PART C -De cis io n un der Appeal The decis ion b eing ap pe al ed is the June 5, 20 1 4 reconsid Development and Social In novation (the "Ministry") in which the Ministry d Appellant was not eligibl e for P e rsons with D isabilities all the requ irements for PWD designation in sect ion Persons with Disabilities Act. Based on t he information provided, t h e Ap pellant has a seve re mental or ph ysi c al im p airm professi on al (i) d i rectly a n d s ignificantly re stricts his ability to perform daily li p e rio dically f or extended periods; and, (ii) as a result of those restr ic tions he r equi r es he The Minist ry was s atisfied that the Appellant has reached 1 medical practitioner his impairment is likel y to c o n t inu P ART D -Relevant Legislation E m p loym ent a n d Assis t a nce for Persons with D isabilities E m p loyment and Assi stance f o r Persons with Disa bil EAA T003( 10/06/01) APPEAL# � e ratio n decision of the Ministry of Social eterm in ed th a t the (" PWD") designation because he did not meet 2(2) of the Employment and A ssis t ance for th e Ministry w as not sati sfied that ent that in t he op inion of a pres c ri bed ving activ ities e ith e r continuously or lp t o per form tho s e activit ies. 8 years of a ge a n d in the opinion of a e for at least 2 yea rs. Act (" E APWDA") Sectio n 2 (2 ) a n d 2 (3). i t i es R e g u latio n ("E A PWDR ") Section 2.
: APPJC:AI 11 PART E -Summary of Facts For its reconsideration decision, the Ministry had the following evidence: 1. Appellant's PWD application consisting of the following three parts: • The Appellant's self report ("SR") signed by him on November 26, 2013; • A physician's report ("PR") dated September 6, 2013 completed by the Appellant's family physician who indicated that the Appellant had been a patient of hers for 2 years and she'd seen the Appellant 2-1 O times in the 12 months preceding the report; and • An assessor's report ("AR") dated November 1, 2013, completed by a psychiatric nurse after one visit with the Appellant and based on the physician's report in the PR. 2. A series of medical reports about the Appellant prepared for his family doctor, including: • July 5, 2013 report from a general surgeon regarding gastroscopy ("gastritis, told to stop smoking/drinking") and colonoscopy ("benign: needs a repeat colonoscopy in 3-4 yrs") and that the Appellant's "UIS is benign (liver cyst)." • May 13, 2013 surgical pathology report indicating "mild background chronic inflammation ... in keeping with reactive gastropathy." • December 28, 2012 lab report (blood tests); and • January 30, 2013 lab report (blood tests). 3. 3-page "Disability Self Report" for the Appellant prepared by an advocate stamped received by the Ministry on November 5, 2013; 4. Appellant's request for reconsideration dated May 15, 2014; and 5. 3-page additional medical information document prepared by an advocate based on information reported by the Appellant to the advocate, signed by the Appellant's family physician and dated May 16, 2014. This document refers specifically to the Appellant's conditions and is prepared as a series of statements for the doctor to check mark, with a space on the third page for the doctor to provide additional comments, date and sign. The following is a summary of the relevant evidence from the PWD application, as well as the information before the Ministry at reconsideration, and the evidence provided at the hearing. Diagnoses -Physical & Mental Impairment In the PR, the Appellant's physician diagnosed the Appellant with chronic gastritis (onset 2009), COPD (chronic obstructive pulmonary disease) (onset 2009), Dyslipidemia (onset 2009), anxiety (onset 2012) and impaired glucose tolerance (onset 2010). The physician noted the Appellant has not been prescribed any medications and/or treatments that interfere with his ability to perform his daily living activities and at the hearing, the Appellant was adamant that he would not take prescription medications, only over the counter pain relief. In the PR, the physician described the severity of the Appellant's medical conditions and impacts as follows: • "Intermittent filleqiblel discomfort & other related symptoms heiqhtens patient's anxiety and EMT 003( 10/06/01)
