APPEAL# I PART C -Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (the ministry) reconsideration decision dated July 11, 2014 which found that the appellant did not meet three of the five statutory requirements of Section 2 of the Employment and Assistance for Persons with Disabilities Act for designation as a person with disabilities (PWD). The ministry found that the appellant met the age requirement and that her impairment is likely to continue for at least two years. However, the ministry was not satisfied that the evidence establishes that: • the appellant has a severe physical or mental impairment; • the appellant's daily living activities (DLA) are, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods; and, • as a result of these restrictions, the appellant requires the significant help or supervision of another person, the use of an assistive device, or the services of an assistance animal to perform DLA. PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Act (EAPWDA), Section 2 Employment and Assistance for Persons with Disabilities Regulation (EAPWDR), Section 2
APPEAL# I PART E -Summary of Facts The evidence before the ministry at the time of the reconsideration decision included the Person With Disabilities (PWD) Application comprised of the applicant information and self-report dated January 30, 2014, a physician report (PR) dated February 3, 2014 completed by a general practitioner who has known the appellant for approximately 1 ½ years and an assessor report (AR) dated February 24, 2014, completed by a neurologist who has known the appellant for approximately 10 months. The evidence also included the following: 1) Letter dated July 9, 2014 from a specialist in internal medicine and adult stroke neurology 'To whom it may concern'; and, 2) Request for Reconsideration dated June 4, 2014. Diagnoses In the PR, the appellant was diagnosed by the medical practitioner with epilepsy with onset in June 2005. Physical Impairment In the PR, the appellant's physician reported that: • In terms of health history, the appellant reported that she gets seizures (grand ma!) 2 to 3 nights per week. Her seizures are not controlled by medication. She continues to see the neurologist. She reports that she feels weak and tired post nocturnal seizures and has difficulty remembering most things after her seizures. • The appellant does not require an aid for her impairment. • In terms of functional skills, the appellant is able to walk 4 or more blocks unaided on a flat surface, climb 5 or more steps unaided, and has no limitation with lifting or the time she can remain seated. In the AR, the appellant's neurologist indicated that: • Regarding the assistance required relating to impairment that directly restrict the appellant's ability to manage walking indoors and outdoors, climbing stairs, standing, lifting, and carrying and holding, the neurologist noted "no." • In the section of the AR relating to assistance provided through the use of assistive devices, none of the listed items have been indicated by the neurologist. In her self-report, the appellant wrote that: • She was diagnosed with epilepsy in 2006 and it has affected her life in many ways. • She has at least 3 seizures per week and they are grand ma!. She wakes up with a severe headache and blood covering her face and pillow from either biting her tongue or from clawing her face. • The days after her seizures are very hard on her. She is sluggish with little to no energy. It is hard for her to concentrate or understand anything. • She has young children and ii is hard to do anything with them. She is worried that she might have a seizure and her children would not know what to do and something could happen to them. • Her mother stays with her one week out of the month and her sister stays with her another week out of the month. • Her continuous seizures have made her memorv very poor. This makes it hard to aet a iob.
APPEAL# I • Her seizures leave her feeling tired, sore and miserable throughout the days which makes it hard to engage in any activities with her children. • She also has times throughout the days that she "zones out". It has happened most of her life and people around her usually have to snap her out of it. • When she misses a dose of her medication, she will always have a seizure. It happens mostly through the day because of her missed morning medication. In the letter dated July 9, 2014, the specialist in internal medicine and adult stroke neurology wrote: • The appellant was seen in follow-up regarding her seizure disorder diagnosed more than 8 years ago. • The appellant is recently getting recurrent breakthrough generalized tonic-clonic seizures despite being on medication, which is interfering with her daily living activities and limiting her ability to drive or work in a full-time job. Mental Impairment In the PR, the appellant's physician reported that: • The appellant has no difficulties with communication. • There are significant deficits with the appellant's cognitive and emotional function in the areas of executive ("post seizures"), and memory ("post seizures"), with a comment added: "patient says she forgets when and how to do things post seizures as her memory is poor." • The appellant is not restricted with her social functioning. In the AR, the neurologist indicated that: • Regarding her ability to communication, the neurologist wrote: "no communication difficulty." • There is an impact in 2 of 14 listed areas of cognitive and emotional functioning, namely a moderate impact in the area of emotion and a minimal impact with psychotic symptoms. The neurologist wrote: "anxious mood"; "has had occasional hallucinations." • There is no assessment provided for the 5 aspects of social functioning or her level of functioning with her immediate or extended social networks. • For additional comments: "Anxious lady lives by herself. We believe mother is moving to help her." In her self-report, the appellant wrote that: • The days after her seizures are very hard on her. It is hard for her to concentrate or to understand anything. • Her continuous seizures have made her memory very poor. Daily Living Activities (DLA) In the PR, the physician indicated that: • The appellant has been prescribed medications that interfere with her daily living activities as they "may cause drowsiness." • The appellant is periodically restricted with management of her medications "post seizures." Regarding the degree of restriction, the general practitioner wrote: "tired and forgetful post seizures." • The appellant is not restricted with the remaining listed DLA, namely: personal self care, meal preparation, basic housework, daily shopping, mobility inside and outside the home, use of transportation, manaaement of finances, and social functionina.
