PART C-Decis ion under Appe al Th e de c isio n un der appeal is the Mi n i s try of Social Dev "minis try") r econside ratio n decisi on dated June 4 , 20 two of th e f ive st atut ory r equir ements of S ecti on 2 of w i th Di s abil iti e s Act f or d esi gn ation a s a pe rson w ith disabili appe llant m et the age re q uire ment and tha t h e has a seve a medical p ra ct ition e r , is l i k ely to continue f or at l east satisfied that the e viden ce es t ablishes that: • the appe llant ha s a sev ere physi cal impairm ent; • the app e l lan t's dai ly l iving activi ties ("DLA") are, dir e ctly a nd sign if ica ntly r estricted eit h e r c onti • as a re s ult o f t hese rest rictions , the a ppe lla nt a nother per s on, the use of an as sis tive device, or perform D LA. PART D -Relev ant Leg i slation Emplo yment a n d Assistance for Pers ons with D is abili Employment an d Assistanc e for Pe rsons w i t h Dis ab EAA1 003(10/06/01) I �P PE AL# e l opmen t a nd Soc ial Inn o vation (the 14 which f ound that the app ellan t d id n ot meet t he Em ploym en t a nd A ssistance for P ersons t i e s ("P W D" ). The m i n i st ry fou n d t ha t th e r e mental impairmen t t ha t , in t h e opinion o f t wo years. Howev er, t h e ministr y was not in th e o pinion o f a pres c r ib e d p r ofessi onal , n uous ly o r pe rio d ic a lly f or e xtend ed periods; an d, req uire s the s i gn i fic a nt he lp o r s upervision o f t he s ervices of an ass ist a nce ani m al to ties Act ("EA P WDA") , secti on 2 ilities Re g ulatio n ("EAPWDR") , sectio n 2
P A R T E S u m m a o f F a c t s W i t h t h e c o n s e n t o f t h e p a r t i e s t h e h e a r i n g w a s h e l d 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 i n f o r m a t i o n b e f o r e t h e m i n i s t ry a t t h e t i m e o f r e • T h e a p p e l l a n t ' s P W D a p p l i c a t i o n f o r m c o n s i s a t t a c h m e n t [ d a t e d O c t o b e r 2 4 , 2 0 1 3 ] , a p h y s p s y c h i a t r i s t [ d a t e d O c t o b e r 1 5 , 2 0 1 3 ] a n d a n w o r k e r [ d a t e d O c t o b e r 2 8 , 2 0 1 3 ] . • T h e a p p e l l a n t ' s R e q u e s t f o r R e c o n s i d e r a t i o n r e c o n s i d e r a t i o n s u b m i s s i o n p r e p a r e d b y h i s m w o r k e r ' ' ) . • A n o u t p a t i e n t p s y c h i a t r i c c o n s u l t a t i o n r e p o rt • X r a y a n d b o n e d e n s i t y r e p o rt s d a t e d N o v e m A d m i s s i b i l i t y o f A d d i t i o n a l I n f o r m a t i o n F o r p u r p o s e s o f t h i s a p p e a l , t h e a p p e l l a n t s u b m i t t e d • A t y p e w r i t t e n s u b m i s s i o n p r e p a r e d b y t h e a p • A f o u r p a g e s u b m i s s i o n h a n d w r i t t e n b y t h e a 2 0 1 4 . T h e p a n e l h a s a c c e p t e d b o t h d o c u m e n t s a s g o i n g t T h e m i n i s t r y r e l i e d o n i t s r e c o n s i d e r a t i o n d e c i s i o n a * * T h e p a n e l r e v i e w e d t h e e v i d e n c e a s f o l l o w s : D i a g n o s e s : • I n t h e P R t h e p s y c h i a t r i s t , w h o h a d s e e n t h e g e n e r a l i z e d a n x i e t y d i s o r d e r , o b s e s s i v e c o m p a g o r a p h o b i a , d e p r e s s i v e d i s o r d e r N O S , o s t e o a p p e l l a n t i s u n d e r i n v e s t i g a t i o n f o r h e m o c h r o l o n g s t a n d i n g a n x i e t y a n d O C D u s u a l l y r e s p o n • I n t h e o u t p a t i e n t p s y c h i a t r i c c o n s u l t a t i o n r e p o g e n e r a l i z e d a n x i e t y d i s o r d e r w i t h p a n i c a t t a c k r e m i s s i o n ) ; O C D p e r s o n a l i t y t r a i t s ( c o n s c i e n t o s t e o p o r o s i s a n d b r o k e n b o n e s ; d e s c r i b e d s t F u n c t i o n i n g ) o f 5 5 . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # i n w r i t i n g i n a c c o r d a n c e w i t h s e c t i o n 2 2 ( 3 ) o f _ t h e c o n s i d e r a t i o n i n c l u d e d t h e f o l l o w i n g : t i n g o f t h e a p p e l l a n t ' s s e l f r e p o r t a n d h a n d w r i t t e n i c i a n ' s r e p o r t ( " P R " ) s i g n e d b y t h e a p p e l l a n t ' s a s s e s s o r ' s r e p o rt ( " A R " ) s i g n e d b y a s o c i a l d a t e d M a r c h 3 1 , 2 0 1 4 w i t h a n a t t a c h e d , u n d a t e d e n t a l h e a l t h o u t r e a c h w o r k e r ( t h e " o u t r e a c h d a t e d F e b r u a r y 2 0 , 2 0 1 3 . b e r 2 6 , 2 0 1 2 a n d F e b r u a r y 2 7 , 2 0 1 3 r e s p e c t i v e l y . t h e f o l l o w i n g d o c u m e n t s : p e l l a n t ' s o u t r e a c h w o r k e r [ d a t e d J u l y 1 , 2 0 1 4 ] . p p e l l a n t , a n d r e c e i v e d b y t h e T r i b u n a l o n J u l y 8 , o a r g u m e n t . n d p r o v i d e d n o a d d i