s n o t r e q u i r A s t o f u n c t i o n a l s k i l l s , t h e G P r e p o r t s t h a t t h e a p p e s t e p s , i s l i m i t e d t o l i f t i n g b e t w e e n 1 5 t o 3 0 l b s . , a n d c o m m e n t : " b e f o r e s y m p t o m s b e c o m e w o r s e " ) . A R : T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t ' s i m p a i r m e n t t h w i t h p a i n , w e a k n e s s , g i v i n g w a y a n d n u m b n e s s i n t M e n t a l i m p a i r m e n t P R : U n d e r h e a l t h h i s t o r y , t h e G P w r i t e s : " I n a d d i t i o n , o v e r t h e p a s t y e a r o r t w o h e e p i s o d e s a n d s i g n i f i c a n t s y m p t o m s o f s o r e f e r r e d f o r p s y c h i a t r i c a s s e s s m e n t a n d U n d e r a d d i t i o n a l c o m m e n t s , t h e G P w r i t e s : " A d d i t i o n a l l y h e h a s b e e n s e e n b y [ n a m e d i s o r d e r a n d a g o r a p h o b i a w i t h r e c o m m e h o p e f u l l y , p a r t i c i p a t i o n i n g r o u p t h e r a p y p D e c 4 / 1 3 . " T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t h a s n o d i f f i c u l t i e 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 w i t h s i g n i f i c a n t d e f i a r e a s o f e m o t i o n a l d i s t u r b a n c e , m o t i v a t i o n , i m p u l s e d e v e l o p e d t h e s i g n i f i c a n t s o c i a l a n x i e t y d i s o r d e r w i t a t t i m e s . " A R : T h e G P i n d i c a t e s t h a t t h e a p p e l l a n t ' s i m p a i r m e n t t h a n x i e t y d i s o r d e r & a g o r a p h o b i a c o m p o u n d e d b y d e 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 ' s a b i l i t y i n s p e a k i n g A b i l i t y t o p e rf o r m D L A A R : E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L s h a n d i n h a n d w i t h n o r m a l e l e c t r o [ u n r e a d a b l e ] r e s c r i b e d m e d i c a t i o n a n d / o r t r e a t m e n t s t h a t e a n y p r o s t h e s e s o r a i d s f o r h i s i m p a i r m e n t . l l a n t c a n w a l k 1 t o 2 b l o c k s u n a i d e d , c a n c l i m b 5 + h e c a n r e m a i n s e a t e d f o r 1 t o 2 h o u r s ( G P a t i m p a c t s h i s a b i l i t y t o m a n a g e D L A a s " D i f f i c u l t y h e R l e g . " h a s b e c o m e p r o g r e s s i v e l y d e p r e s s e d w i t h p a n i c c i a l a n x i e t y d i s o r d e r f o r w h i c h h e h a s b e e n t r e a t m e n t w i t h l i t t l e i m p r o v e m e n t t o d a t e . " ] p s y c h i a t r i s t w h o h a s d i a g n o s e d s o c i a l a n x i e t y n d a t i o n s f o r c o g n i t i v e b e h a v i o r a l t h e r a p y a n d , r o g r a m s . H e w a s s e e n b y [ t h e p s y c h i a t r i s t ] o n s w i t h c o m m u n i c a t i o n . 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 c o n t r o l a n d m o t o r a c t i v i t y , c o m m e n t i n g : " H e h a s h p a n i c e p i s o d e s , a g i t a t i o n & p o o r i m p u l s e c o n t r o l a t i m p a c t s h i s a b i l i t y t o m a n a g e D L A a s " S o c i a l p r e s s i o n " . , r e a d i n g , w r i t i n g a n d h e a r i n g a s g o o d .