i m p a i r s f u n c t i o n i n g . " e " C O P D c a u s e s s o m e f a t i g u e a n d r e s u l t s i n ( r e g i m e n t o a s s i s t h i s o t h e r m e d i c a l c o n d i t i o I n t h e f u n c t i o n a l s k i l l s s e c t i o n o f t h e P R , t h e A p p e l l w a l k u n a i d e d 4 + b l o c k s , c l i m b 5 + s t a i r s u n a i d e d , l i f " b a s e d o n p a t i e n t ' s r e p o r t . " I n t h e A R , t h e p s y c h i a t r i c n u r s e d e s c r i b e d t h e A p p e a n x i e t y , d y s l i p i d e m i a , i m p a i r e d e x e r c i s e t o l e r a n c e , t h e A p p e l l a n t ' s s p e a k i n g a n d h e a r i n g i s s a t i s f a c t o r y s e c o n d l a n g u a g e . " I n t h e m o b i l i t y a n d p h y s i c a l a b i 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 t a k e s s i g n i f i c a n t l y l o n g e w r i t i n g " 4 + b l o c k s " b e s i d e w a l k i n g i n d o o r s a n d w a l k a n d " 2 -7 k g " l i f t i n g , w i t h t h e c o m e n t a r y , " m o b i l i t y a n r e s t r i c t e d b y h i s m e d i c a l c o n d i t i o n s ( C O P D , s h o r t n e I n t h e D i s a b i l i t y S e l f R e p o r t , t h e A p p e l l a n t i n d i c a t e s s t a i r s b e f o r e h e h a s t o r e s t d u r i n g t h e d a y , b u t h e i s n i g h t w h e n h i s s h o r t n e s s o f b r e a t h w o r s e n s . T h e A a m i n i m a l a m o u n t i n t h e D i s a b i l i t y S e l f R e p o r t . T h e t e s t i m o n y a t t h e h e a r i n g , t e l l i n g t h e p a n e l t h a t h e c a d r i v e h i m s e l f t o d o h i s s h o p p i n g a n d b a n k i n g , b u t t h c l i m b i n g m o r e t h a n a f e w s t e p s b e c a u s e o f h i s C O P h e d o e s n o t t a k e a n y m e d i c a t i o n f o r h i s d e p r e s s i o n I n t h e P R , t h e p h y s i c i a n r e p o r t e d s i g n i f i c a n t d e f i c i t s a r e a s e m o t i o n a l d i s t u r b a n c e ( e . g . d e p r e s s i o n , a n x c o m m e n t s e x p l a i n i n g t h e c h e c k m a r k s . I n t h e s e c t i o n o f t h e A R r e g a r d i n g c o g n i t i v e a n d e m a m a j o r i m p a c t i n t h e a r e a s o f b o d i l y f u n c t i o n s , e m o " d e p r e s s i o n " ) , a t t e n t i o n / c o n c e n t r a t i o n , m e m o r y , a n d i n t h e a r e a s o f c o n s c i o u s n e s s , i m p u l s e c o n t r o l , i n s i g l a n g u a g e , p s y c h o t i c s y m p t o m s , a n d o t h e r n e u r o p s y p s y c h o m o t o r p r o b l e m s , l e a r n i n g d i s a b i l i t i e s e t c . ) , a n 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 p s y c h i a t r i c n u r f u n c t i o n i n g i s s i g n i f i c a n t l y i m p a i r e d . C l i e n t r e p o r t e d t i m e , s l e e p d i s t u r b a n c e s , l o w e n e r g y a n d l a c k o f m o S e v e ri t y o f I m p a i r m e n t s I n t h e M a y 1 6 , 2 0 1 4 a d d i t i o n a l m e d i c a l i n f o r m a t i o n / q c h e c k m a r k e d t h e b o x e s b e s i d e t h e s t a t e m e n t : " T h i s A p p e l l a n t ] s u f f e r s f r o m s e v e r e c o n d i t i o n s i n c l u d i n g : c o l o n i c p o l y p / a d e n o m a a n d o s t e o a r t h r i t i s . " E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # � f e e l i n g s o f ) i n a b i l i t y t o c o m p l y w i t h m e d i c a l n s . " a n t ' s p h y s i c i a n 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 c a n t 2 -7 k g , a n d c a n r e m a i n s e a t e d l e s s t h a n 1 h o u r l l a n t ' s i m p a i r m e n t s a s " c h r o n i c g a s t r i t i s , C O P D , L l e g a r t h r i t i s , d e p r e s s i o n " a n d a l s o r e p o r t e d t h a t , r e a d i n g a n d w r i t i n g a r e p o o r " E n g l i s h i s a l i t y s e c t i o n o f t h e A R , t h e p s y c h i a t r i c n u r s e r t h a n t y p i c a l t o p e r f o r m a l l o f t h e l i s t e d a c t i v i t i e s , i n g o u t d o o r s , " 5 + s t e p s " b e s i d e c l i m b i n g s t a i r s , d p h y s i c a l a b i l i t y o f t h e c l i e n t i s s i g n i f i c a n t l y s s o f b r e a t h o n e x e r t i o n , L l e g a r t h r i t i s ) . " t h a t h e c a n w a l k 3 -4 b l o c k s a n d c a n c l i m b 5 -1 O u n a b l e t o c l i m b s t a i r s o r w a l k a n y d i s t a n c e a t p p e l l a n t r e p o r t e d t h a t h e c a n n o t c a r r y m o r e t h a n A p p e l l a n t r e i t e r a t e d t h i s e v i d e n c e d u r i n g h i s n d r e s s , c l e a n a n d d r e s s h i m s e l f . H e s a i d h e w i l l a t h e h a s d i f f i c u l t y w a l k i n g f o r a n y d i s t a n c e o r D a n d h i s s h o rt n e s s o f b r e a t h . H e t o l d t h e p a n e l a n d h a s n o t b e e n r e f e r r e d t o c o u n s e l i n g f o r i t . 