t i o n a l i n f o r m a t i o n . * a p p e l l a n t o n c e , d i a g n o s e d t h e a p p e l l a n t w i t h u l s i v e d i s o r d e r ( " O C D " ) , p a n i c d i s o r d e r w i t h p o r o s i s a n d p a i n ( b a c k ) . S h e a l s o w r o t e t h a t t h e m a t o s i s b y a n i n t e r n i s t . S h e c o m m e n t e d t h a t d s u b o p t i m a l l y e v e n w i t h t h e b e s t t r e a t m e n t . r t , a p h y s i c i a n d e s c r i b e d t h e a p p e l l a n t a s h a v i n g s , O C D , r e c u r r e n t m a j o r d e p r e s s i o n ( i n p a r t i a l i o u s , h a r d w o r k i n g a n d p e rf o r m a n c e o r i e n t e d ) ; r e s s o r s ; a n d G A F ( G l o b a l A s s e s s m e n t o f
P h y s i c a l I m p a i r m e n t I n t h e P R t h e p s y c h i a t r i s t r e p o r t e d t h a t : • T h e a p p e l l a n t h a d s e e n a p s y c h i a t r i s t f r o m a g i v e n d u e t o m a n y m o v e s . • I n t e r m s o f p h y s i c a l f u n c t i o n a l s k i l l s t h e p s y c b l o c k s u n a i d e d o n a f l a t s u r f a c e , c l i m b 5 + s t e ( n e e d s i n v e s t i g a t i o n f o r o s t e o p o r o s i s ) , a n d h p h y s i c a l a s s e s s m e n t b y r h e u m a t o l o g i s t ) . • I n t h e A R t h e s o c i a l w o r k e r w h o h a d s e e n t r e p o rt e d t h a t t h e a p p e l l a n t i n d e p e n d e n t l y m a b u t a l l t a k e s i g n i f i c a n t l y l o n g e r t h a n t y p i c a l . W c o m m e n t e d " M u s t u s e w a l l o r r a i l s o n e s t e p c o m m e n t e d " p a i n i n s h o u l d e r / b a c k n e c k p a i n s h o u l d e r / b a c k k n e e a n d n e c k . H e c a r r i e r e s t . " • I n t h e o u t p a t i e n t p s y c h i a t r i c c o n s u l t a t i o n r e p o o s t e o p o r o s i s a n d h a d a b o n e d e n s i t y s c a n b o r e c e n t l y b r o k e h i s j a w , w h i c h r e q u i r e d w i r i n g s u r g e ry , m e d i c a t i o n a l l e r g i e s , u n c o n s c i o u s n e • T h e x r a y r e p o r t i d e n t i f i e d a n o b l i q u e f r a c t u r e • T h e b o n e m i n e r a l d e n s i t y r e p o r t i n d i c a t e d a d a p p e l l a n t ' s a g e i n t h e l u m b a r s p i n e a n d f e m o n o t a p p l i c a b l e . " T h e s e c o n d p a g e o f t h e r e p o • I n h i s s e l f r e p o r t t h e a p p e l l a n t w r o t e t h a t h e h • I n t h e r e c o n s i d e r a t i o n s u b m i s s i o n p r e p a r e d b t h a t t h e a p p e l l a n t g e t s a n x i o u s o n s t a i r s f o r f e n o r m a l l y b e a 1 5 m i n u t e w a l k m a y t a k e a l m o h i s s h o u l d e r , b a c k , n e c k a n d k n e e d u e t o c h r D L A • T h e p s y c h i a t r i s t i n d i c a t e d t h a t t h e a p p e l l a n t h 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 . I n r e s p o n s e t m e d i c a t i o n , t h e p s y c h i a t r i s t w r o t e " L o n g t e r m l i f e l o n g d e p e n d i n g o n r e s p o n s e t o C B T [ c o g n 1 0 y r s . " • I n t h e P R t h e p s y c h i a t r i s t r e p o r t e d t h a t t h e a p m a n a g e m e n t o f m e d i c a t i o n s , m o b i l i t y i n s i d e a f i n a n c e s . S h e i n d i c a t e d t h a t h e h a s c o n t i n u o p e r s o n a l s e l f c a r e , m e a l p r e p a r a t i o n , b a s i c h o a n d s o c i a l f u n c t i o n i n g . • T h e p s y c h i a t r i s t w r o t e t h a t t h e a p p e l l a n t ' s O C r e p o r t e d " [ D L A ] s e v e r e l y r e s t r i c t e d b y a n x i e t y • T h e p s y c h i a t r i s t i n d i c a t e d t h a t t h e a p p e l l a n t h c o m m e n t i n g " A n x i e t y / O C D / P a n i c / D e p r e s s i o n s i n i f i c a n t l " E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # g e 1 6 t o 1 9 b u t n o t r e a t m e n t w a s c o n s i s t e n t l y h i a t r i s t r e p o r t e d t h a t t h e a p p e l l a n t c a n w a l k 4 + p s u n a i d e d , h i s l i m i t a t i o n s i n l i f t i n g a r e u n k n o w n i s a b i l i t y t o r e m a i n s e a t e d i s u n k n o w n ( n e e d s h e a p p e l l a n t 2 t o 1 0 t i m e s i n s i x m o n t h s n a g e s a l l a s p e c t s o f 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 i t h r e s p e c t t o c l i m b i n g s t a i r s t h e s o c i a l w o r k e r a t a t i m e . " R e g a r d i n g l i f t i n g , t h e s o c i a l w o r k e r i n i n k n e e s . " R e g a r d i n g c a r r y i n g / h o l d i n g -" P a i n s f o r s h o r t d i s t a n c e s ½ b l o c k a p p . t h e n h a s t o r t a p h y s i c i a n r e p o r t e d t h a t t h e a p p e l l a n t h a s o k e d . " H e h a s e a s i l y b r o k e n r i b s i n t h e p a s t a n d o n D e