I APPFAI # PART C-Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (the Ministry) October 24, 2014 reconsideration decision in which the Ministry determined that the Appellant did not meet all of the statutory requirements for designation as a person with disabilities (PWD) under Section 2 of the Employment and Assistance for Persons with Disabilities Act. The Ministry found that the Appellant met the age requirement and that his impairment is likely to continue for at least two years. However, the Ministry was not satisfied that the evidence establishes that: • the Appellant has a severe physical or mental impairment; • in the opinion of a prescribed professional, the Appellant's daily living activities are directly and significantly restricted either continuously or periodically for extended periods by a severe impairment; and, • in the opinion of a prescribed professional, as a result of these restrictions, the Appellant requires the significant help or supervision of another person, the use of an assistive device, or the services of an assistance animal to perform daily living activities. PART D-Relevant Legislation Employment and Assistance for Persons with Disabilities Act ("EAPWDA") Section 2(2) and 2(3). Employment and Assistance for Persons with Disabilities Regulation ("EAPWDR") Section 2. EAAT 003(10/06/01)
PA RT E -Summary of Facts The.Mini stry d id not-app ear at the hearing. The Panel noti ce of the h earin g and then p ro ceeded with the h Empl oyme n t and As si s tance R egu lat ion. F or its r econsider ation decision the Ministr y had the foll 1. A pp e llant's P WD applic ation consisting of: • H is s el f-repo rt da ted O ctober 10, 2013. • A ph ysi cian's r epo r t and an a sse s sor's report, A ppell ant's doc t or wh o wrote tha t t h e A ppell pati e n t ) and he h ad s e en t h e Ap pella nt betwee do ctor n oted co ns u lt a tions wit h a ne ur ol ogist • Febr ua r y 27, 20 13 c on sultation report from a docto • Rad iologi st re port d ated M ay 21 -22, 2013 and MRI • N e urologist's report da ted F ebru ary 19 , 2014. • O ut p a tient clinic consu lta tion n o t e d ated May 1 2. A pp e llant's re quest f o r recon s idera ti on with h is typ le tt e r dated Oc t o b er 3, 2 014 fro m his doc t o r. Dia gnose s In th e ph ys ician's repor t , th e do ctor diagno s ed t he (onset ab out 2 012), cervical spondyloso s an d d eg enerat the Appellant ha d ba ck p roble ms for years, but t he with a to ol. Th e re w as no diagnosis o f any me n tal he Physic al Impairmen t In his PWD appl i cation and reconsideration statement, the • His b ack, h i p s an d kn e es a r e i n consta nt p a any l ength of tim e; c an cli mb 2 or 3 s tai rs b efore lyi ng d o w n f or an hour or more; is unab le to g a nd falls, and also inc r eases p ai n so t hat has to lie d • H e ca nnot lift anything ove r 10 lbs. w ithout se down for an hour or more to recover, including carrying groceries. • He i s u nab le to sit for more than 10 minutes without his pain getting worse, requirin stand o r l i e do w n t o try to bring his p a i n down • He fel l in the shower and injured hi m s el f. • He is unable to work at his trade because of the heavy lifting, bend • Without the ability to earn an income his standard • Constant pain in his back, hips and knees makes it difficult to sleep comfortably, to get in the shower, to walk even short distances, to stand in one spot for perio • Doing basic housework is very difficult; bending and kneeling is almost impossible; any back a n d forward m otions (vacuuming, making a immediately to intolerable levels, so mostly these tasks don't get done. • He is unable to flush the toilet without aggravat the pain; bending over to put on his pants gives him a flare-up, requires resting. EAAT 003(10/06/01) APPEA L# � co nfirmed that U1e M i nis try w as pro vi ded with earin g i n a cc o rda n ce with section 86 (b ) of the owing evide nce: both com pleted on M ay 21, 20 1 4 b y t h e ant ha s b e en h i s patien t for ab o u t a y e ar ( new n 2-1 0 ti mes in the pre cedin g 12 months. The , a neuro surgeo n and [ill egible] . r who is a p a in m ana g e m e nt specia lis t. r eport dated Feb ruary 16, 2 01 4. 7, 2014 c ompleted by a medical s p ecia list. ed st atement pr epared b y an advoc ate a nd a Ap pell a nt wi t h n europ a t h ic low ba c k and leg pain ive di sc dis e as e . The doctor also ad ded tha t y w orsened c onsi derab ly i n 2012 wh e n wo rk ing a lth cond itio n. A ppell a nt s tate d t hat: in ma k ing it very diff icult to w alk, s t an d or si t for p ai n cause s him t o s top and then re quires o d o w n stair s without a handrail -l o s es ba l anc e o w n for a n hour o r more to r ecover. verely i nc re asing his pa i n and requiring him to lie g him to . ing and climbing involved. of living is critical. d s of time. b ed, w ashing d ishes) increase h is ba c k pain ing his pain; dressing and grooming increase
