P A R T C D e c i s i o n u n d e r A p p e a l T h e d e c i s i o n b e i n g a p p e a l e d i s t h e M i n i s t r y o f S o c i a " M i n i s t r y " ) A u g u s t 5 , 2 0 1 4 r e c o n s i d e r a t i o n d e c i s i o n 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 e r s o n s w i t h D i s a b i l i t i a l l t h e r e q u i r e m e n t s f o r P W D d e s i g n a t i o n i n s e c t i o n P e r s o n s w i t h D i s a b i l i t i e s A c t . B a s e d o n t h e i n f o r m a t h e A p p e l l a n t ' s s e v e r e m e n t a l i m p a i r m e n t , i n t h e o p ( 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 h e r a b i l i t y t o p 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 e s u l t o f t h o s e r e s t r i c t i o n s s h e r e q u i r e s h T h e M i n i s t r y w a s s a t i s f i e d t h a t t h e A p p e l l a n t h a s r e a m e d i c a l p r a c t i t i o n e r , h e r s e v e r e m e n t a l i m p a i r m e n t P A R T D R e l e v a n t L e g i s l a t i o n E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )l D e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ( t h e i n w h i c h t h e M i n i s t r y d e t e r m i n e d t h a t t h e e s ( " P W D " ) d e s i g n a t i o n b e c a u s e s h e d i d n o t m e e t 2 ( 2 ) 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 f o r t i o n p r o v i d e d , t h e M i n i s t r y w a s n o t s a t i s f i e d t h a t 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 , 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 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 h e d 1 8 y e a r s o f a g e a n d t h a t , i n t h e o p i n i o n o f a i s l i k e l y t o c o n t i n u e f o r a t l e a s t 2 y e a r s . i l i t i e s A c t ( " E A P W D A " ) S e c t i o n 2 ( 2 ) a n d 2 ( 3 ) . i l i t i e s R e g u l a t i o n ( " E A P W D R " ) S e c t i o n 2 .
PART E -Summarv of Facts The Appe llant did not appear at the hearing. The Pane pr ovided to the Appellant and t hen, in accordance with section 86(b) of the Employment a:nd Assistance Regulat ion, procee d e d with the hear ing For its rec onsideration decision, the Ministry had the followi 1. Appellant's M ar c h 2 4, 2014 PWD ap plication consi • A physician's report complete d on Fe b r uary in d i cated that the Appellant has been her patient since 2008 2-10 times in the past 12 months • An a s se s sor's report complet ed on March 4, 2014 by a nurse p in d i cated that sh e h a s know n the Appellant for 5 years and had seen in the l ast year . The nurse practitioner ad ded tha outreach clinics. • A psych ia t ry consult dat e d February 18, 2014 compl 2. Appella nt's J uly 30, 2014 request for r ec onsid eration an d a ls o submitted a lette r fr om Dr . N 3. Letter dated July 30, 2014 t o t h e Ministry fr om D r. Be c ause t he Appellan t di d n ot appear at t h e h reco n sid e ration statement to be her position in th i s re c onsideration d ecision . The Pa nel ha s su m mari zed the evide nce rele v a nt to t Diagno ses and de s criptio n of the Appellant's m ental In the ph ysic ia n's repor t , Dr . L ha d d iagno s e d de pre s sion. T he mo re updat ed dia gnoses of the App fr om Dr . N, th e psyc h iatris t ; th at is, m ajo r depr es stress dis o r d er -ch r o nic a nd seve re; socia l anxi ety w rot e tha t the Appe l lan t d is l ikes b eing on pills if a t a that time and is concerned about how the depression is affecting Daily Living Activities The Appellan t descri b ed her daily functioning limitations as follows: • Tried to go to work one day and had a hard time leaving the house. Her anxiety about leaving and throughout the day was hard. She does not have the energy to go out and she finds that s he ca nnot b e in public for too long. She has missed app ointments an d a different doctor won't see her. • Has a r e al ly hard t ime going to slee p when she needs to. • Finds it hard to socialize with a ny one. • Is fi n di n g it hard to keep up with her own housework, cooking and cle In the physician's report, Dr. L provided the following information about the Appellant's ability to m a naae dail v livina activi ties: EMT 003( 10/06/01) l confirmed that notice of the heari ng was in h er absence. ng evidence: sting of: 26, 2014 by a doctor (hereafter "Dr. L") who an d she h a d s e en th e A p pellant ractiti o n er (here after "NP") who the Appel lant 2-10 times t t h e Appellant has seen her regularly during et ed by a psychiat r ist (her e after "Dr. N '). in which she pr o vi ded a w rit ten stat ement N. earing, the Panel will c on s ider her r eq u es t f or appe al. Th e M i nistry re lie d on and reaf firmed its he t wo PWD criteri a a t i s sue i n this ap peal. h eal t h c on ditions. t h e A p pell a nt wi t h m ood di s ord er, an xiety a nd ellan t's conditions are in t he July 20, 201 4 letter sive dis o rder r e curr e n t , s ever e; p osttra umatic disor der; and , alcoh ol use disorde r. Dr. N also l l possibl e , was no t moti v ated to try coun se li ng at her functioning and energy. tw o really i m p orta n t m edical aning.