c e m b e r 3 , 2 0 1 2 . T h e r e h a s b e e n n o o t h e r s s o r s e i z u r e s . " o f t h e r i g h t j a w . e n s i t y b e l o w t h e e x p e c t e d r a n g e f o r t h e r a l n e c k , a n d n o t e d t h a t " 1 O y e a r f r a c t u r e r i s k i s r t i s n o t i n c l u d e d i n t h e a p p e a l r e c o r d . a s l o w b o n e d e n s i t y i n h i s l o w e r b a c k . y t h e o u t r e a c h w o r k e r , t h e o u t r e a c h w o r k e r w r o t e a r o f b r e a k i n g b o n e s . S h e w r o t e t h a t w h a t w o u l d s t ½ h o u r a s t h e a p p e l l a n t s t o p s f r e q u e n t l y t o r e s t o n i c p a i n . a s b e e n p r e s c r i b e d m e d i c a t i o n t h a t i n t e r f e r e s o a q u e s t i o n a s t o t h e a n t i c i p a t e d d u r a t i o n o f t h e u n t i l [ i l l e g i b l e ] a n x i e t y m i n i m i z e d C B T m a y b e i t i v e b e h a v i o r a l t h e r a p y ] o r l e n g t h o f O C D i . e . > p e l l a n t i n d e p e n d e n t l y m a n a g e s t h e 3 D L A o f n d o u t s i d e t h e h o m e , a n d m a n a g e m e n t o f u s r e s t r i c t i o n s w i t h r e s p e c t t o t h e 6 D L A o f u s e w o r k , d a i l y s h o p p i n g , u s e o f t r a n s p o r t a t i o n , D c a n t r a p h i m i n s i d e t h e h o u s e ( r i t u a l s } . S h e / O C D " a n d d e s c r i b e d a f e a r o f g e r m s a n d p e o p l e . a s c o g n i t i v e d i f f i c u l t i e s w i t h c o m m u n i c a t i o n , a l l i m p a i r s o c i a l i z a t i o n m e m o r y / c o n c e n t r a t i o n
APPEAL# '. • In the AR the social worker reported that the appellant lives alone. She described the appellant's ability to communicate as being good in all respects. • In the PR the psychiatrist reported the appellant as having significant deficits with 8 of 12 areas of cognitive and emotional function: executive, language, memory, emotional disturbance, motivation, impulse control, motor activity, and attention/concentration. • In the AR the social worker reported the appellant as having major impacts in 3 areas of cognitive and emotional function -bodily functions, emotion, and impulse control. She reported moderate impacts with respect to consciousness, motivation, and motor activity. • The social worker reported the appellant independently manages virtually all tasks related to all DLA, though indicated that some tasks take significantly longer than typical. With respect to the DLA use of transportation, regarding public transportation the social worker wrote "must be almost emergency to use bus -anxiety (tremors -chest pains -shortness of breath perspiration -fright kicks in). • Regarding the DLA relate to, communicate or interact with others effectively (social functioning), the social worker indicated that the appellant manages all tasks independently except for needing periodic support/supervision with developing/maintaining relationships. She described the appellant as being marginally functional with respect to his immediate and extended social networks. • In the outpatient psychiatric consultation report, a physician wrote that the appellant described himself as being good at communication. The physician wrote that there are no signs of mania or psychosis, and described memory and decisiveness as "normal". The physician described options for medication and CBT. • In his self-report the appellant wrote that he only goes out if necessary for doctor's appointments, social worker, and food. He also wrote that he has an uncontrollable fear/nervousness of crowded places, vehicles and public transportation. He reported that he has a drivers licence, but always felt extremely anxious when trying to drive. He stated he sometimes gets physical symptoms from anxiety: chest pains, tremors, uncontrollable sweating, shortness of breath, nausea, problems concentrating, and insomnia. • The appellant described obsessively cleaning himself and organizing/cleaning his room. He described his social life as "difficult" all his life with family, friends, and employers because he is constantly worrying what others think of him. The appellant wrote that he is hoping to get his life in order with medication and CBT. He also wrote that he has joined a mental health association clubhouse in the hopes of meeting others in his situation and getting support from people who understand. • In his reconsideration submission, which was prepared with the help of the outreach worker, the outreach worker wrote that the appellant's anxiety is "definitely more than just generalized it is almost debilitating." She wrote that "He has no social life as his anxiety prohibits such." • The outreach worker wrote that when the appellant leaves his residence alone as requested by his physician, the appellant goes out early in the morning to avoid people, and stated "Goes out to survive only (immediate necessities of life)". She said when it comes to communication levels "he does do ok, only once a bond of trust has been established, which may take hours and months of building up that trust with the individuals almost always are professionals." She stated he will write and rewrite written communications. • The outreach worker reported that most days are spent dealing with OCD rituals. Help with DLA • In describinQ the assistance required by the aooellant to perform DLA, the psychiatrist wrote EAA T003( 10/06/01)
