PART C -Decision under App eal The decision being appealed is the Ministry of Social Deve "Ministry") J u l y 2 5 , 2014 r econsideration decision in was n ot el igi ble for Persons w ith D isa bil i ties ("PWD") design requirements for P WD designa tion in section 2(2) of t wi t h Disabi lit i es Act . Bas ed o n the informa tion p rovided, A ppella nt h a s a severe mental or physical impairment that in the opinio (i ) directly an d signifi cantly restricts her ability to perform d periodically for extended p e rio ds ; a nd , (ii) as a result of those re st r ic tions sh e requi re s h The Ministry was satisfied that the A p pell ant has reached medi c al pract itioner her i mpa i rment is like ly to cont PART D -R elevan t Legis l ati on E mployment and As sis t an c e for Persons with Disabilities Employm ent and A ssistance for Pers on s with Di sabili EAAT 003(10/06/01) lopm ent and Social I nno v a tion (the whi ch the M i nistry determined that the Appe llan t ati on because she did not meet all the h e E mpl oyment a nd As sistance for Persons t he Mini stry was not s a tis fied th a t the n of a p r e scribed professional ail y l i v i ng ac tivities eithe r co ntinuously or elp to pe rf orm t ho se activ ities. 18 years of age and in the opinion of a inue f o r a t least 2 years. Act ("EAPWDA") Section 2(2) a nd 2(3). t i es R egulat io n ("EA PWDR ") S e c tion 2.
PART E -Summary of Facts With the oral consent of the Appellant, an observer from her advocate's office attended but did not participate in the hearing. For its reconsideration decision, the Ministry had the following evidence: 1. Appellant's PWD application consisting of: • Her self-report dated June 2, 2014. • A physician's report and an assessor's report both completed on June 8, 2014 by a doctor (hereafter "Dr. C") who indicated that the Appellant has been his patient for 2 years and he had seen her 11 or more times in the past year. 2. The Appellant's request f o r reconsideration dated July 14, 2014 with: • A statement by her dated July 14, 2014 • A report by Dr. C dated July 8, 2014 consisting of handwritten answers to prepared questions. For this appeal the Appellant's advocate submitted a written statement with information about the Appellant's circumstances, arguments in support of her appeal and a letter dated September 8, 2014 from Dr. C. In the September 8, 2014 letter, Dr. C wrote that the Appellant asked him to provide further details regarding her long-term conditions and the impact these conditions have on her activities of daily living. He stated that upon reviewing the original application and further information from the Appellant, it was clear that the original application was lacking in some detail and clarity. The Appellant also testified at the hearing. The Ministry did not object to the admissibility of the testimony, the written statement or the doctor's letter. The Panel finds that the Appellant's testimony, as well as the information in the written statement and in the doctor's letter about the Appellant's health conditions and how they impact her daily functioning substantiate and support the evidence that was bef o re the Ministry at the time of reconsideration. Theref o re, the Panel admits the testimony and the written information in accordance with section 22(4) of the Employment and Assistance Act. The information about the Appellant's conditions is summarized below and the arguments are summarized in Part F Reasons of this decision. The Ministry relied on and reaffirmed its reconsideration decision. Diagnoses In the physician's report Dr. C diagnosed the Appellant with COPD [chronic obstructive pulmonary disease], diarrhea NYD [not yet determined], chronic renal failure, and substance abuse. Then in the July 2014 letter, Dr. C referred to the Appellant's history of depression, social isolation, and loss of motivation and anxiety issues. In the September 8, 2014 letter, the doctor described the Appellant's conditions as: asthma/COPD, severe chronic diarrhea (which is likely IBS [irritable bowel syndrome]), depression with anxiety and renal insufficiency. Physical Impairment In her June 2014 self-report, the Appellant described her disabilities as follows: • Has a very dysfunctional bowel; messes her pants and beds sometimes; has to go to the washroom almost 7 times a day. • Cannot qo anvwhere: has to be near a washroom at all times when she qoes out. EAAT003(10/06101)
