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 u n d e r a p p e a l i s t h e M i n i s t r y o f S o c i a l " m i n i s t r y " ) r e c o n s i d e r a t i o n d e c i s i o n o f J u l y 2 2 , 2 0 1 4 t h r e e o f f i v e s t a t u t o r y r e q u i r e m e n t s o f s e c t i o n 2 o f t D i s a b i l i t i e s A c t ( " E A P W D A " ) f o r d e s i g n a t i o n a s a p e t h a t t h e a p p e l l a n t m e t t h e a g e r e q u i r e m e n t a n d t h a t a p p e l l a n t ' s i m p a i r m e n t 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 a t i s f i e d t h a t : • t h e e v i d e n c e e s t a b l i s h e s t h a t t h e a p p e l l a n t h • t h e a p p e l l a n t ' s d a i l y l i v i n g a c t i v i t i e s ( " D L A " ) a d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t e d e i t h e r c o n t i n u o u s • 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 a p p e l l a n t a n o t h e r p e r s o n , a n a s s i s t i v e d e v i c e , o r t h e s e r v i c e s 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 )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 , w h i c h f o u n d 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 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 P e r s o n s W i t h r s o n w i t h d i s a b i l i t i e s ( " P W D " ) . T h e m i n i s t r y f o u n d i n t h e o p i n i o n o f m e d i c a l p r a c t i t i o n e r t h e s t t w o y e a r s . H o w e v e r , t h e m i n i s t r y w a s n o t a s a 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 ; r e , 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 , 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 d s ; a n d t h a t r e q u i r e s t h e s i g n i f i c a n t h e l p o r s u p e r v i s i o n o f o f a n a s s i s t a n c e a n i m a l . i l i t i e s A c t ( E A P W D A ) s e c t i o n 2 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 -Summary of Facts The information in chronological order that was before the ministry at the time of reconsideration included the following: 1. A letter from a specialist dated July 21, 1994 indicated that the appellant needs a bowel resection and arrangements will be made. 2. A Medical History Report on the appellant dated August 17, 1994 indicated that she was booked for right Hemicolectomy resection for Crohn's. 3. A Clinical History Final Report dated August 30, 1994 indicated the appellant's diagnoses as Right Hemicolectomy, Severe Active Crohn's Disease and Terminal Ileum. 4. A Consultation Report dated June 16, 2002 indicated ongoing Crohn's disease. 5. A letter dated August 19, 2002 from a consultant in Rheumatology indicated that the appellant has right knee arthropathy associated with Crohn's disease and it has improved considerably with her treatment. 6. An Operative Report dated February 18, 2003 indicated that a portion of the appellant's bowel was removed and that the Crohn's disease was not the cause of the bowel obstruction and she was left with a short gut syndrome. 7. A Surgical Summary Report dated May 1, 2003 indicated that the appellant's discharge diagnosis was Small Bowel Obstruction, secondary to adhesions and the secondary diagnosis was Crohn's disease -moderately active. 8. An X-Ray Report for Chest and Abdomen dated July 17, 2004. 9. An X-Ray Report for multiple views -Abdomen dated July 18, 2004. 10. A CT Report for Abdomen/Pelvis with Contrast dated December 5, 2004 indicated severe, recurrent Crohn's disease, with evidence of mechanical small bowel obstruction. 11. An Operative Report dated December 5, 2004 indicated that a laparotomy with lysis of adhesions and small bowel resection was performed. 12.A Clinical History Report dated December 9, 2004. 13.A Treatment Record dated March 7, 2005 (unreadable) concerned a right swollen knee. 14.An Operative Report dated April 28, 2009 indicated that a colonoscopy was performed and no evidence of obvious active Crohn's disease in the area was seen. 15. A standing order from a medical laboratory which expired November 12, 2011. 16. A Visit Note for the appellant from a Gastroenterology & Endoscopy Center dated March 5, 2012. 17. The appellant's PWD Designation Application, dated November 6, 2013. 18. The appellant's Self Report (SR) dated November 6, 2013. 19.A letter from an Internal Medicine/Gastroenterology specialist dated December 11, 2013 indicated that the appellant may be having a recurrence of Crohn's disease and that she hasn't had major activity proven for a number of years and that a colonoscopy will be organized. 20. An Operative and Procedural Document dated December 17, 2013 which indicated that a colonoscopy was performed and no obvious evidence of Crohn's recurrence was seen. 21. A list of Medication dated December 28, 2013. 22.A Physician Report (PR) not-dated, completed by the appellant's medical practitioner who has known the appellant since 1994 and seen her once in the past 12 months. 23. An Assessor Report (AR) dated January 29, 2014 completed by the same medical practitioner. 24. The annellant's Request for Reconsideration dated June 18, 2014. EMT 003(10/06/01)
25. The appellant's advocate's submission dated July 22, 2014. Diagnosis In the AR, the appellant's physician has diagnosed the appellant with a right hemi-colectomy for Crohn's, anxiety and arthritis-osteoarthritis. It is noted that she has declined a colostomy. In response to the question; Has the applicant been prescribed any medication and/or treatments that interfere with her ability to perform DLA? The physician indicated no. In response to the question; Does the applicant require any prostheses or aids for her impairment? The physician indicated no. In the SR, the appellant indicated that her last major surgery was in 2004 and that the next surgery -colostomy -is one that she is trying not to have as she doesn't believe she could cope with it and the devices it entails. Physical Impairment In the PR, under functional skills, the physician reports that the appellant can walk unaided 4+ blocks, climb 5+ stairs, lift 5 to 15 pounds, remain seated 1 to 2 hours and has no difficulties with communication. In terms of DLA, the physician indicates that the appellant's arthritis makes walking difficult; she can't sleep in one position too long and cannot make it to the toilet which leads to accidents. In the AR, under mobility and physical ability, the physician assesses the appellant as independent with respect to walking indoors and standing (short periods only), and requiring periodic assistance from another person with respect to walking outdoors ( assistance required on hills or uneven ground), lifting and carrying and holding (son assists). The appellant is noted to take significantly longer than typical with climbing stairs and that she needs help. It is also indicated that the appellant's ability to speak and write is good whereas her writing