" Men tal Hea lt h have p rovi d ed a care w orke r c a n no t d o above [DLA ] good ." • In respon se t o a questio n in the AR as k in g fo assi stanc e req ui r ed wit h DLA th e social w orke peop l e ok Ho weve r if he is alone a nd #'s of people in • W hen a sked t o indic ate w h a t a ssist ance is prov s oci a l w orker responded "c o mmun it y se rvice r equ ir es any pros theses or aids for h i s impairments, an h ave an as si stance ani mal. EAAT 003(10/06/01) I APP EAL # to help [ i lleg i ble ] s a ys ki tc hen/fo od [il l e g i b le ) as r a d esc r i pti on o f t he type a n d amount of r wr o te "In sto r es if he g oes in and little # of crease w ill leav e t h e lin e a nd the s tore." i d ed to the appe ll a n t by other people, the a genc ies ". S h e did not in d i cate t hat the appel lant d repor te d t h at t h e app ell a nt do es no t
PART F -Reasons for Panel Decision The issue on this appeal is whether the mini st ry's decision to deny the appella PWD was reasonably suppo rted by th e evidence o r w enactment in the circumstances of the appellant. In particular, was determining that the appellant does not have a severe physica a prescribed professional the a ppell a nt's impairments do not directl from performing DLA e it he r c on ti n uously or periodically for those restrictions th e appell an t does not requir e help to p The r eleva nt legislation is a s follows: EAPWDA: 2 (1) In this section: "a ss istive d e vi ce " means a devi c e designed to en activi ty t ha t , be cau s e of a severe mental perf o rm; " d aily livi n g activi t y " ha s the pre "p r esc ribe d p rofes sional" h as the prescri ( 2) The min is ter m a y design a te a p e rson who has disa bilities fo r the purposes of this Act if the men ta l or physical i mpairm e n t tha t ( a ) in the opini on of a medical year s, a nd (b) in the opinio n of a prescrib (i) d ire ctl y an d signific l iving a c tivities e it he r (A) con ti nu ousl (B) periodically for extended periods, and (i i) as a res ult of those r those activities. (3) F o r the purposes of subsection (2), (a) a p e r son who has a seve me ntal d is order, and (b) a perso n requires help in relatio perform it, the person requires (i) an assistive device, (ii) the sig nific a nt help or (iii) the servic e s of an EMT 003(10/06/01) APPEAL# � nt designation as a as a reas onable applicat ion of the applicable th e min istry r eas onable i n l impairment, and th at in the opin ion of y and significantly restrict him exte n ded pe riods, a n d that as a result of erf orm DLA . able a p e rs o n to pe rf orm a daily living o r ph y sical impa irment, t he p erso n is unabl e to s c ribed meanin g; bed m eaning . reac hed 1 8 years of age as a p e rson with minist e r is satisf i e d t hat the per s on has a se v e re practit ioner is l ike ly to co ntinu e for at l east 2 ed profess io nal antly rest r ict s the pe r son 's ability to per f orm d ai ly y , o r es tri ct i ons, the person r e q uires help t o per form r e m ental im p airmen t i ncludes a person wi t h a n to a daily livi n g a c tivity if, in ord er t o supervision of another person, or ass i s t ance animal.
EAPWD R: 2 (1) For the pu rpos es of the Act and this regulation, "daily living activiti (a) in relati o n to a per s o n mental impairme n t, means the following activities: (i) pre p a re own mea (ii) manage persona (ii i) sho p for personal (iv) use public or per (v) perform housework to maintain the perso ac ceptable s a ni tar y condition; (vi) move about i ndoo (vi i) perfo rm per sona ( v iii) m anage p ers onal med (b) i n r elat i on to a person who fo l lo w i ng activ ities: ( I ) make deci s i on s a (ii) r elate to, commu (2) For the pu rposes of the Act , "pre scri (a ) authorized und e r a n enact (i) m e d ic al pra ctitioner, (ii) re gistered ps y chologi (iii) reg istere d nurse or (iv ) occu patio nal the (v) physic a l therapist, (vi ) soci a l worker, (vii ) c hiro pract or, (viii) nurse practitioner, or (b) acting in the c our s e of the by (i) an authority, as that term is defined in