APPEAL# I In the AR, the neurologist reported that: • The appellant requires no assistance with moving about indoors and outdoors. • Regarding the assistance required relating to impairment that directly restrict the appellant's ability to manage in tasks of various listed DLA, the neurologist wrote "no" at the beginning of this section. • There is no assistance required with the DLA of personal care, basic housekeeping or shopping, with the comment added: "Needs to be supervised for bathing and other activities because of seizures. No limitations otherwise." • There is no assessment for the assistance required with the DLA of meals, paying rent and bills, medications, and transportation, with the comment added: "Needs supervision for activities. No major cognition deficits." In her self-report, the appellant wrote that: • Her family has to remind her to take her medications as she is always forgetting. • It is hard for her to get a job as she misunderstands questions during interviews and she is · unsure of how to reply. She has to have things repeated to her as she does not understand. • She often arrives late to appointments because she forgets where she is going or she does not remember directions. • She is always forgetting to pay bills and she has trouble handling money as she is not good at how to plan. In the letter dated July 9, 2014, the specialist in internal medicine and adult stroke neurology wrote: • Recently the appellant is getting recurrent breakthrough generalized tonic-clonic seizures despite being on medication which is interfering with her DLA and limiting her ability to drive or work in a full-time job. Need for Help The physician reported in the PR that: • Regarding the assistance needed with DLA, she "needs reminders to take medications. This is usually done by her family members." The neurologist reported in the AR that: • In the section of the report indicating assistance provided by other people or through the use of assistive devices, the physician did not indicate that anyone provides assistance or that devices are used. In her Notice of Appeal dated July 17, 2014, the appellant expressed her disagreement with the ministry's reconsideration decision and wrote that this is her third time applying for disability and she has had to switch neurologists twice due to communication barriers. She feels as though her disability is not taken seriously. She suffers daily with normal living activities which is causing her a lot of stress and depression. She is unable to get a job due to her disability. At the hearing, the appellant and her advocate stated: • The appellant experiences 2 to 3 seizures per week where she has a loss of consciousness and violent muscle contractions. She claws at her face and wakes up with blood on her face. • For davs followina her seizures, the appellant cannot do anvthina. She needs information
r ep eat ed becau s e she for gets and she b ecomes o The appell ant is al so extr e me l y fatigu ed with i ncluded with the P WD ap plica t ion. • The per sistence o f her seiz u r es ha s lead to anxiety ab out whe n she w il l hav e her nex t debilitating f r ee o f an xiety. • Afte r s h e has a seizure , th e ap pell ant c annot m ore th an 2 b l ocks and s h e canno t c limb any cli m b stair s, she st arts to f eel "awfu l " and she canno • The appell ant rece ives help fro m he r moth er month . She w il l do th ose ac tivit ies of d aily living tha • The a ppel lant's siste r al so helps her with t he payin g bil ls, filling her prescription s and with • She has a friend wh o a ls o has yo u ng ch i ldr en siste r ar e not availa ble. Sh e t a kes the a ppellant' • W h e n she has h ad a s eiz ure i n t he nig h t, the he adach e. Her seizure s are mo st ly j ust at night daytim e too. • W h e n she wa s d i a g nosed , it was ve ry ra re to anxious s h e ca n have on e d uri ng th e da y. T • M o re recentl y, s ince Febru ary 2014 , she has been • O n t h e d ays tha t she is fee li n g well, she can s h e w ill ta k e th e bus or a cab. • T he a p pellant s tated that it c an ta ke a d a y or the ap pellant stated that sh e e xp e rie n c es t he a p eriod of a month. • She feels t hat the n eurologi st wh o completed t There wa s a commun ication pro blem. She h w ho wrote the let ter dated Ju ly 9, 20 14. He has chang seizures. • When th e neu rol ogi st comple ted the AR, he asked filled out the report later. He sent the AR directly to the min opportunity to review the AR, which appears to have been an assess one of her good da ys . Admissibility of New Information The ministry did not raise an objection to the admissi behalf of the appellant, which provided additional information regarding the appellant's impairment As this information provides additional detail with respect to issues application, t