is satisfactory because of arthritic cramping and her hearing is also satisfactory -right ear plugs with wax. In the SR, the appellant writes that the arthritis in her right knee is partly due to Crohn's and after surgeries has swollen to the size of a football causing severe pain and making personal tasks difficult. She indicates that she has disabilities in walking, sitting, lying down or any movement. The appellant reports that she had a couple of falls, one at her job in 201 0 and another this year at her daughter's home out of the country. Her diarrhea started to be really bad in the summer of 2012 and since that time she takes spare clothes with her, "everywhere". She indicates that she moves with a slow limping gait, takes stairs one at a time up or down as she doesn't want to repeat the fall at her daughter's home in May. Mental Impairment In the PR, the physician indicated that the appellant has 1 significant deficit with cognitive and emotional function -Emotional disturbance and no problems with communication. In the AR, under Cognitive and Emotional Functioning, the physician assesses a major impact with bodily functions (toileting -unable to reach toilet in time resulting in diarrhea accidents up to 2-3 times a dav) and a moderate impact with emotion. Minimal imoacts are noted for consciousness, and EMT003(10/06/01)
memory ( canno t put na me s and f ac es t ogethe r until she has is note d for; impulse control , insight and judgment, att m otor act i v i ty, language, psych o t i c symptoms, other neu emotional or mental problems. In the SR, t he appella nt stat es that s h e has hig h levels o o f "diarrhea". Dail y Living Activities In th e AR, the physici an indicated that th e appellan Under Personal Car e -requires periodic a ssistance help s her g et in a nd out of t u b /shower); while she ind feedin g self and regulate diet. T he appellant takes sig to dress) and fo r toileting if she has an ac cident and has to clean in /o u t of be d and transfers on/off chair, it is comm ented Hou s e k e eping , she re q u ires pe riodic a ssistan ce in it e m s u p a nd dow n and helps ) . Un der S hoppin g s he la be ls, m aking a ppr opr iate cho ic es a n d paying for goi ng to and from s t ores a n d for car ryin g p urchases appellan t in d ep endently m a nages meal plannin g a n peri odic assistanc e w i th f ood prepa ratio n; her son coo appella nt indepe ndently man ag e s all 3 aspect s of DLA b ills . Un d e r Me d ic ation s, t he ap pell an t independently m p rescript ions, t ak ing a s directe d and s a fe handling ( tr a nspo r tation , the a ppe lla n t requi res pe riodic assistance a ssists ) . Sh e does n o t use pub lic t rans i t (be c au se o co m ments, it is no t e d that the a pp ellant i s c urr ently ge t tin g in/out of s h ower a nd to chang e t he be d . P art C pert a ining to Soc ial Func t i oning i s n ote d N/A In the SR, the appellant writes that she needs her son' are very high, to get out she holds on t o t he open bathroom the right leg after her, hoping that the right leg d oe s ac ciden t (di arrhea), she does this twice a day. She has tried a bathmat but states that if she slips at the side of it, it will bunch up . The ap pellant states that preparing m ea ls i s a s l o w process -her son usually pre meals -and she helps the best she can. The appellant states that when standing in one position for a len g th of time that her right knee pops out and she grabs counters for helps her with housekeeping, meal prep and di she s laundry to he r to fold and then he carries the basket s Her son vacuums and cleans the tub and toilet while the appellant wipes down the sink and counters. Although the appellant's son handles most of the shopping, the appellant has gone with him and has managed fairly well as long as sh e is pus hing a bu ggy ba t h rooms and carrie s a cha n ae of clothes. She has used the adult underwear; however, finds that it EAA T003(10/06/01) seen them 3-4 t im e s ) while no impact ention/concent ratio n , exec uti ve, motivat i on, r opsychologi ca l problems and othe r f st r ess and a nxiety for any outing b ecause t : from another person to manage b a th ing (son epende ntly mana ges grooming, t oileting, n ificantly longer t h an typical for dress ing (s i ts -up and re-dress). For transfers that knees stiff/hard to get up. Under Basic bot h laund ry a nd b a si c ho usekee ping (s o n c arri es in d epen d e nt ly mana ges re ading pr i ce s and p urchases. She re q uires p eri odic assistance for h ome (son d oes most of t his) . Un der Meal s , t h e d s af e st or a ge o f food whe reas s h e requi res k s most me al s. Unde r Pay Rent and Bi l ls, t h e -bankin g , budgetin g and p aying re nt and anag e s a l l 3 a spe cts of DL A -fi ll ing/refil lin g misses medicatio ns o ccas i onall y). Under getting in and o u t of a v e hicle (f r ie nd or son f la ck of a cce s s to toi let). U n der a d diti o na l pa y in g for occasion al extra a ss i st a nce w i th . s he lp t o get int o the tub be cause the sides door -pl a ces left leg over side and pu lls n 't sl ip wh ile s t i l l i n t u b. Sometimes due to an pa r es the main support. The appellant's son (pots and pans). Her son brings the finished upstairs where he will help her put them away. . She is al way s aware of the lo cation of t h e
do e s not al w a y s hol d back the flow which n eeds to be m ea ning a ret u rn h ome b efore t he s hop ping is f i n i s out doo rs is st r essful s h e must kn o w wher e she is going-b if t he ground is lev el or u n even , hill y, rocky or p aved wal H elp Req uired with DL A With respect t o ass i s t an ce prov ided b y o th e r people, the phy dai ly basis bu t wil l be leaving the pr o vinc e for w ork The a p pel lant state s th at her s on pay s a care w o r ke her ro om a n d bath in g. She u se s a gra b ber t o p ick things u Als o, speci fie d is that she would lik e "grab b ar s " f o r no t to h ave a n As sistanc e Animal. Pri or to t he hearing the ap pella nt s u bm i tte d : 1. a 2 nd su bmiss ion by her adv ocat e da te d Augus 2 . a lett e r d a t ed Ju ly 14, 20 14 writt e n by the ap w hich incl u d ed a copy of a prepa red lett er fo 3. t h e p r ep a red l e t ter dated July 2 3 , 2014 signed by t th at the appellant i s on multi ple prescri bed medicati arthritis ; th a t she ta ke s ap proxim at el y 3 ti me sti f fness fr o m arthritis, that h er son provide s she can c limb no m or e t ha n 5 s tai rs u na i ded, benefit f r o m acc ess to a me ntal health prof essional; 4. an X Ray Right Kne e for th e appe llant dated M At th e hea ring, the appellan t' s a d vocate pre s ented an appellant. Th e ap pellant' s advocate' s su b mis si on w ent t o a rgu In answer to questions by her advocate, the appellant stated that; • after su rger y her right knee swelled to the size of a • she takes medicati o n 