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 r e c o n s i d e r a t i o n d e c i s i o n d a t e d N o v e m b e r 3 , 2 0 1 4 w o f t h e 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 h e D i s a b i l i t i e s A c t f o r d e s i g n a t i o n a s a p e r s o n w i t h d i s a 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 h i s i m p H o w e v e r , t h e m i n i s t r y w a s n o t s a t i s f i e d t h a t t h e e v i d • t h e a p p e l l a n t h a s a s e v e r e p h y s i c a l o r m e n t a • 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 r e 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 • a s a r e s u l t o f t h e 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 a n o t h e r p e r s o n , t h e u s e o f a n a s s i s t i v e d e v i c p e r f o r m D L A . 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 I A P P E A L # D e v e l o p m e n t a n d S o c i a l I n n o v a t i o n ( t h e m i n i s t r y ) 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 t h r e 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 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 t h a t t h e 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 t t w o y e a r s . e n c e e s t a b l i s h e s t h a t : l i m p a i r m e n t ; , i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l , 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 , 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 e , o r t h e s e rv 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 o 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
I APPEAL -ff. PART E-Summa of Facts The evidence before the ministry at the time of the reconsideration decision included the Persons With Disabilities (PWD) Application comprised of the applicant information and self-report including attached typed pages dated May 12, 2014, a physician report (PR) dated April 3, 2014 completed by an anesthesiologist who has known the appellant since March 2013, and an assessor report (AR) dated May 12, 2014, completed by a registered nurse who has known the appellant for 8 years. The approaches and information sources used to complete the AR consisted of both a home assessment and family/friends/caregivers. The evidence also included: 1) Letter dated May 28, 2014 from the anesthesiologist who completed the PR; and, 2) The appellant's Request for Reconsideration dated September 29, 2014 with attached written submission by a legal advocate on behalf of the appellant and excerpts from the Interpretation Act RSBC 1996, c. 238. Diagnoses In the PR, the appellant was diagnosed by the anesthesiologist with chronic low back pain and depression, both with an onset of 2010. Physical Impairment In the PR, the anesthesiologist reported that: • In terms of health history, the appellant has been in constant pain since an MVA [motor vehicle accident] in 2010. He had to give up his trade. The initial musculoskeletal injuries likely initiated his pain syndrome. His condition is chronic and not curable, with a low likelihood of resolution. His pain symptoms are severe and unpredictable. He is prone to exacerbations which are significantly disabling. He will likely require a combination of treatment to manage his symptoms, including medications which cause him significant side effects, and invasive procedures as required. • The appellant does not require any prosthesis or aid for his impairment. • In terms of functional skills, it is not known how far the appellant can walk or how many stairs he can climb, he can lift 7 to 16 kg. (15 to 35 lbs.) and remain seated less than 1 hour. • The appellant is not restricted with mobility inside the home and is continuously restricted with mobility outside the home. In the AR the nurse indicated that: • The appellant is assessed as being independent with walking indoors and outdoors, climbing stairs and standing. He requires continuous assistance from another person with lifting and carrying and holding, with a comment: "unable to lift any items over a few pounds; lifting difficult and unable to carry any heavy items." • No assistive devices are indicated in the section of the AR relating to assistance provided and the nurse wrote "N/A," or not applicable. In his self-report, the appellant indicated that: • He was involved in a serious motor vehicle accident in 2010 and suffered severe injuries. • He struggles getting around due to constant severe back and overall body pain. He is now on medications and in·ections to hel with the back ain. He does not ever slee ro erl 3 to 4
h o u r s ) a n d w h e n h e w a k e s d u r i n g t h e n i g h t s e v e r e p a i n . • F o r m o b i l i t y i n s i d e t h e h o m e , i t i s e x t r e m e l y s t a i r s , h e r e l i e s h e a v i l y o n t h e h a n d r a i l a n d h p i c k t h i n g s u p o f f t h e f l o o r o r t o k n e e l a n d g e • F o r m o b i l i t y o u t s i d e t h e h o m e , h e a v o i d s w a t o 2 b l o c k s m a x i m u m w i t h o u t a i d o r r e s t . D r I n t h e l e t t e r d a t e d M a y 2 8 , 2 0 1 4 , t h e a n e s t h e s i o l o g • H e w a n t e d t o c l a r i fy h i s a s s e s s m e n t o f t h e a c o n d i t i o n t h a t r e s t r i c t s h i s d a i l y f u n c t i o n . • T h e a p p e l l a n t d e s c r i b e s c o n s t a n t p a i n i n t h e u n r e m i t t i n g . H e u s e s m e d i c a t i o n s t o h e l p c o s i g n i f i c a n t s i d e e ff e c t s f r o m t h e m e d i c a t i o n s u p s e t a n d c o g n i t i v e s l o w i n g . • T h e a p p e l l a n t ' s c o n d i t i o n i s c h r o n i c a n d s e v e t r e a t m e n t t h a t h a s p r o v i d e d s o m e b e n e f i t b u f u t u r e , t h e r e i s n o g u a r a n t e e t h a t a s i m i l a r b • H i s s y m p t o m s a r e c o n s t a n t a n d c a n p e r i o d i c e x a c e r b a t i o n s , h i s a c t i v i t y i s s i g n i f i c a n t l y l i m M e n t a l I m p a i r m e n t I n t h e P R , t h e a n e s t h e s i o l o g i s t r e p o r t e d : • I n t e r m s o f h e a l t h h i s t o ry , t h e a p p e l l a n t d e v e • T h e a p p e l l a n t h a s n o d i ffi c u l t y w i t h c o m m u n i • T h e a p p e l l a n t h a s a s i g n i f i c a n t d e f i c i t w i t h c o e m o t i o n a l d i s t u r b a n c e , w i t h a c o m m e n t a d d e c h r o n i c p a i n . " • I t i s u n k n o w n w h e t h e r t h e a p p e l l a n t i s r e s t r i c I n t h e A R , t