o H as very bad asthma (CO P D); cannot do things when it is hot outsi or rid e he r bike; sh e has problems br eathing. For her recons ideration request , the Appellant pr o vided the following inf o Since bein g d iagnose d with COPD, has bee living act i v ities. e Is con stantly fatigu ed and e xhausted ; often needs " Sometimes is unable to carry out weekl y activities • Usually has her dau ghter help with cho r e s such as sho pping and food preparation; if her daug hter comp l eted. e She requires co ntinuous s upport an d assistance • H as p re scriptions f or hypertensio n, C OPD and • I s very ea sil y tired; lacks interes t and mo t iva others. • R e a li zes he r disa bilities ha ve ess entiall y led to T he following ad di t i onal inf ormat i o n w a s p r ovid ed in the Appel lan t 's o r al te stimo ny at t he hear i n g : o Sev ere C OPD c auses her to ex perienc e shortn activity , not o nly upon e xertion . • B r e a t hin g requires effor t a nd at times expe r i enc • C o nt i n ue s to suffer fr om s toma c h pa in an d c • C h ro nic rena l d isease a p pear s to be sta bl e an ris k of rel a pse. • Curr e n t le vel o f ph y sic al func tion ing made pos Mini s try' s err o neo us assumption tha t ph ysic a • Able independe ntly to w a l k abou t 2 or m ore b t ries to lea n on s o me thing; ta kes ½ an h our to w • Can lif t abou t 5 lbs. but needs t o stop f or sev c anno t hold, car ry o r lift o n a repe ti t i v e basis. • Due to COP D r e ma ins c o nst a ntly exh au st ed • When sta nding mor e than a couple of minutes will oft unavailable . • Limit ation s exist regardless of weather c ondit • Often experie n ce s drowsi ness and disorien ta • Limits the number of times s he leaves her apartment to about easily exhausted and also because she has to always be near a washroom; some days she remains chronicall y fa t igue d so that she is unable In the physician's report, Dr. C described the Appellant's impai • Mo de r ate -s e vere COPD -gets short of breath. • Diarrhea illness, gene ral investigation negative, bowel syndrome ("!BS"). • Has diarrhea several times a day and needs to be close to a washroom. • Renal disease is stable; substance abuse in remission with risk of relapse. EAAT 003(10106/01) de; hard to go out for w alk s orma t ion: n s ignificantly restricted in carryin g out her daily to take br ea ks w hile completing tasks. all together. laundry, basic house cleaning, grocery is unable t o co me, t he tas k d oes no t get a s confir me d by Dr. C . Acid reflux; t io n to leave h er apartment a nd soc ialize with h er s ocial isolati on. advocat e 's app eal state m e nt and t he e ss of breath du ring a ny type of phy s ical e s t ig h tn e s s i n che s t due to COPD. r amps; sy mpt o ms not helped by medica t ion. d sub st a nce ab u s e is i n remiss ion, bu t there is sible with the use of all h er medic at io ns -n ot l func tio ning w ould i n creas e w i t h m edicati o ns. l o cks, but has to s top every c oup le of steps and a lk abo ut 3 -4 b loc ks to a s tor e. era l break s , sit d own and catch her b re a th; and chro nically fa tigue d. e n lean on something if a seat is ions w her e she lives. tio n as side effects of prescribed medications. onc e a week because she is t o g e t out of bed. r m en t s as follows: no hel p fr om m edication s -likely irritable
o C a n w a l k u n a i d e d o n a f l a t s u r f a c e f o r 2 -4 b r e m a i n s e a t e d 2 -3 h o u r s ( o f t e n n e e d s t o u s e M o r e r e c e n t l y , i n t h e S e p t e m b e r 8 , 2 0 1 4 l e t t e r , t h e o C O P D c a u s e s s h o r t n e s s o f b r e a t h a s w e l l a • I s a b l e t o w a l k t w o b l o c k s , b u t o f t e n h a s t o s s t a i r s u n a i d e d b u t a g a i n h a s t o s t o p d u e t o s a n d n o t l i m i t e d t o h o t d a y s . • I s a b l e t o l i f t b e t w e e n 5 -1 5 l b s . b u t n o t o n r e w e i g h t f o r a n y d i s t a n c e . • I s o n m a x i m u m d o s e s o f h e r i n h a l e r s , s o m e f u n c t i o n a l a b i