3-4 times per day as neede • her B-12 injections have stopped as the part of the inte been removed, • a worst day is described as not making it to the toilet during the night and her son has to help her in the shower, • when her son's away she moves downstairs • she keeps 2 changes of clothes downstairs, • she uses an office chair to gel around to pre pare • she uses Facebook to stay in touch with relatives and friends, • she takes a lot of preparation to go out -usually finishes the s hopping, • th e s ides of the tub are h igh and she i s n erv o u • she plans to see someone abou t her anxiety, • she missed an annointment with a physician due to an accident on Auaust 25, 2014 and EAA T003(10/06/01) de alt wi th a s s oon a s p os si ble, some t ime s hed. The a pp e llant s ta te s th at m ovi n g about a thro oms m ust be close -s h e must kn o w kways. si ci an in d icates that the son helps o n a and tha t a fri end helps o ccasionally . r w ho c omes in o n an o n call basis t o he lp wit h p or reach things down from a high self . sho w er/tub and a non-slip mat a pp e ll a nt is noted t 28, 2014; pell ant 's adv ocate t o the a ppe lla n t' s physician r the physician; he app el lant 's ph y s ici a n w hich confirme d on s for Crohn ' s and a p ainkiller for s longer t han an average person d ue to p ain a n d assi stance a t le ast 3 time s a we ek for D LA, that that she can lift up t o 12 lb s., and tha t s h e co u l d and ay 2 , 2014 . updated list of me d i c ation s w rit ten b y the me nt. football a n d it occurs again occ a sion al ly, d, stine to which it was absorbed has there is no shower there, breakfast and do housework, onc e a week -lasts about 15 minutes-son s getting out,
e h e r w o r s e d a y s o c c u r 4 -5 t i m e s a w e e k . I n r e s p o n s e t o t h e m i n i s t r y ' s q u e s t i o n s , t h e a p p e l l a n i g h t a n d t a k e s T y l e n o l 3 ' s e v e r y e v e n i n g . T h e a p p o u t o f t h e p r o v i n c e , b u t w i l l b e k e e p i n g h i s r e s i d e n c b y d o i n g c o m p u t e r w o r k f o r h i m . T h e l a s t p a i d h e l p I t w a s c o n f i r m e d b y t h e a p p e l l a n t t h a t s h e t a k e s 3 t I n r e s p o n s e t o t h e p a n e l ' s q u e s t i o n s , t h e a p p e l l a n t a s s h e i s f a m i l i a r w i t h t h e m f r o m p r e v i o u s w o r k a n d a p p e l l a n t i n d i c a t e d t h a t s h e l i k e s c o o k i n g v e g e t a b l e l a s t i n g t h e m o n t h . S h e i n d i c a t e d t h a t i f h e r s o n w a s d o n e b y h e r s o n b e f o r e h e l e a v e s , s h e s i t s o n t h e s b y h a n d . T h e a p p e l l a n t i n d i c a t e s t h a t h e r s o n w o r k s w i t h w o r k w a s F e b r u a r y w h e n h e w a s e x t r e m e l y b u t o o n e w e e k a t a t i m e u s u a l l y i n t h e a r e a . T h e a p p e d e v i c e s a n d h e r s o n h e l p s h e r o u t o f c h a i r s . T h e a p h e r k n e e , r e c e i v e d a c o r t i s o n e s h o t i n h e r k n e e o n J p r o b l e m s . T h e a p p e l l a n t c o n f i r m e d t h a t s h e l a s t h a d T h e a p p e l l a n t ' s s o n t e s t i f i e d t h a t h e p r o v i d e s t h e f o h e l p s w i t h l a u n d r y , h e l p s h e r u p a n d d o w n t h e s t a i r s s h o p p i n g m o r e a n d m o r e , a n d h e l p s h e r u p o f f t h e m o b i l i t y i s l i m i t e d ; s h e a l s o d o e s n ' t h a v e t h e s t r e n g t m o r e c o n f u s e d . I t ' s h a r d f o r h e r t o d o t h i n g s ; s h e i s t h e s t a i r s a l o n e . H e f u r t h e r s t a t e d t h a t t h e r e i s n o t a T h e m i n i s t r y r e p r e s e n t a t i v e w a s a s k e d i f s h e h a d t i m b y t h e a p p e l l a n t ' s a d v o c a t e a n d i f s h e h a d a n y o b j e e v i d e n c e . T h e m i n i s t r y r e p r e s e n t a t i v e c o n f i r m e d t h a i n c l u d i n g t h e u p d a t e d l i s t o f m e d i c a t i o n a n d h a d n o T h e p a n e l f i n d s t h a t t h e n e w i n f o r m a t i o n p r o v i d e d b t e s t i m o n y a n d t h a t o f h e r s o n ' s , a t t h e h e a r i n g i s i n s b e f o r e t h e m i n i 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 a s i s s u e s a d d r e s s e d i n t h e o r i g i n a l P W D a p p l i c a t i o n f o i n f o r m a t i o n a s e v i d e n c e p u r s u a n t t o s e c t i o n 2 2 ( 4 ) o f d e s c r i b e s t h e i m p a c t s o f t h e a p p e l l a n t ' s m e d i c a l c o n E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )n t i n d i c a t e d t h a t s h e g e t s 3 -5 h o u r s a s l e e p p e r e l l a n t i n d i c a t e d t h a t h e r s o n s p e n d s t i m e i n a n d e l o c a l l y a n d t h a t h e p a y s h e r o c c a s i o n a l h e l p e r w a s i n F e b r u a r y a s t h e h e l p e r i s e x t r e m e l y b u s y . i m e s a s l o n g a s a n o r m a l p e r s o n t o c o m p l e t e D L A . i n d i c a t e d t h a t s h e d o e s n o t w a n t a c o l o s t o m y b a g d o e s n ' t l i k e w h a t h a p p e n s w i t h t h e m . T h e s , s o u p s a n d s t e w s a n d t h a t h e r f u n d s a r e n o t n o t a v a i l a b l e , s h e w o u l d t a k e a t a x i . L a u n d r y i s t a i r s w h i l e i t i s b e i n g d o n e a n d a l s o d o e s l a u n d r y o n a n o n c a l l b a s i s ; t h e l a s t t i m e h e w a s a w a y s y . I n t h e s u m m e r h e g o e s a w a y c a m p i n g f o r u p l l a n t s t a t e d t h a t s h e d o e s n ' t u s e a n y a s s i s t i v e p e l l a n t s t a t e d t h a t s h e h a s h a d l i q u i d d r a i n e d f r o m u l y 3 1 , 2 0 1 4 a n d t h a t h e r a r t h r i t i s i s c a u s i n g t h e s u r g e r y i n 2 0 0 5 . l l o w i n g a s s i s t a n c e t o h i s m o t h e r ; c o o k s m e a l s , , h e l p s h e r i n a n d o u t o f t h e b a t h , d o e s g r o c e r y c o u c h . H e a d d e d t h a t b e c a u s e o f h e r k n e e s , h e r h t o g e t a r o u n d . A s s h e a g e s s h e i s b e c o m i n g n e r v o u s a b o u t f a l l i n g a n d s i t s w h e n s h e g o e s u p b a t h / s h o w e r o n t h e m a i n f l o o r . e t o r e v i e w t h e a d d i t i o n a l i n f o r m a t i o n s u b m i t t e d c t i o n t o t h e n e w i n f o r m a t i o n b e i n g a c c e p t e d a s t s h e h a d r e v i e w e d a l l t h e i n f o r m a t i o n s u b m i t t e d o b j e c t i o n o r c o m m e n t s . y t h e a p p e l l a n t p r i o r t o t h e h e a r i n g , a s w e l l a s h e r u p p o r t o f t h e i n f o r m a t i o n a n d r e c o r d s t h a t w e r e t h e y c o n t a i n e d a d d i t i o n a l d e t a i l w i t h r e s p e c t t o r m s . T h e p a n e l t h e r e f o r e a d m i t s t h e n e w 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 t a s i t f u r t h e r d i t i o n s o n h e r D L A .