I APPEAL# • Sitting . for.a meal must be done in 5 to 10 minute increments_witbJJreaks to restoo...his.back • Getting in and out of a car, sitting in a car all greatly increase his pain and require resting for an hour or more to recover. • It can take him as much as ten minutes to get out of a chair and it always increases his pain. • All daily living activities aggravate his existing pain and require a rest of an hour or more to return to his "normal" levels of pain. • He is also having increasing problems with his balance, having more falls and is therefore, at risk of breaking bones . The February 27, 2013 report from the pain management specialist reviewed the Appellant's complaints and history, and the impressions and treatment are summarized as follows: • At least 10 years of chronic bilateral low back pain and stiffness; sustained severe right-sided low back pain and stiffness radiating to anterior aspect of both knees. • Sitting f o r even a short period aggravates; is most comfortable when lying supine. • Not taking medication, was drinking alcohol to relieve pain; chiropractic has not helped. • Moderately severe signs of myofascial dysfunction affecting back and lower limb muscles. • Signs and symptoms improved with manual therapy, but stiff legged gait persisted. • Was taught some self-treatment techniques and remedial exercises. The May 2013 radiologist's report indicated the following findings: • Pelvis and bilateral hips findings: very minimal joint space narrowing seen within the right hip relative to the left, with very minimal lateral acatabular osteophyte formation on the right; no significant degenerative change seen on the left hip; no fracture or focal bone lesion identified; SI joints are normal in appearance bilaterally. • Lumbar spine findings: alignment of the lumbar spine is normal; mild anterior wedging of T12 and L1 of indeterminate age; vertebral body height otherwise well preserved; diffuse degenerative disc disease seen within the lumbar spine, particularly at L5/S1 and a diffuse facet arthropathy, especially at the lower levels; symptoms of radiculopathy. The February 2014 MRI of the Appellant's spine indicated the following conditions: • 5 lumbar type vertebrae; osseous alignment is normal; no fractures. • Conus medullaris terminates at lever of the L 1/2 intervetebral disc, is morphologically normal. • T11/12-disc space narrowing and desiccation, no disc protrusion, mild bilateral facet osteoarthritis; T12/L1 -disc space narrowing and desiccation, no traversing or exiting nerve root impingement; L 1 /2-disc space narrowing and desiccation, no disc protrusion, no traversing or exiting nerve root impingement. • L2/3 -severe intervertebral disc space narrowing and pronounced associated vertebral and endplate reactive change, mild bilateral facet osteoarthritis, mild bilateral neural foraminal narrowing, no traversing nerve root impingement present. • L3/4 -severe intervertebral disc spacing narrowing with moderate reactive change in adjacent vertebral endplates, large generalized posterior disc bulge, advanced bilateral facet osteoarthritis with associated redundancy of the ligamentum flavum; combination results in moderate central canal stenosis; moderate bilateral neural foraminal narrowing is present. • L4/5 -pronounce intervertebral disc space narrowing, moderate generalized posterior disc bulge, advanced bilateral facet osteoarthritis with redundancy of ligamentum flavum; combination results in a moderate degree of central canal stenosis; severe bilateral neural f o raminal narrowing is present. • L5/S1 -severe intervertebral disc space narrowinQ, bilateral facet osteoarthritis, no traversing EAAT003(10/06/01)
I APPEAL# nerve root impingement, severe bilateral neural foraminal stenosis. T_he neuroloaist wrote_that he.sawJhe Appellant on November 14, 2013 and provided the following assessment regarding his low back pain and left posterior thigh pain: • Had low back pain for 2 years radiating to both buttocks, both posterior thighs; had heaviness and tightness in the lower limbs which was worse when he walked. • Clinical examination showed sensory changes in the L5/S1 distribution bilaterally. • Ankle reflexes were diminished bilaterally; strength was normal. • EMG and nerve conduction sturdy showed no generalized neuropathy or entrapment neuropathy in the right lower limb. • Mild chronic right L5/S1 