l i t i e s . o C a n s t a n d i n d e p e n d e n t l y , b u t n o t f o r l o n g p e • I B S c a u s e s s e v e r e c r a m p s a n d a b d o m i n a l p e f f e c t i v e t r e a t m e n t s t o t h i s p o i n t ; i m p a c t s h e c o m m u n i t y f o r a n y l e n g t h o f t i m e n e e d s c o • I n h i s o p i n i o n , t h e s e l i m i t a t i o n s s p e a k t o a s e t h e i n i t i a l a p p l i c a t i o n h e d i d n o t h a v e a l l o f t h A p p e l l a n t ' s h o m e s i t u a t i o n . M e n t a l I m p a i r m e n t A t t h e h e a r i n g , t h e A p p e l l a n t s a i d t h a t s h e i n i t i a l l y d d e p r e s s i o n b y h e r p r e v i o u s d o c t o r w h o p r e s c r i b e d m e f f e c t s . S h e d i d n o t w a n t t o r e s u m e t a k i n g s u c h m e C a b o u t h e r d e p r e s s i o n , a n x i e t y a n d s o c i a l i s o l a t i o n f o l l o w i n g i n f o r m a t i o n i s i n t h e A p p e l l a n t ' s r e c o n s i d e h e r o r a l t e s t i m o n y : • L a c k s i n t e r e s t a n d m o t i v a t i o n t o l e a v e h e r a p • R e a l i z e s h e r d i s a b i l i t i e s h a v e e s s e n t i a l l y l e d s e v e r e r e s t r i c t i o n s o n h e r m o b i l i t y ; h a s n o f a m d a u g h t e r . • I n a b i l i t y t o c a r r y o u t d a i l y l i v i n g a c t i v i t i e s a n d d e p r e s s i o n . • S y m p t o m s o f d e p r e s s i o n a n d a n x i e t y c o n t i n u f e e l d r o w s y a n d d i s o r i e n t e d . I n t h e p h y s i c i a n ' s a n d a s s e s s o r ' s r e p o r t , t h e d o c t o r 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 t h a t t h e A p p e l l a n t h a s h i s t o r y o f d e p r e s s i o n / a n x i e t y a l s o t a k e s 5 m e d i c a t i o n s . D r . C . w r o t e , i n t h e S e p t e o f s e c t i o n s o f t h e p h y s i c i a n ' s a n d a s s e s s o r ' s r e p o r t . A p p e l l a n t o f t e n h a s d i f f i c u l t y m a i n t a i n i n g c o n c e n t r a t e a s i l y . T h i s o f t e n l e a d s t o a n i n a b i l i t y t o f u l l y u n d e r s s p e e c h a n d t h i n k i n g . S h e i s n o t m o t i v a t e d t o g e t o u t h i s . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )l o c k s ; c a n c l i m b 2 -5 s t a i r s ; c a n l i f t 5 -1 5 I b s . ; c a n w a s h r o o m ) . d o c t o r w r o t e t h e f o l l o w i n g a b o u t t h e A p p e l l a n t : s f a t i g u e w i t h a n y p h y s i c a l a c t i v i t y s u c h a s w a l k i n g . t o p d u e t o s h o r t n e s s o f b r e a t h ; c a n c l i m b a f e w h o r t n e s s o f b r e a t h a l l i r r e s p e c t i v e o f t h e w e a t h e r p e t i t i v e o r o n g o i n g b a s i s ; u n a b l e t o c a r r y t h i s d i c a t i o n s w o u l d n o t f u r t h e r i n c r e a s e h e r p h y s i c a l r i o d s n o t m o r e t h a n ½ h o u r w i t h o u t h a v i n g t o s i t . a i n a s w e l l a s d i a r r h e a o n a d a i l y b a s i s ; n o r a b i l i t y t o p e r f o r m s u s t a i n e d t a s k s o r b e o u t i n t h e n s t a n t a c c e s s t o a b a t h r o o m . v e r e d e g r e e o f p h y s i c a l i m p a i r m e n t ; a t t h e t i m e o f e i n f o r m a t i o n n e c e s s a r y t o a c c u r a t e l y a s s e s s t h e i d n o t t e l l D r . C . t h a t s h e h a d b e e n t r e a t e d f o r e d i c a t i o n t h a t s h e s t o p p e d t a k i n g b e c a u s e o f i t s d i c a t i o n s . T h e A p p e l l a n t s a i d t h a t s h e d i d t e l l D r . f o r t h e r e c o n s i d e r a t i o n s u b m i s s i o n s . T h e r a t i o n s t a t e m e n t , t h e a p p e a l s u b m i s s i o n a n d f r o m a r t m e n t a n d s o c i a l i z e w i t h o t h e r s . t o h e r s o c i a l i s o l a t i o n ; i s s o c i a l l y i s o l a t e d d u e t o i l y o r f r i e n d s i n s o c i a l s u p p o r t s y s t e m e x c e p t h e r s u p p o r t / t a k e c a r e o f h e r s e l f h a s l e d t o e e v e n w i t h m e d i c a t i o n s ; m e d i c a t i o n s m a k e h 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 d i d n o t h a v e a n y t i o n i n g . I n h i s J u l y 2 0 1 4 l e t t e r , t h e d o c t o r w r o t e w i t h l o s s o f m o t i v a t i o n a n d s o c i a l i s o l a t i o n . S h e m b e r 8 , 2 0 1 4 l e t t e r , t h a t h e o v e r l o o k e d a c o u p l e H e s t a t e d t h a t i t i s h i s u n d e r s t a n d i n g t h a t t h e i o n a n d t e n d s t o g e t c o n f u s e d a n d o v e rw h e l m e d t a n d q u e s t i o n s a s k e d a n d d i s o r g a n i z a t i o n i n h e r t o f t h e h o u s e a n d i s s o c i a l l y i s o l a t e d b e c a u s e o f