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 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 i s i n 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 e t a l l 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 o f t h e E A P W D A . S p e c i f i c a l l y 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 i n f o r m a t i o n p r o v i d e d d i d n o t e s t a b l i s h t h a t t h e a p p e l l a n t h a s 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 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 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 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 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 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 M i n i s t r y d i d d e t e r m i n e t h a t s h e m e t t h e 2 o t h e r c r i t e r i a i n E A P W D A s e c t i o n 2 ( 2 ) s e t o u t b e l o w . R e l e v a n t L e g i s l a t i o n , E A P W D A : 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 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 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 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 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 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 ( 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 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 ( 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 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 , t h e p e r s o n 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 . ( 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 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 ( 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 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 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 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 ( 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 f o l l o w i n g s e c t i o n o f t h e E A P W D R a p p l i e s t o t h i s a p p e a l : 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 , " d a i l y l i v i n g a c t i v i t i e s " , ( 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 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 , 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 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 p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s ; ( v ) p e r f o r m h o u s e w o r k t o m a i n t a i n t h e p e r s o n ' s p l a c e 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 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 r s a n d o u t d o o r s ; ( v i i ) p e rf o r m p e r s o n a l h y g i e n e a n d s e l f c a r e ; ( v i i i ) m a n a g e p e r s o n a l m e d i c a t i o n , a n d ( b ) i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e m e n t a l i m p a i 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 : ( i ) m a k e d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r f i 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 w i t h o t h e r s e f f e c t i v e l y . E A A T 0 0 3 ( 1 0 / 0 6 / 0 1 )
S e v e r e P h y s i c a l I m p a i r m e n t I n t h e 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 r e v i e w e t h e a p p e l l a n t ' s S R . T h e m i n i s t r y n o t e d i n t h e a p p e l l a 5 + s t e p s u n a i d e d , l i f t 5 t o 1 5 p o u n d s a n d c a n r e m a i i n d i c a t e s t h a t t h e a p p e l l a n t t a k e s s i g n i f i c a n t l y l o n g e s t o p o n l a n d i n g " ; h o w e v e r , n o f u r t h e r i n f o r m a t i o n i s a s s i s t a n c e t h a t s h e r e q u i r e s t o m a n a g e t h e s e a b i l i t i t h a t t h e a p p e l l a n t i s i n d e p e n d e n t l y a b l e t o w a l k i n d o t h e a p p e l l a n t ' s f u n c t i o n a l s k i l l l i m i t a t i o n s a r e m o r e i n i m p a i r m e n t . T h e m i n i s t e r i s t h e r e f o r e n o t s a t i s f i e d t h s e v e r e p h y s i c a l i m p a i r m e n t . T h e m i n i s t r y r e p r e s e n t a t i v e a r g u e d t h a t t a k i n g 3 t i m t h e m i n i s t r y b u t r a t h e r a m o d e r a t e i m p a i r m e n t . S h e d i f f e r e n t t h a n w h a t h a d b e e n p r e s e n t e d i n t h e P W D r e p o r t e d b 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 , t h a t l i f t i n g u t h a t i t h a d b e e n n o t e d t h a t t h e a p p e l l a n t c a n w a l k u p c a s e . T h e m i n i s t r y r e p r e s e n t a t i v e n o t e d t h a t t h e a p p t h a t h e r a p p l i c a t i o n w a s c o m p l e t e d b y t h e g a s t r o e n t s t a t e d t h a t s e v e r i t y i s t h e m i n i s t r y ' s c o n s i d e r a t i o n a n t h e i n f o r m a t i o n S h e s t a t e d t h a t t h e P W D d e s i g n a t i o n n e e d f o r h e l p b e c a u s e o f t h e i m p a i r m e n t . T h e m i n i s t a p p e l l a n t m e t t h e n e e d f o r a s s i s t a n c e w i t h D L A b u t t h e a p p l i c a t i o n . T h e a d v o c a t e r e s p o n d e d t o t h e m i n i s t r y ' s a r g u m e n t a r g u i n g t h a t t h e m i n i s t r y r e p r e s e n t a t i v e ' s p o s i t i o n r e n e e d f o r m o n e y a n d t h e n e e d f o r h e l p b e c a u s e o f t h t h e y a r e n o t i n c l u d e d i n t h e l e g i s l a t i o n . T h e a d v o c a t e l o n g e r t h a n t y p i c a l t o c o m p l e t e D L A i s a l s o n o t l e g i s l S e c t i o n 8 o f t h e I n t e r p r e t a t i o n A c t [ R S B C 1 9 9 6 c . 