h e n u r s e 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 h a s a g o o d a b i l i t y t o c o m m u n i • T h e r e a r e n o m a j o r i m p a c t s t o t h e a p p e l l a n t ' i m p a c t s a r e a s s e s s e d t o b o d i l y f u n c t i o n s , e m t o 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 n o i m p a c t s t o c o m m e n t e d : " C h r o n i c p a i n a n d d e p r e s s i o n a p e r i o d s o f t i m e . L o n g t e r m h / o [ h i s t o r y o f ] d a n d m a i n t a i n f o c u s d / t [ d u e t o ] m e d i c a t i o n . " • W i t h r e s p e c t t o s o c i a l f u n c t i o n i n g , t h e a p p e l l a n a m e l y : w i t h m a k i n g a p p r o p r i a t e s o c i a l d e c i i n t e r a c t i n g a p p r o p r i a t e l y w i t h o t h e r s , d e a l i n g s e c u r i n g a s s i s t a n c e f r o m o t h e r s . • T h e a p p e l l a n t h a s g o o d f u n c t i o n i n g i n b o t h h n o f u r t h e r c o m m e n t s a d d e d . I n h i s s e l f r e p o r t , t h e a p p e l l a n t i n d i c a t e d t h a t : • H e n e e d s a s s i s t a n c e c o o i n g w i t h d e p r e s s i o n I A P P E A L # h e c a n n o t a l w a y s g e t b a c k t o s l e e p d u e t o t h e d i f f i c u l t a n d t a k e s s i g n i f i c a n t l y l o n g e r . F o r c l i m b i n g e i s o t h e rw i s e u n a b l e . H e i s u n a b l e t o b e n d t o t u p f r o m . l k i n g o n u n e v e n p a v e m e n t / g r o u n d . H e c a n w a l k 1 i v i n g m a k e s h i m a n x i o u s . i s t w h o c o m p l e t e d t h e P R a d d e d : p p e l l a n t a s w e l l a s t h e s e v e r i t y o f h i s c h r o n i c p a i n l o w e r b a c k a r e a ; h e r a t e s t h i s p a i n a s s e v e r e a n d n t r o l h i s s y m p t o m s ; h o w e v e r , h e r e p o r t s i n c l u d i n g : d i zz i n e s s , d r o w s i n e s s , g a s t r o i n t e s t i n a l r e i n n a t u r e ; h e h a s r e c e n t l y u n d e r t a k e n t i s n o t a p e r m a n e n t f i x a n d , i f r e p e a t e d i n t h e e n e f i t w i l l b e o b t a i n e d . a l l y w o r s e n i n s e v e r i t y . W h e n h e e x p e r i e n c e s i t e d . l o p e d d e p r e s s i o n w i t h h i s p a i n . c a t i o n . g n i t i v e a n d e m o t i o n a l f u n c t i o n i n t h e a r e a o f d : " d e p r e s s i o n a n d s l e e p d i s o r d e r s e c o n d a r y t o t e d w i t h s o c i a l f u n c t i o n i n g . c a t e i n a l l a r e a s . s c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n g . M o d e r a t e o t i o n a n d m o t i v a t i o n . T h e r e i s a m i n i m a l i m p a c t t h e r e m a i n i n g 1 0 a r e a s o f f u n c t i o n i n g . T h e n u r s e f f e c t s s l e e p h a b i t s . U n a b l e t o s l e e p f o r l o n g e p r e s s i o n . O ft e n f i n d s i t d i ff i c u l t t o c o n c e n t r a t e n t i s a s s e s s e d a s b e i n g i n d e p e n d e n t i n a l l a r e a s , s i o n s , d e v e l o p i n g a n d m a i n t a i n i n g r e l a t i o n s h i p s , a p p r o p r i a t e l y w i t h u n e x p e c t e d d e m a n d s , a n d i s i m m e d i a t e a n d e x t e n d e d s o c i a l n e t w o r k s , w i t h a n d h e c h a i n s m o k e s .
• H e nee ds ass i stan c e c opi ng wit h se nsiti vit y to li spots in h is visio n. Daily Livin g Activit ies ( D LA) I n th e PR, t he a nesthesio logist indica t ed th a t : • The a pp el lan t has b een pre s c ri bed medi cati o the an e sthe s i olo gist wrote t h at th e pain medication is su es wh ic h t h e app ellan t re port s inter fer es • The ap pellant is not restric ted wi th the DLA of o r with m o b ility i n side the ho m e. • The a p pel lan t is c o nti nu ou sly restri cted with sh op pi ng, mob il i ty ou t si d e th e home and u s e • It is un known whether the a pp ellant is r estri cted f un c tioning . In the AR, the n ur se re ported th at : • T he appel lant is indepe ndent with moving ab • R egar ding pers on al car e, t he appellan t i s indepen gr oom ing, bat hing, to ileting, feeding self, re gulating cha ir. • F or ba s ic h o usekeepi n g, th e appellant re q u i r b as ic h ousekeeping an d i s in dependent wi t h d p er for m tasks i nvolvin g lifting/ bending . " • For sh op ping, th e app ellant is indep en d en t wi labels , making a ppropria te choice s an d p aying for fr o m anothe r pe rson w i th ca rrying purchases hom a ssis tan c e for hea v i er it e ms. " • T h e appella nt i s i ndep endent wi th all tasks o and trans portatio n. In h i s self-rep o r t, the appellant in d i c ated that: • He ne eds a s sista n ce w it h me al p repar ation as t constant severe pain. • He needs assistance with eating since he has a lack of appetite and sometimes goes until late in the day or even without foocf. • For shopping, he needs assistance with walking around stores since he is unable to do this on his own and requires ass i s tan c e from his family or he does not ca rry groceries. • Regarding transportation, he is unable to stand at the bus stop or on the bus, it is ex difficult and he relie s on the handrail for go ing due to anxiety from his accident and needs to stop to rest after 30 t It is "extremely diffi cult " getting into and out of vehicles. • He requires assistance f or many tasks of house cleaning or he takes significantly longer. • For mobility inside and outside of the home, he takes significantly longer and relies on handrails, he avoids walking on uneven pavement/ground and can walk a maximum of blocks without aid or rest. • Regarding personal hvaiene and self-care, he would benefit from handrails and, due to the I APP E A L # gh t speci f i cally as it caus e s di z zin e ss and ns t hat inter fere with hi s dail y l ivin g ac t ivities an d s cau se cognit ive impair ment and memory w ith his d a ily fun cti o n. p ers on a l self care, mana geme n t of m edications, meal p repa ration, basic hou sew ork, d a il y of transportat ion. w ith manag e ment of fin an ces o r so c ial ou t indo or s and outdo ors. dent with all ta s k s, n a mely: d ressi ng, die t , t ran sf ers in/out of be d a nd on/off o f es periodic a s sista n ce fro m anothe r pe rs on w ith oing la u n dry, w ith a c omme nt added: "una bl e to t h goi ng t o an d from st o re s , reading p r i c e s and pu rchases an d r equir es periodic as si s ta nc e e , w ith a c o m ment t ha t the ap pellant "needs f t he DLA me als, pay r ent an d bills , medica t ions asks take sign ific antly lon g er due t o t he go. He is unable to move/ tr emely up and down s ta i rs. He is unable to drive a car o 4 5 minu tes riding in a car. 1 to 2