section 1 (1) of the Independent School Act, or (ii) a board or a francophone education authority, as those terms are de fined in section 1 (1) of the School Act, if qualificat ions in psychology are a condition of such employment. * Severe Physical Impairment The appellant's position is that his osteoporosis and chronic pain constitute a severe physical impairment. He argued, through h is o u trea c h worker, because he will not ask for help. He noted that the professionals indicated it takes him significantly lon\:]er to comolete ohvsical tasks and that he also has a fear of ohvsical tasks because of anxiety EMT003(10/06/01) I APPE A L # e s" , w ho h a s a seve re physica l imp ai rm ent or a s e v e re ls; l fi nances; nee ds ; s onal transportation faciliti e s ; n' s p l ace of residence in rs and outdoor s ; l hygiene and self care; ic a t io n, a nd has a seve r e mental im pairm ent, includes the bo ut pe rsonal a c tivi ties, c a re or f inanc e s; nic a t e or interact wi th other s eff ecti vely. bed professi ona l " mean s a pers on who is m en t t o pr ac tis e the p rof es sion of s t , r e gi stered p syc hiatric n urse, rapist, o r p e rson's employment as a scho ol p sy ch ol og is t * ***** that whil e he is i ndependent in most th ings it is
a b o u t b r e a k i n g b o n e s . 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 t h e r e i s n o t e n o u g h e v T h e m i n i s t r y a r g u e d t h a t t h e s o c i a l w o r k e r i n d i c a t e d m o b i l i t y a n d p h y s i c a l a c t i v i t i e s , a n d p r o v i d e d n o e v i d h i m . P a n e l D e c i s i o n A d i a g n o s i s o f a s e r i o u s m e d i c a l c o n d i t i o n d o e s n o t s e v e r e i m p a i r m e n t . A n " i m p a i r m e n t " i s a m e d i c a l c o a b i l i t y t o f u n c t i o n i n d e p e n d e n t l y o r e f f e c t i v e l y . T o a s s e s s t h e s e v e r i t y o f a n i m p a i r m e n t o n e m u s t c e x t e n t o f i t s i m p a c t o n d a i l y f u n c t i o n i n g a s e v i d e n c e d w h i c h p e r f o r m i n g D L A i s r e s t r i c t e d . A m e d i c a l b a r r i e e m p l o y m e n t i s n o t a l e g i s l a t e d c r i t e r i o n f o r s e v e r i t y . c o n s i d e r a l l t h e r e l e v a n t e v i d e n c e , i n c l u d i n g t h a t o f t t h e f u n d a m e n t a l b a s i s f o r t h e a n a l y s i s i s t h e e v i d e n c d e c i s i o n m a k i n g p o w e r t h e m i n i s t r y c a n n o t m e r e l y d r e s p e c t t o w h e t h e r t h e s t a t u t o r y r e q u i r e m e n t s a r e m f e t t e r i n g o f d i s c r e t i o n . T h e p r o f e s s i o n a l e v i d e n c e h a e v i d e n c e . I n t h e a p p e l l a n t ' s c a s e , t h e p h y s i c a l f u n c t i o n a l s k i l l s a r e g e n e r a l l y i n t h e m i d t o u p p e r r a n g e o f f u n c t i o n a l a p p e l l a n t t a k e s s i g n i f i c a n t l y l o n g e r t h a n t y p i c a l w i t h m u c h l o n g e r . D e t a i l s p r o v i d e d b y t h e a p p e l l a n t a n d t a k e s a l i t t l e l e s s t h a n t w i c e a s l o n g t h a n t y p i c a l w i t h w h i l e s o m e o f t h e s l o w n e s s i s r e l a t e d t o c h r o n i c p a i n s t a i r s ) i s c a u s e d b y h i s m e n t a l i m p a i r m e n t ( a n x i e t y ) . r e p o r t d o e s n o t s p e c i f y a n e l e v a t e d r i s k o f f r a c t u r e d d e n s i t y . A s d i s c u s s e d i n m o r e d e t a i l i n a s u b s e q u e n t s e c t i o n R e s t r i c t i o n s t o D L A , a n y l i m i t a t i o n s r e s u l t i n g f r o m t h t r a n s l a t e d i n t o s i g n i f i c a n t r e s t r i c t i o n s i n h i s a b i l i t y t o m e v i d e n c e a s a w h o l e , t h e p a n e l c o n c l u d e s t h a t t h e m d e m o n s t r a t e a s e v e r e p h y s i c a l i m p a i r m e n t . S i g n i f i c a n t R e s t r i c t i o n s t o D L A T h e a p p e l l a n t ' s p o s i t i o n i s t h a t h i s O C D , a n x i e t y a n d p e rf o r m D L A . T h e p s y c h i a t r i s t h a s d e s c r i b e d t h e r e s a p p e l l a n t a r g u e d t h a t i f t h e m i n i s t r y b e l i e v e s t h a t h i s h i s i m p a i r m e n t d o e s n o t s i o n i f i c a n t l v a f f e c t h i s D L A . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # i d e n c e t o e s t a b l i s h a s e v e r e p h y s i c a l i m p a i r m e n t . t h a t t h e a p p e l l a n t i n d e p e n d e n t l y m a n a g e s h i s e n c e a s t o h o w m u c h l o n g e r t h e s e t a s k s t a k e i n i t s e l f d e t e r m i n e P W D e l i g i b i l i t y o r e s t a b l i s h a n d i t i o n t h a t r e s u l t s i n r e s t r i c t i o n s t o a p e r s o n ' s o n s i d e r t h e n a t u r e o f t h e i m p a i r m e n t a n d t h e b y f u n c t i o n a l s k i l l l i m i t a t i o n s a n d t h e d e g r e e t o r t o t h e a p p e l l a n t ' s a b i l i t y t o e n g a g e i n p a i d I n m a k i n g i t s d e t e r m i n a t i o n t h e m i n i s t r y m u s t h e a p p e l l a n t . W h i l e t h e l e g i s l a t i o n i s c l e a r t h a t e f r o m p r e s c r i b e d p r o f e s s i o n a l s , i n e x e r c i s i n g i t s e f e r t o t h e o p i n i o n o f t h e p r o f e s s i o n a l s w i t h e t a s t h a t a p p r o a c h w o u l d a m o u n t t o a n i m p r o p e r s t o b e w e i g h e d a n d a s s e s s e d l i k e a n y o t h e r d e s c r i b e d b y t h e p s y c h i a t r i s t a n d s o c i a l w o r k e r i t y . T h e s o c i a l w o r k e r ' s e v i d e n c e i s t h a t t h e m o s t f u n c t i o n s b u t p r o v i d e d n o d e t a i l a s t o h o w t h e o u t r e a c h w o r k e r i n d i c a t e t h a t t h e a p p e l l a n t r e s p e c t t o w a l k i n g . T h e e v i d e n c e i n d i c a t e s t h a t , o t h e r a s p e c t s ( s u c h a s t a k i n g e x t r e m e c a r e o n A l s o , t h e p a n e l n o t e s t h a t t h e b o n e d e n s i t y u e t o t h e a p p e l l a n t ' s l o w e r t h a n e x p e c t e d b o n e o f t h i s d e c i s i o n u n d e r t h e h e a d i n g S i g n i f i c a n t e a p p e l l a n t ' s i m p a i r m e n t s d o n o t a p p e a r t o h a v e a n a g e h i s D L A i n d e p e n d e n t l y . C o n s i d e r i n g t h e 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 i t d o e s n o t d e p r e s s i o n 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 t r i c t i o n s t o D L A a s b e i n g " s e v e r e . " T h e m e n t a l i m p a i r m e n t i s s e v e r e , i t c a n n o t s a y t h a t T h e a n n e l l a n t a l s o a r o u e d t h a t t h e m i n i s t r v d i d
n o t g i v e s u f f i c i e n t w e i g h t t o t h e e v i d e n c e o f t h e o u t r c o n s i d e r t h e a p p e l l a n t ' s o w n e v i d e n c e i t s h o u l d b e w w o r k e r w h o w h i l e n o t a s o c i a l w o r k e r i s a q u a l i f i e d a i l y b a s i s . F i n a l l y , t h e a p p e l l a n t a r g u e d t h a t t h e m e v i d e n c e a s o p p o s e d t o t h e p s y c h i a t r i s t ' s e v i d e n c e . i n d i c a t e d t h a t t h e a p p e l l a n t i s c o n t i n u o u s l y r e s t r i c t e d T h e m i n i s t r y ' s p o s i t i o n , a s s e t o u t i n i t s r e c o n s i d e r a t b e t w e e n t h e e v i d e n c e o f t h e p h y s i c i a n a n d t h e s o c i a t h e s o c i a l w o r k e r h a d s e e n t h e a p p e l l a n t m o r e o f t e n o b s e r v e d t h a t t h e r e i s n o e v i d e n c e a s t o h o w m u c h p e r f o r m s o m e t a s k s a s n o t e d b y t h e s o c i a l w o r k e r . e v i d e n c e t o c o n f i r m t h a t t h e a p p e l l a n t ' s i m p a i r m e n t s p e r f o r m 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 P a n e l D e c i s i o n T h e l e g i s l a t i o n s . 2 ( 2 ) ( b ) ( i ) o f t h e E A P W D A r e q u 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 o f D L A i n c o n s i d e r a t i o n o c a s e t h e a p p e l l a n t ' s p s y c h i a t r i s t a n d s o c i a l w o r k e r . b e f a c t o r e d i n a s r e q u i r e d t o p r o v i d e c l a r i f i c a t i o n o f t l a n g u a g e m a k e s i t c l e a r t h a t t h e p r e s c r i b e d p r o f e s s i d e t e r m i n a t i o n a s t o w h e t h e r i t i s " s a t i s f i e d " . T h e o n u s i s o n t h e a p p e l l a n t t o p r o v e o n t h e b a l a n c e c r i t e r i a f o r d e s i g n a t i o n a s a P W D . A s d i s c u s s e d a b o i t s a s s e s s m e n t o n t h e e v i d e n c e o f p r e s c r i b e d p r o f e s w o r k e r . I n t h e a p p e l l a n t ' s c a s e , t h e p s y c h i a t r i s t h a s r e s t r i c t i o n s i n a n u m b e r o f D L A , b u t t h e a d d i t i o n a l d e t h e r e s t r i c t i o n s p r i m a r i l y c o n s i s t o f t a k i n g s i g n i f i c a n t l t i m e i s d u e i n s o m e i n s t a n c e s t o c h r o n i c p a i n , a n d i n g e r m s o r b r e a k i n g b o n e s . T h e o n l y e v i d e n c e b e f o r e t a k e i s t h e o u t r e a c h w o r k e r ' s s t a t e m e n t t h a t w a l k i n g s h o u l d b e a 1 5 m i n u t e w a l k c a n t a k e a l m o s t h a l f a n a p p e l l a n t u p t o a n h o u r ( i n s t e a d o f 1 0 t o 1 5 m i n u t e s ) u n s p e c i f i e d t a s k s t h a t " w o u l d ' n o r m a l l y ' t a k e m a y b e d a y s . . . " T h e a p p e l l a n t h a s a r g u e d t h a t t h e e v i d e n c e o f h i s o u H o w e v e r , t h e l e g i s l a t i o n p u t s t h e e m p h a s i s o n t h e e a p p e l l a n t ' s c a s e 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 h a v e p t h a t d o e s n o t d e m o n s t r a t e s i g n i f i c a n t r e s t r i c t i o n s . A o f " p r e s c r i b e d p r o f e s s i o n a l " i n s e c t i o n 2 ( 2 ) o f t h e E A S e c t i o n 2 ( 1 ) ( b ) o f t h e E A P W D R p r e s c r i b e s t w o D L A d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r f i n a n c e s 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 v ( s o c i a l f u n c t i o n i n a ) . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I � P P E A L # e a c h w o r k e r , s t a t i n g t h a t i f t h e m i n i s t ry i s w i l l i n g t o i l l i n g t o c o n s i d e r t h e e v i d e n c e o f t h e o u t r e a c h d p e r s o n w h o w o r k s w i t h c l i e n t s o n a n a l m o s t i n i s t r y p u t t o o m u c h w e i g h t o n t h e s o c i a l w o r k e r ' s T h e a p p e l l a n t n o t e d t h a t t h e p s y c h i a t r i s t w i t h 6 o f t h e 1 O p r e s c r i b e d D L A . i o n d e c i s i o n , i s t h a t t h e r e i s i n c o n s i s t e n c y l w o r k e r a s t o t h e d e g r e e o f l i m i t a t i o n s , a n d t h a t t h a n t h e p s y c h i a t r i s t h a d . T h e m i n i s t r y a l s o l o n g e r t h a n t y p i c a l i t t a k e s t h e a p p e l l a n t t o T h e m i n i s t r y a r g u e d t h a t t h e r e i s n o t e n o u g h 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 i l i t y t o x t e n d e d p e r i o d s . i r e s t h e m i n i s t e r t o s u b s t a n t i a l l y a s s e s s d i r e c t f 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 , i n t h i s T h i s d o e s n ' t m e a n t h a t o t h e r e v i d e n c e s h o u l d n ' t h e p r o f e s s i o n a l e v i d e n c e , b u t t h e l e g i s l a t i v e o n a l ' s o p i n i o n i s f u n d a m e n t a l t o t h e m i n i s t r y ' s o f p r o b a b i l i t i e s t h a t h e s a t i s f i e s t h e s t a t u t o r y v e , t h e m i n i s t r y i s r e q u i r e d t o s u b s t a n t i a l l y b a s e s i o n a l s , s u c h a s t h e p s y c h i a t r i s t a n d t h e s o c i a l i n d i c a t e d t h a t t h e a p p e l l a n t e x p e r i e n c e s t a i l p r o v i d e d b y t h e s o c i a l w o r k e r i n d i c a t e s t h a t y l o n g e r t h a n t y p i c a l t o p e r f o r m D L A . T h e e x t r a o t h e r i n s t a n c e s t o O C D r i t u a l s o r f e a r o f p e o p l e , t h e p a n e l w i t h r e s p e c t t o h o w m u c h l o n g e r D L A c a n t a k e a l m o s t t w i c e a s l o n g a s t y p i c a l w h a t h o u r , a n d t h a t d a i l y h y g i e n e c a n t a k e t h e . T h e o u t r e a c h w o r k e r a l s o s p e c u l a t e d t h a t a f e w h o u r s p o t e n t i a l l y c o u l d t a k e [ t h e a p p e l l a n t ] t r e a c h w o r k e r s h o u l d b e g i v e n s i g n i f i c a n t w e i g h t . v i d e n c e o f p r e s c r i b e d p r o f e s s i o n a l s , a n d i n t h e r o v i d e d e i t h e r c o n f l i c t i n g e v i d e n c e o r e v i d e n c e n o u t r e a c h w o r k e r i s n o t i n c l u d e d i n t h e d e f i n i t i o n P W D R . t h a t a r e s p e c i f i c t o m e n t a l i m p a i r m e n t m a k e ( d e c i s i o n m a k i n g ) , a n d r e l a t e t o , c o m m u n i c a t e o r
T h e e v i d e n c e i n d i c a t e s t h a t t h e a p p e l l a n t i s n o t s i g n i n t h a t h e i n d e p e n d e n t l y m a n a g e s t h e d e c i s i o n m a k ( f i l l i n g / r e f i l l i n g / t a k i n g a s d i r e c t e d ) , m a n a g e p e r s o n a l m e a l p r e p a r a t i o n ( m e a l p l a n n i n g ) a n d s o c i a l f u n c t i o t h e p a n e l c o n c l u d e s t h a t t h e e v i d e n c e i n d i c a t e s t h e W i t h r e s p e c t t o s o c i a l f u n c t i o n i n g , t h e e v i d e n c e o f t h a d e q u a t e l y t o f u l f i l l h i s b a s i c n e e d s , a l b e i t a t a m a r g g e t s o u t o n h i s o w n t o m a n a g e D L A w h e n i t i s n e c e s a n x i e t y a n d h e s o m e t i m e s d e l a y s d o i n g s o u n t i l " i t i s a p p e l l a n t r e p o r t e d b e i n g a b l e t o g e t o u t o f h i s h o m e t h o u g h g o i n g o u t e a r l y t o m i n i m i z e h i s c o n t a c t w i t h o T h e e v i d e n c e a l s o i n d i c a t e s t h a t w h i l e t h e a p p e l l a n t i m p a i r m e n t s i n h i s t e e n s , t h e r e a p p e a r s t o h a v e b e e w i t h t r e a t m e n t o n l y r e c e n t l y b e g i n n i n g a g a i n . T h e a o n c e a t t h e t i m e t h e P W D a p p l i