PAR T C -Decision u nder Appeal T he de cisi on bei ng a pp ea l ed is the M i nistry o f So c ial De "Ministry") May 16, 2014 reconsider at i on decision i was not e ligible for Persons w it h Disabiliti es ("PWD") designation because requirem ents for PWD designation in section 2(2 ) of with Disabilit ies Act. Based on the informatio n provided, the Ministr Appell ant has a severe m ental o r phys ica l impairme (i) directly and significantly restricts hi s ability to per p eriod i cally fo r e x tended periods; and, (ii) a s a res ult of tho se res t rictions he requires h elp to The Ministry wa s satis fied tha t the Appellant has reached 18 years of age and in the opinio medic al practitio ner h is i mpairment is likely to co ntinue PA R T D -Relev ant Legis lation Emp loymen t an d As sistance fo r Persons w ith Dis abil Emp loymen t a nd A s sis tance fo r Pers ons w ith Dis abil EAAT 003(10/06/01) I A PPEAL# velop me nt and Social Innovat i on (the n whi ch t h e Ministry determined that the Appe llant he did not meet all the the Employme nt a nd Assistance for Person s y was not satisf i ed that the nt that in the opinio n o f a pr esc r ibed p rofe ssi ona l form d a i ly l iving a ct i vi ties either c on ti n uously or p e rform t h o se activities. n of a f or at least 2 years. iti e s Act ( "E AP W D A") Section 2( 2 ) and 2(3 ) . iti e s Reg u lation ("E APWDR" ) S ection 2.
P A R T E S u m m a r v o f F a c t s F o r 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 , t h e M i n i s t r y h a d t h 1 . A p p e l l a n t ' s P W D a p p l i c a t i o n c o n s i s t i n g o f : o H i s s e l f r e p o rt d a t e d S e p t e m b e r , 2 4 , 2 0 1 3 a • A p h y s i c i a n ' s r e p o r t c o m p l e t e d o n N o v e m b e C . ) , w h o i n d i c a t e d t h a t h e i s a s p e c i a l i s t i n P A p p e l l a n t i n 1 1 o r m o r e v i s i t s i n t h e p r e c e d i n o A n a s s e s s o r ' s r e p o r t c o m p l e t e d o n N o v e m b D r . A ) , w h o n o t e d t h a t h e h a d k n o w n t h e A p i n d i c a t i n g t h a t h e h a d s e e n t h e A p p e l l a n t 2 -1 • A l e t t e r d a t e d O c t o b e r 2 5 , 2 0 1 3 f r o m D r . A t r e g a r d i n g h i s a s s e s s m e n t o f t h e A p p e l l a n t . • A r e f e r r a l f o r p h y s i o t h e r a p y d a t e d N o v e m b e r e f e r r e d t o a s D r . H ) . E x c e p t f o r m e d i c a t i o n s • A n o t e d a t e d S e p t e m b e r 2 3 , 2 0 1 3 f r o m D r . R m e d i c a l l y i l l , a w a i t i n g t e s t s a n d a s p e c i a l i s t c t h e n e x t m o n t h . • A n o t e o n a p r e s c r i p t i o n p a i d d a t e d N o v e m b w i t h a d a t e s t a m p f r o m t h e M i n i s t r y o f J u n e 2 [ A p p e l l a n t ] i s u n a b l e t o w o r k d u e t o m e d s a n 2 . 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 d a t e d A p • A l e t t e r d a t e d A p r i l 1 6 , 2 0 1 4 f r o m t h e A p p e l l a F o r t h i s a p p e a l , t h e A p p e l l a n t ' s a d v o c a t e s u b m i t t e d • A r e v i s e d p a g e 1 2 o f t h e p h y s i c i a n ' s r e p o r t p A u g u s t 1 8 , 2 0 1 4 . • A n a s s e s s o r ' s r e p o r t c o m p l e t e d b y a r e g i s t e r s h e h a d s e e n t h e A p p e l l a n t o n c e ; t h i s w a s h • W r i t t e n a r g u m e n t s w h i c h a r e s u m m a r i z e d i n A t t h e h e a r i n g , t h e A p p e l l a n t , h i s m o t h e r a n d a d v o v a r i o u s m e d i c a l p r o f e s s i o n a l s , a n d w h e n a n d w h y t • D r . C i s t h e p h y s i c i a n w h o o v e r s e e s t h e A p p h a v e r e g u l a r a p p o i n t m e n t s a n d t h e d o c t o r i s • D r . R i s t h e A p p e l l a n t ' s f a m i l y p h y s i c i a n a n d y e a r . D r . R r e f e r r e d h i m t o D r . A f o r a C O P D a s s e s s m e n t . D r . R p r e p a r e d a r e v i s e d p a g e D r . C g a v e h i s p e r m i s s i o n f o r t h e A p p e l l a n t t o • D r . A s a w t h e A p p e l l a n t t w i c e , o n c e t o d o t h e a s s e s s o r ' s r e p o rt . T h e A p p e l l a n t s a i d t h a t w h r e p o r t f o r h i s o r i g i n a l P W D a p p l i c a t i o n , D r . A n o t a s k t h e A p p e l l a n t a n y q u e s t i o n s . T h e A p p a p p l i c a t i o n f o r m b e f o r e , d i d n o t u n d e r s t a n d i t m o t h e r c o n f i r m e d t h a t t h e A p p e l l a n t w a s w i t h • T h e a d v o c a t e e x p l a i n e d t h a t t h e r e a i s t e r e d n E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # e f o l l o w i n g e v i d e n c e : n d a n a d d i t i o n a l u n d a t e d w r i t t e n s t a t e m e n t . r 7 , 2 0 1 3 , b y a d o c t o r ( h e r e a f t e r r e f e r r e d t o a s D r . s y c h i a t r y / A d d i c t i o n s a n d t h a t h e h a d s e e n t h e g 1 2 m o n t h s . T h e d o c t o r a d d e d 1 -2 w e e k v i s i t s . e r 1 4 , 2 0 1 3 b y a d o c t o r ( h e r e a f t e r r e f e r r e d t o a s p e l l a n t f o r 3 m o n t h s a n d c h e c k e d t h e b o x 0 t i m e s i n t h e l a s t y e a r . o a t h i r d d o c t o r ( h e r e a f t e r r e f e r r e d t o a s D r . R ) D r . C w a s c o p i e d o n t h i s l e t t e r . r 8 , 2 0 1 0 a n d s i g n e d b y a f o u r t h d o c t o r ( h e r e a f t e r , t h e d o c t o r ' s w r i t i n g w a s i l l e g i b l e . t o " e m p l o y e r ' ' s t a t i n g t h a t t h e A p p e l l a n t i s o n s u l t t o c l a r i f y h i s c o n d i t i o n . H e c a n n o t w o r k o v e r e r 8 , 2 0 1 0 , w i t h a s i g n a t u r e s i m i l a r t o D r . H ' s a n d 6 , 2 0 1 3 ; a n d s t a t i n g , " t h e a b o v e p a t i e n t d l o w e r b a c k s p a s m a n d a rt h r i t i s . " . r i l 1 6 , 2 0 1 4 , t o g e t h e r w i t h : n t ' s m o t h e r w h o i s a l s o h i s r e p r e s e n t a t i v e . t h r e e d o c u m e n t s : a r t o f t h e P W D a p p l i c a t i o n , c o m p l e t e d b y D r . R o n e d n u r s e o n A u g u s t 1 0 , 2 0 1 4 w h o i n d i c a t e d t h a t e r f i r s t c o n t a c t w i t h h i m . P a r t F o f t h i s d e c i s i o n . c a t e p r o v i d e d t h e f o l l o w i n g i n f o r m a t i o n a b o u t t h e h e A p p e l l a n t h a d s e e n t h e m : e l l a n t ' s m e t h a d o n e t r e a t m e n t b e c a u s e h e c a n c l o s e t o w h e r e h e c u r r e n t l y l i v e s . t h e A p p e l l a n t h a s b e e n s e e i n g h i m f o r a b o u t a ( c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e ) 1 2 o f t h e p h y s i c i a n ' s r e p o r t o n A u g u s t 1 8 , 2 0 1 4 . h a v e D r . R c o m p l e t e t h i s f o r m . C O P D a s s e s s m e n t a n d o n c e t o d o t h e e n h e a s k e d D r . A t o c o m p l e t e t h e a s s e s s o r ' s t o o k a b o u t 5 m i n u t e s t o c h e c k t h e b o x e s a n d d i d e l l a n t a l s o s a i d t h a t h e h a d n e v e r s e e n t h e a t a l l o r w h a t w a s n e e d e d . T h e A p p e l l a n t ' s t h e d o c t o r f o r o n l y a b o u t 5 m i n u t e s . u r s e h a s d o n e o t h e r P W D a s s e s s m e n t s .