s e v e r e c o n s t a n t p a i n , h e i s n o t a l w a y s a b l e • F o r m a n a g i n g h i s p e r s o n a l m e d i c a t i o n , h e s t r e m e m b e r i n g t o t a k e h i s m e d i c a t i o n s a n d h a I n t h e l e t t e r d a t e d M a y 2 8 , 2 0 1 4 , t h e a n e s t h e s i o l o g • T h e a p p e l l a n t i s c u r r e n t l y r e l y i n g o n h i s f a m i d e p e n d s o n t h e m t o a s s i s t w i t h m a i n t a i n i n g a p p o i n t m e n t s . H e r e p o rt s t h a t h i s p a i n f l u c t c h r o n i c p a i n . • W h e n h i s s y m p t o m s a r e e x a c e r b a t e d , h e h a D L A . • H e w i l l a l s o r e q u i r e t h e a s s i s t a n c e o f a c a n e e x a c e r b a t i o n . N e e d fo r H e l p • T h e a n e s t h e s i o l o g i s t i n d i c a t e d i n t h e P R t h a p r o v i d e a s s i s t a n c e . H i s n e e d s a r e g r e a t e r w p a i n s y m p t o m s . " • I n t h e A R , t h e n u r s e r e p o r t e d t h a t , w i t h r e s p e a p p e l l a n t ' s f a m i l y a n d f r i e n d s a s s i s t h i m . T h A s s i s t s I / C [ i n c l u d i n g ] A O L ' s [ a c t i v i t i e s o f d a i t e m s . " T h e s e c t i o n o f t h e r e p o r t i n d i c a t i n g a d e v i c e s i s n o t c o m p l e t e d . • I n h i s s e l f r e p o r t , t h e a p p e l l a n t i n d i c a t e d t h a t a n d h e a l s o r e q u i r e s a n u m b e r o f a s s i s t i v e d s h o w e r / b a t h t u b r a i l a n d s t o o l , w a l l b a r s , j a r o I n h i s N o t i c e o f A p p e a l d a t e d N o v e m b e r 1 8 , 2 0 1 4 , t m i n i s t ry ' s r e c o n s i d e r a t i o n d e c i s i o n a n d w r o t e t h a t : • H e i s u n a b l e t o w o r k a n d h a s t r o u b l e w i t h d a • F i n a n c i a l l y , h e i s u n a b l e t o k e e p a r o o f o v e r A t t h e h e a r i n g , t h e a p p e l l a n t s t a t e d t h a t : • H e i s i n c o n s t a n t p a i n a n d t h e a n e s t h e s i o l o g o n t h e w o r d " e x a c e r b a t e " u s e d b y t h e a n e s t h n o t r e l a t e t o s h o r t n e s s o f b r e a t h s u c h a s w i t h w h i c h h e d o e s n o t h a v e . I t i s m e a n t t o i n d i c a w o r s e . • H e w a s i n v o l v e d i n a m o t o r v e h i c l e a c c i d e n t H e h a s m a j o r d i s c b u l g e s i n h i s s p i n e a t L 4 L a d v i s e d t h a t i t w i l l t a k e s o m e t i m e t o r e a c h a m a k e s o u t , a n d h e h a s n o t r e c e i v e d a n y p a y m e a n t i m e . • H e h a d m a n y c a r e e r a s p i r a t i o n s t h a t w e r e t a t o w a r d s a t r a d e d e s i g n a t i o n a n d c o u l d n o l o n h i s h o m e c o m m u n i t y a n d h i s r o o m m a t e h e l p • H e q u a l i f i e d f o r b e n e f i t s i n a n o t h e r p r o v i n c e t I A P P E A L # t o g e t h i m s e l f t o b r u s h h i s t e e t h a n d h a i r e a c h d a y . r u g g l e s w i t h t a k i n g t h e r i g h t a m o u n t , w i t h v i n g h i s p r e s c r i p t i o n s f i l l e d . i s t w h o c o m p l e t e d t h e P R a d d e d : l y a n d f r i e n d s t o a s s i s t w i t h d a i l y f u n c t i o n s . H e h i s h o m e a n d t r a n s p o r t i n g h i m t o v a r i o u s u a t e s i n s e v e r i t y , w h i c h i s a c o m m o n f e a t u r e o f s d i f f i c u l t y m a i n t a i n i n g h i s h o m e a n d m a n y o f h i s f o r a m b u l a t i o n d u r i n g t h e s e p e r i o d s o f t t h e a p p e l l a n t " r e l i e s o n h i s f a m i l y a n d f r i e n d s t o h e n h e i s s u f f e r i n g f r o m a n e x a c e r b a t i o n o f h i s c t t o t h e a s s i s t a n c e p r o v i d e d b y o t h e r p e o p l e , t h e e n u r s e w r o t e : " f a t h e r p r o v i d e s t r a n s p o rt a t i o n . i l y l i v i n g ] t h a t r e q u i r e l i f t i n g a n d c a r r y i n g h e a v i e r s s i s t a n c e p r o v i d e d t h r o u g h t h e u s e o f a s s i s t i v e h e r e c e i v e s a s s i s t a n c e f r o m h i s f a m i l y a n d f r i e n d s e v i c e s , n a m e l y : a r a i s e d t o i l e t , t o i l e t r a i l s , p e n e r s a n d r e a c h e r / " g r a b b e r . " h e a p p e l l a n t e x p r e s s e d h i s d i s a g r e e m e n t w i t h t h e i l y a c t i v i t i e s . h i s h e a d l e t a l o n e f e e d h i m s e l f . i s t c o n f i r m e d t h a t i n t h e P R . T h e m i n i s t r y f o c u s e d e s i o l o g i s t a n d h e w a n t s t o c l a r i fy t h a t t h i s d o e s C O P D [ c h r o n i c o b s t r u c t i v e p u l m o n a r y d i s e a s e ] , t e t h a t s o m e t i m e s h i s b a c k p a i n b e c o m e s m u c h i n S e p t e m b e r o f 2 0 1 0 a n d s u f f e r e d m a j o r i n j u r i e s . 5 a n d a m i n o r d i s c b u l g e a t S 1 . H i s l a w y e r h a s s e t t l e m e n t b e c a u s e t h e y h a v e t o s e e h o w w e l l h e m e n t s t o c o v e r h i s m e d i c a l e x p e n s e s i n t h e k e n a w a y w i t h t h e a c c i d e n t . H e w a s w o r k i n g g e r f u n c t i o n i n s c h o o l . H e h a d t o m o v e b a c k t o e d h i m w i t h t h e d a y t o d a y c h o r e s . h a t a r e m e a n t f o r t h o s e w h o a r e s e v e r e l y
I APPEAL# handicapped. He had treatments with a spine medication machine but these treatments were extremely expensive and they are not available in B.C. • He had severe negative reactions to some of the medications available to him in B.C. and he ended up in the hospital twice. He had to live with his family while he fought to get the medications he needs to control his pain. His doctor has helped him to secure compassion care to provide the medications he needs. • He found that some anti-depressant medication that he has taken in the past also helped with his back. He has been weaned off that medication and he battles depression but he tries to keep positive and mentally keep going. • Every 6 months for the rest of his life he will have to get the "IDET" [lntradiscal Electrothermal Annuloplasty] procedure done for his back. The procedure involves cauterization of the discs at L4, LS and S1, which helps to reduce the pain experienced. He has to keep stepping up his regular pain medication for about 3 weeks up to the point