The G P repor ts that the appel l a n t l iv e s w it h family. Th e GP reports th at the appellant's ability to communicate he aring. R egardi ng mo bility an d physica l abil ity , th e GP provides w a lking indoors and standing; per io dic assistance required from another perso and climbin g stairs; and takin g significantly longe r than typical for lifting and car The GP c om ments: "R eq uires accompaniment or comp his own mostly i n stores or outside for any le n g th of time." With regar d to cognit ive an d e mo t ional f uncti oning, t impairme nt a s ha v ing a major imp act on daily fun ctioning in the areas of imp ulse contr ol, insight and judgment, motor activity , a nd othe r emo tio n al or men tal problems; no impac t i n the a reas of bodily functio ns consci ousnes ne uropsych ol o g ica l pro blem s. The GP c omm e nts: foll owing the l engt h y pr obl e ms he h as h ad with his The GP assesses th e assis tance re q u ired f o r m anagin pare nthe s e s ): • Per sonal car e -inde pende nt in all aspects. • Bas ic housekee p ing -inde p en dent for laundry; required f or basic hou sekeep ing ( d ifficulty lifting • Shopping -i ndependent for r e ading prices and labels for purchases; pe riodic assis t a nc e fro m another a nd car ry i ng pu rchases hom e. • Meals -independent for m eal planning and an othe r pers on required for fo od p repara tion for any le ng th of tim e ). • Pay rent a nd b ills i n depe ndent in all as pects. • Medic ati ons -independe nt in all aspects. • Tra nsp or tation -in d ependent fo r using public tr ansportation; periodic assistance f ro m a no the vehicle. With respect to social functioning the GP assesse s and maintain relationships and to secure assistance from others; periodic assistance from another person required for making appropriate social decisions, interacting appropriately with others (GP comments: "poor impulse control could be a problem here") and dealing appropriately with unexpected demands. The GP reports that the appellant has very disruptive functioning with his immediate social network ( The G P comments: "Ang e r, a gitation & associat ed d to become abusive and quite aggressive at times with major withdrawal from life & interaction with others.") The GP assesses the appellant as having marginal functioning with his extended social networks, referrinq to the comment above. EMT 003(10/06/01) I APPEA L is good for speaking, readin g , writ ing a n d the following a ssess ments: in de p e nd e nt for n for walking o u tdoo rs rying an d holding. anion in si tuations w her e h e is g o i ng to be on he G P assesses the a ppellant's ment al in th e are a of emotion; a mo derate impact atten tion/conc entration, executive, motivation, mini mal i mp act in th e a re a of memory; and s, languag e and psyc ho t ic symptoms or othe r "O c casi o nal h osti li ty toward s c are giv er an d mothe r disab ili ty. " g DL A as fo llows (the G P's comments in period i c assis tance fr om anothe r p erson , pus h i ng, pulli ng , he avier hou se w ork). , maki ng a ppr opria te choice s, an d pay ing person required for go ing to an d from s t o res safe st or age of fo od; perio d i c a ss ista n ce from and cooking (somet i mes has difficulty s ta nding t ransi t and using tran s it sch edules a nd arrang ing r person required for g etting in a nd out of the appellant as independent for ability to develop epression with panic episodes hav e cau s e d him
H elp provided/required PR: The G P i ndicates that the a ppellant does not require any prost A R : The GP indicates that help provided for DLA is provided companions f o r going out shopping and social interaction. The G P does not i n dicate t h a t t he appe llant rout inely assis tance animal. S e/f repot1 In his SR, the app ellant wr ite s tha t his number o n e two ca rs abo ut 4 1/2 years ag o and he has ha d not aches, at night m os tly, keeping him from slee p i ng p snaps a nd g ives out o n a re g ular basis and c ramp s a n hour), mak ing it very diffic ul t to do any dai ly ac t iv it more and m ore di ff i c ult to find work, cau si ng him to where he fee ls like a rec l use. He w rit es that w he n he does si mpl e t h i ngs li k e going feel ing like everyone is w a t chi n g h im and judgi ng and he st anx io us a nd u su a l ly e nd s up leavi ng befo re he can he has to go f or an appoint men t with a spec ialist or out in the pouring sweat and