APPEAL# I PART C-Decision under Appeal The decision under appeal is the Ministry of Social Development and Social Innovation (the ministry) reconsideration decision dated October 9, 2014 which found that the appellant did not meet three of the five statutory requirements of Section 2 of the Employment and Assistance for Persons with Disabilities Act for designation as a person with disabilities (PWD). The ministry found that the appellant met the age requirement and that her 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; • the appellant's daily living activities (DLA) are, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods; and, • 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 DLA. PART D -Relevant Legislation Employment and Assistance for Persons with Disabilities Act (EAPWDA), Section 2 Employment and Assistance for Persons with Disabilities Regulation (EAPWDR), Section 2
P ART E-Sum ma ry of Facts With the consent of both parties, the he aring was conducted as a written hearing, pursuant 22(3)(b) of th e Employ ment a n d Assistance Act . Th e evidence b efore the m i n i stry a t the time of the r D is a bilities ( PW D) Ap pl ication com pri sed of th e a ppl physician report ( P R) dated November 6, 2014 and comple known the appell ant f or 4 y e ars and an a ssessor rep com ple t ed by a registered nurse wh o has kn own t h The evidence also included th e following: 1) L ett er dated O ctob er 4, 20 1 3 from a physicia 2) Lette r date d October 9, 2013 from a ph y s icia prog ram; 3) E ndocrinology R epor ts dated April 2 5, 201 4 4) Report s d a t ed Dec ember 15, 201 3 of MRI co bra in; 5) L etter from a p hysician who i s a s pec ialist in neurolog Augu st 12 , 2 01 4 ; a nd, 6) Req u est f or R econsider ation dat e d S ept em ber 2 In her Notic e o f Ap peal d at ed O ctober 9, 201 4, the mi n i stry ' s r e cons ideration decisio n an d w rote t h a t she is awai detailed inform ati on fr om the g ene r al pract itio ne r and the regis Prior t o the hearing, th e appe l l ant provide d t he fo l lowing add 1 ) Wri tten submis sion on behalf o f t h e app el lant with reconsid erat io n decis i on; 2 ) Lett er dated Octobe r 10 , 2014 signed and stamped the P R and se t s o ut that: • The appellan t was diag nosed w ith l u pus by a t hyroid dis order, a pitu itary disorder and an anxiety diso knees, feet, hands, shoulders, neck and lower and i s worse in the winter and in damp and cold weather. m ost days. • The appellant ca n not w alk further than assessment by an OT (occupational therapist) for a walker. • The appellant requires someone to be with her when she is outside of the house. finds c l imbin g stairs v ery diff icult a n d house. • The appellant has difficulty standing for any period. • The appellant has to hold onto furniture to get around indoo as little as possible. • Regardin g lifting, the appellant is unable to carry such items as heavy pans full of water for cooking or heavy shopping bags. not weigh very much. APP E A L # I to section econ s ideration dec i sion i ncl u de d the Per son With ica n t i n formation dated O ctober 31, 201 4, a ted by a general practitioner who has o rt ( AR) d at ed No vembe r 22, 2014 and e ap pellant for a ppr oximately 2 to 3 years . n who is a specialist in in te r nal medicine; n w h o is a medica l c ons ulta n t w ith an arthritis a nd October 2 5 , 201 3; n d ucted o n the app e llant's cerv ica l sp i ne a nd y a n d elect rodiagnos t i c results da ted 4 , 201 4 . appellant ex press ed her d i s agre em en t with the ting app roval for a w a lker and more tered nurse . i tion a l i nfo r mat i o n : highl i gh t e d excerpts fr om t he minis try 's b y t he general p ra ctit ioner who comp l eted r heumatolog i s t i n 20 12. She al s o has a rder. She has pain in her bac k. T h e pain is prese nt m ost days Her fee t and ankles sw ell 2 bl ock s due to p ain and she is awaiting an She uses ra ils to help her get up the 3 sta i rs t o h er rs and tries to walk aroun d She can prepare smaller items of food which do