A c c o r d i n g t o t h e A p p e l l a n t a n d h i s m o t h e r , t h e l p i n g t h e A p p e l l a n t a n d h i s m o t h e r r e m e m T h e y s a i d t h a t t h e y p r o v i d e d h e r w i t h h i s w h T h e f o l l o w i n g i n f o r m a t i o n w a s a v a i l a b l e t o t h e M i n i s D i a g n o s e s D r . C , i n t h e p h y s i c i a n ' s r e p o r t d i a g n o s e d t h e A p p e s u b s t a n c e , C O P D , d e g e n e r a t i v e d i s c d i s e a s e , l o w p o s t t r a u m a t i c s t r e s s d i s o r d e r ( " P T S D " ) . I n t h e O c t o b e r 2 5 , 2 0 1 3 l e t t e r , D r . A r e f e r s t o t h e A P h y s i c a l I m p a i r m e n t 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 d e s c r i b e d h i s d i s a b i • C h r o n i c l u n g a n d b a c k p r o b l e m s ; h a d s u r g e r r a y s s h o w t h a t p e r m a n e n t s c a r r i n g i n h i s l o w s p i n e . • H a s b e e n d i a g n o s e d w i t h a s e r i o u s l u n g d i s e t h i c k e n i n g a n d p a t c h y r i g h t b a s a l p r i m a r y s c a • H a s c l u b f i n g e r s w h i c h a r e a d i r e c t r e s u l t o f l • D e a l s w i t h c o n s t a n t s c i a t i c p a i n i n h i s b a c k a b e d ; h e c a n n o t l i f t h e a v y o b j e c t s o r s i t i n o n e • D e a l s w i t h w a l k i n g h u n c h e d o v e r o n b a d d a y • B r e a t h i n g i s s o b a d t h a t h e h a s b e e n t o t h e d h e w a l k s f a s t o r s t a r t s t o f e e l a n x i o u s f o r a n y s t a r t s t o d r o w n i n h i s o w n b o d y . • C a n n o t r u n , c a n n o t d o a n y t h i n g t h a t w i l l r a i s e o f t i m e s a d a y t o t h e p o i n t h e d r o p s t o h i s k n • I f h e c a n c a l m h i m s e l f , h e c a n r e g a i n h i s b r e a • I s v e r y l i m i t e d t o w h a t h e c a n d o w i t h h i s b a c t o e v e n c l e a n h i s h o u s e w i t h o u t o v e r e x e rt i n g • H a s p r o b l e m s e v e n s l i d i n g h i s b e d a w a y f r o m • I f h e h a s t o h u r r y t o c a t c h a b u s , o f t e n e n d s u • H a s p r o b l e m s c a r r y i n g g r o c e r i e s , e v e n u p s t a I n t h e u n d a t e d s t a t e m e n t t h e A p p e l l a n t w r o t e : • H i s l i f e i n t h e l a s t t e n y e a r s h a s b e e n a c o n s t p e r m a n e n t s c a r t i s s u e d a m a g e a n d l i v e s w i t h • M a k e s i t a l m o s t i m p o s s i b l e t o g e t o u t o f b e d o n u m e r o u s o c c a s i o n s ; h a d x r a y s i n 2 0 1 0 s h o • S o m e d a y s i t i s a l m o s t i m p o s s i b l e t o d r e s s h i • R e c e n t l y h e w a s d i a g n o s e d w i t h l u n g p r o b l e m r u n s o u t o f b r e a t h s e v e r a l t i m e s a d a y f r o m j u e v e n t y i n g h i s s h o e s . • H i s l i f e h a s f a l l e n a o a r t a s h e i s c o m o l e t e l v l i m E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� A P P E A L # h e n u r s e d i d a v e r y t h o r o u g h i n t e r v i e w , i n c l u d i n g b e r h i s c h i l d h o o d i n j u r i e s a n d o t h e r d i f f i c u l t i e s . o l e m e d i c a l h i s t o r y , i n c l u d i n g m e d i c a l r e p o r t s . t r y a t t h e t i m e o f r e c o n s i d e r a t i o n . l l a n t w i t h n a r c o t i c d e p e n d e n c e , a b u s e o f a n i l l e g a l t e s t o s t e r o n e , h e p a t i t i s C p o s i t i v e , d e p r e s s i o n a n d p p e l l a n t ' s c h r o n i c d y s p n e a a n d f i b r o t h o r a x . l i t i e s a s f o l l o w s : y a n d s u f f e r s f r o m c o n t i n u o u s p a i n i n h i s b a c k ; x  e r L 4 L 5 ; h a s s c o l i o s i s a n d s o m e c u r v a t u r e i n t h e a s e ; x r a y s s h o w l o n g s t a n d i n g r i g h t p l e u r a l r r i n g ; l e f t c o n v e x s c o l i o s i s . u n g d i s e a s e . n d r i g h t l e g ; s o m e d a y s h e c a n b a r e l y g e t o u t o f p l a c e f o r l o n g p e r i o d s o f t i m e . s a n d o f t e n r e t r e a t s h o m e . o c t o r ' s o f f i c e a n d h o s p i t a l n u m e r o u s o c c a s i o n s ; i f r e a s o n , h i s b r e a t h i n g g e t s v e r y s h a l l o w a n d h e h i s h e a r t r a t e ; l o s e s h i s b r e a t h a t l e a s t a c o u p l e e e s p r e p a r e d t o c a l l 9 1 1 . t h i n g , b u t t h e e m o t i o n a l t o l l i s i n d e s c r i b a b l e . k a n d l u n g p r o b l e m s ; v e r y d i f f i c u l t t o g e t a r o u n d , h i m s e l f . t h e w a l l t o c h a n g e h i s s h e e t s . p k n e e l i n g o n t h e b u s t r y i n g t o c a t c h h i s b r e a t h . i r s t o h i s a p a r t m e n t , w i t h o u t l o s i n g h i s b r e a t h . a n t b a t t l e w i t h b a c k p a i n a n d s u r g e r y ; h a s s c i a t i c p a i n e v e r y d a y . n t h e b a d o n e s ; h a s l a n d e d i n t h e h o s p i t a l o n w i n g e v e n m o r e p e r m a n e n t d a m a g e . m s e l f o r e v e n g o t o t h e b a t h r o o m . s , w h i c h h a s m a d e h i s l i f e a l m o s t i m p o s s i b l e ; h e s t w a l k i n g t o t h e b u s s t o p ; h e r u n s o u t o f b r e a t h i t e d t o a l m o s t a n y t h i n q t h a t w o n ' t r a i s e h i s h e a r t
rate. • If he catc hes tran sit, he has to walk slow ly f or fear • His handic aps ha ve des tro yed h i s rela tionsh lo neliness. D r. A , i n the Octo ber 2013 l etter to D r. R, wrote t hat h is chronic dys pn ea. T he doctor provided the follow • Rec ent CT scan show ed si gnific ant pl eu ral t f ibro thora x due to p rior he mop neu mot ho r a ces. • PFTs sho w e d moderatel y sever e i mpai rmen • D L C O was s urprisin gly lo w at 66% ; ho weve r • Als o h ad sig nif ica nt bro nc h odi la tor reve r sib ility • On that day's ex aminat ion, had a signi fica nt • Added anot her m ed ica t i on f or obstructive l un s m oki n g ces sation. • F ibr o thorax will b e a very difficult pr o blem; ordered a assoc i ated paren c h y m a disease given t he dim to ensure no e v idence of p ul m on ary hype r t ension g • Will refe r the Appe ll a nt to a thoracic su rgeo n ben efit f rom surgi c al d ecortication s; an d will r D r . C wr o te i n his p hysi cian's report t h at h e was seein doc t or, who ha s known the Ap pellan t since 2012 , descri and func tioning ab i li ties as follows : • H ad chron i c b ac k p ain fr om 201 2, lo w ene r gy-• H ad subsequently inj ur ed hi s ba ck at w o r k a nd • New d i a gno s e s of COPD and re s t ricting l ung diseas (planned). • Do es not re quire a ny pro sthe s e s o r aids