gets very ne rvous and f sweats so badl y that all of h is clothe s h ave swe at s w he n h i s friends tr y to get h im to g o out , late ly and he snap her do the shop pin g. His frien ds hav e help ed h im t o doctor, so he did and was sent to the p sy c hi atrist who t disorder and something called agoraph obia and that therapy could help him. In the Request for Reconsideration, the appellant stated that he went to his GP with the ministry's letter denying his request for PWD designation and with a list of "needed information" he had ob t ained from a phone ca l l with the mini stry, The GP was s ap pellan t was t ol d was sti l l "nee ded inf o r matio n" was clearly indicated on the appellant did notice however that his nee d for a leg brace (an osteoarthritic unloading brace) was not mentioned. He attached a copy of an undated page of a consult letter from a speci recomm e nded thi s and requested his GP send another letter to the In the consul t letter, the specialist states that the appellant has documented osteoarthritis involving primarily the medial compartment, but also the patelofemoral joint. He is developing a varus deformity to his knee, His MRI shows no mechanical problems, meaning that the arthroscopy at this stage will make no difference, To manage his osteoarthritis, the specialist suggests weight loss and using soft sole shoes, adiustinq his activities to what his knee will allow. The specialist also sunnests a EM T003(10/06/01) I APPEA h eses or ai ds for his impairment. by family and fr i end s, sta t in g t h at he needs uses a ny a ssistive device; nor doe s h e have an p ro b l em is h is l e g, whic h was crushed bet ween hin g b ut pro bl e ms with it s ince. It cons tantl y r op er ly (up every c o up l e o f h our s ) and it rand omly up i f he sit s fo r long p e riod s o f time (n o m o r e than i ties. S ince thi s is happ e ned to h i m, h e h a s fo un d be co m e more and more depr e s se d to the p oint to the gr ocery store he gets an overwhelmin g a rt s to sweat rea lly bad ly a nd g ets v er y get to the cashie r. T he same thing happen s when when h e tries to go fo r a j ob i nte rv i ew. He bre ak s e els like a co m p let e f oo l fo r even tr yi ng. He tains on them. He pa nics and eve n gets an gry s at his ow n mother for askin g h im to h e l p identify th at he h as a r e al p ro b l em and to see a old him he was suffering from s ocial anxiety ho c ked that a good 95% of w hat the app lica t ion form. The alist who min istry r egarding h is applic ation,
m e d i c a t i o n r e g i m e a n d s t a t e s t h a t t h e a p p e l l a n t w o b r a c e . I n h i s N o t i c e o f A p p e a l , d a t e d 3 J u n e 2 0 1 4 , t h e a p M a y 2 0 1 4 , a n d w r o t e t h a t h e d i s a g r e e s w i t h t h e r e r e c e i v e t h e l e t t e r f r o m h i s G P w i t h t h e f u r t h e r i n f o r m o f f i c e . H e r e t r i e v e d t h e l e t t e r f r o m t h e o f f i c e a n d i s t h a t t h e m i n i s t r y w i l l f i n a l l y h e l p h i m . I n h i s 1 5 M a y 2 0 1 4 l e t t e r , t h e G P w r i t e s : " [ T h e A p p e l l a n t ] t e l l s m e t h a t f o l l o w i n g a w a s i n f o r m e d t h a t t h e r e w a s i n s u f f i c i e n t f a c t t h a t o n g o i n g o v e r t h e i n f o r m a t i o n t h t h e r e . [ T h e a p p e l l a n t ' s ] m o t h e r a p p a r e n n o t e d , s o m e o f t h e m h a d a l r e a d y b e e n a t h e m i n t h e o r d e r p r e s e n t e d . " T h e G P g o e s o n t o p r o v i d e t h e f o l l o w i n g : • H o w l o n g c a n t h e a p p e l l a n t s t a n d a n d s i t a t p o s i t i o n a l c h a n g e s a r e r e q u i r e d a s a r e s u l t o • L e v e l o f a c t i v i t y a n d f u n c t i o n r e l a t i v e l y m i n p u l l i n g , w e i g h t l i f t i n g a n d s u s t a i n e d a c t i v i t y p • S o m a t i c s y m p t o m s a s a r e s u l t o f s t r e s s e s a r i s e a s a r e s u l t o f a n x i e t y a n d s t r e s s e s . • D e g r e e t h a t a g o r a p h o b i a a f f e c t s f u n c t i o n h o r i n s t o r e s e t t i n g s o r a t o t h e r g a t h e r i n g s , m p r o f u s e s w e a t i n g a n d t a c h y c a r d i a , p r e f e r r i n g a n d s o c i a l a n x i e t y d i s o r d e r . • M e n t a l c h a l l e n g e s a p s y c h i a t r i s t h a s d i a g n • S l e e p d i s t u r b a n c e d e c r e a s e d s l e e p q u