that he makes the trip on the "medical bus" into another community to get the procedure. After the procedure, he is laid up for about 3 weeks as he recovers. During this time, he is completely reliant on his family members who cook and bring him meals and buy him groceries. It is about 2 to 2 ½ months of a year that he is in severe pain. • He will get some relief of the pain for a while and he is good for about 3 to 4 months and then he has to slowly start ramping up with his pain medications again. He also has to build up the muscle each time that he has lost while recovering. • His situation is not always severe. It is severe to moderate and his hope is to maximize the time that it is 'moderate.' Even during the better times, he can have good days and bad days. • He is concerned about the impact to his vital organs caused by ramping up and weaning off heavy pain medications and has wondered if there is an alternative. The current pain medication slows his mind which makes his situation overwhelming for him. • His family has helped him around the house. He cannot commit to what he can do in any given day because it depends on how well he slept the night before. His father has helped him with cleaning because he cannot afford care workers to come in. He needs help to get his groceries and he is incapable of doing many things. • He sometimes wakes up with migraines which make it hard to function and he feels confused during the day. If he has slept well, he can walk his dog for an hour. He volunteers at a local animal rescue shelter and sometimes walks other people's dogs but he cannot commit to doing so on any particular day. • He can only sit for about 35 to 45 minutes at a time and he always has to move to keep comfortable. He has to do a half hour of stretches every day just to be comfortable enough to move about. • He can lift 15 to 35 lbs. but this is not on a daily basis and he would have to "work up to" lifting that amount, like a weight-lifter does, if he has to move his dog's food, for example. Although 15 to 35 lbs. may seem like quite a bit, he used to be very muscular and could lift much more. Now he questions everything he lifts because his body "will pay for it." The assessments in the PR and in the AR are both correct as his ability to lift varies. Sometimes if he lifts 10 lbs., he will be bedridden the next day. • The nurse who completed the AR is his father's wife who works at a hospital full time so she is not as available to help. She did not review the PR before completing the AR. She is more of a witness as to what he can and cannot do. On the other hand, he tries to stay positive when he is with her. • He has lived with his father and his father's wife and she also helps with groceries, with some
re habil it a t ion, a nd discuss es the me d icati ons it had b ecome a strain on his r e lationsh ips. • He has gone int o debt with hi s family just to get b ec a use h e has p r ov ided fo r himsel f sinc e he was He relies o n the food ba n k w hich is diff ic ult t o • He was unab l e to fi nd a g eneral pra c ti tio ne r anesth e s iol ogi st who adm in ister s his injecti o • He re li ed on the use of a T ra nscutaneous Electrical Nerve Stimulati an ot he r p r ovinc e t o h elp relieve his p ain. • T hi s i s the third tim e his a pplication f or P WD t o g et help from differe n t p e ople w i t h each application. uses a c a n e , he h ad never bro u ght t hat up si • In the r econsi deratio n decis i on, the m inistry o f a n urse a nd h e o nly po ints t hat out to show th • He wants hi s MLA to re v i ew all th ree a pplicatio years and i t was straight-forw ard i n t he oth e r A dmissibility o f New In for mation The mi nistry d id not ra i se an objection t o t h e a ppel lant his Not ice of A p peal . The appe l lan t provid e d additional i impai r ment as d i agnosed in the P WD appl ication. The panel admitted this be i ng in support of i n formati o n a nd rec ords t h at were b recons ider a ti on, i n a ccord anc e w i ths. 22(4)(b) of t he E T h e min i st r y rel ied on its r e consid e ration d ecis ion as min istry a lso c l a rified t hat , i n th e rec onsid era tion d e appellant's a nesthesiol og ist r egarding the 'e x ac e rb ation ass ess or wa s i n co rre c tly r eferred t o in th e reco nside a re g i s te red n urse, but noted t h a t bo th de si gnati ons legislative defin itio n I AP PE A L# with h im . He li ve s on hi s o w n right now becau se by. The fi na n cia l s t rain is v ery har d for him a te enage r and i f he could work , h e w o uld. g et to s inc e he r es ides i n a ru r al area. who is still taking patie nts s o he h ad th e n s complete the PR. on (TENS) machine in de s ign a tion has bee n d e nied. He h a s be en tr y ing Alth o u gh the advocate stat e d t hat he n ce he d oes n ot use on e . r efe rred to the ass e s sor as a socia l worker instead at p eopl e ma ke m ista kes. ns because h e has bee n b ack a nd forth fo r 2 provinc e w here he q u al i f ied . ' s o r a l testimony or the inf orm a t ion provi d ed in nf o rmatio n rega rdi n g th e im pac t of h i s add itional i nfo rmatio n as efo r e th e ministry at the ti me of mp l oym e nt a n d A ss istance A c t . su m marize d at the h e a r ing . At th e h eari ng, t he ci si on, t h e m inis try relied o n th e d escr iption b y th e s ' to his pai n. Th e ministry sta ted t hat th e ra tion d e c ision as a social w o rk e r wherea s she is qualify as a p res cribed pr ofe ssi o nal und er t he