• Has not been prescribed any medication and/or treatments that intertere with her ability to pertorm daily living activities. • Has very poor sleep which affects her ability to function during the day. • Due to her depressed mood, lacks motivation, concentration and this affects her me· mory. • Answered yes to the question whether the Appellant's impairment directly restricts her ability to pertorm daily living activities. • Next to the list of daily living activities in part E of the report, boxes for "yes" are checked off, crossed out and also boxes for "no" are checked off next to personal self care, meal preparation, basic housework, daily shopping, mobility inside and outside the home, use of transportation, and management of finances. There are no explanations for these changes. • Management of medications is restricted periodically -"forgetful". • Social functioning is restricted periodically. • For the explanation for "periodic" the doctor added "severely impaired at times, especially under stress". "Her social functioning is impaired by her depression & anxious mood." • Degree of restriction -"moderate to severe". In the assessor's report, the NP reported the impacts of the Appellant's impairments as follows: • Has good ability to communicate in all areas (speaking, reading, writing, and hearing). • Independently manages walking indoors/outdoors and climbing stairs, but takes significantly longer with all three -"fatigue"; independently manages lifting, and carrying and holding. • Low mood impacts all daily activities; severe insomnia, poor appetite, very low energy. • Independently manages all areas of personal care, paying rent and bills -"has direct payment of rent/utilities", medications and transportation. • Independently manages laundry and basic housekeeping, needs periodic assistance with both and they take significantly longer -"poor motivation, some support from mother". • Independently manages all areas of shopping; going to/from stores and carrying purchases home take significantly longer. • Independently manages all areas of meals; meal planning, food preparation and cooking take significantly longer. • Needs periodic assistance with all areas of social functioning. • Has marginal functioning with her immediate social network -"tends to isolate self", and with her extended social network. Dr. N described the impacts of the Appellant's impairments on her functioning as follows: • Sleep is a major issue varying from 2-9 hours at night and sometimes days without sleep resulting in worsening of fatigue. • Despite successful abstinence from alcohol for months, the Appellant's major depressive disorder has resulted in a further decline in functioning in the last few months. • Missed multiple medical appointments and tried to return to a prior job unsuccessfully due to increase in depression and anxiety under the stress of leaving the house, and taking on past work. • Sleep, appetite, energy, concentration and communication are affected by major depression with social isolation, anhedonia and hopelessness. • Has a history of difficulty with compliance with medication due to ambivalence regarding medications and attention/memory problems. EAAT 003( 10/06/01)
Help with Daily Living Activities Dr. L w r ote that the App ellant is struggling with caring for her children ext r a help. The NP noted th at fa mi l y help the Appellant, h e r pare ag en c ies provide assistance. Also th e Appellant nee pass, recreatio n cent re pass for herself and her childre providing foo d and free bab ysitting. The Appellant does not have an equipment or devi ces , the NP wrote " N/A"[not a ppli cable Dr. N wrote that counse l ing for depres si o n and anxiet motivated to try it; concurrent disorder treatment might be attempted. EMT003(10/06/01) d ue t o her m o od and ne eds n ts support her, and community se rvice ds the following help: o ngoing counseling, bus n. Sh e a lso needs f o od ; her p a ren ts are as sistance a ni mal and for ]. y could be helpful, b ut the Ap pellant i s no t
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 s 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 s 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 ' s s e v e 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 e i t h e r c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o r e q u 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 . 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 i ( 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 i ( 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 e 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 ( 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 r e a s o n a b l e n e s s o f t h e M i n i s a t i s s u e i n t h i s a p p e a l . 