for h • Unlikely to reco ver to the p oint o f d oing the job • Fu ncti on al ly can wa l k 2-4 blocks una i de d on uses elevator; cannot lift and can remain seated for less than 1 ho • " Currently seeing a medical a nd t horacic speci upcoming for possible lung resection ('s car red lungs")". Dr. A reported that the Appellant: • Indep endently manages wa l k i n g indoors and outdoor • Takes significantly longer climbing stairs, lifting, and carrying and holding. • " Si g nificant mixed v entilatory d efect on PFTs [pulmonary function tests and fibrothor ax from prior pleural effusion/pneumo I n he r April 1 6, 2014 n ote, t h e Appel lant's mother wrote that the Appe • Learned more information about his health; saw a specialist and will be meetin doctor next week. • Has been diagnosed with COPD and emphysema; he is struggling and is very restricted in wh at he can do . EAAT 003(10/06/01) APP E AL# '. of not be ing a ble t o bre ath e. ips an d hav e l ed h i m to l i v i ng alo ne an d the A pp ellant w a s rev iewe d t hat day r egardin g ing r epor t abo ut t h e A ppel lant's co nd ition s: hickening in the su b p l e ura l b and s, a li kel y t; has a mi xed obs tructiv e restri ctiv e pic t ur e. , it did corr ect for his lu ng volu mes. and remains on two medi cati ons. wheeze; a l so diminished thoracic expansion. g disease a nd str e sse d th e imp ortance of h i gh -resol u tion C T to e ns u r e there is no in i sh ed DL CO ; a l so ordered an echocardiogram i ven previou s drug use. fo r an o pin ion as to wh ethe r the Appe l lant might eview hi m in a bout 3 mon ths. g the App ellan t for n arco t ic dep ende nce. This b ed the severit y of t he Ap pella nt's imp airmen t he patitis C po sitive. w a s not able to work. e; po ssi ble su rg ica l r e sectio n to lu ngs i s impa i rme nt. s h e was s ki lled to do. a f lat surface; can not cl imb a ny s ta i rs un ai d ed ur. ali st for man ag ing lu ng disease. Appo intmen t s, and standing. ] second a ry to COPD thorax". l la nt: g with his family
Me nta l Imp air ment In h is s elf-report and undated statement , t he Appellan • Has battled w i t h ad diction due to p a in r e li e f a • He has a li felon g p rob lem wi t h t he ba ttle of a to a l low h is bo d y t o get a ny wo rse. • He just has to c o m e to t er m s w i t h hi s disa bili Dr. C reported th at the App ella nt w as s tab i lized well on Appell a nt is a dher ing t o hi s pr ogram and n o l ong e r the Appe ll ant ha s dyspheri a from depre ssi on and : • Has signifi c a n t de f ici ts with co g niti ve an d e m em otion al dis t u rbanc e ( depression , an xi et y) • Has "pos t-tra u mati c stres s symp toms , dy s per Dr. A wrote "no cog ni ti v e or em otion al impairmen t" a and em ot i onal function i n g. The Appe ll a n t' s mother wrot e that the Appellan t: • Is ve r y d epress ed ri ght now and th at is why her has b ee n very angry la tely. • His d ependence on others t o h el p him f unction is causing fu e xacerbates the situati o n. D aily L i vi ng A c tivi tie s Dr. C re po r ted tha t the A ppell ant had not bee n presc interfere w i th h is abilit y t o perform da i ly li v i ng a c t iv i ties i mpa i rments directly restrict hi s abili ty t o p erf o rm dail • Pe r iodic r es t ric tions wit h me al pr e pa ration. • Continuous r estri ctions wi t h mobil ity outsid e t of finances. • Ch e cked bo x for n o re s triction f o r basic hous also checked box for "continuous". • No restriction with management of medications, mobility inside the home and social functioning. • "Can sometimes cook, but not able to when worse in symptoms • "Not able to shop daily, limitations going out. els ewher e. Uses el evat ors only". Dr. A, in his asse ssor's report, provi ded the following information about the Appellant: • Wrote "none for ADLs (activities of daily living)" in response to the question whether the Appellant's mental or physical impairments impact his ability to manage daily living activities. • Independently manages all areas of personal care, basic housekeeping, meals, paying r and bills, medications, transportation and social functioning with good functioning with immediate and extended social networks. E M T 0 03(10/06/01) I APPEAL# t des cribed his i mpair me n t s as fo llows: nd is now on t he methad o n e program. ddiction, b ut has be en stay ing cl ean a s he refus es t ies and he wan ts t o be able t o li ve a normal life . a methadone maint e nan ce p r ogram. Th e us ing the i l le g al n arc ot ic . T he doct or wrote tha t otional fun c tioni ng in the are as of memory an d ia, po or short-t er m memory" . nd indicated no imp a cts to an y ar e a s of cogn i tiv e help is n eede d; no t o nly depress e d but als o r t h e r depres sio n wh ich r ibed an y medicati on a n d / o r t reatment tha t . Thi s doct or a lso in dicate d th a t the Appel la nt's y liv ing ac ti v i ties as follow s: h e h o m e, use of tran spo rtation and managem ent ework and da i ly sho p pi ng -"not able t o daily", but " Finances managed by parents who live ent
• I n d e p e n d e n t l y m a n a g e s a l l a r e a s o f s h o p p s t o r e s , a n d c a r r y i n g p u r c h a s e s h o m e . • " N o d i f f i c u l t i e s w i t h A D L s " . H e l p w i t h D a i l y L i v i n g A c t i v i t i e s I n t h e p h y s i c i a n ' s r e p o r t , i n r e s p o n s e t o t h e q u e s t i C w r o t e " n o t u s u a l l y , s o m e t i m e s u s e s a c a n e " . D r . A i n h i s r e p o r t : • W r o t e " n i l " i n r e s p o n s e t o w h e t h e r t h e A p p e a s s i s t a n c e . • W r o t e " n o n e " f o r a n y a s s i s t i v e d e v i c e s u s e d • N o t e d t h a t t h e A p p e l l a n t d o e s n o t h a v e a n I n h e r A p r i l 2 0 1 4 l e t t e r , t h e A p p e l l a n t ' s m o t h e r w r o p o i n t a n d t h a t w a s w h y h e n e e d e d h e r h e l p . T h e A h e l p f r o m h i s b r o t h e r a n d f a m i l y , a n d f r o m h i s p a r e H e a ri n g S u m m a r y A t t h e h e a r i n g , t h e A p p e l l a n t d e s c r i b e d t h e s a m e h a l s o d e s c r i b e d h o w h a r d i t i s f o r h i m t o w a l k o r s t a m o t h e r c o o k s a n d s h e c o n f i r m e d t h a t s h e p r o v i d e s a l s o p r o v i d e s m e a l s . T h e A p p e l l a n t s a i d t h a t h e c a H i s b r o t h e r o f t e n h e l p s h i m . T h e A p p e l l a n t s t a t e d c o n t i n u i n g t o s e e a s p e c i a l i s t f o r t h i s c o n d i t i o n . H e s a i d t h a t h e g e t s v e r y d e p r e s s e d a n d o f t e