polyradiculopathy noted unassociated with neuropathic changes; was felt to have neuropathic and mechanical low back pain and neuropathic leg symptoms. • Medications recommended. • Has now had further studies -MRI scan of lumbosacral spine; has multiple level spondylosis; has significant disc space narrowing and exit foraminal multiple level spondylosis; has significant disc space narrowing and exit foraminal narrowing at L3/4 and L4/5 due to ligamentous thickening, facet joint degenerative changes and disc space narrowing; central canal stenosis and exit foraminal stenosis noted at those levels. • Symptoms relate to combination of central spinal stenosis and lateral recess stenosis particularly at L3/4 and L4/5; has mechanical and neuropathic back pain as suspected; has neuropathic leg symptoms. • If does not respond to medications might be considered for epidural steroid injections at L3/4 and/or L4/5. The specialist who completed that outpatient assessment on May 17, 2014 described the Appellant's conditions as follows: • Presents with right-sided, persistent low back pain; also described his knees not quite feeling right-feels.weak; has no numbness or tingling in his legs by history. • Feels he is unable to work, go up and down stairs, etc. • On examination, has some flattening of lumbar lordosis; has fairly normal strength in his legs and specifically his knee extensors are 5/5 even though the Appellant said his knees feel wobbly; has no objective numbness in his legs, no nerve root tension signs; gait is steady. • Review of MRI of February 2014 indicates multilevel degenerative disease with facet arthropathy and an L3-4 generalized disc protrusion with some lateral recess stenosis, but no foraminal nerve root compromise; overall degree of canal compressions is actually mild. • Symptoms likely due to mechanical low back pain, facet arthropathy and should be managed conservatively; fusion for this type of problem generally does not help; could try facet injections. • Knee symptoms are more puzzling; some degree of L4 lateral recess stenosis but does not have any sensory deficits or pain in the L4 distribution; knee extensions are full as are his ankle doral flexors. In the physician's report, the Appellant's doctor reported the degree of impairment as follows: • Unknown at that point if there are remedial treatments as the Appellant is still going for neurosurgical assessments; no surgical intervention indicated; must rely on medical treatments. • Functional skills are limited as follows: can walk unaided on a flat surface for less than 1 block "before increased pain in back"; can climb 5+ steps -"can QO up with a handrail; worsened EAAT 003(10/06/01)
APPEAL# I coming down"; no lifting; and can remain seated for less than 1 hour. In the assessor's report, the same doctor noted that the Appellant: • Takes significantly longer walking indoors and outdoors, and climbing stairs, but he manages these independently. • Independently manages standing, but takes significantly longer -"cannot stand for long periods of time". • Needs continuous assistance with lifting- "only light weights", and with carrying and holding. Mental Impairment The doctor reported that there are no significant deficits with or impacts to cognitive and emotional functioning. The doctor also did not complete the section in the assessor's report for the Appellant's need for support or supervision in areas of social functioning. The Appellant described no mental or emotional impairments in his PWD application or his reconsideration statement. Daily Living Activities In the physician's report, the doctor indicated that the Appellant has not been prescribed any medication and/or treatments that interfere with his ability to perform daily living activities. The doctor also checked "yes" in response to the question whether the Appellant's impairment directly restricts his ability to perform daily living activities and also checked off that basic housework is restricted. The rest of that form is blank. In the assessor's report, the doctor reported that the Appellant: • Takes significantly longer walking indoors and outdoors, and climbing stairs, but he manages these independently. • Independently manages standing, but takes significantly longer -"cannot stand for long periods of time" • Needs continuous assistance with lifting -"only light weights", and with carrying and holding. • Independently manages all areas of personal care; however, dressing takes significantly longer -"sits down to put socks on"; bathing takes significantly longer- "showers ok, getting in and out is difficult"; transfers in/out of bed take significantly longer -"rolls out of