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 w o i e t y ) a n d i m p u l s e c o n t r o l b u t d i d n o t p r o v i d e a n y o t i o n 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 c n u r s e i n d i c a t e d t i o n ( u n d e r l i n i n g t h e w o r d s " a n x i e t y " a n d m o t i v a t i o n . H e a l s o i n d i c a t e d a m o d e r a t e i m p a c t h t a n d j u d g m e n t , e x e c u t i v e , m o t o r a c t i v i t y , c h o l o g i c a l p r o b l e m s ( e . g . v i s u a l / s p a t i a l p r o b l e m s , d a m i n i m a l i m p a c t i n t h e a r e a o f " o t h e r s e w r o t e , " c l i e n t ' s c o g n i t i v e a n d e m o t i o n a l s y m p t o m s o f d e p r e s s i o n l o w m o o d m o s t o f t h e t i v a t i o n m o s t o f t h e t i m e . " u e s t i o n n a i r e , t h e A p p e l l a n t ' s p h y s i c i a n h a s i s t o c o n f i r m , i n m y m e d i c a l o p i n i o n t h a t [ t h e d e p r e s s i o n , C O P D , c h r o n i c g a s t r i t i s , h e p a t i c c y s t ,
Daily Living Ac tivities In the PR, the Appella nt's physician indicated that the Appellant's impairments restricted his ability perform the DLAs of basic housework and us e of transportati restri ction to the Appellant' s u se o f tra nsportatio n was restrict ion to the performan ce of basic hou sework was continuous or physician did not p rovide a ny further commentary regarding h In the A R, the psychiatric nurse reported the following • Takes signif icant ly longer t h a n typical to perform all rent and bills, medications and transportation, but did not indicate how much longer it takes • Requires periodi c assist ance for all of th e task and m ea l s, w r it in g "7 0% o f the t ime -daughter helps with some of the daily living activities." • Req u i re s per iodic sup po rt /sup er vision for all of t fu n ctioning (ap prop riate so cial dec isions, ab ap pr o p riat e ly w i th ot hers , a ble to d ea l appropria secu re as sistance f r om other s ), wri ting "70 % • Margina l fu nc tioni ng with hi s i mm edi ate and In t he May 16 , 2 014 add ition a l medical information, th box bes i d e the statement, "[ th e A ppellant] is d ire ctly da ily livi ng a ctivi ties contin uously , as a res ult of the condition s no te d pre viou sly). The Ap pellant's ph y sicia of t h e other s t ate me n ts on the additional med ical i nformati w o rds "and a rthri tis" t o the sta t em ent , " Payi n g f o r p up s du e t o an x iet y . " Hel p with Dai ly L iving Activitie s The Appellant ' s physician did not provide any commentary in the PR that the Appellan ass ist ance wi t h his D LA. In the AR , th e psy chiatric nurse from family. In the May 16, 2014 additi onal medical information, the Appellant's physician has not check marked any of the boxes beside the statements under the heading "as a result n oted res t rictions th e f o l lo win g assistance is re quired the st atem ent s that the Appellant needs ass i s t ance paying bills In his testimony, the Appellant said that his daughter comes to his apartment once or twice a week and prepares his meals for him and she also takes and does his la Ap pe l lant said tha t there are laundry facilities in his apartment building on the ground floor, but he lives on the third floor and there is no elevator. He said that he has never d daughter does it for him at her home. The Appellant said that he can shop for himsel for himself, but his dauqhter orovides meals for him and sometimes assists with a EAAT 003(10/06/01) � APPEAL# t o on. The physician indi cated that th e p e r iodic, bu t did not indicate whe ther the periodic and the Appellant's er answers on the PR. impacts on the App el lant's DLAs: tasks of the DLAs of personal care, pay . s of the DLAs of basi c house keeping, shopping " and, "Client requir es periodic assi stance he liste d aspects of t he DLA of so cial l e t o develop a n d ma i nta i n relationships, in tera cts tely w i th unexpected demands and ab le to of t i m e, growing so cial isolation." e xte nded s ocial n e t wo r ks, but no comm entary. e A p pell a nt's phys ician has che ck marke d t h e and si g nifi cantly restr i cted i n his abili t y t o do h i s conditions n ote d above " (t he list ed medical n has no t checked any o f t he boxes b esid e an y o n d oc u ment , alth oug h she has a dd ed the urch ases: d irectly restr i cted fro m stand ing in li n e t requires indicat ed th a t the Ap pellant receives he l p of the above with the following activities" but has crossed out and fill i ng prescriptions. undry f or him once a week. The one his laundry and his f and will cook rocerv shooo inq.