n f e e l s r e s o m e t i m e s s l e e p s i n h i s c l o t h e s . H e i s v e r y e m b a l o s i n g h i s t e e t h . S o m e t i m e s h e w a n t s t o k i l l h i m s e i n c i d e n t t h a t h a p p e n e d w h e n h e w a s a b o u t 1 8 a n d T h e A p p e l l a n t ' s m o t h e r s a i d t h a t f o r s o m e t i m e s h e h a d a t o u g h j o u r n e y t o g e t h e r . T h e A p p e l l a n t ' s b r o A p p e l l a n t i s p r e p a r i n g t o m o v e c l o s e r t o h i s p a r e n t I n t h e r e v i s e d p a g e o f t h e p h y s i c i a n ' s r e p o r t p a g e , d i r e c 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 f o r m d a i l y l i v i n g a c • P e r s o n a l c a r e i s p e r i o d i c a l l y r e s t r i c t e d -f l u c t u a t i o n " . • M e a l p r e p a r a t i o n , m a n a g e m e n t o f m e d i c a 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 o f t r a n c o n t i n u o u s l y r e s t r i c t e d . • S o c i a l f u n c t i o n i n g i s c o n t i n u o u s l y r e s t r i c t e b r e a t h l e s s n e s s , l e a d s t o i s o l a t i o n a n d l e s s s • S e v e r e l y r e s t r i c t e d d u e t o C O P D a n d d y s p r e D r R . a l s o w r o t e t h a t t h e A p p e l l a n t n e e d s a c a n e fo EAA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # i n g , b u 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 g o i n g t o a n d f r o m o n a b o u t w h a t a s s i s t a n c e t h e A p p e l l a n t n e e d s , D r . l l a n t r e q u i r e s h e l p , b u t d i d n o t e t h a t f a m i l y p r o v i d e s b y t h e A p p e l l a n t . a s s i s t a n c e a n i m a l . t e t h a t t h e A p p e l l a n t w a s v e r y d e p r e s s e d a t t h a t p p e l l a n t h a s b e e n g e t t i n g e m o t i o n a l a n d p h y s i c a l n t s . I f n o t f o r t h e m , h e w o u l d n o t b e a b l e t o g e t b y . e a l t h c o n d i t i o n s a s a r e i n t h e d o c t o r s ' r e p o r t s . H e n d . H e d o e s n o t s h o p w i t h o u t a n y h e l p . U s u a l l y h i s h i m w i t h c o o k e d a n d f r o z e n d i n n e r s . H i s b r o t h e r n ' t c a r r y g r o c e r i e s u p t h e s t a i r s t o w h e r e h e l i v e s . t h a t h i s l u n g c a p a c i t y i s a t 6 0 % a n d h e i s i s a l s o c o n t i n u i n g t o s e e D r . C . T h e A p p e l l a n t a l s o a l l y h o p e l e s s . H e c a n ' t e v e n d r e s s h i m s e l f a n d r r a s s e d a b o u t a l l o f h i s i l l n e s s e s a n d n o w h e i s l f . T h e A p p e l l a n t a l s o d e s c r i b e d a v e r y v i o l e n t w h i c h h e s a i d c a u s e d h i s P T S D s y m p t o m s . d i d n o t r e a l i z e h o w s i c k h e r s o n i s . T h e y h a v e t h e r a l s o h a s b e e n h e l p i n g h i m a n d n o w t h e s . D r . R r e p o r t e d t h a t t h e A p p e l l a n t ' s i m p a i r m e n t t i v i t i e s a s f o l l o w s : " a b l e t o d o s o m e s e l f c a r e b u t l i m i t e d b y m o o d t i o n s , b a s i c h o u s e w o r k , d a i l y s h o p p i n g , m o b i l i t y s p o r t a t i o n a n d m a n a g e m e n t o f f i n a n c e s a r e a l l d i s o l a t e d d u e t o d e p r e s s i o n , f a t i g u e d u e t o o c i a l i n t e r a c t i o n . a a s w e l l a s d e p r e s s i o n . r m o b i l i t v a n d t h e a s s i s t a n c e o f h i s o a r e n t s , h e a l t h
c a r e , h i s b r o t h e r a n d a d v o c a t e s . T h e n u r s e i n d e n t i f i e d t h e A p p e l l a n t ' s m e n t a l a n d p h t a c h y c a r d i a , s e v e r e C O P D s e v e r e s h o r t n e s s o f b c e r v i c a l a n d l u m b a r s p i n e , h e p a t i t i s C , d e p r e s s i o n , o b s e s s i v e c o m p u l s i v e t e n d e n c i e s , p o s s i b l e h e a d i n t h e A p p e l l a n t ' s a b i l i t y t o c o m m u n i c a t e a s f o l l o w s : • P o o r s p e a k i n g a b i l i t y s h o r t n e s s o f b r e a t h a • R e a d i n g -1 0 m i n u t e a t t e n t i o n s p a n . • W r i t i n g l o s e s t r a i n o f t h o u g h t , t a k e s 2 x a s l A s f o r 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 b i l i t y , t f o l l o w i n g a s s i s t a n c e : • C o n t i n u o u s a s s i s t a n c e w a l k i n g i n d o o r s -5 -1 b r e a t h ] ; w a l k s w i t h b a c k h u n c h e d o v e r i n p a i • C o n t i n u o u s a s s i s t a n c e w a l k i n g o u t d o o r s u e v e r y 5 m i n u t e s w i t h S . O . B a n d f a t i g u e . • C o n t i n u o u s a s s i s t a n c e c l i m b i n g s t a i r s e l e v • C o n t i n u o u s a s s i s t a n c e c a n e -1 O m i n u t e s • C o n t i n u o u s a s s i s t a n c e w i t h l i f t i n g -5 l b s . • C o n t i n u o u s a s s i s t a n c e w i t h c a r r y i n g a n d h o l d s c i a t i c a . • S e v e r e b a c k p a i n / s u r g e r y 2 0 0 6 ; d e s p i t e s u r g b a c k p a i n s i t t i n g , s t a n d i n g , l i f t i n g , u s e s a c a T h e n u r s e p r o v i d e d t h e f o l l o w i n g i n f o r m a t i o n r e g a r d f u n c t i o n i n g : • M a j o r i m p a c t t o b o d i l y f u n c t i o n s ( e a t i n g a n d t f l u c t u a t i o n s , a p p e t i t e f l u c t u a t i o n s , d i a r r h e a d a • M a j o r i m p a c t t o c o n s c i o u s n e s s e x c e s s i v e d m a j o r d e p r e s s i o n s e l f m a n a g e d r e l a x a t i o n t d i s o r d e r ) b e h a v i o r s c o u n t i n g s t e p s o v e r l i n e s d e t a i l ; t o i n s i g h t a n d j u d g m e n t s e l f m u t i l a t i o a t t e n t i o n / c o n c e n t r a t i o n v e r y p o o r a t t e n t i o n o r g a n i z e ; t o m o t i v a t i o n -" p o o r d u e t o [ i n c o m • M a j o r i m p a c t t o o t h e r n e u r o p s y c h o l o g i c a l p r o p o o r s h o r t t e r m m e m o ry , f o g g i n g ; t o o t h e r e m • M o d e r a t e i m p a c t t o m o t o r a c t i v i t y ( b i z a r r e b e s y m p t o m s , h a l l u c i n a t i o n s o f p e o p l e , s o m e p a • N o i m p a c t t o l a n g u a g e . • S l e e p a w a k e n s w i t h s h o r t n e s s o f b r e a t h e v d u r i n g t h e d a y . F o r a s s i s t a n c e w i t h d a i l y l i v i n g a c t i v i t i e s , t h e n u r s e n • P e r s o n a l C a r e i n d e p e n d e n t w i t h g r o o m i n g , t o i l e t i n g b u 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 ( d i a r r h e p e r i o d i c a s s i s t a n c e w i t h d r e s s i n g & t a k e s s i g b e n d o v e r d u e t o b a c k p a i n , n e e d s t o