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 o n t h e 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 ' s r e a p p e l l a n t i s n o t e l i g i b l e f o r d e s i g n a t i o n a s a p e r s o n b y t h e e v i d e n c e o r w a s a r e a s o n a b l e a p p l i c a t i o n o f t h e a p p e l l a n t . T h e m i n i s t r y f o u n d t h a t t h e a p p e l l a n t i m p a i r m e n t b a s e d o n t h e i n f o r m a t i o n p r o v i d e d a n d 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 , d i r e c t l y a n d s i g 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 l s o , a s a r e s u l t t h a t t h e a p p e l l a n 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 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 o f a n a s s i s t a n c e a n T h e c r i t e r i a f o r b e i n g d e s i g n a t e d a s a p e r s o n w i t h d E A P W D A a s f o l l o w s : P e r s o n s w i t h d i s a b i l i t i e s 2 ( 1 ) I n t h i s s e c t i o n : " a s s i s t i v e d e v i c e " m e a n s a d e v i c e d e s i g n e d t o e n a b l e 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 e p e r s o n i s u n " d a i l y l i v i n g a c t i v i t y " h a s t h e p r e s c r i b e d m e a n i n g ; " 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 t h e p r e s c r i b e d m e a n i n g ( 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 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 ) 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 ( 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 ( 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 ( 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 ( 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 ( 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 ( 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 . ( 4 ) T h e m i n i s t e r m a y r e s c i n d a d e s i g n a t i o n u n d e r s u b s e c t i o S e c t i o n 2 ( 1 ) ( a ) o f t h e E A P W D R d e f i n e s D L A f o r a p e r s o f o l l o w s : D e f i n i t i o n s f o r A c t 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 ( 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 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 A P P E A L # c o n s i d e r a t i o n d e c i s i o n , w h i c h f o u n d t h a t t h e w i t h d i s a b i l i t i e s ( P W D ) , w a s r e a s o n a b l y s u p p o r t e d t h e a p p l i c a b l e e n a c t m e n t i n t h e c i r c u m s t a n c e s o f d o e s n o t h a v e a s e v e r e m e n t a l o r p h y s i c a l t h a t h i s d a i l y l i v i n g a c t i v i t i e s ( D L A ) a r e n o t , i n t h e 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 l y o r o f t h o s e r e s t r i c t i o n s , i t c o u l d n o t b e d e t e r m i n e d p e r v i s i o n o f a n o t h e r p e r s o n , t h e u s e o f a n i m a l t o p e rf o r m D L A . i s a b i l i t i e s ( P W D ) a r e s e t o u t i n S e c t i o n 2 o f t h e a p e r s o n t o p e rf o r m a d a i l y l i v i n g a c t i v i t y t h a t , b e c a u s e o f a a b l e t o p e r f o r m ; . 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 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 t i n u e f o r a t l e a s t 2 y e a r s , a n d 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 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 . 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 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 o n , o r n ( 2 ) . n w h o h 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 a s i n g a c t i v i t i e s " 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
(ii i) s hop for persona l need s ; (iv) u se p ublic or pe r so n a l transpo rtation facilities; (v) p erform h ous ework to ma intai n the p e rso n 's plac e of ( vi) move about indo ors and o u tdo ors; (vii) p erform per sonal hygiene and self care; (v iii) mana ge per s o nal m edica t i on, and (b ) in relat ion to a pers o n who has a s ev ere men tal impai (i) mak e decisions a b o u t personal a cti v i ties, car e or (ii) rel at e to , c ommuni cate or interac t with o th e rs effec Sev e re Physi cal Im p a ir m ent Th e ap pell ant's p osition is t hat a severe physical impai chronic low back pain. The advocate wro t e th at the an sym ptoms are se vere a nd unpredictable and he is prone to disabl ing. The an esthesio lo gis t also wr ot e that the p e riod ica ll y worsen in s e ve r i ty . The ap pellan t stat ed up/do w n stairs and if there is n o handr ail then he is unabl Sec t i on 8 o f the I n te rp retatio n Act which state s tha t b e co nstrue d as b eing remedial and m us t be g i ven s int erp re tation as bes t e nsur e s the at ta in men t of its ob The m inistry's posit i o n is t ha t the appella nt's functio an d t he i nf o rma tion provid ed does no t e sta b lish that m inistr y argued th at th e anesthes iolo g ist r eporte d that the appell unpre dic t abl e and are prone to exacerbat i ons ; however, exacerba ti ons oc cu r . The mi nistry argu e d t hat th e a no t r equi re an aid for his impairment, it is u nknow n how far t he can lift between 15 a nd 35 l bs. T he m inistry a rgued assist ance with lifting and car ry ing an d h old ing and that c limbing s t airs and s t andi n g. P an el De ci sion A diagnosis of a serious medical condition does not in itself determine PWD eligibility or establish a seve re imp air m ent. A n "impairmen t" is a medical condition that results in restriction ability to fu n ction independently or effectively. To assess the severity of an impairment the ministry must consider the nature of t the extent of its impact on daily functio ning as evidenced by functional skill limitati to which performing DLA is restricted. In making its determination the mi relevant evidence, including that of the appellant. H fundamental basis for the analysis is the evidence from a prescribed professional -in this case, the anesthesiologist and the registered nu r se. The anesthesiologist, who had known the appella n t chronic low back pain. The anesthesiologist described the appellant's pain symptoms as severe and un redictable and wrote that the a ellant is rone to exacerbations which are si I APPEA L# res idence in ac cep table sani t ar y c o nd ition; r m ent, includ e s the fo l lowing ac t iviti es: fin a n ce s ; tively. r me n t is esta blish ed by the e vidence of h is e s the s iolo gist reported that the ap pel lant ' pain exace r b ations wh ich are sign i fic antly appellan t's symptoms are constant and c an tha t he r el ies he avily o n the ha n dr a il whe n go ing e t o do sta ir s. The a dvoca te h igh li g ht ed i t appli e s t o all provincial en actm ent s , w hic h must u ch fa ir , larg e a nd l ibe ral constr uct ion a nd j e cts. nal skill limi tat ions ar e not significantly re stricted he has a se ver e phys ical i mpairmen t. The ant ' s pain symp t oms a re s e vere and n o informat ion is prov ided on how often th e nesthesiol ogist reported t hat the app ellant does he app ella nt can wal k or c limb sta i rs and tha t the nurse re ported a n eed f o r cont i nuous the appellant is indepen dent with m obility , s to a person's h e impairment and o ns and the degree nis t ry must co nsider all th e o wever, the l egislation i s clear that the since March 2013, diagnosed the appellant with nificantl disablin .