he pan el has admitted th is a d ditional i nf records that were bef ore the minist ry a t the t i m e of r Employment and Assistance Act. The ministry relied on its reconsideration decision, as summarized at the hearing. I A P PE A L# easily confused. a l oss of m o tivatio n, as s et o ut in her s el f-re p or t and d epres sio n, and the appel lant is afrai d se izur e. H er you ng chi l d ren have lo s t a m othe r eng age in any physical a ctivity. She can not wal k s ta ir s and she cannot even eat. I f s h e trie s to t d o i t . wh o come s to stay with her f or one w eek eac h t t he appellan t can not per form. laun dry an d housek ee p in g, meal preparatio n, ge neral t r ansp o r t a t ion . and she wi l l he l p w hen t he a p p ell a n t' s mo t he r o r s chil dren an d does th i ngs with them. appel la nt w ill oft en w a k e up with a s evere but they have n o w grad u a lly moved in t o t he get a sei zure during t he da y, but no w if she is he sun can mak e it wo rse as well. h avi ng 3 or 4 s eizur es du ri ng the wee k. go out and d o thi n gs. She usu ally walks plac es or two to re cover from a s ei zure. Asked to e stimate, imp a ct fr o m a s e i zure about h a lf of the tim e ov e r he AR d i d not u nd er s tand w hat she wa s sayi ng. as had one app ointment wit h h e r new phys ici an, ed her m e d i cat i ons to try to co nt rol her her some qu estions and took notes but istry and she did not have an ment of her funct io ning on bility of the information in the oral testimony on . addressed in the original PWD ormation as b ei ng in supp o r t of information and e consideration, i n ac cordance with s. 22(4) of the
I APPEAL# PART F -Reasons for Panel Decision The issue on the appeal is whether the ministry's reconsideration decision, which found that the appellant is not eligible for designation as a person with disabilities (PWD), was reasonably supported by the evidence or was a reasonable application of the applicable enactment in the circumstances of the appellant. The ministry found that the appellant does not have a severe mental or physical impairment and that her daily living activities (DLA) are not, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods and that, as a result of those restrictions, it could not be determined that the appellant requires the significant help or supervision of another person, the use of an assistive device, or the services of an assistance animal to perform DLA. The criteria for being designated as a person with disabilities (PWD) are set out in Section 2 of the EAPWDA as follows: Persons with disabilities 2 (1) In this section: "assistive device" means a device designed to enable a person to perform a daily living activity that, because of a severe mental or physical impairment, the person is unable to perform; "daily living activity" has the prescribed meaning; "prescribed professional" has the prescribed meaning. (2) The minister may designate a person who has reached 18 years of age as a person with disabilities for the purposes of this Act if the minister is satisfied that the person has a severe mental or physical impairment that (a) in the opinion of a medical practitioner is likely to continue for at least 2 years, and {b) in the opinion of a prescribed professional (i) directly and significantly restricts the person's abillty to perform daily living activities either (A) continuously, or (B) periodically for extended periods, and (ii) as a result of those restrictions, the person requires help to perform those activities. (3) For the purposes of subsection (2), (a) a person who has a severe mental impairment includes a person with a mental disorder, and (b) a person requires help in relation to a daily living activity if, in order to perform it, the person requires (i) an assistive device, (ii) the significant help or supervision of another person, or (iii) the services of an assistance animal. (4) The minister may rescind a designation under subsection (2). Section 2(1)(a) of the EAPWDR defines DLA for a person who has a severe physical or mental impairment as follows: Definitions for Act 2 (1) For the purposes of the Act and this regulation, "daily living activities" , (a) in relation to a person who has a severe physical impairment or a severe mental impairment, means the following activities: (i) prepare own meals; (ii) manage personal finances;