l a y d o w s e l f / r e a u l a t i n a d i e t & t a k e s s i a n i f i c a n t l v l o n a e E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # � y s i c a l i m p a i r m e n t s a s c h r o n i c d y s p n e a , r e a t h a n d f a t i g u e , d e g e n e r a t i v e d i s c d i s e a s e P T S D d i s o r d e r , l o w t e s t o s t e r o n e l e v e l 3 , j u r y / f r a c t u r e d s k u l l a s a c h i l d . T h e n u r s e r e p o r t e d f f e c t s s p e e c h . o n g t o w r i t e a p a g e . h e n u r s e r e p o r t e d t h a t t h e A p p e l l a n t n e e d s t h e 0 m i n u t e s w i t h b a c k p a i n & S . O . B . [ s h o r t n e s s o f n . s e s c a n e c a n n o t m a n a g e h i l l s ; n e e d s t o r e s t a t o r s ; e x t r e m e l y s h o rt o f b r e a t h . w i t h s u p p o r t . i n g -5 l b s & 5 m i n u t e s d u e t o s e v e r e b a c k p a i n ; e r y A p p e l l a n t s t i l l s u f f e r s w i t h d a i l y c h r o n i c l o w e r n e 2 5 % o f t h e t i m e t o s u p p o r t h i m s e l f . i n g t h e A p p e l l a n t ' s c o g n i t i v e a n d e m o t i o n a l o i l e t i n g p r o b l e m s , s l e e p d i s t u r b a n c e ) w e i g h t i l y . r o w s i n e s s ; t o e m o t i o n ( a n x i e t y , d e p r e s s i o n ) e c h n i q u e s ; t o i m p u l s e c o n t r o l O C D ( c o m p u l s i v e , h o l d s b r e a t h a t s t o p l i g h t s , e x t r e m e a t t e n t i o n t o n i n t h e p a s t ; s e v e r e d e p r e s s i o n a n d s u i c i d a l i t y ; t o s p a n -5 m i n u t e s ; t o e x e c u t i v e r e q u i r e s h e l p t o p l e t e ] " 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 ) a t t e n t i o n d e f i c i t , o t i o n a l o r m e n t a l p r o b l e m s i m p u l s i v e a n g e r . h a v i o r ) O C D b e h a v i o r s / c o u n t i n g ; t o p s y c h o t i c r a n o i a t h a t p e o p l e a r e w a i t i n g / l i s t e n i n g t o h i m . e r y 2 -3 h o u r s a n i g h t ; c o n s t a n t l y f a l l s a s l e e p o t e d t h a t t h e A p p e l l a n t m a n a g e s a s f o l l o w s : w i t h b a t h i n g ( s h o w e r s e v e r y 2 n d d a y ) , a n d w i t h a o n c e / d a y a n d s e v e r e h e a r t b u r n ) ; n e e d s n i f i c a n t l y l o n g e r ( 1 5 m i n u t e s , h o l d s b r e a t h t o n o n s i d e t o p u t s o c k s o n ) , w i t h f e e d i n g r / t e e t h b r e a k i n a a n d f a l l i n a o u t , d i f f i c u l t y
APPEAL# � chewing food, low appetite), with transfers in/out of bed & takes significantly longer (10 min to crawl out on knees), with transfers on/off chair & takes significantly longer (push up off table/support). • Basic Housekeeping -needs continuous help and takes significantly longer with laundry and basic housekeeping (low motivation, extreme fatigue, no energy to carry laundry or do housework). • Shopping -needs continuous help with going to/from stores (mother assists with shopping, can't carry more than 5 lbs.), with making appropriate choices & takes significantly longer (takes 15-20 minutes to decide due to OCD behaviors plus changes his mind), with paying for purchase (loses change and money/uses an A TM card), with carrying purchases home (needs full assistance carrying more than 5 lbs; needs periodic assistance with reading prices and labels (contacts, struggles to see fine print). • Meals -needs continuous help with meal planning, food preparation and cooking (brother or mother cooks and provides frozen meals for Appellant due to very low motivation, fatigue, depression); needs periodic assistance and takes significantly longer with safe storage of food (leaves some perishables out). • Paying rent and bills -needs continuous assistance with all areas (mother assists with all executive and financial tasks). • Medications -independent with filling/refilling prescriptions; needs continuous help with taking as directed and with safe handling and storage (daily supervision and dispensing). • Transportation -independent with using transit schedules/arranging transportation (drives own vehicle); needs periodic assistance and takes significantly longer with getting in/out of a vehicle (5 min. to maneuver in or out due to back pain; needs continuous help using public transit (anxiety in crowds -gets off the bus). • Social functioning -needs continuous support/supervision with making appropriate decisions (no friends for the last year), with being able to develop/maintain relationships (too much energy to develop new relationships with such severe health problems), with being able to deal appropriately with unexpected demands (increases anxiety), with being able to secure assistance from others (emotionally [illegable], impulsive anger); needs periodic supervision with interacting appropriately with others (brief social encounters only, very low attention span, self esteem and tolerance). • Has very disturbed functioning with his immediate social network (major withdrawn) and with his extended social network (major social isolation). • High risk of falling and profound depression, sleep walking. The nurse wrote that the Appellant needs the following help -local liver services, social worker, life skills support through mental health, requires a life line due to severe shortness of breath, advocacy, treatment support, mental health services, rehabilitation, SIL -supportive independent living worker, assistance with cooking, cleaning, laundry, shopping, executive tasks, money management, counseling services and medication management. The nurse reported that the Appellant routinely uses a cane 25% of the time and breathing device (puffers), inhalers for shortness of breath 4x a day, but does not have an assistance animal. She reported that the Appellant gets help from his family and health professionals; i.e., methadone physician & pharmacist, lung specialist and internist. The Appellant's mother or brother assist with shoooinQ, executive tasks, budQetinQ bills, transportation, escortinQ him to aooointments, laundry and EAAT003(10/06/01)