T he a ppell an t c l ar ified at the hea r in g that these exace beco mes i nc reasi n g ly wor se and he ram p s up the am we eks , until he h as a p roce d ure invo l vi ng ca u t eri zat b u lges, at L4 and L5 , and a mino r b ulge a t S1. Th e ha s a period of recov er y that la s ts a bou t 3 weeks wh a ssistan c e fo r many DLA, inc l u d ing meal prep a r at ion and grocery sh t h at h e has th i s proc e d ure perf ormed every 6 mo nths, 2 to 2 1/2 mont h s of exac er bated pa in ove r the period of hi s con ditio n is not al w ays "se vere, " tha t he gets reli go al is to maint ain a "m o derat e " l evel f o r as l o ng as s ta t e d that during h i s moderat e peri o d s he can als o 20 14, the anesthesiolog ist wrote that th e app ell an t p rovided so m e benefit b ut is not a perm a nent f ix an that a sim ilar benefit will be obtaine d. In t h e PR the anesthe siologist r epor ted tha t the appellant does his i mp a irment ; however, in the l e tte r dated May 28, 2 a ssist an c e o f a cane f o r ambulatio n d uring the per iods stat ed tha t he is no t u sing a c a ne a nd t h at he do es n exac e rbation. In terms of fun c tion al sk ills, the anesthesiologist reported t th e appe l lan t can w a l k or ho w many stair s he can climb he can wa l k 1 to 2 b lo c ks ma xi mum wit hout aid o r rest cl imbing s t a irs and he i s otherw ise u na ble . At the hearing, the appel well, h e can wa lk h is dog f o r an ho u r the ne x t day. can li ft 15 to 35 l b s. , a nd rema i n seated le s s than 1 ho can only sit for abo u t 35 to 45 minute s at a tim e and he always has do e s s tretch es for a half hour eve r y day to b e comfortable e reported i n th e AR that th e appellant re q ui res co n tinuous ass h olding and noted t hat he is "una b le to lift a ny items ove carr y hea vy i tem s ." T h e app ellan t stated at th e hear acc ur at e since his f unctioning v ar i es depen din g o n pain . The panel fi n ds that the evidence demonstrates that approximately 2 months in a year when his experience of pain increases to the level that his fun c tioning is significantly reduced. The appellant acknowledge modera te functioning , with occasional "bad days" if he has not slept well. evidence including the appellant's independen t mobility and the mostly moderate the appellant's physical functioning, the panel finds that the ministry reasonably determined that there is not sufficient evidence to establish that the appellant has a severe physical impairment under Sect ion 2(2) of t he EAPWDA. Severe Mental Impairment The appellant's position is that he suffers from depression, he has recently been weaned from an anti-depre ssant medication, and there is suffic ient inf impairment. The advocate wrote that the anesthesiologist reported that the pain medicat cognitive impairments and memory issues that interfere with the I AP PEA L# r ba tions rela te to the pain i n h is back w hic h o unt of pain medications h e takes, f o r about 3 ion o f t he discs in h i s ba ck which hav e major a ppe llant stated that, f o llo wi n g the proced ure, he er e he is "lai d up" and re qu i r e s his fami ly 's o pp i ng. Th e app ella nt s tated or twice a y ear, whic h results i n ap proximate ly a y e ar. The ap pel lant a cknowledg ed t h a t ef f ro m hi s pai n f o r seve ra l mon ths a n d t h a t t h e po ssi ble. A t the h e a r in g, the appe llan t also have some bad days. In the letter d ate d Ma y 28, has recen tly under tak en t r ea tment t h a t h as d, if r epeat ed i n th e futu re , there i s n o gua ran te e not r e q uire an y pro sth es i s o r aid f o r 014, h e wrote that the a p pellant wil l re q ui re the o f ex acerba t ion . At t he hea ring, the appellant ot m ove about m u ch dur ing the periods of pain hat it is n ot known h ow far . In his s elf-report, th e a p pellan t cl arified th a t a nd he rel i e s h eavi ly on the h a ndr ail f o r lant s t ated that if he has sl ept The an e sthe siologi st i ndic at ed th at the appe lla nt u r . At th e heari ng, the appe llant stated that he to m ove t o kee p comfor table . He nough to move about. The nurse istance with li f t ing and ca rrying a nd r a f ew pound s; l if t in g d ifficu lt and unable to ing that the widely varyi ng asse ssm e nt s ar e all whethe r he is experiencing an e xacerbat ion of hi s the appe lla nt expe r iences p e riods of d that he has several months of Considering all of the le v e l of impacts to o rmation to show that he has a severe mental ions cause a p pellant's daily function.
The ministry's position is t h at the r e i s i n s ufficient ev severe ment a l imp a irment. The ministry argu ed that th has a significant deficit to cogniti ve and emotional functionin and the nurse asse ssed no major impacts to daily functioning. anesth esi ologist and the nurse reported that the appe Panel Decision In the PR, the anesthesiologist diagnosed the appellant with depression described as having developed with the appellant's experi ence of pain. wi t h cognitive a n d emotional funct i o n in th e area o f the anesthesiologist that there is "depression a n d sleep disor anesthesiologist reported in the PR that the appe ll ant has bee with his daily l iving activities as the pai n medications cause cognit which the ap pellant reports inte r feres with his d ail y the appell an t 's cognitive and emoti onal fu nctioning f or 8 years re po rted no major impa cts. Mo d e rat e impact and mot i v ation, and th ere i s a min imal i m pact to atte "Chronic pain an d d e pre s sion af fec ts sleep habits. t e r m h isto r y of depre ssi on. Often finds it difficult t o conc medicati on." Cons idering the two DLA t h at are spec ific to m ental ac ti v ities , care or fi nance s (de cis ion ma king), an d re e ffectively (s o cial functi onin g ), the a vailabl e e v id ence r e s tricte d in either. With respect to decis ion mak ing, is independ ent with maki ng app ropriate s ocial decisions and independ (ban k ing, bud geti ng, pa y rent an d bills ) an d his m edication He is also r epo rted as i nd e p e nd ent in the d eci s ion-(making a ppro p r iate choices ), meal preparat ion ( m e tr anspor tat ion (us i n g tr ans i t schedul es an d a r ra ng ing tr Rega r d ing the D LA o f social fu ncti oni ng, t he app e ll ant developing and maintai ning relationships, interacting appropriately with others, and securing ass istance fr o m others. Th e ap pella n t is assessed with a go th e heari ng, the appellant sta te d tha t he b at tles de pression keep going although the fin ancial strain is ve ry h ard for h si nce he wa s a te enager. Given the absence o f impacts functioning, the panel finds that the ministry reasonably determined that a s was no t established un der Section 2(2 ) of the EAPWDA. Restrictions in the ability to perform DLA The app el lant's position is that his physical and mental impai his abilit y to perform DLA on an ongoing basis to the poin of another person, namely his family. The advocate wrote that nowhere in the legislation does it state that a length of time has to be determined or noted by a physician. anesthesiologist noted that the appellant is continuously restricted with meal preparation, basic housework, daily shopping, mobility outside