a l i t y a w a k e n i n g . • K n e e b r a c e a s p e c i a l i s t r e c o m m e n d e d a n • L o w b a c k p a i n t h e a p p e l l a n t w a s d i a g n o s e i n t h e l u m b a r s p i n e i n 2 0 0 3 w i t h p r o g r e s s i v e i n t e r m i t t e n t s c i a t i c a s i n c e t h e n . I n a l e t t e r d a t e d 2 J u l y 2 0 1 4 , t h e m i n i s t r y s t a t e d t h a t h e G P i n t h e l e t t e r d a t e d 1 5 M a y 2 0 1 4 i n r e g a r d t o m i n i s t r y n o t e d t h a t t h e i n f o r m a t i o n w a s t o b e s u b m i d i r e c t e d t o t h e w r o n g l o c a t i o n t h e l o c a l m i n i s t r y o f c o m p l e t e d w i t h o u t t h e i n c l u s i o n o f t h i s l e t t e r . T h e m T h e m i n i s t r y d i d n o t o b j e c t t o t h e a d m i s s i b i l i t y o f t h e n o t e d b e l o w , t h e p a n e l f i n d s t h a t t h e l e t t e r f r o m t h e r e c o r d s b e f o r e t h e m i n i s t r y a t r e c o n s i d e r a t i o n , a s i t P W D D e s i g n a t i o n A p p l i c a t i o n . A c c o r d i n g l y , t h e p a n E m p l o y m e n t a n d A s s i s t a n c e A c t . T h e p a n e l d o e s n d e a e n e r a t i v e d i s c d i s e a s e o r f a c e t j o i n t d i s e a s e , a s E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A i u l d b e a c a n d i d a t e f o r a n o s t e o a r t h r i t i c u p l o a d i n g p e l l a n t s u b m i t t e d a l e t t e r f r o m h i s G P d a t e d 1 5 c o n s i d e r a t i o n d e c i s i o n b e c a u s e t h e m i n i s t r y d i d n o t a t i o n r e q u e s t e d . I t w a s f a x e d t o t h e l o c a l m i n i s t r y a t t a c h i n g i t t o t h i s N o t i c e o f A p p e a l i n t h e h o p e d i s c u s s i o n w i t h a n i n d i v i d u a l a t [ t h e m i n i s t r y ] h e i n f o r m a t i o n i n s o m e a r e a s o f t h e f o r m , d e s p i t e t h e a t h a s b e e n r e q u e s t e d , m u c h o f i t i s a c t u a l l y t l y o b t a i n e d a l i s t o f e x t r a q u e s t i o n a l t h o u g h , a s n s w e r e d . I w i l l a n n o t a t e t h e m a n d g o t h r o u g h a t i m e ? A p p r o x i m a t e l y o n e h o u r b e f o r e f d y s a e t h e s i a a n d n u m b n e s s i n t h e l i m b s . o r a c t i v i t i e s s u c h a s m o w i n g t h e l a w n , p u s h i n g , r o d u c e s y m p t o m s w h i c h m a y l a s t f o r d a y s . o p h a g e a l r e f l e x , n a u s e a a l o n g w i t h e p i g a s t r i c p a i n e i s u n a b l e t o m i x o u t d o o r s w i t h t h e g e n e r a l p u b l i c a l l s , e t c . , a s h e d e v e l o p s a n x i e t y , p a n i c a t t a c k s , t o s t a y a t h o m e ; a c o m b i n a t i o n o f a g o r a p h o b i a o s e d a g o r a p h o b i a , a n x i e t y a n d d e p r e s s i o n . w i t h d i f f i c u l t y g e t t i n g t o s l e e p a n d e a r l y m o r n i n g o s t e o a r t h r i t i c u n l o a d i n g b r a c e t o a l l e v i a t e t h e p a i n . d w i t h d e g e n e r a t i v e d i s c s a n d f a c e t j o i n t d i s e a s e p r o b l e m s a s a r e s u l t o f l o w b a c k p a i n a n d t i t a c c e p t s t h e a d d i t i o n a l i n f o r m a t i o n s u b m i t t e d b y t h e a p p e l l a n t ' s P W D d e s i g n a t i o n a p p l i c a t i o n . T h e t t e d t o t h e R e c o n s i d e r a t i o n S e c t i o n a n d w a s f i c e . T h e r e c o n s i d e r a t i o n d e c i s i o n t h e r e f o r e w a s i n i s t r y d o e s n o t o b j e c t t o t h e n e w i n f o r m a t i o n . G P ' s 1 5 M a y 2 0 1 4 l e t t e r . W i t h t h e e x c e p t i o n a p p e l l a n t ' s G P i s i n s u p p o r t o f t h e i n f o r m a t i o n a n d c o r r o b o r a t e s i n f o r m a t i o n p r o v i d e d i n t h e o r i g i n a l e l a d m i t s t h i s e v i d e n c e u n d e r s e c t i o n 2 2 ( 4 ) o f t h e o t a d m i t a s e v i d e n c e t h e G P ' s d i a g n o s i s o f t h e s e d i a a n o s e s w e r e n o t b e f o r e t h e m i n i s t r v a t
r e c o n s i d e r a t i o n . T h e p a n e l n o t e s t h a t e v e n i f t h e p G P h a s n o t i d e n t i f i e d a n y s p e c i f i c i m p a c t s o n p h y s E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L a n e l h a d a d m i t t e d t h i s d i a g n o s i s a s e v i d e n c e , t h e i c a l f u n c t i o n i n g a r i s i n g f r o m t h e s e c o n d i t i o n s .