m e a l s . T h e n u r s e a d d e d t h a t t h e A p p e l l a n t i s i n v o l v s u r g i c a l i n t e N e n t i o n ; h o w e v e r , h i s h e a l t h i s s o c o m s u r g e r y o r s u r g e r y i s c o n t r a i n d i c a t e d . T h e s u r g e r i e l u n g s u r g e r y . T h e A p p e l l a n t i s l o s i n g f e e l i n g t o h i s f a l l s . T h e P a n e l f i n d s t h a t t h e i n f o r m a t i o n p r o v i d e d b y t h e i n t h e o n e p a g e r e p o r t a n d b y t h e n u r s e i n t h e a s s e d e t a i l s a b o u t t h e A p p e l l a n t ' s h e a l t h c o n d i t i o n s a n d s e c t i o n 2 2 ( 4 ) o f t h e 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 s u b s t a n t i a t i n g a n d b e i n g i n s u p p o r t o f e v i d e n c e t h a A t t h e h e a r i n g , t h e M i n i s t r y r e a f f i r m e d i t s r e c o n s i d e E AA T 0 0 3 ( 1 0 / 0 6 / 0 I )I A P P E A L # e d w i t h s e v e r a l s p e c i a l i s t s w h o a r e c o n s i d e r i n g p r o m i s e d t h a t h e m a y n o t b e a b l e t o t o l e r a t e a s w o u l d i n c l u d e s p i n a l s u r g e r y , n a s a l s e p t u m , a n d f e e t . H e i s s t u m b l i n g m o r e a n d i s a t h i g h r i s k f o r A p p e l l a n t a n d h i s m o t h e r a t t h e h e a r i n g , b y D r . R s s o r ' s r e p o r t p r o v i d e s a d d i t i o n a l a n d c l e a r e r h o w t h e y i m p a c t h i m . T h e r e f o r e , p u r s u a n t t o t , t h e P a n e l a d m i t s a l l o f t h a t i n f o r m a t i o n a s t t h e M i n i s t r y h a d a t r e c o n s i d e r a t i o n . r a t i o n d e c i s i o n .
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 n ( 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 . T h e P a n e l w i l l c o n s i d e r t h e r e a s o n a b l e n e s s o f t h e M c r i t e r i a a t i s s u e i n t h i s a p p e a l . E v i d e n t i a r y F i n d i n g s 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 w h o p r o v i d e d a n a s s e a b i l i t i e s a r e D r . C , D r . A , D r R a n d t h e r e g i s t e r e d n u A p p e l l a n t a n d h i s m o t h e r t h a t D r . A s p e n t a b o u t 5 m a s k e d n o q u e s t i o n s . T h a t d o c t o r a l s o s a w t h e A p p e A ' s a s s e s s o r ' s r e p o r t l i t t l e w e i g h t . I n c o n t r a s t , D r . C o v e r a y e a r o n a r e g u l a r b a s i s . T h e n u r s e c o n d u c t e m o t h e r , a n d h a d a c c e s s t o h i s m e d i c a l h i s t o r v . D r . R E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P F A I # '. 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 . 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 i n i s t r y ' s 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 s s m e n t o f t h e A p p e l l a n t ' s d a i l y f u n c t i o n i n g r s e . T h e P a n e l a c c e p t s t h e e v i d e n c e f r o m t h e i n u t e s c o m p l e t i n g t h e a s s e s s o r ' s r e p o r t a n d l l a n t o n l y t w i c e . T h e r e f o r e , t h e P a n e l g i v e s D r . a n d D r . R h a v e b e e n t r e a t i n g t h e A p p e l l a n t f o r d a d e t a i l e d i n t e r v i e w w i t h t h e A p p e l l a n t a n d h i s a n d t h e n u r s e a l s o o r o v i d e d t h e m o s t r e c e n t
I APPEAL# reports. Therefore, the Panel gives the evidence from Dr. C, Dr. Rand the nurse more weight than Dr. A's assessor's report. Severe Physical Impairment In its reconsideration decision, the Ministry wrote that it had reviewed the Appellant's self-reports, the reports from Dr. C and Dr. A and the other documents in the record. Based on this information, the Ministry determined that there was not enough evidence to establish a severe physical impairment. The Appellant submits that his medical conditions all contribute to his severe physical impairment. He experiences continuous pain in his back and right leg, extreme fatigue and shortness of breath. He is severely impaired in his ability to walk, to climb stairs, to stand and to lift and carry. He also needs continuous assistance with activities requiring physical abilities, such as basic housework shopping, carrying groceries, dressing, catching the bus and standing to cook. The Panel's Findings The diagnosis of a medical condition is not in and of itself evidence of the severity of impairment. To satisfy the requirements in section 2(2) of the EAPWDA, evidence of how and the extent to which a medical condition restricts daily functioning must be considered. This includes the evidence from the Appellant and from a prescribed professional regarding the nature of the impairment and its impact on the Appellant's ability to manage the daily living activities listed in section 2(1) of the EAPWDR. Dr. C diagnosed the Appellant with COPD, degenerative disc disease, low testosterone and hepatitis C positive. The doctor also noted that the Appellant has low energy from hepatitis C. Dr. A, in his October 25, 2014, letter refers to the Appellant's chronic dyspena and fibrothorax. The Appellant described his chronic lung and back problems and how he deals with constant back and leg pain. Sometime he can barely get out of bed. He also wrote about how he often gets short of breath just from walking to a bus stop, tying his shoes or carrying groceries. At least a couple of times a day he has to drop to his knees because he loses his breath. He cannot stand to cook and is limited in his functioning so that he needs help with mobility, meals, housework and shopping. The Appellant also wrote that he cannot lift more than 5 lbs. Dr. C reported that the Appellant can walk 2-4 blocks unaided, cannot climb stairs unaided (uses an elevator), cannot lift and can remain seated for less than 1 hour. Dr. C also indicated that the Appellant is continuously restricted with mobility outside the home. Dr. R reported that the Appellant is continuously restricted with meal preparation, basic housework, daily shopping, and mobility inside and outside the home, in fact in almost all activities requiring physical abilities. That doctor also wrote that the Appellant is severely restricted due to COPD and needs a cane for mobility. The nurse provided further details which substantiate the Appellant's self-reports and the information from Dr. C and Dr. R. She noted the Appellant's need for continuous assistance in all areas of mobility and physical ability, that he takes significantly longer getting in and out of bed or a chair, and he needs continuous assistance with housekeeping, with carrying purchases home and with cooking due to fatigue and other conditions,. The Panel acknowledges that the nurse's report was based on an interview with the Appellant and his mother: however, the Panel accepts their evidence that the nurse was very thorough in her ability to get information from them. Therefore, the nurse's report, in addition to being a Prescribed professional's assessment, can also be considered as an additional EMT003(10/06/01)