the home and use of transportation. that the assessor notes that the a ellant is co nt inuous! I APPEAL# i d ence to e stablis h that t he app ella nt has a e anest h e siologist reported that the appellant g in the area of emot i o nal disturb a nc e The ministry a rg u e d tha t both the l lant has no difficulties with com mu nicatio n . T h e ap pellant is assessed with a s i g nificant d e fi cit e motional di s tur b a nce , w ith a comment a dde d by de r second a ry to chron ic pain." The n prescribed medications that interfere i v e impa irment and memory issues f u nc tion. However, in a s sessing th e imp acts to i n t he AR, the nu rse who has k nown the appellant s ar e ass essed to b odily functions, em o tion ntion/concentrati on . The nurse commente d: Unab l e to s leep f o r long pe rio ds o f tim e. L o n g e nt rate an d m a i nta i n focus due t o imp airment m ake d ecision s about person al l at e to, commu nica t e or interact w i t h ot h ers indicate s t h at the appell ant is n ot signific an tl y t he nurse re p orted in the AR t h at t he app e lla nt ent l y man ag es his fin ances s (taking as di rected and saf e ha ndl ing) . makin g component s of t he D LA of daily shopping al planni ng a nd food storage), and usi ng a n sporta tion). is as sess e d in t he AR as independe n t with od ability to co mm unicate in al l a r eas . At but he t ries to k e ep positive a nd m en t ally im because he has provi de d for himself assessed to the appellant's mental or socia l ever e mental impairment rments directly and significantly restrict t that he requires the signifi cant assis t an ce The advocate wrote that the The advocate wrote r estricted with li ftin and car i n /holdin
a n d s h e n o t e s t h a t h e i s u n a b l e t o l i f t a n y i t e m s o v e t o c a r r y h e a v y i t e m s . T h e a d v o c a t e a r g u e d t h a t t h e o n f a m i l y a n d f r i e n d s t o p r o v i d e a s s i s t a n c e a n d h i s e x a c e r b a t i o n o f h i s p a i n s y m p t o m s . T h e a d v o c a t e a p p e l l a n t ' s fa t h e r p r o v i d e s t r a n s p o r t a t i o n a n d a s s i s c a r r y i n g h e a v i e r i t e m 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 t h e i n f o r m a t i o n f r o m t t h a t t h e a p p e l l a n t ' s i m p a i r m e n t s s i g n i f i c a n t l y r e s t r i c e x t e n d e d p e r i o d s o f t i m e . T h e m i n i s t r y a r g u e 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 c o n t i n u o u s l y r e s t r i c t s h i s a b h o u s e w o r k , d a i l y s h o p p i n g , m o b i l i t y o u t s i d e t h e h o m t h a t t h e a p p e l l a n t ' s n e e d s a r e g r e a t e r d u r i n g e x a c e p r o v i d e d o n h o w o f t e n t h e a p p e l l a n t h a s t h e e x a c e r i n d i c a t e d t h a t t h e a p p e l l a n t r e q u i r e s p e r i o d i c a s s i s t h e a v i e r p u r c h a s e h o m e b u t n o i n f o r m a t i o n i s p r o v i d a n d h e i s a s s e s s e d a s i n d e p e n d e n t i n t h e r e m a i n d P a n e l 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 t h a t a p r e s a p p l i c a n t ' s s e v e r e i m p a i r m e n t d i r e c t l y a n d s i g n i f i c a f o r e x t e n d e d p e r i o d s . I n t h i s c a s e , t h e a n e s t h e s i o l o p r o f e s s i o n a l s . D L A a r e d e f i n e d i n S e c t i o n 2 ( 1 ) o f t h w i t h a d d i t i o n a l d e t a i l s , i n t h e A R . T h e r e f o r e , t h e p r e h a v e t h e o p p o r t u n i t y t o i n d i c a t e w h i c h , i f a n y , D L A a i m p a i r m e n t s c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e I n t h e a p p e l l a n t ' s c i r c u m s t a n c e s , t h e a n e s t h e s i o l o g p r e s c r i b e d p a i n m e d i c a t i o n t h a t c a u s e c o g n i t i v e i m p r e p o r t s i n t e r f e r e s w i t h h i s d a i l y f u n c t i o n . A t t h e h e a a m o u n t o f p a i n m e d i c a t i o n s h e t a k e s a s h i s p a i n i n c p r o c e d u r e i n v o l v i n g c a u t e r i z a t i o n o f t h e d i s c s i n h i s t h e n u r s e r e p o r t e d n o i m p a c t s t o c o g n i t i v e a n d e m o m e m o r y , w i t h a m i n i m a l i m p a c t i n a t t e n t i o n / c o n c e n t T h e a n e s t h e s i o l o g i s 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 i s c p r e p a r a t i o n , b a s i c h o u s e w o r k , d a i l y s h o p p i n g , m o b i a n d i n d i c a t e d t h a t i t i s u n k n o w n w h e t h e r t h e a p p e l l a s o c i a l f u n c t i o n i n g . I n t h e A R , t h e n u r s e w h o r e l i e d o t h a t t h e a p p e l l a n t i n d e p e n d e n t l y p e r f o r m s a l l t a s k s o u t d o o r s , w i t h t h e e x c e p t i o n o f a r e q u i r e m e n t f o r p e h o u s e k e e p i n g ( n o t e : " u n a b l e t o p e r f o r m t a s k s i n v o l v h o m e w h e n s h o p p i n g , w i t h a c o m m e n t t h a t t h e a p p h e a r i n g , t h e a p p e l l a n t s t a t e d t h a t t h e n u r s e , w h o i s h e c a n a n d c a n n o t d o b u t h e a l s o t r i e s t o " s t a y p o s i t h a t n o w h e r e i n t h e l e g i s l a t i o n d o e s i t s t a t e t h a t a l e p h y s i c i a n ; h o w e v e r , w h e r e p e r i o d i c a s s i s t a n c e i s r e p r e s c r i b e d p r o f e s s i o n a l t o a l l o w t h e m i n i s t ry t o d e t e I A P P E A L # r a f e w p o u n d s , l i f t i n g i s d i ff i c u l t , a n d h e i s u n a b l e a n e s t h e s i o l o g i s t n o t e d t h a t t h e a p p e l l a n t r e l i e s n e e d s a r e g r e a t e r w h e n h e i s s u f f e r i n g f r o m a n a r g u e d t h a t t h e a s s e s s o r n o t e d t h a t t h e t a n c e w i t h t h o s e D L A t h a t r e q u i r e l i f t i n g a n d 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 d o e s n o t e s t a b l i s h t h i s 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 a l l y f o r a l t h o u g h t h e a n e s t h e s i o l o g i s t r e p o rt e d t h a t t h e i l i t y t o p e r f o r m t h e D L A m e a l p r e p a r a t i o n , b a s i c e a n d u s e o f t r a n s p o r t a t i o n , h e a l s o e x p l a i n e d r b a t i o n o f h i s p a i n a n d t h e r e i s n o i n f o r m a t i o n b a t i o n s . T h e m i n i s t r y a r g u e d t h a t t h e n u r s e a n c e w i t h b a s i c h o u s e k e e p i n g a n d c a r r y i n g e o n h o w o f t e n t h e a p p e l l a n t r e q u i r e s a s s i s t a n c e e r o f h i s D L A . c r i b e d p r o f e s s i o n a l p r o v i d e a n o p i n i o n t h a t a n n t l y r e s t r i c t s h i s D L 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 g i s t a n d t h e n u r s e a r e t h e p r e s c r i b e d e E A P W D R a n d a r e a l s o l i s t e d i n t h e P R a n d , s c r i b e d p r o f e s s i o n a l s c o m p l e t i n g t h e s e f o r m s r e s i g n i f i c a n t l y r e s t r i c t e d b y t h e a p p e l l a n t ' s d p e r i o d s . i s t r e p o rt e d i n t h e P R t h a t t h e a p p e l l a n t h a s b e e n a i r m e n t a n d m e m o ry i s s u e s w h i c h t h e a p p e l l a n t r i n g , t h e a p p e l l a n t s t a t e d t h a t h e r