( 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 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 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 ( v i ) m o v e a b o u t i n d o o r s a n d o u t d o o r s ; ( v i i ) p e rf o r m p e r s o n a l h y g i e n e 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 d ( 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 p a ( 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 f ( 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 w i t h o t h e r s e f f 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 p o s i t i o n i s t h a t a s e v e r e p h y s i c a l i m w e a k n e s s a n d f a t i g u e a f t e r s e i z u r e s d u e t o e p i l e p s y n o d e f i n i t i o n o f " s e v e r e " i n t h e l e g i s l a t i o n a n d t h e i n c i r c u m s t a n c e s i s n o t r e a s o n a b l e g i v e n t h e d e b i l i t a t i 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 i n n e u r o l o g i s t 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 h a s a s e v e i n t e r m s o f f u n c t i o n a l a s s e s s m e n t , t h e g e n e r a l p r a c m o r e b l o c k s u n a i d e d , c l i m b 5 o r m o r e s t a i r s u n a i d e a b l e t o r e m a i n s e a t e d . 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 q u i r e d w i t h t h e a p p e l l a n t ' s m o b i l i t y a n d p h y s i c a l a s p e c i a l i s t i n i n t e r n a l m e d i c i n e w r o t e t h a t t h e a p p e l l a j o b , t h e a p p l i c a t i o n i s n o t i n t e n d e d t o a s s e s s e m p l o y n o t a n e l i g i b l e c r i t e r i o n f o r d e s i g n a t i o n a s a P W D . 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 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 , t h e m i n i s t r a n d t h e 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 d e g r e e t o 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 . 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T h e a p p e l l a n t ' s a d v o c a t e a r g u e d t h a t t h e r e i s t e r p r e t a t i o n t a k e n b y t h e m i n i s t r y i n t h e a p p e l l a n t ' s n g n a t u r e o f h e r p e r s i s t e n t s e i z u r e s . f o r m a t i o n f r o m t h e g e n e r a l p r a c t i t i o n e r a n d r e p h y s i c a l i m p a i r m e n t . T h e m i n i s t r y a r g u e d t h a t , t i t i o n e r 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 w a l k 4 o r d , a n d s h e h a s n o l i m i t a t i o n s w i t h l i f t i n g o r b e i n g n e u r o l o g i s t a l s o r e p o r t e d t h a t n o a s s i s t a n c e i s b i l i t i e s . T h e m i n i s t r y a r g u e d t h a t , a l t h o u g h t h e n t ' s s e i z u r e s l i m i t h e r a b i l i t y t o w o r k i n a f u l l t i m e a b i l i t y o r v o c a t i o n a l a b i l i t i e s a s e m p l o y a b i l i t y i s 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 o 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 y m u s t c o n s i d e r b o t h t h e n a t u r e o f t h e i m p a i r m e n t v i d e n c e d 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 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 c o n s i d e r l a n t . H o w e v e r , 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 t h e 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 i n t h i s c a s e , t h e l i s t . r i o d o f 1 ½ y e a r s , 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 o t e t h a t t h a t a p p e l l a n t r e p o r t e d t h a t s h e g e t s h e f e e l s w e a k a n d t i r e d p o s t n o c t u r n a l s e i z u r e s s e i z u r 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 , a l k 4 o r m o r e 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 , w i t h l i f t i n g o r t h e t i m e s h e c a n r e m a i n s e a t e d . f h e r h s i c a l f u n c t i o n i n i s a c c u r a t e f o r h e r o o d
days, but the morning after her se izure sh e is n ot able to walk more than 2 blocks and she cannot c l i mb any stairs. How ever, the pane l notes that the physician th e PR and identifi ed th e m a s "post seizure." With resp phy sician indicated that the appellant has no restrictions w home and, for t he on e D LA for wh ich t he ap pella nt medications ), the phy sician wrote "post seizures ." r equired re l a t e d t o impairmen t that directly re strict the appellant's abilit and outdoo r s , climbing stair s , s t a nding, lifting, an d carryin At th e hearing, the ap pella nt s tated th a t when s h e was diagnos during the day, but now if sh e is anxious she can have one during the day and, sin she has b een having 3 or 4 seizures per week. In the letter dated July 9, 2014, the specia int er nal medicine and adult s t roke neu rology wrote that rece breakthrough gene r a lized toni c-clonic seizu r e s despite being on medi her DLA and limi ting her ability t o drive or wo r k in a wr o te t ha t her cont i nuous se i zures have made her m job. For an impai rment t o be a " severe impai r m en t," ministry must b e s atis f i ed t hat the eviden ce de mon to perform specifie d ar ea s of daily function i n g (DLA). in e m ployment is no t listed as on e of t h e pre