I APPE AL PART F -Reasons for P anel Decision Th e is sue in t his appeal is whether the ministry reasonably deter mined that the appe llant is ineligible for PW D designatio n bec au s e he d i d no t m eet a l l the requirem ents i n section 2 of the EAPWDA. S pecifically the ministry determined that the information provided did not estab li sh that the appel lant has a severe mental or p h ysi cal impairment that in the opin i on of a prescribed profe ssional (i) directly and significan tl y restric ts hi s ability to perform daily living activities ei ther contin uously or pe riodi call y for extended periods; and, (ii) as a re sult of t hos e restrictions h e re quires help to per form tho se activities . Th e ministry determi ne d that he met the 2 other criter i a in EA P WDA s ection 2(2) set out below. Th e following section of the EAPWD A ap plies to this appeal: 2 (1) In this section: "a s si stive d evi ce" m e ans a d e vic e des i gned t o enab le a pe rson to perfo r m a daily li ving acti vit y that, b e cause o f a severe men tal o r p h ysic a l impai r m ent , the pe rson i s unable to pe rform; "daily livi ng acti vity" h as t he pres c ribed meaning; "pre s c r ibe d pr ofes sion al" ha s the p resc rib ed meanin g. ( 2) Th e minister m a y design ate a pers on w h o has re ached 1 8 y ea r s of age as a pe rson with disab ilities for the p u rposes o f t his Act i f the mini s ter i s sati s fied tha t t he pe rson has a sev ere me nta l or p hys ical im pairm ent tha t (a) in the opinion o f a med ical pra ctitione r is like ly to conti nue fo r a t least 2 y ears, and (b) in the opin ion o f a pres cribed profe ssion al ( i) directly and si g ni f i ca ntl y r estricts the per son' s abi l i t y to perf o rm daily livi ng act i vities either ( A) c ontinu ous ly, or ( B) pe riodica lly f or ext end ed periods, a n d (i i) as a result of tho s e restrictions, t he person re quir es h e l p to perform th o se activiti es . (3) F or t he purp oses o f s ubsection (2) , ( a ) a pers on w h o h as a severe mental i mpairment includes a person w i th a mental di s ord er, and (b) a pe r son requires help in relation to a dail y livin g acti v i ty i f, in ord er to pe rf o r m it, the p e rs on req uir e s (i) an assistive device, (ii) the significant help or sup e rv ision of another person , or (iii) the services of an assistance animal. The following section of the EAPWDR applies to this appeal: 2 ( 1)Fo r th e p u rp os e s of th e Act and this regulation, "dai ly living ac tivities", (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 ) ma n a ge p ersonal f inances; (iii) shop for personal needs; (iv) use public or personal transportation facilities; (v) perform housework to maintain the person' s place of residence in acce ptable sanitary condition; (vi) move about indoors and outdoors; (vii) perform personal h"niene and self care; EMT003(10/06/01)
APPEAL I (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 (in this case, the appellant's GP) 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 information provided in the PR regarding physical functioning (able to walk 1-2 blocks unaided, etc.) and noted that the appellant is independently able to do most aspects of mobility and physical abilities listed in the AR, with periodic help required to walk outdoors and climb stairs and that no assistive devices are routinely used to help compensate for the appellant's physical impairment. The ministry states that the GP's comment suggests that the appellant requires accompaniment in situations where he is going to be on his own walking indoors or outside for any length of time but that it is unclear if this is related to the physical factor or his social anxiety disorder. Noting that remedial measures including weight loss and medication had been recommended by a specialist, the position of the ministry is that the functional skill limitations are not significantly restrictive and are more in keeping with a mild to moderate degree of physical impairment and the ministry is not satisfied that the information provided is evidence of a severe physical impairment. The aooellant's position is that the evidence provided, includinq that in the GP's letter of 15th May EMT 003(10/06/01)