Daily Living Activities In the advocate's appeal statement, the following information about the Appellant's ability to manage daily living activities was provided: • Symptoms such as shortness of breath, tightness in chest, severe stomach pains and cramps, constant fatigue and exhaustion significantly restrict or prevent her from carrying out daily living activities. • Is unable to independently carry out activities such as shopping; cannot shop daily or make numerous trips a week because too strenuous and would have to carry only one or two items at a time. Relies on help with carrying and delivering groceries once a week. • Rarely leaves her apartment and limits outdoor visits to necessary tasks. • Trip to doctor's office leaves her severely exhausted so unable to get out of bed the next day. • Completes some tasks such as bathing and toileting at an extremely slow pace, with several long breaks; mobility remains severely restricted. • Severely restricted with completing laundry and basic housekeeping; daughter takes laundry to Laundromat and also vacuums, sweeps, mops, dusts, and cleans the kitchen, tub and toilet. In the physician's report the doctor noted that the Appellant has not been prescribed any medications and/or treatments that interfere with her ability to perform daily living activities. In the assessor's report, Dr. C reported the Appellant's ability to function as follows: • Walking indoors and outdoors, and climbing stairs take significantly longer -gets short of breath; needs to be close to washroom. o Standing -independent. • Lifting, and carrying and holding -needs periodic assistance -gets short of breath. • Independently manages personal care except for toileting for which she needs assistive device; i.e., needs to be close to washroom. • Needs periodic assistance with laundry and basic housekeeping -gets short of breath with exertion. • Needs periodic assistance with going to/from stores and with carrying purchases home -gets short of breath with exertion; independently manages reading prices/labels, making appropriate choices, paying for purchases. • Independently manages preparing meals, managing personal finances, managing personal medications. • Needs to be near bathroom when using public transit; independently manages to get in/out of a vehicle and to use transit schedules -difficult for her to travel in the community due to frequent diarrhea. • "NIA" [Not Applicable] for social functioning; has good functioning with her immediate social network and marginal functioning with her extended social network. Dr. C provided the following information in his July 8, 2014 report: • Dressing and grooming take 2 times longer than typical to complete; bathing takes 3 times longer and toileting takes 5 times longer. • Meal preparation takes 2 times longer. • Transfers in/out of bed and transfers in/out of chair take 2 times longer. • Laundry and basic housekeeping -"bundle -gets help from her daughter". • Meal planning takes 2 times longer; food preparation and cooking take 4 times longer. • Getting in/out of vehicle takes 3 times longer and using public transport takes 3 times longer. • Gets short of breath due to COPD; feels fatigue all the time; needs breaks to comolete dailv EAAT003(10/06/01)