P A R T F R e a s o n s f o r P a n e l D e c i s i o n T h e i s s u e i n t h i s a p p e a l i s w h e t h e r t h e M i n i s t r y r e a 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 b e c a u s e h e d i d n o t m E A P W D A , a n d s p e c i f i c a l l y , t h a t t h e A p p e l l a n t d o e s 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 r o f e s s i o n a l ( i ) 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 e i t h e r c o n t i n u o u s l y o r 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 e l p t o p e r f o T h e e l i g i b i l i t y 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 a r e s e t o 2 ( 2 ) T 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 w h o h a s d i s a b i l i t i e s f o r t h e p u r p o s e s o f t h i s A c t i f t h e m i n i s t e o r p h y s i c a l i m p a i r m e n t t h a t ( a ) i n t h e o p i n i o n o f a m e d i c a l p r a c t i t i o n e r i s l i k e l y t o ( b ) 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 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 t h e p e r s o n ' s a b ( A ) c o n t i n u o u s l y , o r ( B ) 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 ( 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 , t h e p e r s o n r e q u ( 3 ) F o r t h e p u r p o s e s o f s u b s e c t i o n ( 2 ) , ( a ) a p e r s o n w h o h a s a s e v e r e m e n t a l i m p a i r m e n t i ( b ) a p e r s o n r e q u i r e s h e l p i n r e l a t i o n t o a d a i l y l i v i n g r e q u i r e s ( i ) a n a s s i s t i v e d e v i c e , ( i i ) t h e s i g n i f i c a n t h e ( i i i ) t h e s e r v i c e s o f a n a s s i s t a n c e a n i m a l . T h e " d a i l y l i v i n g a c t i v i t i e s " r e f e r r e d t o i n E A P W D A s 2 ( 1 ) F o r t h e p u r p o s e s o f t h e A c t a n d t h i s r e g u l a t i o n ( a ) i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e p h y s i c a m e a n s t h e f o l l o w i n g a c t i v i t i e s : ( i ) p r e p a r e o w n m e a l s ; ( i i ) m a n a g e p e r s o n a l f i n a n c e p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s ; ( v ) p e r f o r m h o u s e w a c c e p t a b l e s a n i t a r y c o n d i t i o n ; ( v i ) m o v e a b o u t i n d o o a n d s e l f c a r e ; ( v i i i ) m a n a g e p e r s o n a l m e d i c a t i o n , a n ( b ) i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e m e n t a l ( i ) m a k e 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 w i t h o t h e r s e f f e c t i v e l y . P a n e l ' s d e c i s i o n T h e p a n e l w i l l n o w c o n s i d e r e a c h p a r t y ' s p o s i t i o n r e d e c i s i o n u n d e r t h e a p p l i c a b l e P W D c r i t e r i a a t i s s u e 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 e A p p e l l a n t s u b m i t t e d t h a t h e s u f f e r s f r o m s e v e r e h i s a b i l i t y t o m a n a g e h i s d a i l y l i v i n g t a s k s a n d t h a t a M i n i s t r y , a s p r o v i d e d i n t h e P W D a p p l i c a t i o n a n d a d a r g u e s t h a t b e c a u s e o f h i s C O P D a n d a rt h r i t i s , h e c c a u s e s h i m t o b e d e p r e s s e d a n d a n x i o u s . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # s o n a b l 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 w a s n o t e e t a l l o f t h e r e q u i r e m e n t s i n s e c t i o n 2 ( 2 ) o f t h e n o t h a v e 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 i r m e n t 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 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 n d , ( i i ) a s a r m t h o s e a c t i v i t i e s . u t i n t h e f o l l o w i n g s e c t i o n s o f t h e E A P W D A : r e a c h e d 1 8 y e a r s o f a g e a s a p e r s o n w i t h r i s s a t i s f i e d t h a t t h e p e r s o n h a s a s e v e r e m e n t a l c o n t i n u e f o r a t l e a s t 2 y e a r s , a n d i l i t y t o 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 e i t h e r r i o d s , a n d i r e s h 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 . n c l u d e s a p e r s o n w i t h a m e n t a l d i s o r d e r , a n d a c t i v i t y i f , i n o r d e r t o p e r f o r m i t , t h e p e r s o n l p o r s u p e r v i s i o n o f a n o t h e r p e r s o n , o r e c t i o n 