2 3 c o n s t r u e d a s b e i n g r e m e d i a l a n d g i v e n s u c h f a i r , l a r g b e s t e n s u r e s t h e a t t a i n m e n t o f i t s o b j e c t . T h e a d v o c p o s i t i o n t h a t i f t h e r e i s a n y a m b i g u i t y i n t h e i n t e r p r e t a t h e a p p e l l a n t [ A b r a h a m s v . C a n a d a 1 9 8 3 1 4 2 D . L . R . p r o f e s s i o n a l i n d i c a t i n g a 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 r e q u i r e m e n t f o r m o r e t h a n 2 D L A a n d t h e p h y s i c i a n i n a b r o a d w a y a n d t h e l e g i s l a t i o n i n t e r p r e t e d w i t h a 2 0 0 9 B C S C 1 4 6 1 ] . T h e a d v o c a t e a l s o a r g u e s t h a t t h t h e i n f o r m a t i o n p r o v i d e d i n t h e S R w a s c o n s i d e r e d a T h e p o s i t i o n o f t h e a p p e l l a n t , a s s e t o u t i n h e r a d v o c a d e q u a t e l y a s s e s s e d t h e n a t u r e o f h e r i m p a i r m e n t s . s t a t e s t h a t w h e n r e a d i n g t h e e n t i r e t y o f t h e a p p e l l a n t m u l t i p l e a n d s e v e r e h e a l t h c o n d i t i o n s ; o r i m a r i l v C r o h E A A T 0 0 3 ( 1 0 / 0 6 / 0 1 )d t h e e v i d e n c e s e t o u t i n t h e P R a n d A R a n d i n n t ' s P R t h a t s h e i s a b l e t o w a l k 4 + b l o c k s , c l i m b n s e a t e d f o r 1 t o 2 h o u r s . T h e m e d i c a l p r a c t i t i o n e r r w i t h c l i m b i n g s t a i r s , n o t i n g " o n e s t e p a t a t i m e , p r o v i d e d t o e x p l a i n t h e t y p e o r d e g r e e o f t h e e s . I n a d d i t i o n , t h e m e d i c a l p r a c t i t i o n e r i n d i c a t e s o r s a n d s t a n d w h i c h t h e m i n i s t r y f i n d s e s t a b l i s h e s k e e p i n g w i t h a m o d e r a t e d e g r e e o f p h y s i c a l a t t h e i n f o r m a t i o n p r o v i d e d i s e v i d e n c e o f a e s a s l o n g f o r D L A i s n o t c o n s i d e r e d s e v e r e b y i n d i c a t e d t h a t t h e n e w i n f o r m a t i o n w a s n o t v e r y a p p l i c a t i o n , t h a t t h e r e w e r e n o s p e c i f i c d e t a i l s p t o 1 2 l b s . i s i n a m i l d t o m o d e r a t e r a n g e a n d t o 4 b l o c k s , e v e n t h o u g h i t m a y n o l o n g e r b e t h e e l l a n t h a s n o t y e t s e c u r e d a f a m i l y p h y s i c i a n a n d e r o l o g i s t . T h e m i n i s t ry r e p r e s e n t a t i v e f u r t h e r d t h a t s h e i s n o t s e e i n g s e v e r e i m p a i r m e n t s i n i n v o l v e s 2 i s s u e s ; t h e n e e d f o r m o n e y a n d t h e r y r e p r e s e n t a t i v e s t a t e d t h a t i n h e r o p i n i o n t h e t h e n e e d f o r a d d i t i o n a l f u n d s w a s n o t a p p a r e n t i n b y c i t i n g t h e r e l e v a n t l e g i s l a t i v e c r i t e r i a a n d g a r d i n g t h e 2 i s s u e s o f P W D d e s i g n a t i o n , t h e e i m p a i r m e n t , a r e i n a p p r o p r i a t e c o n s i d e r a t i o n s a s f u r t h e r a r g u e d t h a t t h e a p p e l l a n t t a k i n g 3 t i m e s a t i v e c r i t e r i a . T h e a d v o c a t e h i g h l i g h t e d 8 ] a s r e q u i r i n g t h a t e v e r y e n a c t m e n t b e e a n d l i b e r a l c o n s t r u c t i o n a n d i n t e r p r e t a t i o n t h a t a t e a l s o p o i n t s t o c a s e l a w a s a u t h o r i t y f o r t h e t i o n o f t h e c r i t e r i a , i t i s t o b e r e s o l v e d i n f a v o u r o f { 3 d ) 1 ] a n d t h a t t h e e v i d e n c e o f t h e p r e s c r i b e d t i o n o n a t l e a s t 2 D L A , t h a t t h e r e i s n o s t a t u t o r y a n d t h e a s s e s s o r m u s t b e r e a d i n i t s e n t i r e t y a n d b e n e v o l e n t p u r p o s e i n m i n d [ H u d s o n v . E A A T e r e i s n o i n d i c a t i o n i n t h e r e a s o n s f o r d e n i a l t h a t t a l l , l e t a l o n e g i v e n c o n s i d e r a b l e w e i g h t . a t e ' s s u b m i s s i o n , i s t h a t t h e m i n i s t r y h a s n o t I n h e r s u b m i s s i o n , t h e a p p e l l a n t ' s a d v o c a t e ' s a p p l i c a t i o n , o n e c a n s e e t h a t s h e l i v e s w i t h n ' s d i s e a s e , c u r r e n t a b d o m i n a l o a i n a n d d i a r r h e a
l i m i t i n g h e r l i f e s t y l e , a r t h r i t i s + s t r e s s w h e n l e a v i a b o u t a c c e s s t o t o i l e t f a c i l i t i e s . S h e f i n d s w a l k i n g d i c a n n o t m a k e i t t o t h e t o i l e t w h i c h l e a d s t o a c c i d e n t s p r e s c r i b e d m e d i c a t i o n s f o r C r o h n ' s a s w e l l a s a p a i n T h e a p p e l l a n t i n h e r S R s t a t e s t h a t m o v i n g a b o u t o u t o e n s u r e t h a t t o i l e t f a c i l i t i e s a r e a v a i l a b l e . S h e h a s n e e d s p a v e d w a l k w a y s . S h e m o v e s n o w a t a s l o w l i a s s h e h a s n o w i s h t o r e p e a t t h e f a l l s h e h a d i n M a y t h a t s h e c a n c u r r e n t l y c l i m b n o m o r e t h a n 5 s t a i r s u n a n d t h a t s h e c a n n o l o n g e r w a l k 4 b l o c k s a n d t h a t h P a n e l D e c i s i o n I n c o n s i d e r i n g t h e i n f o r m a t i o n p r o v i d e d r e g a r d i n g t h p a n e l h a s d r a w n u p o n t h e m i n i s t r y ' s d e f i n i t i o n o f " i m i s i n s t r u c t i v e r a t h e r t h a n a l e g i s l a t e d d e f i n i t i o n . T h i s c o m p o n e n t s : " i m p a i r m e n t i s a l o s s o r a b n o r m a l i t y o f s t r u c t u r e o r f u n c t i o n [ t h e c a u s e ] c a u s i n g a r e s t r i c t i o n e f f e c t i v e l y , a p p r o p r i a t e l y o r f o r a r e a s o n a b l e d u r a t i o n d i s e a s e , c o n d i t i o n , s y n d r o m e o r e v e n b y a s y m p t o m c a u s e i s C r o h n ' s d i s e a s e . A s e v e r e i m p a i r m e n t r e q u i m p a c t . T h e a s s e s s m e n t o f s e v e r i t y i s t h e r e f o r e b a s e a r e a s a s f u n c t i o n a l s k i l l l i m i t a t i o n s , c o g n i t i v e a n d e m m a n a g e D L A a n d a s s i s t a n c e r e q u i r e d . T h e d e t e r m i n a t i o n o f s e v e r i t y o f i m p a i r m e n t i s a t t h e " s a t i s f i e d " t h a t t h e s t a t u t o r y c r i t e r i a f o r g r a n t i n g P W D d e t e r m i n a t i o n t h e m i n i s t r y m u s t a c t r e a s o n a b l y a n d c o f t h e a p p e l l a n t . W h i l e t h e l e g i s l a t i o n i s c l e a r t h a t t h e v i d e n c e f r o m p r e s c r i b e d p r o f e s s i o n a l s , t h e p r o f e s s i l i k e a n y o t h e r e v i d e n c e . T h e p a n e l f i n d s t h a t w h i l e t h e a p p e l l a n t ' s C r o h n ' s d i s a n d f e a r s o f a p o t e n t i a l c o l o s t o m y , a n x i e t y f o r w h i c h l i m i t h e r a b i l i t y t o f u n c t i o n , t h e e v i d e