s cribe d pane l f in d s that t h e ministry rea so nably held t h a t e mp for PWD desi gnati on. The ap pel lant sta ted at the hea ring t ha t she su ffers ti me, over a p e r iod of a mont h. Th e pan el f in ds that doc to r an d he r n eurolog i st rep ort no lim it a t ion s to her m i nformati on from the appell a nt's new speci a l ist , as se i n t e r f erenc e wit h her DLA t ha t is no t sp e cified an d limi wo rk in a ful l-ti me job. In the abse nce of f urther detail na tur e , e xte nt an d freq uency of impa cts t o the a ppell t hat the m inist ry rea son ably determ in ed that there is no appella nt has a se v e re physical im pairm e nt , pursuan Severe Mental Impairment The appellant's position is that a severe mental impairment is established b persistent seizures causing loss of conc ent r at ion and poor memory. Notice of Appeal that she suffers daily with [performing] normal living activities, which is causing her a lot o f st r ess and depression. The appellant's advocate the legislation an d the interpretation taken by the ministry in the appellant's circumstances is not rea s o nable given the debilitating nature of her pers istent the appella nt. The ministry's position is that there is insufficient evidence to establish that the appellant has a severe menta l impairment. The mini stry a r gue d th at deficits with cognitive and emotional functioning in the areas of executive and memory post seizures and, in assessing the impacts on daily functioning, the neurologist reported area of emotion and minimal impact to psychotic svmotoms. APPEAL# I has sp e c ified restric t ions elsew here in e ct t o restrictions to DLA, for example, the ith either mobility insi d e or outside the experience s periodic restrictions (m an agem e nt of In the AR, asked to indicate th e as sistance y to manage walking indoors g and holding, the neuro logist wrote: "no ." ed, it was very rare to ge t a seizure c e F eb ruary 2014, l is t in ntl y the appe llant is getting recurrent cation, which is interfering with full-time jo b. In h e r se l f rep o r t , the a p pell ant emory very poor and thi s make s it h a r d to get a section 2( 2 ) of th e EAPWD A re q uire s that the stra tes significan t r estr ic t ions in the p e rson 's ability As the ability to se arch for, acc e p t or con t inue D LA i n s u bs ection 2(1)( a) o f th e EAPWD R, the lo y a b ility is n ot a fac t or in a sses sin g e l igibilit y f rom t h e affe cts of the seizu res abo u t half the t h e eviden ce demo nstr a tes tha t bot h her f a mily ob i li ty or phy s ical abili ties . The update d t o ut in the lette r da ted July 9, 2014, in d i c at es tations to the app el lant 's ab i li ty to drive and t o f ro m the m edic a l practitio ners r e gard ing t he ant ' s cur ren t p h ysical f un c t ionin g, t h e panel finds t suffici e nt ev i dence t o e s tabl ish that t h e t to section 2( 2 ) of the EAPWD A. y th e evidence o f her The appellant argued in her argued th at t h ere is no definition of "severe" in seizures and the resulting anxiety caused to the physician indi cated that the app ellant has a moderate impact in the The ministrv arqued that there are no
i m p a c t s i n d i c a t e d t o t h e r e m a i n d e r o f t h e a p p e l l a n t ' m i n i s t r y a r g u e d t h a t t h e p h y s i c i a n a n d t h e n e u r o l o g 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 . P a n e l D e c i s i o n I n t h e P R , t h e g e n e r a l p r a c t i t i o n e r r e p o r t e d t h a t t h e e p i l e p s y , w h i c h i s a h e a l t h c o n d i t i o n w i t h i m p a c t s t o g e n e r a l p r a c t i t i o n e r r e p o rt e d t h a t t h e a p p e l l a n t h a s t h e n e u r o l o g i s t w r o t e : " n o c o m m u n i c a t i o n d i f f i c u l t y . " d e f i c 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 h e a t h i s i s " p o s t s e i z u r e s " a n d n o t i n g : " p a t i e n t s a y s s h e a s h e r m e m o r y i s p o o r . " I n h e r s e l f r e p o r t , t h e a p p e v e r y h a r d o n h e r . I t i s h a r d f o r h e r t o c o n c e n t r a t e o p o o r . T h e s e c t i o n o f t h e A R d e s c r i b i n g i m p a c t s t o c m a r k e d b y t h e n e u r o l o g i s t w i t h a m o d e r a t e i m p a c t i i n a p p r o p r i a t e a n x i e t y , d e p r e s s i o n , e t c . ) , a m i n i m a l i o c c a s i o n a l h a l l u c i n a t i o n s " ) a n d n o i m p a c t a s s e s s e d a r e a s o f e x e c u t i v e a n d m e m o r y . I n t h e l e t t e r d a t e d J u l y 9 , 2 0 1 4 , t h e s p e c i a l i s t i n i n t e c l o n i c s e i z u r e s a r e i n t e r i e r i n g w i t h t h e a p p e l l a n t ' s D t i m e j o b . A g a i n , 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 