I APPEAL 2014 that relatively minor activities such as mowing the lawn, pushing, pulling, weight lifting and sustained activity produce symptoms which may last for days and that he requires the use of an osteoarthritic uploading brace to alleviate the pain, demonstrates that he is physically impaired. Panel findings The evidence provided by the GP regarding the nature and degree of the restrictions to physical functioning arising from the appellant's knee injury and resulting pain is that he is independent in many aspects of DLA requiring physical effort. In the AR, the GP assesses him as independent for walking indoors and standing, all aspects of personal care, laundry, paying rent and bills and using public transit. The GP has assessed the appellant requiring periodic assistance from another person in a number of areas requiring physical effort, such as basic housekeeping, going to and from stores, carrying purchases home, food preparation,_and cooking and getting in and out of a vehicle, but no information is provided as to how often such assistance is required, to what extent and under what circumstances. As the ministry noted, it is unclear whether the GP's assessment that the appellant requires periodic assistance from another person for walking outdoors, with the comment that he requires accompaniment when he is going to be on his own, mostly in stores or outside for any length of time, relates to his physical impairment or his social anxiety disorder, as no reason is given for this requirement or what the role is of the companion in these situations. Similarly, the GP makes reference in both the PR and AR of the appellant's knee "giving way," without explaining what the consequences are (e.g. falling?), and the frequency and circumstances of such events. No mention is made in the information provided by the GP of any remedial measures, such as medication, that have been trialed and found to help or proved ineffective. An osteoarthritic uploading knee brace has been recommended for the appellant; however, no information has been provided as to how this might be expected to improve his physical functioning or if it has yet been trialed. On the basis of the available information, and considering the evidence that the appellant is able to walk 1-2 blocks unaided, climb 5+ steps and lift 15 to 35 lbs., the panel finds that the ministry was reasonable in determining that a severe physical impairment had not been established. Mental impairment. In the reconsideration decision the ministry notes that the GP reports the development of a significant social anxiety disorder with panic episodes, agitation and poor impulse control at times. Several deficits to cognitive and emotional functioning are reported in the areas of emotional disturbance, motivation, impulse control and motor activity. Communication is good with no difficulty noted. Periodic support/supervision in 3 of 5 aspects of social functioning is reported with the comment "poor impulse control could be a problem here." Impacts on daily functioning are mostly moderate with one major impact on emotion. The ministry states that while it would appear from the psychiatric recommendations that therapy is in order to remediate the social anxiety disorder, the ministry concludes that overall the information in the narrative is not supportive of a severe mental health condition that significantly limits the appellant's ability to function either continuously or periodically for extended periods. The ministry is therefore not satisfied that the information provided is evidence of a severe mental impairment. The position of the appellant is that he has been diagnosed with agoraphobia, anxiety and depression. As the GP reported in his 15 May 2014 letter, these mental health conditions result in him EAAT 003(10/06/01)
I APPEAL being not able to mix outdoors with the general public or in store settings or at other gatherings, malls, etc. as he develops anxiety, panic attacks, profuse sweating and tachycardia, preferring to stay at home. He submits that this is sufficient evidence to establish a severe mental impairment. Panel findings The appellant has been diagnosed with agoraphobia, anxiety and depression, The diagnosis and treatment of a medical condition is not in itself 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 evidence suggests that the main impact is in restrictions in the social functioning DLA of ability to relate to, communicate or interact appropriately with others. In particular, the appellant's GP in his 15 May 2014 letter, states that the appellant is "unable to mix outdoors