2 ( 2 ) ( b ) a r e d e f i n e d i n t h e E A P W D R a s : , " d a i l y l i v i n g a c t i v i t i e s " , l i m p a i r m e n t o r a s e v e r e m e n t a l i m p a i r m e n t , s ; ( i i i ) s h o p f o r p e r s o n a l n e e d s ; ( i v ) u s e p u b l i c o r o r k t o m a i n t a i n t h e p e r s o n ' s p l a c e o f r e s i d e n c e i n r s a n d o u t d o o r s ; ( v i i ) p e r f o r m p e r s o n a l h y g i e n e d i m p a i r m e n t , i n c l u d e s t h e f o l l o w i n g a c t i v i t i e s : f i n a n c e s ; ( i i ) r e l a t e t o , c o m m u n i c a t e o r i n t e r a c t g a r d i n g t h e r e a s o n a b l e n e s s o f t h e M i n i s t r y ' s i n t h i s a p p e a l . p h y s i c a l i m p a i r m e n t s w h i c h s i g n i f i c a n t l y i m p a i r l l o f t h e n e c e s s a r y i n f o r m a t i o n i s b e f o r e t h e d i t i o n a l m e d i c a l i n f o r m a t i o n . T h e A p p e l l a n t a n n o t f u n c t i o n a n d w o r k l i k e h e u s e d a n d t h i s
T h e M i n i s t r y c o n s i d e r e d t h e i n f o r m a t i o n i n t h e A p p r e p o r t s o f t h e A p p e l l a n t ' s c o l o n o s c o p y a n d g a s t r o s t h e D i s a b i l i t y S e l f R e p o r t , a n d t h e p h y s i c i a n ' s M a y T h e M i n i s t r y n o t e d t h a t i n t h e P R , t h e p h y s i c i a n r e p u n a i d e d , c l i m b 5 + s t a i r s u n a i d e d , l i f t b e t w e e n 5 -1 5 T h e M i n i s t r y a l s o n o t e d t h a t i n t h e A R , w h i l e h e r e p t o p e r f o r m t h e a b i l i t y a n d m o b i l i t y t a s k s , t h e p s y c h i t a k e s t h e A p p e l l a n t . 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 b y h i s i m p a i r m e n t s a s d e s c r i b e d b y t h e A p p e l l a n t ' s k e e p i n g w i t h a m o d e r a t e d e g r e e o f i m p a i r m e n t . T h i n f o r m a t i o n p r o v i d e d b y t h e A p p e l l a n t ' s p h y s i c i a n a p h y s i c a l i m p a i r m e n t . T h e P a n e l ' s F i n d i n g s T h e d i a g n o s i s o f a m e d i c a l c o n d i t i o n i s n o t b y i t s e l f t h e r e q u i r e m e n t s i n s e c t i o n 2 ( 2 ) o f t h e E A P W D A , e c o n d i t i o n r e s t r i c t s d a i l y f u n c t i o n i n g m u s t b e c o n s i d e A p p e l l a n t a n d f r o m a p r e s c r i b e d p r o f e s s i o n a l r e g a r o n 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 t h e d a i l y l i v i n g I n t h i s c a s e , i n f o r m a t i o n a b o u t t h e A p p e l l a n t ' s c i r c u p h y s i c i a n ( 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 ) w h o h a s k n c o m p l e t e d S e p t e m b e r 6 , 2 0 1 3 a n d i n t h e a d d i t i o n a l M i n i s t r y a l s o c o n s i d e r e d i n f o r m a t i o n p r o v i d e d i n t h e p s y c h i a t r i c n u r s e a f t e r o n e m e e t i n g w i t h t h e A p p e l l a r e s t r i c t i o n t o t h e A p p e l l a n t ' s f u n c t i o n a l s k i l l s i n t h e P h o u r ) . I n t h e A R , t h e p s y c h i a t r i c n u r s e i n d i c a t e d t h a t y p i c a l " t o p e r f o r m a l l a r e a s o f m o b i l i t y a n d p h y s i c a l i n f o r m a t i o n a s p r o v i d e d b y t h e p h y s i c i a n i n t h e P R . s h o r t d i s t a n c e s d u r i n g t h e d a y , c a n c i i m b s o m e s t a i p o u n d s ) , b u t t h a t h e i s g e n e r a l l y r e s t r i c t e d b y h i s C c o n d i t i o n 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 r m D L A h i m n o t r e s t r i c t e d i n a l l b u t b a s i c h o u s e w o r k a n d u s w i t h o u t e x p l a n a t i o n . I n t h e A R , t h e p s y c h i a t r i c n u r 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 , o r r e q u i r i n g p e r i o d i c w i t h o u t a n y c o m m e n t a r y a s t o h o w m u c h l o n g e r i t t a d i s c u s s i o n b e l o w ) . W h e n t h e p r o f e s s i o n a l a s s e s s m e n t o f t h e A p p e l l a n t i n f o r m a t i o n f r o m t h e p s y c h i a t r i c n u r s e a n d t h e A p p e r e a s o n a b l e f o r t h e M i n i s t r y t o d e t e r m i n e t h a t t h e i n f o A p p e l l a n t h a s 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 . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # � e l l a n t ' s P W D a p p l i c a t i o n , a s w e l l a s t h e m e d i c a l c o p y a n d t h e s u r g i c a l p a t h o l o g y a n d l a b r e p o r t s , 1 6 , 2 0 1 4 a d d i t i o n a l m e d i c a l i n f o r m a t i o n d o c u m e n t . 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 + b l o c k s p o u n d s a n d r e m a i n s e a t e d f o r l e s s t h a n a n h o u r . o r t e d t h a t i t t a k e 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 l o n g e r a t r i c n u r s e d i d n o t i n d i c a t e h o w m u c h l o n g e r i t h e i m p a c t s t o t h e A p p e l l a n t ' s p h y s i c a l f u n c t i o n i n g p h y s i c i a n a n d t h e p s y c h i a t r i c n u r s e , a r e m o r e i n e M i n i s t r y f o u n d t h a t t h e r e i s n o t e n o u g h n d t h e p s y c h i a t r i c n u r s e t o e s t a b l i s h a s e v e r e e v i d e n c e o f t h e s e v e r i t y o f i m p a i r m e n t . T o s a t i s f y v i d e n c e o f h o w a n d t h e e x t e n t t o w h i c h a m e d i c a l r e d . T h i s i n c l u d e s t h e e v i d e n c e f r o m t h e d i n g 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 i t s i m p a c t a c t i v i t i e s l i s t e d i n s e c t i o n 2 ( 1 ) o f t h e E A P W D R . m s t a n c e s w a s p r o v i d e d b y t h e A p p e l l a n t ' s f a m i l y o w n t h e A p p e l l a n t f o r 2 y e a r s , i n t h e P R m e d i c a l i n f o r m a t i o n o f M a y 1 6 , 2 0 1 4 . T h e A R c o m p l e t e d N o v e m b e r 1 , 2 0 1 3 b y t h e n t . T h e A p p e l l a n t ' s p h y s i c i a n n o t e d s o m e R ( e . g . c a n l i f t 5 -1 5 p o u n d s , s i t l e s s t h a n a n t t h e 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 a b i l i t y a n d h i s c o m m e n t s r e f l e c t t h e s a m e T h e A p p e l l a n t ' s e v i d e n c e i s t h a t h e c a n w a l k r s , a n d c a n c a r r y s o m e w e i g h t ( h e s a i d a r o u n d 3 O P D . I n t e r m s o f t h e i m p a c t s o f h i s m e d i c a l r e q u i r i n g p h y s i c a l e f f o r t , t h e p h y s i c i a n a s s e s s e s e o f t r a n s p o r t a t i o n t h e l a t t e r o n a p e r i o d i c b a s i s e a s s e s s e s t h e A p p e l l a n t e i t h e r t a k i n g 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 m o s t D L A k e s h i m o r w h y ( s e e a l s o r e s t r i c t i o n s t o D L A ' s p h y s i c i a n i s c o n s i d e r e d , t o g e t h e r w i t h t h e l l a n t ' s o w n 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 i t w a s 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 t h e
I APPEAL# Severe Mental Impairment With respect to the severity of the Appellant's mental impairment, the Ministry noted discrepancies in the information provided in the PR by the Appellant's physician who has known him for two years and indicated impacts in only 2 areas, and in the AR by the psychiatric nurse who met the Appellant once and who indicated major and moderate impacts in several listed areas. The Ministry found it was difficult to develop a clear and coherent picture of the Appellant's cognitive and emotional functions from the evidence and that there was not enough information to establish the Appellant has a severe mental impairment. The Appellant argued that he suffers from depression and anxiety and, as a result, he suffers from a lack of motivation, poor sleep, poor short-term memory, impulse control and lack of attention. The Appellant's physician in the PR indicated that the Appellant suffers from anxiety, onset in 2012, and that his COPD causes him fatigue and the pain increases his anxiety. With these diagnoses and impacts, he submits that the evidence establishes a severe mental impairment. The Panel's Findings The Appellant's physician in the PR indicated that the Appellant suffers from anxiety, onset in 2012, and that his COPD causes him fatigue and the pain increases his anxiety. In the PR, the Appellant's physician indicated that the Appellant has deficits with cognitive and emotional function in the areas of emotional disturbance and impulse control, but did not provide comments. In the May 16, 2014 additional medical information, the Appellant's physician checked the box beside "depression" in the list of the Appellant's medical conditions