r e a a s s e s s i n g e l i g i b i l i t y f o r P W D d e s i g n a t i o n a n d t h e s p a r e i m p a c t e d b y t h e a p p e l l a n t ' s s e i z u r e s . W i t h r e s p i m p a i r m e n t 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 t o , c o m 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 ( 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 f i c a n t l y r e s t r i c t e d i n e i t h 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 , t h e g e n e r a l p r a c t i t i r e s t r i c t e d w i t h m a n a g i n g h e r f i n a n c e s a l t h o u g h t h e r e m e d i c a t i o n s a s s h e i s " t i r e d a n d f o r g e t f u l p o s t s e i z u m e d i c a t i o n s . " T h e n e u r o l o g i s t d i d n o t a s s e s s t h e d e s h o p p i n g ( m a k i n g a p p r o p r i a t e c h o i c e s ) , m e a l p r e p a t r a n s p o r t a t i o n ( u s i n g t r a n s i t s c h e d u l e s a n d a r r a n g i n a p p e l l a n t " n e e d s s u p e r v i s i o n f o r a c t i v i t i e s " , t h a t t h e r l i m i t a t i o n s o t h e r w i s e . " T h e n e u r o l o g i s t r e f e r r e d t o b r e q u i r e s s u p e r v i s i o n , b u t d i d n o t s p e c i f y a n y o t h e r a t h e P R t h a t t h e a p p e l l a n t i s n o t r e s t r i c t e d w i t h d a i l y s t r a n s p o r t a t i o n . R e g a r d i n g t h e D L A o f s o c i a l f u n c t i o n a p p e l l a n t i s n o t r e s t r i c t e d a n d s h e h a s n o d i f f i c u l t i e s r e p o r t e d i m p a c t s t o t h e a p p e l l a n t ' s m e n t a l o r s o c i a l r e a s o n a b l y d e t e r m i n e d t h a t a s e v e r e m e n t a l i m p a i r m E A P W D A . R e s t r i c t i o n s i n t h e a b i l i t y t o p e r fo r m 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 p h y s i c a l a n d m e n h e r a b i l i t t o e r i o r m D L A o n a n o n o i n b a s i s t o t h e I A P P E A L # s c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n g . T h e i s t a l s o 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 a s n o a p p e l l a n t e x p e r i e n c e s s e i z u r e s a s a r e s u l t o f b o t h p h y s i c a l a n d m e n t a l f u n c t i o n i n g . T h e n o 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 n d , i n t h e A R , T h e g e n e r a l p r a c t i t i o n e r r e p o r t e d a s i g n i f i c a n t r e a s o f e x e c u t i v e a n d m e m o r y , e m p h a s i z i n g t h a t f o r g e t s w h e n a n d h o w t o d o t h i n g s p o s t s e i z u r e s l l a n t w r o t e t h a t t h e d a y s a f t e r h e r s e i z u r e s a r e r t o u n d e r s t a n d a n y t h i n g a n d h e r m e m o r y i s v e r y o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n g i s c h e c k n t h e a r e a o f e m o t i o n ( e . g . e x c e s s i v e o r m p a c t t o p s y c h o t i c s y m p t o m s ( " h a s h a d t o t h e o t h e r 1 2 a r e a s o f f u n c t i o n i n g , i n c l u d i n g t h e r n a l m e d i c i n e w r o t e t h a t t h e g e n e r a l i z e d t o n i c L A a n d l i m i t i n g h e r a b i l i t y t o d r i v e o r w o r k i n a f u l l s o n a b l y h e l d t h a t e m p l o y a b i l i t y i s n o t a f a c t o r i n e c i a l i s t h a s n o t p r o v i d e d d e t a i l o f t h e D L A t h a t e c t t o t h e t w o D L A t h a t a r e s p e c i f i c t o m e n t a l i e s , c a r e o r f i n a n c e s ( d e c i s i o n m a k i n g ) , a n d r e l a t e o c i a l f u n c t i o n i n g ) , t h e m e d i c a l e v i d e n c e i n d i c a t e s e r . o n e r r e p o r t e d i n t h e P R t h a t t h e a p p e l l a n t i s n o t a r e p e r i o d i c r e s t r i c t i o n s t o m a n a g i n g h e r r e s " a n d s h e " n e e d s r e m i n d e r s t o t a k e c i s i o n m a k i n g c o m p o n e n t s o f t h e D L A o f d a i l y r a t i o n ( m e a l p l a n n i n g a n d f o o d s t o r a g e ) a n d g t r a n s p o rt a t i o n ) , b u t h e w r o t e i n t h e A R t h a t t h e e a r e " n o m a j o r c o g n i t i o n d e f i c i t s " a n d " n o a t h i n g a s a n a c t i v i t y f o r w h i c h t h e a p p e l l a n t c t i v i t i e s . A l s o , t h e g e n e r a l p r a c t i t i o n e r r e p o r t e d i n h o p p i n g , m e a l p r e p a r a t i o n , o r u s e o f i n g , t h e g e n e r a l p r a c t i t i o n e r r e p o r t e d t h a t t h e w i t h c o m m u n i c a t i o n , G i v e n t h e a b s e n c e o f f u n c t i o n i n g , t h e p a n e l f i n d s t h a t t h e m i n i s t r y e n t w a s n o t e s t a b l i s h e d u n d e r s e c t i o n 2 ( 2 ) o f t h e t a l i m p a i r m e n t s d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t e x t e n t t h a t s h e r e u i r e s t h e s i n i f i c a n t