bed"; uses an assistive device for toileting -"has to use sink to get off toilet". • Independently manages laundry using an assistive device -"needs to hold onto something to get up and down"; independently manages basic housekeeping, but takes significantly longer -"cannot do chores at regular pace". • Independently manages going to/from stores, reading prices/labels, making appropriate choices, paying for purchases and carrying purchases home, but the latter takes significantly longer -"uses covered buggy". • Independently manages all areas of meals; cooking takes significantly longer -"sits down when using barbeque". • Independently manages all areas of paying rent/bills and all areas of medications. • Takes significantly longer getting in/out of a vehicle and using transit schedules/arranging transportation; needs continuous assistance using public transit- "sitting or standing for prolong periods aggravates back". In his October 3, 2014 letter, the Appellant's doctor stated that the Appellant: • Does have problems with worsened pain with multiple activities of daily living; given that his back and lower extremities are involved in most movement this is not unusual. • Such impacted activities include climbing stairs (only 2-3 at a time before restinq) and requires EAAT 003(10/06/01)
APPEAL# I the handrail to go down, any lifting (groceries of only limited degree), housework (vacuuming is particularly difficult but also bed making and dish washing), bending over for dressing and grooming exacerbate his symptoms. • Getting around, entry and exit into vehicles cause worsening of the Appellant's symptoms, and obviously impair his ability to get around easily. • Requires significant amounts of time to recover from these and more strenuous tasks. • Despite efforts to help control his pain, he does not have adequate pain control at this time. Need for Help with Daily Living Activities In the physician's report and assessor's reports, the doctor reported that the Appellant can use assistance devices to help him walk; that is, a cane. He also wrote in his October 3, 2014 letter that the Appellant's daughter has assisted him when she can in household tasks. At the hearing, the Appellant said that: • He has seen numerous doctors and had various tests done to relieve the chronic pain he has been experiencing for years; has tried different medications which didn't help and now is taking very strong medication, but it is not taking the pain away; he does not drink alcohol at all; he had steroid injections in his back, but that did not help. • His balance is off and he is afraid to walk outside; he has fallen out of the shower, injuring his ribs and has installed handrails in the shower to help if he falls. • He cannot sit for longer than15 minutes. • He can barely do 2 stairs because of the pain and just cannot walk properly; he uses a cane when walking, but he cannot walk for a block and can barely walk to his front door; he feels he may need to use a walker soon. • In the grocery store he uses a buggy and can lift a small item; cannot carry a bag of groceries. • His daughter comes to help him when she can, about every 2-3 weeks bringing groceries, doing dishes, the laundry, vacuuming and making the bed. • His stress level is increasing; he is getting depressed; he is at his wits end and very frustrated because he is not getting any help; feels that he is not living, just existing because he cannot do anything; cannot even lift tools anymore. • He has an appointment with a psychologist because of his depression and stress. The Appellant's testimony regarding his physical impairments and how they impact his ability to function is consistent with and tends to corroborate the information that the Ministry had at reconsideration. Therefore, the Panel admits that testimony in accordance with section 22(4) of the Employment and Assistance Act. The Appellant's testimony regarding his depression is not admitted because there was no evidence of any mental health conditions or impacts before the Ministry at reconsideration. Since the Ministry did not appear at the hearing, the Panel will consider the reconsideration decision to be the Ministry's position for this appeal. EMT 003(10/06/01)