n c e d o e s n o t e s t a b i l i t y t o f u n c t i o n i n d e p e n d e n t l y , e f f e c t i v e l y , a p p r o p r i t h e p h y s i c i a n c o n f i r m s t h a t t h e a p p e l l a n t ' s a b i l i t y t o p o r t r e a t m e n t a n d t h a t s h e d o e s n o t r e q u i r e a n y p r o s t h 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 p r e s c r i b e d p r o f e s s i o n t h e s t e p c l i m b i n g a n d l i f t i n g l i m i t s r e p o r t e d i n t h e J u l y o f 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 i n t h e A m o d e r a t e r a t h e r t h a n s e v e r e i m p a i r m e n t o f d a i l y p h y s B a s e d o n a l l t h e e v i d e n c e , t h e p a n e l f i n d s t h a t t h e m i n f o r m a t i o n p r o v i d e d d i d n o t e s t a b l i s h a s e v e r e p h y s i E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )n g t h e h o u s e , p l a n s e x t r a c l o t h i n g a n d w o r r i e s f f i c u l t c a n ' t s l e e p i n o n e p o s i t i o n t o o l o n g a n d ( 2 -3 t i m e s p e r d a y ) . S h e i s o n m u l t i p l e k i l l e r f o r h e r a r t h r i t i s . t d o o r s i s s t r e s s f u l a n d m u s t b e c a r e f u l l y p l a n n e d d i f f i c u l t y w i t h u n e v e n o r s l o p i n g g r o u n d a n d m p i n g g a i t , t a k e s s t a i r s o n e a t a t i m e u p o r d o w n a t h e r d a u g h t e r ' s h o m e . T h e a p p e l l a n t s u b m i t s a i d e d a n d t h e m a x i m u m s h e c a n l i f t i s 1 2 p o u n d s e r a r t h r i t i s i s a l s o i n h e r o t h e r k n e e a n d h a n d s . e s e v e r i t y o f t h e a p p e l l a n t ' s i m p a i r m e n t s , t h e p a i r m e n t , " a s s e t o u t i n t h e P R , r e c o g n i z i n g t h a t i t d e f i n i t i o n c o n s i s t s o f " c a u s e " a n d " i m p a c t " p s y c h o l o g i c a l , a n a t o m i c a l o r p h y s i o l o g i c a l i n t h e a b i l i t y t o f u n c t i o n i n d e p e n d e n t l y , [ i m p a c t ] . " T h e c a u s e i s u s u a l l y s e t o u t a s a ( e . g . p a i n ) . I n t h e p r e s e n t a p p e a l , t h e p r i m a r y i r e s t h e i d e n t i f i e d c a u s e t o h a v e a s e v e r e d o n o f t h e i m p a c t o n d a i l y f u n c t i o n i n g , i n s u c h o t i o n a l d e f i c i t s , r e s t r i c t i o n s o n t h e a b i l i t y t o d i s c r e t i o n o f t h e m i n i s t e r t h e m i n i s t ry m u s t b e d e s i g n a t i o n a r e f u l f i l l e d . I n m a k i n g i t s o n s i d e r a l l t h e r e l e v a n t e v i d e n c e , i n c l u d i n g t h a t e f u n d a m e n t a l b a s i s f o r t h e a n a l y s i s i s t h e o n a l e v i d e n c e h a s t o b e w e i g h e d a n d a s s e s s e d e a s e ( f o r w h i c h s h e u n d e r w e n t s u r g e r y i n 2 0 0 5 ) s h e i n t e n d s t o s e e k c o u n s e l l i n g a n d a r t h r i t i s m a y a b l i s h t h a t t h e s y m p t o m s r e s t r i c t t h e a p p e l l a n t ' s a t e l y o r f o r a r e a s o n a b l e d u r a t i o n . F o r e x a m p l e , e r f o r m D L A i s n o t i n t e r f e r e d w i t h b y m e d i c a t i o n e s e s o r a i d s f o r h e r i m p a i r m e n t . F u r t h e r m o r e , a l r e s p e c t i n g p h y s i c a l F u n c t i o n a l S k i l l s i n c l u d i n g 2 3 , 2 0 1 4 p h y s i c i a n ' s l e t t e r , a n d t h e d e s c r i p t i o n R w e r e r e a s o n a b l y v i e w e d b y t h e m i n i s t r y a s a i c a l f u n c t i o n i n g . 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 c a l 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 I n t h e 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 n o t e d t s i g n i f i c a n t d e f i c i t w i t h c o g n i t i v e a n d e m o t i o n a l f u n c t " a n x i e t y " . I n t h e A R , t h e p h y s i c i a n i n d i c a t e s t h a t t h e f u n c t i o n s , a m o d e r a t e i m p a c t w i t h e m o t i o n , 2 m i n i m m e m o r y a n d n o o t h e r i m p a c t s i n t h e o t h e r a r e a s . I n i n d i c a t e s n o d i f f i c u l t i e s a n d t h e a b i l i t y t o w r i t e a n d h e a r w a x p l u g g i n g i n t h e r i g h t e a r . S p e a k i n g a n d r e a p o s i t i o n i s t h a t m o s t o f 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 D L A a n d h e r a b i l i t y t o c o m m u n i c a t e i s g o o d , t h e m i i s e v i d e n c e o f 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 h e r s u b m i s s i o n , t h e a p p e l l a n t ' s a d v o c a t e c o m b i n t h e a p p e l l a n t ' s m e n t a l i m p a i r m e n t w i t h t h o s e r e g a r d T h e a p p e l l a n t a r g u e s t h a t s h e h a s r e c e n t l y s t a r t e d a s c h a l l e n g e s w i t h 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 e m i n m o t i v a t i o n w i t h p e r f o r m i n g m u l t i p l e D L A w h i c h i s m o t i v a t e d i n d i v i d u a l a n d s h e f e e l s t h a t s h e c o u l d b e w i t h h e r l o s s o f i n d e p e n d e n c e . D u e t o t h e a p p e l l a n t 5 h o u r s o f s l e e p p e r n i g h t . P a n e l D e c i s i o n I n t h e a p p e l l a n t ' s c a s e , t h e P R d o e s n o t d i a g n o s e a p h y s i c i a n h a s n o t r e p o r t e d t h a t t h e a p p e l l a n t h a s b e t h a t i n t e r f e r e w i t h h e r a b i l i t y t o p e r f o r m D L A . T h e a p 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 E m o t i o n a l d i s t u r b a n d E m o t i o n a l F u n c t i o n i n g , t h e p h y s i c i a n a s s e s s e s S e c t i o n 2 ( 1 ) ( b ) o f t h e E A P W D R p r e s c r i b e s t w o D L A d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r f i n a n c e s i n t e r a c t w i t h o t h e r s e f f e c t i v e l y ( s o c i a l f u n c t i o n i n g ) . I n t h e A R , i t w a s 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 i n d e p e a n d m e d i c a t i o n s a n d t h a t s h e i n d e p e n d e n t l y m a n a g s t o r a g e o f f o o d a n d i s a b l e t o m a k e a p p r o p r i a t e c h o f u n c t i o n i n g w a s d e t e r m i n e d a s N / A b y t h e p r e s c r i b e B a s