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 , n a m e l y h e r m o t h e r a a r g u e d t h a t t h e l e g i s l a t i o n d o e s n o t r e q u i r e e v i d e n c t o s o m e D L A . T h e a d v o c a t e a r g u e d t h a t i t i s n o t c l r e l a t i n g t o a s s i s t a n c e r e q u i r e d w i t h t a s k s o f D L A w t a s k s g i v e n t h e n e u r o l o g i s t ' s o t h e r c o m m e n t s . T h e t h a t t h e r e a r e r e s t r i c t i o n s t o h e r a b i l i t y t o d o l a u n d r y f i l l i n g p r e s c r i p t i o n s a n d m a n a g i n g t r a n s p o r t a t i o n . T t h e s p e c i a l i s t w h i c h s t a t e s t h a t t h e a p p e l l a n t ' s s e i z u 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 a p p e l l a n t ' s p h y s i c o f h e r D L A a n d , f o r t h e p e r i o d i c a s s i s t a n c e r e q u i r e d i n d i c a t i o n o f h o w o f t e n a s s i s t a n c e i s r e q u i r e d . T h e a s s i s t a n c e i s n o t r e q u i r e d w i t h D L A b u t s u p e r v i s i o n a c t i v i t i e s . T h e m i n i s t r y a r g u e d t h a t t h e n e u r o l o g i s t a s s i s t a n c e w i t h h e r s o c i a l f u n c t i o n i n g . T h e m i n i s t r y l e t t e r t h a t t h e a p p e l l a n t ' s s e i z u r e s i n t e r f e r e w i t h h e r p r o v i d e d o n w h i c h D L A a r e a f f e c t e d o r i f t h e y a r e a e x t e n d e d p e r i o d s . P a n e l D e c i s i o n S e c t i o n 2 ( 2 ) ( b ) o f t h e E A P W D A r e q u i r e s t h a t a p r e s a p p l i c a n t ' s s e v e r e i m p a i r m e n t d i r e c t l y a n d s i g n i f i c a f o r e x t e n d e d p e r i o d s . I n t h i s c a s e , t h e g e n e r a l p r a c p r e s c r i b e d p r o f e s s i o n a l s . D L A a r e d e f i n e d i n s e c t i o P R a n d , w i t h a d d i t i o n a l d e t a i l s , i n t h e A R . T h e r e f o r f o r m s h a s t h e o p p o rt u n i t y t o i n d i c a t e w h i c h , i f a n y , D i m p a i r m e n t s 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 I n t h e a p p e l l a n t ' s c i r c u m s t a n c e s , t h e g e n e r a l p r a c t i t r e s t r i c t e d w i t h m o s t o f h e r D L A , n a m e l y : p e r s o n a l s s h o p p i n g , m o b i l i t y i n s i d e a n d o u t s i d e t h e h o m e , u s e s o c i a l f u n c t i o n i n g . W h i l e t h e a p p e l l a n t i s p e r i o d i c a l l i s d e s c r i b e d b y t h e g e n e r a l p r a c t i t i o n e r a s : " t i r e d a n t a k e m e d i c a t i o n s . " O t h e r t h a n w r i t i n g i n t h e h e a l t h h t o 3 n i g h t s p e r w e e k , t h e g e n e r a l p r a c t i t i o n e r h a s n o r e q u i r e d b y h e r f a m i l y . T h e g e n e r a l p r a c t i t i o n e r a l s o m e d i c a t i o n s t h a t i n t e r f e r e w i t h h e r d a i l y l i v i n g a c t i v i t A c c o r d i n g t o S e c t i o n 2 ( 3 ) o f t h e E A P W D A , a p e r s o n 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 r e q u i r e s , a m o n g o f a n o t h e r p e r s o n . " T h e n e u r o l o g i s t d i d n o t a s s e s s p a r t i c u l a r t a s k s o f D L A b u t w r o t e t h a t s h e r e q u i r e s s t h a t s h e h a s " n o l i m i t a t i o n o t h e r w i s e . " G i v e n t h a t t h t h e s e c t i o n o f t h e A R r e l a t i n g t o t h e a s s i s t a n c e r e q u t h e e v i d e n c e o f t h e n e u r o l o g i s t i s n o t c l e a r r e g a r d i n g r e s t r i c t i o n s t o t h e a p p e l l a n t ' s D L A . I n h e r s e l f r e n o rt , t h e a n n e l l a n t w r o t e t h a t h e r f a m i l v I A P P E A L # n d s i s t e r a n d a f r i e n d . T h e a p p e l l a n t ' s a d v o c a t e e t h a t t h e r e a r e r e s t r i c t i o n s t o a l l D L A b u t , r a t h e r , e a r t h a t t h e " n o " a p p e a r i n g i n t h e s e c t i o n o f t h e A R a s m e a n t t o a p p l y t o a l l o f e v e n s o m e o f t h e l i s t e d a d v o c a t e a r g u e d t h a t t h e a p p e l l a n t h a s c o n f i r m e d , h o u s e k e e p i n g , m e a l p r e p a r a t i o n , p a y i n g b i l l s , h e a d v o c a t e p o i n t e d t o t h e J u l y 9 , 2 0 1 4 l e t t e r f r o m r e s i n t e r f e r e w i t h h e r D L A . i a n i n d i c a t e d t h a t s h e i s n o t r e s t r i c t e d i n a m a j o r i t y f o r m a n a g e m e n t o f h e r m e d i c a t i o n s , t h e r e i s n o m i n i s t r y a r g u e d t h a t t h e n e u r o l o g i s t r e p o r t e d t h a t i s r e q u i r e d f o r b a t h i n g a n d " o t h e r ' ' n o n s p e c i f i e d d o e s n o t i n d i c a t e i f t h e a p p e l l a n t r e q u i r e s a r g u e d t h a t a l t h o u g h t h e s p e c i a l i s t w r o t e i n 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 