I APPEAL # PART F -Reasons for Panel Decision The issue in this appeal is whether the Ministry's reconsideration decision, concluding that the Appellant was not eligible for PWD designation because he did not meet all the requirements in section 2(2) of the EAPWDA, was reasonably supported by the evidence or was a reasonable application of the applicable enactment in the Appellant's circumstances. Specifically, the Ministry determined that the Appellant does not have a severe mental or physical impairment that in the opinion of a prescribed professional directly and significantly restricts his ability to perform daily living activities either continuously or periodically for extended periods and as a result of those restrictions he requires help to perform those activities. Applicable Legislation The following sections of the EAPWDA apply to the Appellant's circumstances in this appeal: 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 supetvision 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 position is that every physical activity he undertakes is severely affected and limited by chronic lower back and leg pain. Specialists, radiology tests and his family doctor have confirmed that he has significant pain from severe back conditions. His back, hips and knees are in constant pain making it very difficult to walk, stand or sit f o r any length of time. After every activity, he must rest for an hour or more. He already uses a cane to walk and thinks he may have to start using a walker. Medications and steroid infections have not helped to ease the pain or help with his mobility. Also, he is unable to work at his trade because of the heavy lifting, bending and climbing involved. EAAT003(10/06/01)
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 A p p e l l a n t a n d t h e d o c t o r s . I t d e t e r m i n e d t h a t t h e A a n d t h a t r e m e d i a l m e d i c a l t r e a t m e n t s s u c h a s a n a M i n i s t r y c o n c l u d 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 s i g n i f i c a n t r e s t r i c t i o n i n t h e A p p e l l a n t s ' a b i l i t y t o p T h e P a n e l ' s D e c i s i o n T h e d i a g n o s i s o f a s e r i o u s m e d i c a l c o n d i t i o n d o e s s a t i s f y 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 E A P e x t e n t t o w h i c h a n i m p a i r m e n t r e s t r i c t s d a i l y f u n c t w e l l a s 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 , s u c h a s i n T h e P a n e l n o t e s t h a t , i n c o n t r a s t t o t h e C a n a d a P P e r s o n w i t h P e r s i s t e n t M u l t i p l e B a r r i e r s l e g i s l a t i o n f o r d e s i g n a t i o n a s a P W D i n t h e E A P W D s t a t u t e . T h e A p p e l l a n t ' s d o c t o r d i a g n o s e d t h e A p p e l l a n t w 2 0 1 2 ) , c e r v i c a l s p o n d y l o s o s a n d d e g e n e r a t i v e d i s t h e s p e c i a l i s t s ' a n d r a d i o l o g y r e p o rt s . T h e n e u r o l o w o r k , t h e n e p i d u r a l s t e r o i d i n j e c t i o n s s h o u l d b e t r i A p p e l l a n t ' s d o c t o r w r o t e t h a t n o s u r g i c a l i n t e r v e n t m e d i c a l t r e a t m e n t s . I n t h e M a y 2 0 1 4 p h y s i c i a n ' s r e p o r t , t h e A p p e l l a n t ' f u n c t i o n a l s k i l l s a s f o l l o w s . 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F o r e x a m p l e , t h e A p p e l l a n t c a n c l i m b o n h o u s e w o r k , b e n d i n g o v e r f o r d r e s s i n g a n d g r o o m e x a c e r b a t e h i s s y m p t o m s . T h e d o c t o r a l s o n o t e d t i m e t o r e c o v e r f r o m t h e s e a n d m o r e s t r e n u o u s t a A p p e l l a n t d o e s n o t h a v e a d e q u a t e p a i n c o n t r o l a t A p p e l l a n t n e e d s t o u s e a c a n e a n d h a s h e l p f r o m T h e A p p e l l a n t a l s o d e s c r i b e d h i s p a i n a n d p h y s i c a e i d u r a l s t e r o i d i n · e c t i o n s ; t h e d i d n ' t w o r k . T h e s EM T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # h a t i t r e v i e yi, e d 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 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 n o t s e v e r e l g e s i c s a r e a v a i l a b l e t o c o n t r o l t h e s y m p t o m s . T h e i d n o t d e m o n s t r a t e e i t h e r a s e v e r e i m p a i r m e n t o r 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 . n o t i n i t s e l f e s t a b l i s h a s e v e r e i m p a i r m e n t . T o W D A , t h e r e m u s t b e e v i d e n c e o f h o w a n d t h e i o n i n g . T h i s i n c l u d e s e v i d e n c e f r o m t h e A p p e l l a n t a s t h i s c a s e , t h e s p e c i a l i s t s a n d t h e A p p e l l a n t ' s d o c t o r . e n s i o n P l a n d i s a b i l i t y l e g i s l a t i o n a n d t h e p r o v i n c e ' s , t h e a b i l i t y t o w o r k a n d / o r f i n d w o r k i s n o t a c r i t e r i a i t h n e u r o p a t h i c l o w b a c k a n d l e g p a i n ( o n s e t a b o u t c d i s e a s e . T h e s e c o n d i t i o n s w