e d o n t h e e v i d e n c e , t h e p a n e l f i n d s t h a t t h e m i n i i m p a i r m e n t h a d n o t b e e n e s t a b l i s h e d . S i g n i f i c a n t R e s t r i c t i o n s t o D L A I n t h e 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 n o t e d t h E M T 0 0 3 ( 1 0 / 0 6 / 0 1 )h a t t h e P R i n d i c a t e s t h a t t h e a p p e l l a n t h a s a i o n s i n t h e a r e a s o f e m o t i o n a l d i s t u r b a n c e , a p p e l l a n t h a s o n e m a j o r i m p a c t w i t h b o d i l y a l i m p a c t s i n t h e a r e a s o f c o n s c i o u s n e s s a n d a s s e s s i n g c o m m u n i c a t i o n , t h e p h y s i c i a n e a r a r e s a t i s f a c t o r y , n o t i n g a r t h r i t i c c r a m p i n g a n d d i n g a b i l i t y a r e n o t e d a s g o o d . T h e m i n i s t r y ' s e m o t i o n a l f u n c t i o n i n g a s m i n i m a l o r n o i m p a c t o n n i s t e r i s n o t s a t i s f i e d 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 e d h e r a r g u m e n t s w i t h r e s p e c t t o t h e s e v e r i t y o f i n g p h y s i c a l i m p a i r m e n t . e x p e r i e n c i n g a d d i t i o n a l s y m p t o m s o f a n x i e t y s u c h o r y . S h e h a s e x p e r i e n c e d a s i g n i f i c a n t d e c r e a s e c o n c e r n i n g f o r h e r a s s h e u s e d t o b e a h i g h l y n e f i t f r o m a c c e s s t o c o u n s e l l i n g t o h e l p h e r c o p e ' s h i g h l e v e l s o f a n x i e t y s h e g e t s a p p r o x i m a t e l y 4 -n y m e n t a l i m p a i r m e n t o r b r a i n i n j u r y a n d t h e e n p r e s c r i b e d a n y m e d i c a t i o n a n d / o r t r e a t m e n t s p e l l a n t i s n o t e d t o h a v e 1 s i g n i f i c a n t d e f i c i t w i t h a n c e ( a n x i e t y ) a n d i n t h e A R , u n d e r C o g n i t i v e a m o d e r a t e i m p a c t w i t h e m o t i o n . t h a t a r e s p e c i f i c t o m e n t a l i m p a i r m e n t m a k e ( d e c i s i o n m a k i n g ) , a n d r e l a t e t o , c o m m u n i c a t e o r n d e n t l y m a n a g e s a l l a s p e c t s o f p a y r e n t a n d b i l l s , e s t o r e g u l a t e h e r d i e t , m e a l p l a n n i n g a n d s a f e i c e s w h e n s h o p p i n g . T h e a r e a o f s o c i a l d p r o f e s s i o n a l . 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 a s e v e r e m e n t a l a t t h e p h v s i c i a n i n d i c a t e s t h a t t h e a p p e l l a n t
r e q u i r e s p e r i o d i c a s s i s t a n c e w i t h b a t h i n g , b a s i c h o u p u r c h a s e s h o m e , f o o d p r e p a r a t i o n a n d g e t t i n g i n a n a p p e l l a n t ' s s o n h e l p s m o s t t i m e s a n d t h a t t h e a p p e l a s s i s t a n c e w i t h g e t t i n g i n a n d o u t o f t h e s h o w e r a n d a n d d u r a t i o n o f t h e a s s i s t a n c e r e m a i n s u n c l e a r . T h e a p p e l l a n t ' s a b i l i t y t o m a n a g e t h e s e a c t i v i t i e s i s s e v e a p p e l l a n t t a k e s s i g n i f i c a n t l y l o n g e r t o m a n a g e d r e s s p r o v i d e d t o e x p l a i n h o w m u c h l o n g e r t h e a p p e l l a n t t p h y s i c i a n i n d i c a t e s t h a t t h e a p p e l l a n t i s a b l e t o i n d e i n c l u d i n g 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 , p a y i n g r e f u n c t i o n i n g t h e p h y s i c i a n i n d i c a t e s N I A . N o i n f o r m a t r e l a t i o n s h i p w i t h b o t h h e r i m m e d i a t e o r e x t e n d e d n e a p p e l l a n t e x p e r i e n c e s s o m e l i m i t a t i o n s a s a r e s u l t o p r e s c r i b e d p r o f e s s i o n a l d o e s n o t e s t a b l i s h t h a t i m p a c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s . T h e a d v o c a t e s u b m i t s t h a t t h e a p p e l l a n t f a c e s n u m e s i g n i f i c a n t l y l o n g e r w i t h d r e s s i n g ( s h e h a s t o s i t t o d ( h e r s o n h e l p s h e r i n / o u t o f s h o w e r ) , t a k e s s i g n i f i c a c c i d e n t , i t t a k e s t i m e t o c l e a n u p a n d r e d r e s s . S h e w i t h g e t t i n g i n a n d o u t o f s h o w e r a n d t o c h a n g e t h e l o n g e r t h a n a h e a l t h y p e r s o n w i t h m u l t i p l e a c t i v i t i e s a n d o u t o f b e d a s w e l l a s o n a n d o f f c h a i r s . T h e a p p l a u n d r y a n d b a s i c h o u s e k e e p i n g , w i t h g o i n g t o a n d f a n d w i t h g e t t i n g i n a n d o u t o f a v e h i c l e h e r s o n o r a p u b l i c t r a n s i t b e c a u s e o f l a c k o f a c c e s s t o a t o i l e t . I t t h a t t h e a p p e l l a n t i s p r o v i d e d a s s i s t a n c e a t l e a s t 3 t i s h o p p i n g , f o o d p r e p a r a t i o n , c o o k i n g a n d g e t t i n g i n a P a n e l D e c i s i o n T h e l e g i s l a t i o n r e q u i r e s t h e m i n i s t e r t o s u b s t a n t i a l l y a i n c o n s i d e r a t i o n o f 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 u c h a s t h a t f r o m t h e a p p e l l a n t s h o u l d n ' t b e f a c t o r e p r o f e s s i o n a l e v i d e n c e , b u t t h e l e g i s l a t i v e l a n g u a g e m o p i n i o n i s f u n d a m e n t a l t o t h e m i n i s t r y ' s d e t e r m i n a t i o n c a s e , 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 h a s s u p p l i e d l i t t l e i d e g r e e o f r e s t r i c t i o n t o D L A . T h e l e g i s l a t i o n r e q u i r e s t h a t a s e v e r e i m p a i r m e n t d i r e a b i l i t y t o p e r f o r m D L A 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 m e a n s t h a t t h e r e m u s t b e a c a u s a l l i n k b e t w e e n t h e a l s o a c o m p o n e n t r e l a t e d t o t i m e o r d u r a t i o n . T h e d i c o n t i n u o u s o r p e r i o d i c . I f i t i s p e r i o d i c i t m u s t b e f o r a p e r i o d i c i t y m u s t a l s o i n c l u d e c o n s i d e r a t i o n o f t h e f r e q i n d i c a t e s t h a t a r e s t r i c t i o n a r i s e s p e r i o d i c a l l y , i t i s e n t e v i d e n c e o f t h e d u r a t i o n a n d f r e q u e n c y o f t h e r e s t r i c t E A A T 0 0 3 ( 1 0 / 0 6 / 0 