r e i s n o i n f o r m a t i o n f f e c t e d 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 c r i b e d p r o f e s s i o n a l p r o v i d e a n o p i n i o n t h a t a n n t l y r e s t r i c t s h e r D L A , c o n t i n u o u s l y o r p e r i o d i c a l l y t i t i o n e r , t h e n e u r o l o g i s t , a n d t h e s p e c i a l i s t a r e t h e n 2 ( 1 ) o f t h e E A P W D R a n d a r e a l s o l i s t e d i n t h e e , a p r e s c r i b e d p r o f e s s i o n a l c o m p l e t i n g t h e s e 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 b y t h e a p p e l l a n t ' s d p e r i o d s . i o n e r r e p o r t e d i n t h e P R t h a t t h e a p p e l l a n t i s n o t 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 u s e w o r k , d a i l y o f t r a n s p o r t a t i o n , m a n a g e m e n t o f f i n a n c e s , a n d y r e s t r i c t e d w i t h m a n a g e m e n t o f m e d i c a t i o n s , t h i s d f o r g e t f u l p o s t s e i z u r e s " , " n e e d s r e m i n d e r s t o i s t o r y 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 s e i z u r e s 2 t s p e c i f i e d t h e f r e q u e n c y o f t h e r e m i n d e r s 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 b e e n p r e s c r i b e d i e s a s t h e y " m a y c a u s e d r o w s i n e s s . " 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 a c t i v i t y o t h e r t h i n g s , " t h e s i g n i f i c a n t h e l p o r s u p e rv i s i o n t h e a p p e l l a n t ' s f u n c t i o n i n g w i t h r e s p e c t t o u p e r v i s i o n f o r b a t h i n g a n d " o t h e r a c t i v i t i e s " a n d e n e u r o l o g i s t a l s o w r o t e " n o " a t t h e b e g i n n i n g o f i r e d i n t a s k s o f v a r i o u s D L A , t h e p a n e l f i n d s t h a t t h e n a t u r e , e x t e n t o r f r e q u e n c y o f a n y h a s t o r e m i n d h e r t o t a k e h e r m e d i c a t i o n s a s s h e
APPEAL# I is always forgetting. She forgets to pay bills and she has trouble handling money as she is not good at how to plan. At the hearing, the appellant stated that on a "bad day" post-seizure, she cannot walk more than 2 blocks. The appellant also stated that her mother and sister help her with the laundry and housekeeping, meal preparation, paying bills, filling her prescriptions and with general transportation. While the appellant stated that her condition has worsened since February 2014 as she is now experiencing seizures during the day and the frequency has increased, her new specialist, as a prescribed professional, did not define the extent of the restrictions to particular DLA, although given an opportunity to do so in his July 9, 2014 letter. The panel finds that the ministry reasonably concluded that there is not enough evidence from the prescribed professionals to establish that the appellant's impairment significantly restricts her ability to manage her DLA either continuously or periodically for extended periods, thereby not satisfying the legislative criterion of section 2(2)(b)(i) of the EAPWDA. Help to perform DLA The appellant's position is that she requires the significant assistance of another person to perform DLA. The ministry's position is that because it has not been established that DLA are significantly restricted, it cannot be determined that significant help is required. The ministry argued that no assistance devices or the services of an assistance animal are required. Panel Decision Section 2(2)(b)(ii) of the EAPWDA requires that, as a result of direct and significant restrictions in the ability to perform DLA, a person requires help to perform those activities. Help is defined in subsection (3) as the requirement for an assistive device, the significant help or supervision of another person, or the services of an assistance animal in order to perform a DLA. The physician reported in the PR that the appellant requires assistance in "reminders to take medications" and that "this is usually done by her family members." The neurologist did not indicate in the AR that anyone provides assistance or that any devices are used. The panel finds that the ministry reasonably determined that as direct and significant restrictions in the appellant's ability to perform DLA have not been established, it cannot be determined that the appellant requires help to perform DLA as a result of those restrictions, as defined by section 2(3)(b) of the EAPWDA. Conclusion Having reviewed and considered all of the evidence and relevant legislation, the panel finds that the ministry's reconsideration decision which determined that the appellant was not eligible for PWD designation was reasonably supported by the evidence, and therefore confirms the decision.
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