• The a ppellant takes s ign ifican tl y l on ger t ben c h when cl e a n ing hersel f . • The app ellant suffers fr om frequent an with mem o ry an d concen t ration. She • The a p pe l l ant re quires help wi t h daily shop ping bags or househo l d tools. She requires ca r ry heav i er items . • Regarding all of the liste d tasks , the appe the ta s k s and som e times lo nger t han t 3) L e tter d ated No vember 14 , 201 4 in whic h an • T h e appe ll a nt h a s c o morbid h ealt h cond i ndep en de n tly. She has lu pus , degenerative conditions ma k e a cti v it ies of daily l iving • The fati gue, brain fo g, and chr on i c pain t ba rriers in h er dai ly life. • She ha s rec ently prescrib ed a wal k er to ass is t wi th p erson al ca r e. The ministry relied on its re consid e ratio n deci sion as its subm Admis sibility of New I nform at ion Th e m i n i stry di d not raise an o bj e c t ion to the admi ss of the a ppel lan t. The letter d ated Oc t ober 10, 2014 from a p pella nt's ment al a nd physic al i mpairments an d how co nsi ste n t w ith and t ends to corrobor ate th e info rmat The refore, the p a n el has a dm i tted t h is lette r a s be i ng i bef ore the mi n is t r y at the t im e o f rec o nsid eration, in Emp lo y ment and Assistance A ct. The le tter date d No vember 1 4, 201 4 f rom the OT in b een dia gnose d b y a me dical pr ac t itio n e r, and provided a recent pre w ith a mbul at i on w hereas th e o riginal ass ess m e nt in the ai d to t he appellant's i mpairm en t. In h er Request for Reconsideration, the appellant stated that she does not have a wal k er or a cane b eca u se her apartment is too admit this letter as it provides informa tion t h at is n ot consistent with the information that the ministry had at reconsideration. The panel considered the written submission as argument on behal appellant. Diagnoses In the PR, the appellant was diagnosed by the general practitioner with lupus and thyroid disorder, with an onset of June 2006, pituitary dysfunction, with onset of September 2008, and anxiety disorder with an onset of July 2008. Physical Impairment In the PR, the general prac titioner repo rt e d that: • In terms of heal th hi s to ry, the appellant h as p and lower back. The pain is present most davs and is worse in the winter. AP PEA L# I o dress an d she r e quires a sho we r c hair or bath xiet y a tta cks wh ich ca use p r oblems at the ti me do es not h ave a perman e n t n eu rolo g i cal defici t. house work, da ily s hoppin g , an d is unable to lif t h e l p wi th laundry du e t o h er in a bil ity to llant ta k es at le a st twice as long to compl e te his; and, O T sets o ut : iti o ns whic h i mpa i r her ability to funct i on dis c disease and o s t eoarth ri t is. Th e s e tir ing and painful. hat the appell ant e xperie nc e s poses sig nifi cant ass is t with a mbu l atio n a s well as a bath se a t to is sion. ibi lity of the new infor m at i o n su bm it ted on behalf the general practiti on e r e lab o rate s on th e the y i mpac t her abil ity to f un ction an d is io n t hat t he mi nistry had at re considerat i o n. n s upport of info rmatio n an d re cor ds th at were acco rdance w ith Section 22(4 ) of the c lud ed a refe re n ce to o s t eoar thr i tis, whi c h had not scr i ption for a wa lke r to ass is t PR and A R di d n o t lis t a walker as a re q u i re d na rrow . Th erefore, the panel did not f of the ain in her knees , fee t, hands, s houlders, nec k The app ellant Qets
I APPEAL# swelling in her feet and ankles most days and some areas of her skin are sensitive to touch. • The appellant cannot walk further than 2 to 4 blocks due to pain and "feels dizzy." She needs someone to be with her when she is out walking. • The appellant requires an aid for her impairment as she uses a shower chair in the shower due to falling in the shower and she has handrails on the stairs. • For functional skills, the appellant is assessed as able to walk 2 to 4 blocks unaided, she can climb 2 to 5 stairs unaided, she can do no lifting, and she can remain seated less than 1 hour. • The appellant is continuously restricted with mobility inside and outside the home. In the AR, the nurse indicated that: • The appellant is independent with walking indoors (note: "fine with short distances, requires railings with stairs") and takes significantly longer than typical with walking outdoors (note:"syncope makes ambulation difficult"). • The appellant uses an assistive device for climbing stairs, with a comment that she "requires assistance and stationary assistance." • The appellant requires continuous assistance from another person with standing and the nurse noted "pain in leg and back, swelling generally occurs." • The appellant takes significantly longer than typical with lifting (note: "unable") and with carrying and holding, with a comment that she is "able to carry light groceries, unable to carry laundry." • In the section of the AR relating to assistance provided through the use of assistive devices, the