after the statement, "this is to confirm in my medical opinion that [the Appellant] suffers from severe conditions including:" The panel notes that the Appellant's physician did not provide any comments on the May 16, 2014 medical information document. The information provided by the psychiatric nurse in the AR after one interview with the Appellant was that the Appellant's mental impairment has a major or moderate impact in 13 of the 14 listed the areas, with the commentary that the Appellant's "cognitive and emotional functioning is significantly impaired. [The Appellant] reported symptoms of depression -low mood most of the time sleep disturbances, low energy and lack of motivation most of the time." No narrative is provided that describes these impacts in more specific terms; for example, there is no indication as to the areas of daily functioning in which the Appellant lacks motivation. The psychiatric nurse noted in the AR that the Appellant requires periodic support/supervision in his social functioning 70% of the time with the comment "growing social isolation" and has marginal functioning in his immediate and extended social networks, but no information is provided about the nature and degree of support/supervision required. The panel considers reasonable the Ministry's assessment that it was difficult to develop a clear and coherent picture of the Appellant's cognitive and emotional functions from the evidence. The panel finds that the only diagnosis of a mental health condition or mental impairment before the Ministry is the physician's reference in the PR to the Appellant's anxiety -while the physician may have checked the box beside "depression" in the prepared medical information document of May 16, 2014, the diagnosis of depression was not indicated in the PR by the physician herself. At the hearing, the Appellant said that he does not take medication for his depression, has not attended counseling for it, and described depression stemming from frustration with his life circumstances. EAAT 003(10/06/01)
I APPEAL# Based on the above review of the available information, the panel finds that the Ministry reasonably determined that the evidence does not establish a severe mental impairment. Restrictions to Daily Living Activities The Appellant submitted that his ability to manage daily living activities is significantly restricted by his impairments and that this information is all before the Ministry in the documents. The Ministry determined that the information provided by the Appellant's physician does not establish that a severe impairment significantly restricts his ability to perform DLA either continuously or periodically for extended periods. The Ministry considered the information provided in the PR, the AR and in the May 16, 2014 document found that it did not have enough evidence to confirm that the Appellant's impairments significantly restrict his ability to perform his DLA either continuously or periodically for extended periods. The Panel's Findings Section 2(2)(b) of the EAPWDA requires that a prescribed professional provide an opinion that an applicant's severe impairment directly and significantly restricts his daily living activities, continuously or periodically for extended periods. In this case, the Appellant's physician and the psychiatric nurse the prescribed professional. Daily living activities are defined in section 2(1) of the EAPWDR and are also listed in the PR and in the AR. The Appellant's physician reported in the PR that the Appellant is periodically restricted in his use of transportation and that he is restricted with basic housework, without indicating whether the restriction is periodic or continuous. In the AR, the psychiatric nurse reported that the Appellant takes significantly longer than typical to perform all tasks of the DLA of personal care, paying rent and bills, medications and transportation, and requires periodic assistance (70% of the time) from his daughter with all tasks of the DLA of basic housekeeping, shopping and meals. The psychiatric nurse also indicated that the Appellant requires periodic assistance with all aspects of social functioning "growing social isolation" and has marginal functioning in his immediate and extended social networks, but without any explanation. In the additional medical information