c a t i o n w a s s u b m i t t e d w i t h d i f f e r e n t m e d i c a t i o n s . T h e p s y c h i a t r i s t p r o v i d e d t r e a t m e n t o u t c o m e s o t h e r t h a n t h a t t h e a p p e l l a n t ' s n d e p e n d i n g o n h i s r e s p o n s e t o t r e a t m e n t , a n d t h a t l o s u b o p t i m a l l y . I n a d d i t i o n , t h e o u t p a t i e n t p s y c h i a t r i c t r e a t m e n t o p t i o n s a n d t h e a p p e l l a n t ' s e v i d e n c e c o n t t h e s e h a v e b e e n p u r s u e d a n d t h e o u t c o m e f o r e a c h V i e w i n g t h e e v i d e n c e a s a w h o l e , t h e p a n e l f i n d s t h a i n f o r m a t i o n p r o v i d e d i s n o t s u f f i c i e n t t o d e m o n s t r a t e e x p e r i e n c e s s i g n i f i c a n t r e s t r i c t i o n s i n h i s a b i l i t y t o m 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 a p p e l l a n t ' s p o s i t i o n i s t h a t h e r e q u i r e s a s s i s t a n c 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 s i n c e i t h a s n o t b e e n 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 c a n n o t b e d e t e r m i n e d t h a t s P a n e l D e c i s i o n F i n d i n g s o f a s e v e r e i m p a i r m e n t a n d s i g n i f i c a n t r e s t p r e c o n d i t i o n s t o a f i n d i n g t h a t a n a p p e l l a n t r e q u i r e s F o r t h e r e a s o n s p r o v i d e d a b o v e , t h e p a n e l f i n d s t h a t b e 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 r e q u i r e s h e l p w i t h D E AA 1 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P F A I ii i f i c a n t l y r e s t r i c t e d w i t h r e s p e c t t o d e c i s i o n m a k i n g i n g a s p e c t s o f m a n a g e p e r s o n a l m e d i c a t i o n s f i n a n c e s ( b a n k i n g , b u d g e t i n g , p a y r e n t a n d b i l l s ) , n i n g ( 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 ) . O n b a l a n c e a p p e l l a n t m a n a g e s h i s o w n d e c i s i o n m a k i n g . e s o c i a l w o r k e r i s t h a t t h e a p p e l l a n t f u n c t i o n s i n a l l e v e l . T h e a p p e l l a n t a l s o i n d i c a t e d t h a t h e s a r y t o d o s o , t h o u g h i t c a u s e s h i m s i g n i f i c a n t a l m o s t a n e m e r g e n c y " . T h e p a n e l n o t e s t h a t t h e i n a c c o r d a n c e w i t h h i s p s y c h i a t r i s t ' s i n s t r u c t i o n s , t h e r p e o p l e . w a s r e c e i v i n g t r e a t m e n t f o r h i s m e n t a l n a s i g n i f i c a n t g a p i n t r e a t m e n t o v e r m a n y y e a r s , p p e l l a n t h a d a p p a r e n t l y o n l y s e e n h i s p s y c h i a t r i s t , a n d t h e p s y c h i a t r i s t w a s s t i l l t r y i n g t h e a p p e l l a n t n o s p e c i f i c p r o g n o s i s w i t h r e s p e c t t o p o t e n t i a l e e d f o r m e d i c a t i o n o r t r e a t m e n t " m a y b e l i f e l o n g " n g s t a n d i n g a n x i e t y a n d O C D u s u a l l y r e s p o n d c o n s u l t a t i o n r e p o r t s u g g e s t e d a n u m b e r o f a i n e d n o c o m p r e h e n s i v e s u m m a r y o f w h i c h o f . t t h e m i n i s t r y r e a s o n a b l y c o n c l u d e d t h a t t h e o n t h e b a l a n c e o f p r o b a b i l i t i e s t h a t t h e a p p e l l a n t a n a g e 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 f r o m o t h e r s t o p e r f o r m h i s D L A . s t a b l i s h e d t h a t t h e a p p e l l a n t ' s D L A a r e i g n i f i c a n t h e l p i s r e q u i r e d f r o m o t h e r p e r s o n s . 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 L A a r e h e l p w i t h D L A . t h e m i n i s t r y r e a s o n a b l y c o n c l u d e d i t c o u l d n o t L A a s d e f i n e d b y s . 2 ( 3 ) ( b ) o f t h e E A P W D A .
C o n c l u s i o n T h e p a n e l a c k n o w l e d g e s t h a t t h e a p p e l l a n t ' s m e d i c a f u n c t i o n . H o w e v e r , 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 t h e p a n e l c o n c l u d e s t h a t t h e m i n i s t r y ' s d e c i s i o n f i n d a r e a s o n a b l e a p p l i c a t i o n o f t h e l e g i s l a t i o n i n t h e c i r c c o n f i r m s t h e m i n i s t r y ' s r e c o n s i d e r a t i o n d e c i s i o n . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # l c o n d i t i o n s h a v e a n i m p a c t o n h i s a b i l i t y t o a l l o f t h e e v i d e n c e 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 , i n g t h e a p p e l l a n t i n e l i g i b l e f o r P W D d e s i g n a t i o n i s u m s t a n c e s o f t h e a p p e l l a n t . T h e p a n e l t h e r e f o r e
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.