a m p s u p t h e r e a s e s , fo r a b o u t 3 w e e k s , u n t i l h e h a s a b a c k w h i c h o c c u r s t w o t i m e s p e r y e a r . I n t h e A R , t i o n a l f u n c t i o n i n g i n t h e a r e a s o f e x e c u t i v e a n d r a t i o n . o n t i n u o u s l y r e s t r i c t e d w i t h t h e D LA m e a l l i t y o u t s i d e t h e h o m e a n d u s e o f t r a n s p o r t a t i o n , n t i s r e s t r i c t e d w i t h m a n a g e m e n t o f f i n a n c e s o r n a h o m e a s s e s s m e n t o f t h e a p p e l l a n t , r e p o r t e d o f e a c h D L A i n c l u d i n g m o v i n g a b o u t i n d o o r s a n d r i o d i c a s s i s t a n c e f r o m a n o t h e r p e r s o n w i t h b a s i c i n g l i f t i n g / b e n d i n g " ) a n d w i t h c a r r y i n g p u r c h a s e s e l l a n t " n e e d s a s s i s t a n c e f o r h e a v i e r i t e m s . " A t t h e h i s f a t h e r ' s w i f e , i s m o r e o f a w i t n e s s a s t o w h a t t i v e " w h e n h e i s w i t h h e r . T h e a d v o c a t e a r g u e d n g t h o f t i m e h a s t o b e d e t e r m i n e d o r n o t e d b y a q u i r e d , t h e r e m u s t b e s u ff i c i e n t i n fo r m a t i o n f r o m a r m i n e t h a t t h e p e r i o d i c a s s i s t a n c e i s r e q u i r e d f o r
I APPEAL# 'extended periods of time.' The nurse noted that the periodic assistance relates to certain activities relating to the two identified tasks, those involving lifting and bending and carrying heavier items, with no further explanations or descriptions added regarding the frequency or duration of the assistance required in order to allow the ministry to determine that the assistance is required for extended periods. In the letter dated May 28, 2014, the anesthesiologist wrote that the appellant is currently relying on his family and friends to assist with daily functions, to assist with maintaining his home and transporting him to various appointments. The anesthesiologist indicated that when the appellant's symptoms are exacerbated, he has difficulty maintaining his home and many of his DLA In his self report, the appellant indicated that he needs assistance with several tasks, including: meal preparation as tasks take significantly longer due to the constant severe pain, with eating since he has a lack of appetite, with walking around stores and carrying groceries when shopping since he is unable to do this on his own, for transportation as he is unable to stand at the bus stop or on the bus and it is "extremely difficult" getting into and out of vehicles. The appellant also stated that he requires assistance for many tasks of house cleaning or he takes significantly longer and, due to the severe constant pain, he is not always able to get himself to brush his teeth and hair each day. For managing his personal medication, he struggles with taking the right amount, with remembering to take his medications and having his prescriptions filled. The appellant stated at the hearing that his fun ctioning is reduced due to severe pain approximately 2 to 2 ½ months per year and his self-report reflects a lower level of functioning than that reported in the AR by the nurse, likely descriptive of an exacerbated period or "bad day." Considering the evidence as a whole, particularly that of the nurse as the prescribed professional most familiar with the appellant's day-to-day functioning and including the appellant's evidence of the frequency of the exacerbations to his pain, the panel finds that the ministry reasonably concluded that the evidence is insufficient to show, on the balance of probabilities, that the appellant's overall ability to perform his DLA is significantly restricted either continuously or periodically for extended periods, thereby not satisfying the legislative criterion of Section 2(2)(b)(i) of the EAPWDA. Help to perform DLA The appellant's position is that his combined physical and mental impairments significantly restrict his daily living functions to a severe enough extent that significant assistance is required from his family and friends and he also requires a number of assistive devices, namely: a raised toilet, toilet rails, shower/bathtub rail and stool, wall bars, jar openers and reacher/ "grabber." The ministry's position is that because it has not been established that DLA are significantly restricted, it cannot be determined that significant help is required. The ministry stated that the use of an assistive device such as a cane does not, in itself, establish a severe impairment. Panel Decision Section 2(2)(b)(ii) of the EAPWDA requires that, as a result of direct and significant restrictions in the ability to perform DLA, a person requires help to perform those activities. Help is defined in subsection (3) as the requirement for an assistive device, the significant help or supervision of another person, or the services of an assistance animal in order to perform a DLA. The anesthesiologist indicated in the PR that the appellant relies on his family and friends to provide assistance and "his needs are reater when he is sufferin from an exacerbation of his ain
s y m p t o m s . " I n t h e A R , t h e n u r s e w r o t e : " f a t h e r p r o r e q u i r i n g l i f t i n g a n d c a r r y i n g h e a v i e r i t e m s . T h e s e t h r o u g h t h e u s e o f a s s i s t i v e d e v i c e s i s n o t c o m p l e t e a s s i s t i v e d e v i c e s i s , t h e r e f o r e , n o t c o n f i r m e d b y a p w r o t e i n h i s M a y 2 8 , 2 0 1 4 l e t t e r t h a t t h e a p p e l l a n t w a m b u l a t i o n d u r i n g p e r i o d s o f e x a c e r b a t i o n , t h e a p p c a n 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 s t r y r e a s o n a b l y r e s t r i c t i o n s 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 e rf o r m D L A 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 r e q u i r e s h e l p t o p e rf o d e f i n e d b y s e c t i o n 2 ( 3 ) ( b ) o f t h e E A P W D A . C o n c l u s i o n H a v i n g r e v i e w e d a n d c o n s i d e r e d a l l o f t h e e v i d e n c e m i n i s t r y ' s r e c o n s i d e r a t i o n d e c i s i o n w h i c h d e t e r m i n e d e s i g n a t i o n w a s r e a s o n a b l y s u p p o r t e d b y t h e e v i d e I A P P E A L # v i d e s t r a n s p o rt a t i o n " a n d a s s i s t s w i t h D L A c t i o n o f t h e A R i n d i c a t i n g a s s i s t a n c e p r o v i d e d d b y t h e n u r s e a n d t h e a p p e l l a n t ' s n e e d f o r o t h e r r e s c r i b e d p r o f e s s i o n a l . W h i l e t h e a n e s t h e s i o l o g i s t i l l a l s o r e q u i r e t h e a s s i s t a n c e o f a c a n e f o r e l l a n t s t a t e d a t t h e h e a r i n g t h a t h e d o e s n o t u s e a d e t e r m i n e d t h a t a s d i r e c t a n d s i g n i f i c a n t h a v e n o t b e e n e s t a b l i s h e d , i t c a n n o t b e r m D L A 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 , a s a n d r e l e v a n t l e g i s l a t i o n , t h e p a n e l f i n d s t h a t t h e d t h a t t h e a p p e l l a n t w a s n o t e l i g i b l e f o r P W D n c e , a n d t h e r e f o r e c o n f i r m s t h e d e c i s i o n .
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.