living activities. o Needs continuous assistance with the above activities; that is, needs help continuously with cleaning, groceries and food preparation. • Takes 5 different medications. In September 2014, Dr. C wrote that at the time of the initial application he did not have all of the information necessary to accurately assess the Appellant's home situation. He now feels that: • She requires continuous assistance rather than periodic completing daily living activities such as house cleaning, grocery shopping and doing laundry. o Combination of her medical symptomatology, such as restricted mobility and social isolation makes it difficult for her to independently care for herself and she often has her daughter assist her with daily tasks. • In some cases she is unable to complete tasks on her own. • In his opinion, the Appellant suffers from severe impairments that directly and significantly restrict her from carrying out daily living activities. Help with Daily Living Activities Dr. C noted in the physician's report that the Appellant does not need any prostheses or aids for her impairment. In the assessor's report. Dr. C indicated that the Appellant receives help from family and friends, and does not have an assistance animal. In July 2014 and in September 2014 Dr. C wrote that the Appellant needs continuous help with living activities such as house cleaning, grocery shopping, food preparation and doing laundry. Her daughter assists her. The Appellant stated that her daughter helps with weekly tasks such as grocery shopping, house cleaning and laundry. Otherwise, these tasks would not get done. She needs her daughter's continuous help with these activities. EAAT 003(10/06/01I
PART F -Reasons for Panel Decision The issue in this appeal is whether the Ministry reasonably determined that the Appellant was not eligible for PWD designation because she did not meet all of the requirements in section 2(2) of the EAPWDA, and specifically, that the Appellant does not have a severe mental or physical impairment that in the opinion of a prescribed professional (i) directly and significantly restricts her ability to perform daily living activities either continuously or periodically for extended periods; and, (ii) as a result of those restrictions she requires help to perform those activities. The eligibility criteria for PWD designation are set out in the following sections of the EAPWDA: 2 (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 ability 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. The "daily living activities" referred to in EAPWDA section 2(2)(b) are defined in the EAPWDR as: 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; (iii) shop for personal needs; (iv) use public or personal transportation facilities; (v) perform housework to maintain the person's place of residence in acceptable sanitary condition; (vi) move about indoors and outdoors; (vii) perform personal hygiene and self-care; (viii) manage personal medication, and (b) in relation to a person who has a severe mental impairment, includes the following activities: (i) make decisions about personal activities, care or finances; (ii) relate to, communicate or interact with others effectively. Severe Physical Impairment The Appellant's advocate argued that the Ministry did not reasonably consider all of the information provided by the Appellant and her doctor. The Ministry also erroneously assumed that the Appellant's functioning could be increased with medication when in fact the Appellant's current level of physical functioning is possible because she is using the maximum amount of her medications. The Appellant's position is that her evidence and her doctor's establish that she does have a severe physical impairment which significantly restricts her physical functioning abilities. In its reconsideration decision, the Ministry wrote that it reviewed the Appellant's self-reports and the doctor's reports. The Ministry noted that medication information was provided with the reconsideration information and then it wrote that it was reasonable to assume that the Aooellant was EAAT003(10/06/01)