with the general public or in store settings .... prefers to stay at home." The panel notes however that no mention of such a significant restriction in social functioning is made in the PR or AR, and the GP in his letter made no reference to how his condition may have deteriorated to this extent since the original application, which was completed 4 months earlier in January 2014. Further, in the PR the GP indicates no difficulties with the appellant's ability to communicate and in the AR rates his abilities as "good" in all aspects of communications. The panel also notes that in the original AR, no mention was made of a social functioning restriction in the DLA of shopping, where the appellant is assessed as independent for reading prices and labels, making appropriate choices, and paying for purchases, indicating to the panel that he has good mental functioning when in-store, while requiring unspecified periodic assistance for going to and from stores and carrying purchases home, presumably because of physical factors. It is unclear to the panel whether the appellant's social functioning challenges described by the GP in his recent letter are episodic/occasional, or either continuous or periodic for an (unknown) extended period of time. As the ministry noted, the GP has assessed a major impact of the appellant's mental impairment on daily functioning in the area of emotion. While the GP assesses moderate impacts in 7 other areas, including other emotional or mental problems, the only comment relates to "occasional hostility around caregiver or mother''. No impact is reported for bodily functions, despite the appellant's reference in his SR and in the GP's letter to "profuse sweating". While the GP indicates support/supervision is required on a periodic basis in 3 of 5 areas of the social functioning DLA of ability to make decisions about personal activities, care or finances, no description of the degree and duration of such support/supervision is provided. Given the information available, the panel finds that the ministry was reasonable in determining that a severe mental impairment had not been established. Significant restrictions in the ability to perform DLA. The ministry, in its reconsideration decision, reviewed the GP's assessments of the appellant's ability to perform DLA. The ministry noted that the appellant was seen by a psychiatrist on 4 December 2013 with recommendations for cognitive behavioral therapy and participation in group therapy programs. As the application was completed on 20 January 2014, it is too early to comment progress on resolution of anxiety. The ministry concluded that as the majority of DLA are performed independently or require little help from others, the information from the appellant's prescribed professional -his GP -does not establish that impairment significantly restricts DLA either continuously or periodically for extended periods. EAAT 003(10/06/01)
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 t h e e v i d e n c e c i m p a i r m e n t s d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t h i s a b 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 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 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 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 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 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 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 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 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 I n t e r m s o f r e s t r i c t i o n s t o D L A a s a r e s u l t o f h i s p h y a p p e l l a n t a s r e q u i r i n g 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 m o v i n g a b o u t i n d o o r s a n d o u t d o o r s , b a s i c h o u s e k e t r a n s p o r t a t i o n . H o w e v e r , t h e G P h a s n o t d e s c r i b e d h o w o f t e n a n d u n d e r w h a t c i r c u m s t a n c e s . S i m i l a r l y a p p e l l a n t ' s m e n t a l i m p a i r m e n t t h e G P h a s a s s e s s e f r o m a n o t h e r p e r s o n i n 3 o f 5 a s p e c t s o f t h e s o c i a l 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 , a g a i n w i t h o u t a b o v e u n d e r s e v e r i t y o f m e n t a l i m p a i r m e n t , t h e p a n r e s t r i c t i o n s i n t h e a p p e l l a n t ' s a b i l i t y t o r e l a t e