e r e a l s o d e t a i l e d i n g i s t r e c o m m e n d e d m e d i c a t i o n s a n d i f t h a t d i d n o t e d . C h i r o p r a c t i c t r e a t m e n t s h a v e n o t w o r k e d . T h e i o n i s i n d i c a t e d a n d t h e A p p e l l a n t m u s t r e l y o n s d o c t o r r e p o rt e d d i r e c t l i m i t a t i o n s t o t h e A p p e l l a n t ' s n a f l a t s u r f a c e f o r l e s s t h a n 1 b l o c k " b e f o r e g u p w i t h a h a n d r a i l ; w o r s e n e d c o m i n g d o w n , n o . A l s o , i n t h e a s s e s s o r ' s r e p o r t , t h e d o c t o r i n d i c a t e d c a l a n d m o b i l i t y a c t i v i t i e s i n d e p e n d e n t l y , m o s t a r e i r m e n t s . F o r e x a m p l e , t h e f o l l o w i n g a c t i v i t i e s a l l , c l i m b i n g s t a i r s , d r e s s i n g , b a t h i n g , t r a n s f e r s i n / o u t s i n / o u t o f a v e h i c l e . T h e A p p e l l a n t a l s o n e e d s l d i n g a s h e c a n o n l y l i f t l i g h t w e i g h t s . c e n t m e d i c a l r e p o r t , t h e A p p e l l a n t ' s d o c t o r w r o t e i n w i t h m u l t i p l e a c t i v i t i e s o f d a i l y l i v i n g ; g i v e n t h a t t m o v e m e n t t h i s i s n o t u n u s u a l . I n f a c t i n t h i s l i m i t a t i o n s i n d i c a t e i n c r e a s i n g r e s t r i c t i o n s t o p h y s i c a l l y 2 -3 s t a i r s b e f o r e r e s t i n g . A l s o , a n y l i ft i n g , i n g , g e t t i n g a r o u n d , a n d e n t r y a n d e x i t i n t o v e h i c l 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 s i g n i f i c a n t a m o u n t s o f s k s . D e s p i t e e f f o rt s t o h e l p c o n t r o l h i s p a i n , t h e t h i s t i m e . T h e d o c t o r a l s o r e p o r t e d t h a t t h e h i s d a u g h t e r . l l i m i t a t i o n s a s g e t t i n g w o r s e . H e s a i d t h a t h e h a d t r o n m e d i c a t i o n s h e i s t a k i n a r e n o t w o r k i n a n d
h e i s a t h i s w i t s e n d w i t h s t r e s s a n d f r u s t r a t i o n o v d e s c r i b e d h o w e v e r y k i n d o f p h y s i c a l m o v e m e n t d o i n g h o u s e w o r k , g e tt i n g i n a n d o u t o f a c a r , s i t t t h a t h e h a s t o r e s t f o r a n h o u r o r m o r e a f t e r e v e n h e h a s b e e n u s i n g a c a n e , b u t f e e l s h e w i l l s o o n s h o w e r b e c a u s e h e f e l l . H i s d a u g h t e r h e l p s w i t h T h e P a n e l f i n d s t h a t a l l o f t h e e v i d e n c e , e s p e c i a l A p p e l l a n t ' s s t a t e m e n t s w h i c h a r e c o n s i s t e n t w i t h t h a t t h e A p p e l l a n t ' s p h y s i c a l h e a l t h c o n d i t i o n s a n f u n c t i o n i n g t o t h e d e g r e e t h a t a l l a c t i v i t i e s t a k e s i r e s t s a f t e r o n l y 1 0 t o 1 5 m i n u t e s o f a c t i v i t y . M o r e a n a l g e s i c s a n d e p i d u r a l s t e r o i d i n j e c t i o n s b e i n g a A p p e l l a n t ' s c a s e , m e d i c a t i o n s a r e n o t w o r k i n g . T t h e A p p e l l a n t ' s d e s c r i p t i o n s o f h i s c o n d i t i o n a r e c r e a s o n a b l e i n c o n c l u d i n g t h a t t h e A p p e l l a n t d o e s S e v e r e M e n t a l I m p a i r m e n t T h e P a n e l n o t e s t h a t t h e r e w a s n o d i a g n o s i s o f a a n y i m p a c t s t o o r d e f i c i t s i n c o g n i t i v e a n d e m o t i o c o m p l e t e t h e s e c t i o n f o r s o c i a l f u n c t i o n i n g i n t h e M i n i s t r y r e a s o n a b l y c o n c l u d e d t h a t t h e r e i s n o s e 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 v i rt u a l l y e v e r y p h y r e s t r i c t e d b y c h r o n i c p a i n . E v e r y a c t i v i t y t a k e s s i a f t e r w a r d s . H e u s e s a c a n e a n d m a y s t a r t u s i n g l i f t i n g a n d c a r r y i n g , a n d h i s d a u g h t e r h e l p s w i t h g T h e M i n i s t r y w r o t e t h a t a s t h e m a j o r i t y o f d a i l y l i v l i t t l e h e l p f r o m o t h e r s , t h e i n f o r m a t i o n f r o m t h e p r 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 d a i l y l i v i n g a c t i v i p e r i o d s . T h e P a n e l ' s D e c i s i o n S e c t i o n 2 ( 2 ) ( b ) o f t h e E A P W D A r e q u i r e s a p r e s c r A p p e l l a n t ' s s e v e r e p h y s i c a l i m p a i r m e n t d i r e c t l y 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 E A P W D R a n d a l s o a r e l i s t e d i n t h e p h y s i c i a n m e d i c a l p r o f e s s i o n a l s a r e i n c l u d e d i n t h e r e c o r d a H o w e v e r , o n l y t h e A p p e l l a