able to increase her physical functionality with the use of medications. The Ministry determined that the information provided established a moderate degree of physical impairment. The Panel's Findings The diagnosis of a serious medical condition does not in itself establish a severe impairment. To satisfy the requirements in section 2(2) of the EAPWDA, there must be evidence of how and the extent to which an impairment restricts the Appellant's functioning. This includes evidence from the Appellant as well as from a prescribed professional, who in this case is Dr. C. Dr. C. wrote that the Appellant suffers from asthma/COPD, severe chronic diarrhea (likely !BS) and renal insufficiency. In the more recent report of September 4, 2014, Dr. C. stated that the COPD causes shortness of breath as well as fatigue with any physical activity such as walking. The doctor also explained, in the September letter, that he had more information about the Appellant's impairments than when he completed the physician's and assessor's reports for the PWD application. In September 2014, the doctor wrote that the Appellant can walk 2 blocks and climb a few stairs, but has to stop due to shortness of breath, regardless of the weather. The Appellant can lift between 5-15 lbs but not on a repetitive basis or for any distance. Dr. C. stated that medications would not further increase the Appellant physical functioning. In his July 2014 letter, the doctor also noted that activities requiring physical abilities such as dressing, grooming, bathing, meal preparation, transferring in/out of bed, transferring in/out of chairs, and going to and from stores take from 2 to 5 times longer than typical. The doctor wrote that the Appellant needs breaks to complete activities and for some activities needs continuous assistance. In addition, !BS causes severe cramps and abdominal pain as well as diarrhea on a daily basis with no effective treatments to this point. These conditions impacts the Appellant's ability to perform sustained tasks or be out in the community for any length of time. In his opinion, these limitations speak to a severe degree of physical impairment. The Appellant said that she can walk about 2 blocks, but has to stop every couple of steps to take a breath and the same with climbing stairs. She also stated that she is constantly fatigued and exhausted, needing breaks while completing tasks. Sometimes she is unable to do any tasks and other times she stays in bed for a day to recover. Also her diarrhea and bowel illnesses limit her ability to do things or leave her apartment because she has to be near a bathroom. The Panel finds that there was no sufficient basis in the information in the record for the Ministry to make the assumption that medications would improve the Appellant's functioning. In fact, the evidence from the doctor and the Appellant is that she is taking the maximum amount of inhaler dosage. Further, the Panel finds that when all of the evidence from the Appellant and especially the more recent reports from Dr. C about the many and sustained restrictions to the Appellant's physical functioning are considered, it was not reasonable for the Ministry to determine that the Appellant does not have a severe physical impairment. Severe Mental Impairment The Appellant's advocate submitted that the Appellant also has a severe mental impairment. Her inability to support and take care of herself has led to her depression and her social isolation. The Ministry wrote that based on the information provided it could not determine that the Appellant had a severe mental im airmen!. EAAT 003(10/06/01)
T h e P a n e l ' s F i n d i n g s 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 h a s a h i s t o r y o f d e a n d a n x i e t y i s s u e s . T h e d o c t o r a l s o w r o t e t h a t t h e q u e s t i o n s a s k e d , i s d i s o r g a n i z e d i n h e r s p e e c h a n d t h a n t h e s e s y m p t o m s , a n d t h e A p p e l l a n t ' s s o c i a l i s n o o t h e r i n f o r m a t i o n a b o u t h o w t h e A p p e l l a n t ' s m e n e m o t i o n a l f u n c t i o n i n g . T h e A p p e l l a n t d e s c r i b e d h e r i s o l a t i o n a n d c a u s i n g h e r d e p r e s s i o n . A g a i n , h o w e o u t o f h e r a p a r t m e n t , t h e A p p e l l a n t d i d n o t p r o v i d e h a v e o n h e r c o g n i t i v e a b i l i t i e s ; f o r e x a m p l e , t a k i n g m d e c i s i o n s i n s o c i a l f u n c t i o n i n g o r c o p i n g w i t h u n e x p i n f o r m a t i o n i s c o n s i d e r e d , t h e P a n e l f i n d s t h a t t h e M d o e s n o t 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 . R e s t r i c t i o n s t o D a i l y L i v i n g A c t i v i t i e s 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 d e f i n i t i o n E A P W D R s h o u l d b e a p p l i e d t o t h e A p