document of May 16, 2014, the Appellant's physician did not check any of the boxes beside the tasks restricted by the Appellant's impairment. The information provided by the Appellant's physician in the PR indicates that the Appellant can perform all of his DLA, but requires periodic assistance with use of transportation and assistance with basic housework, without any explanatory comments. The AR was completed by the psychiatric nurse who admitted he based it on one interview with the Appellant. The information in the AR reiterates the information provided by the Appellant in his testimony at the hearing. The Appellant's evidence is that and he feels anxious and depressed because of his impairments and his life circumstances. He drives himself to do his shopping, and his daughter provides him some prepared meals, although he does some of his own cooking. The Appellant also testified that his daughter does all of his laundry as he has never done his laundry -not because he is incapable of doing his laundry. The Appellant's testimony qualifies the information provided by the prescribed professionals. The panel also notes that the Appellant's physician did not check any of the boxes beside the statements in the additional medical information of May 16, 2014 (other than as noted) and did not provide anv comments to clarifv or explain information on this document. EAAT 003( 10/06/01)
The Pan el finds t h a t w hen c ons i d ering a ll of th e informat together with the expl a nations offered by the Appe llan that it d i d not have en o ugh evidence from th e prescribed profess Appellant's impai r ments significan tl y restrict daily l iving activitie e x ten ded periods, as requ ired by th e legislation. Help wi th Daily Livi ng Activitie s T he Appell ant submi ts that because of his impairments, he ne daughter with hou s ework, laundry, meal preparation and shopping. Th e M inistry' s position is t hat b eca u se t he e v iden c e does significan tly r estricted, it c an no t b e determined that signi The P anel' s Findings Sec tion 2 (2 )( b)(ii ) of the EAPW D A also requir e s th e that becau se of r es trictions in his ability to m an age wi th th ose a c tivities . The A p pellant testif ied that hi s daughter p or twice per w e ek, as well as meal some prep a ration and all psy chiat ri c n u rse i n t he A R , h owever it is n o t cl ea r that t bec a u se of his impai r ment s ( a s opp o s ed to ha v ing o The pre scri bed professi on al who knows th e Ap pell ant in formation t ha t a s sistan ce is required b y th e Ap pell mus t t ak e into accoun t th a t t he in formatio n s et out i n was prepared by an a d voca t e based o n the Appell an Ap pell ant' s physici an di d not provide a ny com menta or est abl ish that the Ap pellant requires th e assistance. reasonabl y concl u ded t hat i t c ould n o t d etermine whethe ot her pe rs ons to man age daily l iving a ct ivities. Conclus ion Having reviewed and considered all of the ev i d ence the Ministry's reco n sideratio n decision, which det er m designation, was reasonably supported by the evidence. Therefore the panel confirms that decision. EAAT 003( 10/06/01) I A P PEA L# i on from the prescribed pro fessionals, t, the Mini st r y was reas o nabl e in determining io nals to esta b lish that the s eithe r con tinuously or perio d i cally for eds and receives help f rom his not establish that daily living a c t i vities are ficant h e l p is required from ot her persons . o pinio n of a p re scri bed prof e ssiona l confirm i n g d aily living ac t ivitie s, th e Appe lla nt requires help erf o r m s th e housework fo r h i m once his laund ry , and this i s reite r at ed by t he he Ap pell ant r e qui res th is as sis t ance n g oi n g a s sistan ce from his f am ily members ). we ll -his family physici a n -h as not prov id e d ant as a result o f his i m p a i r me nt s. Th e panel th e M ay 16 , 2 014 addit i onal medical informa tio n t 's inf ormatio n and t he panel notes that th e r y on the M a y 16 , 2 01 4 document to give details Therefore, th e pan e l fi nds t hat the Mini str y r th e A pp ellan t n e ed s s ign i f i can t hel p fr om and the relevant legislation, the panel finds that ined that the Appellant w as not eligible for PWD
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