t o , c o m t h a t 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 ' s a b i l i t y t o c o m m t h e G P ' s s t a t e m e n t t h a t h e i s u n a b l e t o m i x o u t d o o d e v e l o p s a n x i e t y , p a n i c a t t a c k s , p r e f e r r i n g t o s t a y a a p p e l l a n t ' s s o c i a l f u n c t i o n i n g w i t h h i s i m m e d i a t e s o h i s e x t e n d e d s o c i a l n e t w o r k s a s m a r g i n a l f u n c t i o n i n 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 i t h a s n o t b e e n e s t a 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 d i r e c t l y a n d s i g 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 , b e c a u s e o f h i s p e r i o d i c a s s i s t a n c e o f a n o t h e r p e r s o n t o p e r f o r m s e b r a c e . H e a l s o r e q u i r e s t h e r a p y a n d o n g o i n g a s s i s t a n d d e p r e s s i o n . P a n e l f i n d i n a s E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L l e a r l y s h o w s t h a t h i s p h y s i c a l a n d m e n t a l i l i t y t o p e r f o r m D L A o n a n o n g o i n g b a s i s . h 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 e 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 h e m i n i s t e r m a y d e s i g n a t e a p e r s o n a s a p e r s o n c 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 o 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 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 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 s i n t h e a b i l i t y t o p e r f o r m d 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 s . s i c a l i m p a i r m e n t , t h e G P h a s a s s e s s e d t h e t h e r p e r s o n i n s o m e a s p e c t s o f t h e f o l l o w i n g D L A : e p i n g a n d s h o p p i n g , a n d m e a l s a n d t h e n a t u r e a n d e x t e n t o f s u c h h e l p r e q u i r e d , o r , i n t e r m s o f r e s t r i c t i o n s a s a r e s u l t o f t h e d t h e a p p e l l a n t a s r e q u i r i n g p e r i o d i c a s s i s t a n c e f u n c t i o n i n g D L A o f a b i l i t y t o m a k e d e c i s i o n a b o u t p r o v i d i n g a d e s c r i p t i o n o f s u c h h e l p . A s d i s c u s s e d e l i s u n a b l e t o a s s e s s t h e s i g n i f i c a n c e o f a n y m u n i c a t e o r i n t e r a c t w i t h o t h e r s e f f e c t i v e l y , g i v e n u n i c a t e a s " g o o d " a n d t h e u n c e r t a i n t i e s r e l a t e d t o r s w i t h t h e g e n e r a l p u b l i c o r i n s t o r e s , a s h e t h o m e . W h i l e t h e G P h a s a s s e s s e d t h e c i a l n e t w o r k a s v e r y d i s r u p t e d f u n c t i o n i n g a n d w i t h g , o v e r a l l 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 b l i s h e d t h a t t h e a p p e l l a n t ' s i m p a i r m e n t s i n t h e 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 , 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 . k n e e i n j u r y a n d r e s u l t i n g p a i n h e r e q u i r e s t h e v e r a l D L A , a s w e l l a s a n o s t e o a r t h r i t i c k n e e a n c e a s h e s t r u g g l e s w i t h a g o r a p h o b i a , a n x i e t y
The pan e l n otes that th e legislat i o n r e quir es t h a t i n t for help mu st arise from dire ct a nd s ign ifica nt restric cont i n uous or p e ri o d ic for ex te nd e d per iods. While the from s o me periodic hel p f r om ano the r pe rs o n fo r th a osteoarthri tic kne e brac e , the panel finds t hat t he n ot been e s tablished t h a t DL A a re directly an d s ignificant hel p i s require d as p rov i ded under sec t i on 2( 2)( b)(i Co n cl usion Havi ng rev ie wed and cons ider ed all of t he evi denc the m i n is try's decision t ha t the appell a nt was not e supported by the evi dence. T he pa nel t her efore conf EM T003(10/06/01) APP E A L I h e opi n i on of a pr escr ibe d prof e s siona l the n e ed tions in the abilit y to perform DLA t hat are eith er evi dence is th at the appellant w ould benefit e DLA r eq uiri n g p h y s i cal e f fort and from th e use of ministry reasonabl y d e termi ne d tha t s i nce it h as l y res t r icte d , it can not be deter mined th at i ) of the EAPWDA. e and the relevant leg is l a tion, the panel f i n ds that ligibl e for PWD designation was reasona bly i r ms the minis t ry's d e ci s i o n.
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