a n d m o r e d e t a i l e d s e l f r e p o r t f r o m t h e A p p e l l a n t . W h e n a l l o f t h e e v i d e n c e i s c o n s i d e r e d , t h e P a n e l f d e t e r m i n a t i o n t h a t t h e e v i d e n c e d o e s n o t e s t a b l i s h i m p a i r m e n t . S e v e r e M e n t a l I m p a i r m e n t T h e M i n i s t r y r e f e r r e d t o t h e r e p o r t s f r o m D r . C a n d r e p o r t s , t h a t t h e r e w a s n o t e n o u g h e v i d e n c e t o e s t a T h e A p p e l l a n t s u b m i t s t h a t h e h a s b e e n d i a g n o s e d H e r e g u l a r l y s e e s D r . C , a p s y c h i a t r i c a n d a d d i c t i o n C a n d t h e n u r s e 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 w i t h c o a n d t h e n u r s e r e p o r t e d t h a t m a n y d a i l y l i v i n g a c t i v i t i m p a i r m e n t s . T h e P a n e l ' s Fi n d i n g s T h e A p p e l l a n t d e s c r i b e d h o w h i s d e p r e s s i o n m a k e s h i m s e l f . H i s m o t h e r w r o t e t h a t h e r s o n w a s v e r y d e h e l p , i n c l u d i n g w i t h m e a l p r e p a r a t i o n a n d f i n a n c i a l m h i m f u n c t i o n i s c a u s i n g f u r t h e r d e p r e s s i o n . T h e A p m o t i v a t i o n m a k e i t d i f f i c u l t f o r h i m t o e v e n g e t d r e s s D r . C , t h e p s y c h i a t r i c a n d a d d i c t i o n s p e c i a l i s t , d i a g n d e p r e s s i o n , P T S D , a n d d y s p e r i a f r o m d e p r e s s i o n . s i g n i f i c a n t d e f i c i t s w i t h c o g n i t i v e a n d e m o t i o n a l f u n c d i s t u r b a n c e . D r . R n o t e d t h a t a r e a s o f d a i l y l i v i n g a i m p a i r m e n t , s u c h a s m a n a g e m e n t o f m e d i c a t i o n , m a l l c o n t i n u o u s l y r e s t r i c t e d . D r . R a l s o r e p o r t e d t h a t r e s t r i c t e d a n d a d d e d t h a t t h e A p p e l l a n t i s i s o l a t e d d A p p e l l a n t i s s e v e r e l y r e s t r i c t e d d u e t o d y s p r e a a s w T h e n u r s e p r o v i d e d f u r t h e r d e t a i l s a b o u t t h e A p p e l l a r e s t r i c t i o n s , i n p a r t i c u l a r n o t i n g m a j o r i m p a c t s i n t h e d e p r e s s i o n ) , i m p u l s e c o n t r o l , i n s i g h t a n d j u d g m e n t , n o t e d t h a t t h e A p p e l l a n t n e e d s c o n t i n u o u s h e l p w i t h s h o p p i n g c h o i c e s , m e a l p l a n n i n g ( l o w m o t i v a t i o n , d e m e d i c a t i o n s a s d i r e c t e d , a n d s o c i a l f u n c t i o n i n g . T h e p r o f e s s i o n a l s . H i s m o t h e r o r b r o t h e r a s s i s t w i t h s h o p t r a n s p o r t a t i o n , e s c o r t i n g h i m t o a p p o i n t m e n t s , l a u n d a l s o n e e d s h e l p f r o m m e n t a l h e a l t h s e r v i c e s a n d a n W h e n a l l o f t h e e v i d e n c e f r o m t h e A p p e l l a n t , h i s m o t h e P a n e l f i n d s t h a t i t w a s n o t r e a s o n a b l e f o r t h e M i n h a v e a s e v e r e m e n t a l i m p a i r m e n t . E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # i n d s t h a t t h e M i n i s t r y w a s n o t r e a s o n a b l e i n i t s t h a t t h e 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 D r . A a n d d e t e r m i n e d t h a t , b a s e d o n t h e s e b l i s h a s e v e r e m e n t a l i m p a i r m e n t . w i t h d e p r e s s i o n , P T S D a n d n a r c o t i c d e p e n d e n c e . s p e c i a l i s t . T h e A p p e l l a n t a l s o s u b m i t t e d t h a t D r . 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 , a n d D r . C , D r . R i e s 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 h i s s e v e r e m e n t a l h i m f e e l h o p e l e s s a n d s o m e t i m e s l i k e k i l l i n g p r e s s e d a n d s h e d e s c r i b e d h o w h e n e e d s h e r a t t e r s . A l s o , t h i s d e p e n d e n c e o n o t h e r s t o h e l p p e l l a n t d e s c r i b e d h o w h i s d e p r e s s i o n a n d l a c k o f e d a n d t a k e c a r e o f h i m s e l f . o s e d t h e A p p e l l a n t w i t h n a r c o t i c d e p e n d e n c e , T h i s d o c t o r a l s o 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 t i o n i n g i n t h e a r e a s o f m e m o r y a n d e m o t i o n a l c t i v i t i e s , w h i c h w o u l d b e i m p a c t e d b y a m e n t a l e a l p r e p a r a t i o n a n d m a n a g e m e n t o f f i n a n c e s , a r e t h e A p p e l l a n t ' s s o c i a l f u n c t i o n i n g i s c o n t i n u o u s l y u e t o d e p r e s s i o n a n d f a t i g u e . D r . R w r o t e t h a t t h e e l l a s d e p r e s s i o n . n t ' 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 a r e a s o f c o n s c i o u s n e s s , e m o t i o n ( w i t h m a j o r a t t e n t i o n / c o n c e n t r a t i o n a n d m o t i v a t i o n . S h e a l s o b a s i c h o u s e k e e p i n g ( l o w m o t i v a t i o n ) , m a k i n g p r e s s i o n ) , p a y i n g r e n t a n d b i l l s , t a k i n g A p p e l l a n t g e t s h e l p f r o m h i s f a m i l y a n d h e a l t h p i n g , e x e c u t i v e t a s k s , b u d g e t i n g b i l l s , r y a n d m e a l s . T h e n u r s e a d d 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 i v i n g w o r k e r . t h e r , D r . C , D r . R , a n d t h e n u r s e i s c o n s i d e r e d , i s t r y t o d e t e r m i n e t h a t t h e A p p e l l a n t d o e s n o t
Re s t rictions to Daily Living Ac tivi t i e s The Ministry not ed t ha t there were diffe r en ces between the assessments by Dr C' s report was not clear, so that it was diffi cult to develop a cl of rest ricti ons the Appell ant ha s with his daily living act Appellant has serious medical issues; however, it determined t c onfirm t ha t t he Ap pellant's daily living a c tivities w ere directly continuously or periodically for extended periods. Th e App ellant s ubmitted t h at because of his serious medica rest ricted in all his daily living acti v i ties. Hi s d o ctors that every daily living acti vity is continuously restricted, exce peri odic assistance. The nurse also repor ted significant restrictions with activiti e s. The P an el's F i ndi ngs Section 2 (2)(b ) of the EAPWDA requir e s t hat a presc Appe lla nt ' s sev ere men ta l or ph ysic al impairment dir acti vities, con tin uously o r perio dica lly for ex t end e d s e c ti o n 2( 1 ) o f t h e E APWDR, and a r e listed in the phys Dr. C's c hecke d box es had a few inconsi sten ci e s ; howev with m eal preparation, addi ng th e A p pel lant is n o t abl a lso re p orted cont in uous r est r ic t i ons wit h mob ility o mana ge ment