p e l l a n t ' s c i r c u t h e a s s e s s o r ' s r e p o r t . T h e a d v o c a t e s u b m i t t e d t h a t e x p e c t t h a t s h e w o u l d p e r f o r m e a c h o f t h e a c t i v i t i e s F o r e x a m p l e , b e c a u s e o f t h e A p p e l l a n t ' s s e v e r e p h y d a y a n d t r y t o c a r r y h o m e o n e o r t w o i t e m s . I n s t e a d a b o u t o n c e a w e e k . T h e r e f o r e , t h e a d v o c a t e a r g u e d a s s e s s e d b a s e d o n " s h o p fo r p e r s o n a l n e e d s " a s l i s f o r p e r f o r m i n g 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 c o n d i t i o n . T h e a d v o c a t e s u b m i t t e d t h a t , i n t h i s c a s e t h a t t h e A p p e l l a n t i 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 S h e n e e d 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 a n u m b e r o f T h e M i n i s t r y w r o t e t h a t , a l t h o u g h i t a c k n o w l e d g e s t h f r o m h e r m e d i c a l c o n d i t i o n s , i t f o u n d t h a t t h e i n f o r m i m p a i r m e n t s i g n i f i c a n t l y r e s t r i c t s h e r a b i l i t y t o p e r f o r f o r e x t e n d e d p e r i o d s . 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 ) o f t h e E A P W D A r e q u i r e s a p r e s c r i b e A p p e l l a n t ' s s e v e r e p h y s i c a l o r m e n t a l i m p a i r m e n t d i a c t i v i t i e 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 d p s e c t i o n 2 ( 1 ) o f t h e E A P W D R . T h e p r e s c r i b e d p r o f e T h e P a n e l n o t e s t h a t , i n h i s t w o m o r e r e c e n t r e p o r t s r e s t r i c t i o n s a n d d i d n o t j u s t c h e c k o f f b o x e s o n a f o r a r e a s o f p e r s o n a l c a r e , s h o p p i n g , m e a l s a n d t r a n s p f o r b a s i c h o u s e k e e p i n g a n d c a r r y i n g p u r c h a s e s s h e " c o n t i n u o u s " 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 l l a n t n a d d e d t h a t s h e n e e d s h e l p c o n t i n u o u s l y w i t h c l e a n i n e x p l a i n e d t h a t s h e o h v s i c a l l v c a n n o t s h o o o n a d a i l v EM T 0 0 3 ( 1 0 / 0 6 / 0 1 )p r e s s i o n , s o c i a l i s o l a t i o n , a n d l o s s o f m o t i v a t i o n A p p e l l a n t o f t e n i s u n a b l e t o f u l l y u n d e r s t a n d t h i n k i n g , a n d i s s o c i a l l y i s o l a t e d . H o w e v e r , o t h e r o l a t i o n a n d l o s s o f m o t i v a t i o n , t h e d o c t o r p r o v i d e d t a l h e a l t h c o n d i t i o n s i m p a c t h e r c o g n i t i v e a n d p h y s i c a l i m p a i r m e n t s a s l e a d i n g t o h e r s o c i a l v e r , o t h e r t h a n r e s t r i c t i n g h e r i n h e r a b i l i t y t o g e t a n y i n f o r m a t i o n a b o u t t h e i m p a c t t h e s e c o n d i t i o n s e d i c a t i o n s a s r e q u i r e d , m a k i n g a p p r o p r i a t e e c t e d d e m a n d s . T h e r e f o r e , w h e n a l l o f t h e i n i s t r y r e a s o n a b l y d e t e r m i n e d t h a t t h e A p p e l l a n t o f d a i l y l i v i n g a c t i v i t i e s i n s e c t i o n 2 ( 1 ) ( a ) o f t h e m s t a n c e s , r a t h e r t h a n t h e M i n i s t r y ' s l i s t o f t a s k s i n i n t h e A p p e l l a n t ' s c a s e i t w a s n o t r e a s o n a b l e t o l i s t e d i n t h e a s s e s s o r ' s r e p o r t o n a d a i l y b a s i s . s i c a l i m p a i r m e n t s , s h e c a n n o t g o s h o p p i n g e v e r y , s h e r e l i e s o n h e r d a u g h t e r t o d o h e r s h o p p i n g t h a t t h e A p p e l l a n t ' s s e v e r e i m p a i r m e n t s m u s t b e t e d i n s e c t i o n 2 ( 1 ) ( a ) ( i i i ) o f t h e E A P W D R ; l i k e w i s e l a c e o f r e s i d e n c e i n a c c e p t a b l e s a n i t a r y , 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 , D r . C , c o n f i r m e d e d i n h e r a b i l i t y t o i n d e p e n d e n t l y c a r e f o r h e r s e l f . t h e d e f i n e d a c t i v i t i e s . a t t h e A p p e l l a n t h a s c e r t a i n l i m i t a t i o n s t h a t r e s u l t a t i o n p r o v i d e d d i d n o t e s t a b l i s h t h a t a s e v e r e m d a i l y l i v i n g a c t i v i