n t ' s d o c t o r c o m p l e t e d t t h e m o s t r e c e n t i n f o r m a t i o n i n h i s O c t o b e r 3 , 2 0 1 l i v i n g a c t i v i t i e s . T h e r e f o r e , t h e P a n e l w i l l c o n s i d e r p r o f e s s i o n a l f o r t h i s r e q u i r e m e n t . EAA T 0 0 3 ( 1 0 / 0 6 / 0 1 )'. A P P E A L # e r t h e i n a b i l i t y t o l e s s e n t h e p a i n . T h e A p p e l l a n t -, w a l k i n g , s t a n d i n g , d r e s s i n g , t a k i n g a s h o w e r , i n g , e t c . i s d i r e c t l y i m p a c t e d b y s u c h s e v e r e p a i n j u s t 1 0 o r 1 5 m i n u t e s o f a c t i v i t y . T h e A p p e l l a n t s a i d n e e d a w a l k e r . H e a l s o h a d t o i n s t a l l h a n d r a i l s i n h i s g r o c e r i e s a n d h o u s e w o r k w h e n s h e c a n . l y t h e A p p e l l a n t ' s d o c t o r ' s r e p o r t s a n d t h e t h e s e v e r e f i n d i n g s i n t h e m e d i c a l r e p o r t s , i n d i c a t e d s e v e r e p a i n d i r e c t l y i m p a i r a l l h i s p h y s i c a l g n i f i c a n t l y l o n g e r a n d t h e A p p e l l a n t m u s t t a k e l o n g o v e r , d e s p i t e t h e M i n i s t r y ' s c o m m e n t s a b o u t v a i l a b l e a s r e m e d i a l m e a s u r e s , c l e a r l y i n t h e h e r e f o r e , w h e n a l l o f t h e m e d i c a l i n f o r m a t i o n a n d 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 i n i s t r y w a s n o t n o t h a v e 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 . n y m e n t a l h e a l t h c o n d i t i o n a n d n o m e d i c a l r e p o rt s o f n a l f u n c t i o n i n g . A l s o , t h e A p p e l l a n t ' s d o c t o r d i d n o t a s s e s s o r ' s r e p o r t . T h e r e f o r e , t h e P a n e l f i n d s t h a t t h e v e r e m e n t a l i m p a i r m e n t . s i c a l d a i l y l i v i n g a c t i v i t y 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 g n i f i c a n t l y l o n g e r a n d h e h a s t o r e s t f o r l o n g p e r i o d s a w a l k e r . 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 y r o c e r i e s a n d h o u s e w o r k . i n g a c t i v i t i e s a r e p e rf o r m e d i n d e p e n d e n t l y o r r e q u i r e e s c r i b e d p r o f e s s i o n a l s d o e s n o t e s t a b l i s h t h a t 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 i b e 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 n d s i g n i f i c a n t l y r e s t r i c t s h i s d a i l y l i v i n g a c t i v i t i e 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 e c t i o n 2 ( 1 ) o f ' s a n d a s s e s s o r ' s r e p o r t s . T h e r e p o r t s f r o m s e v e r a l n d a l l a r e c o n s i d e r e d p r e s c r i b e d p r o f e s s i o n a l s . 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 s , a n d p r o v i d e d 4 l e t t e r a b o u t 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 d a i l y t h e A p p e l l a n t ' s d o c t o r t o b e t h e p r e s c r i b e d i s
d i r e c t l y r e s t r i c t e d b y p a i n , i s l i m i t e d i n d u r a t i o n a n d a i d s h e u s e s a n d h o w m e d i c a t i o n s a r e n o t h e l p i n g p h y s i c a l a c t i v i t i e s a n d t h e n e e d f o r a c a n e . H o w e t h a t , n o t w i t h s t a n d i n g s u c h d i r e c t a n d s e v e r e i m p a a c t i v i t i e s i n d e p e n d e n t l y . T h e s e i n c l u d e a s p e c t s o h o u s e k e e p i n g , s h o p p i n g , m e a l s , p a y i n g r e n t / b i l l s , d o c t o r r e p o r t e d t h a t o n l y u s i n g p u b l i c t r a n s i t , l i f t i n g a s s i s t a n c e . A l s o , a l t h o u g h i n O c t o b e r 2 0 1 4 , t h e d w o r s e n e d p a i n w i t h m u l t i p l e a c t i v i t i e s o f d a i l y l i v i n g i n d i c a t e t h a t t h e A p p e l l a n t i s u n a b l e t o i n d e p e n d e n o n l y i n d i c a t e d t h a t t h e d a u g h t e r h e l p s w h e n s h e c T h e r e f o r e , a b s e n t m o r e s p e c i f i c e v i d e n c e f r o m t h e a s s e s s i n g t h e A p p e l l a n t ' s n e e d f o r c o n t i n u o u s o r p t h e m a j o r i t y o f d a i l y l i v i n g a c t i v i t i e s , t h e P a n e l f i n d A p p e l l a n t d i d n o t m e e t t h e r e q u i r e m e n t s i n s e c t i o n H e l p w i t h D a i l y L i v i n g A c t i v i t i e s 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 n e e d s a n d u s e s b y h i s d o ct o r a n d h e m a y s o o n n e e d a w a l k e r . H e h o u s e k e e p i n g t a s k s a n d g r o c e r i e s . H e a l s o r e l i e s T h e M i n i s t r y ' s p o s i t i o n i s t h