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 p o s i t i o n i s t h a t h e r s e v e r e m e n t a l i m e x a m p l e , s h e h a s d i f f i c u l t y l e a v i n g h e r h o u s e a n d s o a n d c o o k i n g , a n d m a k i n g i t t o h e r a p p o i n t m e n t s . I n i t s r e c o n s i d e r a t i o n d e c i s i o n , t h e M i n i s t r y w r o t e t h a m e n t a l i m p a i r m e n t , b u t i t w a s n o t s a t i s f i e d t h a t t h e i n i m p a i r m e n t , i n t h e o o i n i o n o f a o r e s c r i b e d p r o f e s s i o n E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )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 r e m e n t a l i m p a i r m e n t , i n t h e o p i n i o n o f a 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 m d a i l y l i v i n g a c t i v i t i e s d s ; a n d , ( 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 s h e 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 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 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 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 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 t r y ' s d e c i s i o n w i t h r e s p e c t t o t h e t w o P W D c r i t e r i a p a i r m e n t s r e s t r i c t h e r a b i l i t y t o f u n c t i o n ; f o r c i a l i z i n g w i t h a n y o n e , t a k i n g c a r e o f h e r h o u s e t i t i s s a t i s f i e d 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 f o r m a t i o n d e m o n s t r a t e s t h a t h e r s e v e r e a l , s i � n i f i c a n t l v r e s t r i c t s h e r a b i l i t v t o p e r f o r m
daily living activities either continuously or periodically for extended periods. The Panel's Findings Section 2(2)(b) of the EAPWDA requires a prescribed professional's opinion confirming that the Appellant's severe mental impairment directly and significantly restricts her daily living activities, continuously or periodically for extended periods. Daily living activities are defined in section 2(1) of the EAPWDR and are also listed in the physician's and assessor's reports. The prescribed professionals in this case are Dr. L., Dr. N the psychiatrist and the nurse practitioner. It is not clear from Dr. L's report how restricted the Appellant is in her ability to manage daily living activities, except for managing medications and social functioning, which Dr. L reported are periodically restricted. The only detail from the doctor is that the Appellant is severely impaired at times, especially under stress, and that she is f o rgetful about her medications and her social functioning is impaired by her depression or anxious moods. The NP reported that, with the exception of social functioning, the Appellant independently manages all her daily living activities, including those requiring cognitive abilities such as making appropriate shopping choices, planning meals and managing her medications. For basic housekeeping, the Appellant is independent, but she also needs periodic assistance and takes longer, with poor motivation and support from her mother. As for social functioning, the NP reported that the Appellant needs periodic support or supervision. However, in the areas of social functioning, neither Dr. L nor the NP provided any details about how much support or supervision the Appellant needs or how often. The NP only added that the Appellant tends to isolate herself in her immediate social network. Although Dr. N wrote that the Appellant's major depressive disorder has resulted in a further decline in functioning in the last few months, Dr. N provided no specifics about such a decline or which daily living activities are restricted and to what extent. Therefore, when the combined information from the three prescribed professionals is considered, the Panel finds that the Ministry reasonably determined that the inf o rmation does not demonstrate that the Appellant's severe mental 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 position is that she needs help from family, from counseling services and from community service groups. 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. As noted above, none of the prescribed professionals provided details about how often or the extent of help or supervision the Aooellant needs with EAAT003(10/06/01)
managing daily living activities. Only general information was provided that the Appellant needs and receives help from her parents, and that she needs ongoing counseling and help from community service agencies. Therefore, the Panel finds that the Ministry reasonably concluded that it could not determine that the Appellant needs significant help to manage her daily living activities. 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 reasonably supported by the evidence. Therefore the Panel confirms that decision. EAA T003(10/06/01)
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