1 )s e k e e p i n g , g o i n g t o a n d f r o m s t o r e s , c a r r y i n g d o u t o f a v e h i c l e . T h e p h y s i c i a n n o t e s t h a t t h e l a n t i s c u r r e n t l y p a y i n g f o r o c c a s i o n a l e x t r a c h a n g i n g t h e b e d . T h e f r e q u e n c y , t h e d e g r e e r e f o r e , i t c a n n o t b e d e t e r m i n e d t h a t t h e r e l y i m p a c t e d . T h e p h y s i c i a n i n d i c a t e s t h a t t h e i n g a n d t o i l e t i n g ; h o w e v e r , n o i n f o r m a t i o n i s a k e s t o m a n a g e t h e s e a c t i v i t i e s . I n a d d i t i o n , t h e p e n d e n t l y m a n a g e a l l o t h e r a c t i v i t i e s o f D L A n t a n d b i l l s a n d m e d i c a t i o n . I n a s s e s s i n g s o c i a l i o n i s p r o v i d e d t o e x p l a i n t h e a p p e l l a n t ' s t w o r k s . T h e m i n i s t r y a c k n o w l e d g e s t h a t t h e f h e r c o n d i t i o n h o w e v e r , t h e i n f o r m a t i o n f r o m t h e 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 D L A e i t h e r r o u s c h a l l e n g e s w i t h p e r s o n a l c a r e t a k e s r e s s ) , r e q u i r e s p e r i o d i c a s s i s t a n c e w i t h b a t h i n g a n t l y l o n g e r w i t h t o i l e t i n g a n d i f s h e h a s a n c u r r e n t l y r e c e i v e s o c c a s i o n a l p a i d a s s i s t a n c e b e d . T h e a p p e l l a n t s u b m i t s t h a t s h e t a k e s 3 t i m e s o f p e r s o n a l c a r e , s u c h a s d r e s s i n g , t r a n s f e r r i n g i n e l l a n t a l s o r e q u i r e s p e r i o d i c a s s i s t a n c e w i t h r o m s t o r e s a s w e l l a s c a r r y i n g p u r c h a s e s h o m e f r i e n d a s s i s t s h e r . T h e a p p e l l a n t i s a f r a i d t o u s e i s f u r t h e r s u b m i t t e d b y t h e a p p e l l a n t ' s a d v o c a t e m e s a w e e k w i t h ; l a u n d r y , h o u s e k e e p i n g , g r o c e r y n d o u t o f a v e h i c l e . s s e s s 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 o f D L A s i o n a l . T h i s d o e s n ' t m e a n t h a t o t h e r e v i d e n c e d i n a s r e q u i r e d t o p r o v i d e c l a r i f i c a t i o n o f t h e a k e s i t c l e a r t h a t 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 a s t o w h e t h e r i t i s " s a t i s f i e d " . I n t h e a p p e l l a n t ' s n t h e w a y o f n a r r a t i v e t o p r o v i d e d e t a i l o f t h 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 a p p e l l a n t ' s a l l y f o r e x t e n d e d p e r i o d s . T h e t e r m " d i r e c t l y " s e v e r e i m p a i r m e n t a n d t h e r e s t r i c t i o n . T h e r e i s 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 m a y b e e i t h e r n e x t e n d e d t i m e . I n h e r e n t l y , a n y a n a l y s i s o f u e n c y . I n c i r c u m s t a n c e s w h e r e t h e e v i d e n c e i r e l y a p p r o p r i a t e f o r t h e m i n i s t r y t o r e q u i r e i o n i n o r d e r t o b e " s a t i s f i e d " t h a t t h i s l e q i s l a t i v e
cr i ter i o n is met. The on us is on the appellan t to prove on the bal ance criteria with respect to direct and seve re restr i ctions in her ability In the panel's v iew, while the evidence i ndicates that t most notably, in the area of bathing (get ti n g in and out of the tub a ssistance, i t also esta b lis h es th at only p eriodi c assistance is required including aspects of b a sic housekeeping, meals, and gett manages to do a lot by using an office chair. The panel also notes not set out a sp ecific r equireme nt f o r h ow mu ch longer a D the m inis try to consider such inf o r mation in assessing whether the pa nel fi nds that based on the appella nt's f unctio t ask s in d ependently (though some take three times longer) at l ea s t 3 times a week), the ministry reasonably d etermined th the o pinion of a p rescri be d pro f essiona l the a ppellant he r ab i l ity to ma nage her DLA eithe r continuousl y or per the p anel fin ds that t h e min ist ry reasonably fo und t hat Help with D LA The mini s try ' s pos ition i s t h a t si nc e i t has not been e si g nificant ly res t rict ed, it ca n not b e dete r min ed t hat The p o s ition of t h e app e ll a n t is that her need for signi si g nifi cant restrictio ns i n h er abili ty to perf orm DLA, as a summar ized above. Panel Decisio n Th e p anel not es that the legisl ati o n r e quires t hat i n the opinion fo r h elp mu st a rise from d i re ct an d significa nt restr ict con tinu ous or periodic for extended periods. The panel finds that the ministry reason that since it has not been established that DLA are directly and significantly restricted, it cannot be determined that help is required as pro vi ded u nder s Conclusion Having reviewed and considered all of the evidence and the relevant legislation, the panel finds that the m in is try's decis io n that the appellant was not eligible for PWD designation was reasonably supported by the evidence and therefore confirms the ministry's decision. EAAT 0 03(10/06/01) of probabilitie s that s he satisfies the legislative to manage her DL A indepen dently. h e a ppe llant h a s some diff i cu lty wi t h her D LA; / sh ower) for whi ch she requi r es daily fo r other tas ks of DLA, i n g in and o ut of a v e h i cle an d t hat she that although the le g islation does L A takes t o perform, it is reason able for a restriction is sign if icant. In this cas e , n al s ki l l s an d her ability to manage most DLA or with periodic a ssistance ( described a s at it has n o t been es tablished that in 's impair m en ts dir e ctly and signi fic antly r e s trict i odic ally fo r extended perio d s. Acc ordi ngly , t h is legisl a t ive cr iterion i s not satisf ied. s t abli shed t hat t h e a ppe llant's DLA are sig nific a n t he l p is requ ired f r om o ther p ersons . fic ant help f r om o ther p er s on ' s res ults from the rgued in the ad voc at e 's submiss ion and of a pre s cribed professional the need ions in t he abi l i t y to perfo rm DLA tha t a r e eit h e r abl y determined ection 2(2) (b)(ii) of the EAPWDA.
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