o f fina nc es. Dr. R repor t ed t hat the App daily liv i n g acti vit ies, exce pt for pers o n a l care whi ch Dr. R ad ded that the A p pel lant is iso lated due to d epre i solation and less soc ia l i n t er actio n . Al s o , th e Ap pel a s w el l a s d epr e s si o n . Th e nurs e n ot o nly chec ked A p pellan t need s cont in uous o r pe riodic assistance wit n o t e s abou t th e h igh deg r ee o f res t r ic t i ons an d the t w he n a ll of the ev i d ence f r om Dr. C, D r . R and the nurse reas onable for the Mini stry to determin e t hat the Ap do not directly an d s igni f i cantly rest rict h i s dai ly livi ng extended periods. Help with Daily Living Activities The Min i stry n o t ed th at the information did no t esta b device, the significant he lp of another perso n or the services o position is that, because the evidence does not establish that daily living activities are significantly r es tr i c te d, it c a n not d etermine that signi f icant help is requir Th e Appellant submi ts th a t h e does n eed s ignif icant help from his family as well as health professionals, and various com munity services. He also uses a cane at times. significant help was confirmed by Dr. C , D r. Rand the registered nurse. of help he needs. EAAT 003(10/06/01) � APP EAL # . C and Dr . A, and Dr. ear and cohesive pict ure of t he deg r ee ivities. T he Mini s t ry a ckn owledg ed that the h at it did not ha ve enough evidence t o and signific ant ly r estricte d e ith e r l condit io n s he is d ire c tly and significantly confirmed the se restrictions and Dr . R r eported p t perso n al car e for which he needs a lmost all daily li v i n g ribed pr ofess ional provide an o p in ion tha t the e c tly and significa ntly rest ri ct s h is daily l iving peri ods . Da ily living a cti vit ies are defined in i cian 's and a s sessor's repo rts . er, h e clea r l y rep orted periodic r estr i cti ons e to cook w hen his sy mptoms are worse. D r . C u tside the ho me , use of tr ansp orta tion and ella nt is c onti n uou sly res tr ict ed in all ar eas o f is periodica lly re stri cte d by m o od fluc tuations . ssion, fatigue du e to brea t hl es sness , leadi ng to la n t is sever e l y r e s tr ict ed due to COPD , d y sprea boxes in t h e ass ess o r's repor t ind i c at ing that the h m ost ar eas of dail y living, she also ad ded y pes of help th e App ella n t need s . Therefore , is considered, th e Panel finds t hat it was n ot pell a nt ' s sever e physical and ment al i mpairments act iviti es either con ti n uously or peri odic ally for l ish th at the Appellant require s an as sistive f an assistive dog. Also, the Mi n istry's ed from other persons. The need for They listed the specific type
T h e P a n e l ' s F i n d i n g s S e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A a l s o r e q u i r e s t h t h a t b e c a u s e o f d i r e c t a n d s i g n i f i c a n t r e s t r i c t i o n s i n 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 t h o s e a c t i v i t i e s . H e l p i s e c t i o n 3 o f t h e E A P W D A a s a n a s s i s t i v e d e v i c e , t o r 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 . D r . C r e p o r 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 t h a t t h e A p p e l l a n t ' s p a r e n t s m a n a g e h i s f i n a n c e s . D m o b i l i t y a n d h e n e e d s t h e a s s i s t a n c e o f h i s p a r e n 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 n e e d s c o n t i n u o u s p e r i o d i c a s s i s t a n c e w i t h p e r s o n a l c a r e . T h e n u r s e c o n t i n u o u s a s s i s t a n c e w i t h t h e m a j o r i t y o f d a i l y l i v i m a n y d i f f e r e n t k i n d s o f s u p p o r t a n d h e l p , i n c l u d i n g t h r o u g h m e n t a l h e a l t h , a l i f e l i n e d u e t o s e v e r e s h o s e r v i c e s , a n i n d e p e n d e n t l i v i n g w o r k e r f o r a s s i s t a n e x e c u t i v e t a s k s , m o n e y m a n a g e m e n t , c o u n s e l i n g s a l s o r e p o r t e d t h a t t h e A p p e l l a n t r o u t i n e l y u s e s a c a o n t h i s e v i d e n c e f r o m t h r e e p r e s c r i b e d p r o f e s s i o n a n e e d s b e c a u s e h i s s e v e r e i m p a i r m e n t s d i r e c t l y a n d P a n e l f i n d s t h a t i t w a s n o t r e a s o n a b l e f o r t h e M i n i s r e q u i r e m e n t s i n s e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A . C o n c l u s i o n 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 a l l o f t h e e v i d e n c e 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 , w h i c h d e t e r d e s i g n a t i o n , w a s n o t r e a s o n a b l y s u p p o r t e d b y t h e d e c i s i o n . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # : 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 c o n f i r m i n g h i s a b i l i t y t o m a n a g e d a i l y l i v i n g a c t i v i t i e s , t h e 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 i s d e f i n e d i n h e s i g n i f i c a n t h e 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 s t r i c t e d i n a n u m b e r o f d a i l y a c t i v i t i e s a n d w r o t e r R . w r o t e t h a t t h e A p p e l l a n t n e e d s a c a n e f o r s , h e a l t h c a r e , h i s b r o t h e r a n d a d v o c a t e s . D r . R a s s i s t a n c e w i t h a l l d a i l y l i v i n g a c t i v i t i e s , e x c e p t f o r n o t e d t h a t t h e A p p e l l a n t n e e d s e i t h e r p e r i o d i c o r n g a c t i v i t i e s . S h e w r o t e t h a t t h e A p p e l l a n t n e e d s t h e f o l l o w i n g : a s o c i a l w o r k e r , l i f e s k i l l s s u p p o r t r t n e s s o f b r e a t h , t r e a t m e n t s u p p o r t , m e n t a l h e a l t h c e w i t h c o o k i n g , c l e a n i n g , l a u n d r y , s h o p p i n g , e r v i c e s a n d m e d i c a t i o n m a n a g e m e n t . T h e n u r s e n e 2 5 % o f t h e t i m e a n d b r e a t h i n g d e v i c e s . B a s e d l s a b o u t t h e e x t e n t o f t h e h e l p t h a t 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 r e s t r i c t h i s d a i l y l i v i n g a c t i v i t i e s , t h e t r y t o d e t e r m i n e t h a t t h e A p p e l l a n t d i d n o t m e e t t h 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 , t h e P a n e l f i n d s t h a t 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 l i g i b l e f o r P W D e v i d e n c e . T h e r e f o r e t h e P a n e l r e s c i n d s t h a t
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.