a t b e c a u s e t h e e v i d e n c s i g n i f i c a n t l y r e s t r i c t e d , i t c a n n o t d e t e r m i n e t h a t t h e p e r s o n s . A l s o , i t i n d i c a t e d t h a t t h e i n f o r m a t i o n f r o m r e q u i r e s a n y a s s i s t i v e d e v i c e s , t h e s i g n i f i c a n t h e l p T h e P a n e l ' s D e c i s i o n S e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A a l s o r e q u i r e s t h t h a t , b e c a u s e o f d i r e c t a n d s i g n i f i c a n t r e s t r i c t i o n s i A p p e l l a n t n e e d s h e l p w i t h t h o s e a c t i v i t i e s . T h e A p d a u g h t e r h e l p s h i m w i t h g r o c e r i e s a n d h o u s e w o r k A p p e l l a n t ' s d o c t o r a l s o r e p o r t e d t h a t t h e A p p e l l a n t h e l p s w h e n s h e c a n . H o w e v e r , i n t h e a s s e s s o r ' s 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 n e e d s c o n t i n u o u s a s s w i t h p u b l i c t r a n s i t . M o s t o t h e r a c t i v i t i e s a r e m a n a b a s e d o n t h e A p p e l l a n t ' s d o c t o r ' s ' r e p o r t s a n d b a s 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 a r e n o t d i r e c t l y a n c o n c l u d e d t h a t t h e e v i d e n c e d o e s n o t e s t a b l i s h t h a s e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A . C o n c l u s i o n H a v i n g r e v i e w e d a l l o f t h e e v i d e n c e a n d t h e r e l e v a r e c o n s i d e r a t i o n d e c i s i o n w a s r e a s o n a b l y s u p p o rt e a p p l i c a t i o n o f t h e a p p l i c a b l e e n a c t m e n t s i n t h e A p p c o n f i r m s t h a t d e c i s i o n . EAA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # r e q u i r e s l o n g r e s t p e r i o d s . H e a l s o d e s c r i b e d t h e . T h e d o c t o r a l s o r e p o r t e d d i r e c t l i m i t a t i o n s i n m o s t v e r , i n t h e a s s e s s o r ' s r e p o r t t h e d o c t o r i n d i c a t e d i r m e n t s , t h e A p p e l l a n t m a n a g e s m o s t d a i l y l i v i n g f 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 , p e r s o n a l c a r e , b a s i c m e d i c a t i o n s a n d g e t t i n g i n / o u t o f v e h i c l e s . T h e , a n d c a r r y i n g a n d h o l d i n g r e q u i r e c o n t i n u o u s o c t o r d e s c r i b e d t h e A p p e l l a n t a s e x p e r i e n c i n g a n d i n c r e a s e d r e s t r i c t i o n s , t h e d o c t o r d i d n o t t l y m a n a g e t h e a c t i v i t i e s d e s c r i b e d . T h e d o c t o r a n w i t h h o u s e h o l d t a s k s . f a m i l y d o c t o r o r a n o t h e r p r e s c r i b e d p r o f e s s i o n a l e r i o d i c a s s i s t a n c e o v e r a n e x t e n d e d p e r i o d w i t h s t h a t 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 2 ( 2 ) ( b ) o f t h e E A P W D A . a s s i s t i v e d e v i c e s , e s p e c i a l l y a c a n e a s c o n f i r m e d n e e d s a n d g e t s h e l p f r o m h i s d a u g h t e r w i t h o n f r i e n d s t o t a k e h i m p l a c e s a n d t o c a r r y t h i n g s . e d o e s n o t e s t a b l i s h t h a t d a i l y l i v i n g a c t i v i t i e s a r e A p p e l l a n t r e q u i r e s s i g n i f i c a n t h e l p f r o m o t h e r t h e d o c t o r 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 o f a n o t h e r p e r s o n o r a n a s s i s t a n c e a n i m a l . e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l c o n f i r m i n g n h i s a b i l i t y t o m a n a g e d a i l y l i v i n g a c t i v i t i e s , t h e p e l l a n t s t a t e d t h a t h e u s e s a c a n e , t h a t h i s a n d h e i n s t a l l e d r a i l s i n h i s s h o w e r . T h e u s e s a c a n e a n d t h a t t h e A p p e l l a n t ' s d a u g h t e r e p o rt a n d i n t h e O c t o b e r 2 0 1 4 l e t t e r , t h i s d o c t o r i s t a n c e o n l y w i t h c a r r y i n g , l i f t i n g a n d h o l d i n g , a n d g e d i n d e p e n d e n t l y . T h e P a n e l f i n d s , t h e r e f o r e , t h a t e d o n t h e M i n i s t ry ' s d e t e r m i n a t i o n t h a t t h e d s i g n i f i c a n t l y r e s t r i c t e d , t h e M i n i s t r y r e a s o n a b l y t t h e A p p e l l a n t s a t i s f i e d t h e r e q u i r e m e n t s i n n t l e g i s l a t i o n , t h e P a n e l f i n d s t h a t t h e M i n i s t r y ' s d b y t h e e v i d e n c e a n d w a s a r e a s o n a b l e e l l a n t ' s c i r c u m s t a n c e s . T h e r e f o r e t h e P a n e l
You are being directed to the most recent version of the statute which may not be the version considered at the time of the judgment.