t i e 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 d p r o f e s s i o n a l ' s o p i n i o n c o n f i r m i n g t h a t t h e 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 e r d a i l y l i v i n g e r i o d s . D a i l y l i v i n g a c t i v i t i e s a r e d e f i n e d i n s s i o n a l i n t h i s c a s e i s D r . C . , D r . C p r o v i d e d d e t a i l s o f t h e A p p e l l a n t ' s m . I n J u l y 2 0 1 4 , t h e d o c t o r r e p o r t e d t h a t i n a l l o r t a t i o n , t h e A p p e l l a n t t a k e s 2 -5 t i m e s l o n g e r a n d n e e d s h e l p . T h e d o c t o r a l s o a n s w e r e d e e d s p e r i o d i c o r c o n t i n u o u s a s s i s t a n c e . H e g , g r o c e r i e s a n d f o o d p r e p a r a t i o n . T h e A p p e l l a n t b a s i s a n d s h e r e l i e s o n h e r d a u g h t e r t o d o t h e
weekly shopping, cleaning tasks and food preparation. In September 2014, the doctor described the Appellant has having a severe degree of impairment. The COPD (shortness of breath and fatigue) and IBS result in her inability to perform sustained tasks or be out in the community. He also wrote that, after having more information about the Appellant's home situation, he felt that she requires continuous assistance rather than periodic with completing activities such as house cleaning, grocery shopping and doing laundry. He added that the combination of her medical symptomatology, such as restricted mobility and social isolation, makes it difficult for her to independently care for herself. When the more recent combined information from Dr. C is considered, the Panel finds that the doctor confirmed that the Appellant needs continuous assistance with the following activities listed in section 2(1)(a) of the EAPWDR: prepare own meals, shop for personal needs and perform housework to maintain her place of residence in acceptable sanitary condition. The doctor also reported that the Appellant has severe impairments in moving about indoors and outdoors, performing personal hygiene and self care, and using transportation facilities. Therefore, based on Dr. C's assessments, the Panel finds that the Ministry did not reasonably determine that the information did not demonstrate that the Appellant's severe physical impairment directly and significantly restricts her ability to perform daily living activities either continuously or periodically for extended periods Help with Daily Living Activities The Appellant's advocate submitted that the Appellant needs continuous help with a number of the living activities defined in the EAPWDR. Her daughter helps her continuously with those otherwise they would not get done. The Ministry's submitted that the information did not establish that the Appellant's needs the significant help of another person, any assistive devices or an assistance animal. Also, its position is that because the evidence does not establish that daily living activities are significantly restricted, it cannot determine that significant help is required from other persons. The Panel's Findings Section 2(2)(b )(ii) of the EAPWDA also requires the opinion of a prescribed professional confirming that, because of direct and significant restrictions in her ability to manage daily living activities, the Appellant requires help with those activities. Dr. C confirmed that the Appellant needs continuous help with a number of the activities defined in section 2(2)(1 )(a) such as prepare own meals, shop for personal needs and perform housework to maintain her place of residence in a sanitary condition. He also confirmed that the Appellant's daughter provides such help. Theref o re, based on Dr. C's reports, the Panel finds that the Ministry did not reasonably determine that the Appellant did not need significant help from another person. Conclusion Having reviewed and considered all of the evidence and the relevant legislation, the Panel finds that the Ministry's reconsideration decision, which determined that the Appellant was not eligible for PWD designation, was not reasonably supported by the evidence. Therefore the Panel rescinds the decision in favour of the Aooellant. EAAT 003( 10/06/01)
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