nurse identified a bath bench as being routinely used by the appellant. Asked if equipment is required but is not currently being used, the nurse wrote that the appellant requires a bath bench/shower stool, plus or minus a bath bar. In her Request for Reconsideration, the appellant wrote that: • She does not have a walker or a cane because her apartment is too narrow. • She has recently been diagnosed with degenerative disc disease. In the letter dated October 4, 2013, the physician who is a specialist in internal medicine wrote: • The appellant suffers from right upper arm numbness and a number of diagnoses were queried and further investigation was recommended. • Diagnoses listed include depression, galactorrhea, small goiter and atypical chest pain. In the letter dated October 9, 2013, the physician who is a medical consultant with an arthritis program wrote that: • There is no question that the appellant has lupus. • She had an episode of numbness involving the right upper extremity which seems to be improving and it is not clear what that was. In the endocrinology Reports dated April 25, 2014 and October 25, 2013, the findings include: • Ambulation is normal. • Assessments include galactorrhea which is intermittent, pituitary asymmetry, hypotension, and palpitations. The Reports dated December 15, 2013 of MRI conducted on the appellant's cervical spine and brain included the followinQ findinQs:
APPEAL# I • Mild degenerative disc disease is seen. There is mild left-sided foraminal narrowing of the appellant's cervical spine. There is no evidence of nerve root impingement. • There are a few tiny hyperintense foci involving the white matter of the right and possibly a single lesion within the left cerebellar hemisphere of the appellant's brain. These lesions do not meet the criteria for multiple sclerosis but this diagnosis cannot be excluded on the basis of this examination alone. In the letter from the neurologist and in the electrodiagnostic results dated August 12, 2014, the following is set out: • The appellant advised the neurologist that she had an attack of lupus two years ago. She became symptomatic with sore legs, back pain, neck pain. She was then exhausted, had galactorrhea and the appellant reports that her liver was swollen. She is now taking medications. The appellant continues with the leg pain which has an aching or burning quality. She has neck pain and low back pain. She has been "losing feeling in her hands" and they periodically swell and ache and sometimes get purplish. • The neurologist observed that the appellant has normal deep tendon reflexes. There is no weakness or wasting. She put out full power of her right wrist dorsiflexor but complained of pain related to an old fracture. Tone is normal. She felt cool and vibration normally in all four limbs. Tests of coordination were well-performed. She had full range of motion of all the joints in her upper limbs, there was no swelling, color change or synovitis in her joints. She had a good pulse in her hands. • The impression expressed by the neurologist is that he cannot find evidence of a neurologic disorder. He believes the appellant has diffuse myofascial pain and views her hand complaints as part of that. Mental Impairment In the PR, the general practitioner reported that: • In terms of health history, the appellant gets anxiety attacks when she is in a stressful situation, especially with strangers or several people. She has fitful sleep most nights. • The appellant has no difficulties with communication. • The appellant has significant deficits in her cognitive and emotional functioning in the areas of memory, emotional disturbance and attention or sustained concentration. The general practitioner wrote that the appellant "has anxiety attacks, difficulty with long-term memory." • The appellant is not restricted with social functioning. In the AR, the nurse indicated that: • The appellant has a good or satisfactory ability to communicate in all areas. For speaking, the nurse noted that "lupus fog" makes communication occasionally difficult. With writing, she is unable to sustain writing for long periods of time secondary to pain. With hearing, the appellant experiences comprehension difficulties more than mechanical hearing (difficulties). • There are no major or moderate impacts in the 14 listed areas of cognitive and emotional functioning. There are minimal impacts in 13 areas, including memory, emotion and attention/concentration. • The appellant's anxiety disorder suppresses her appetite and she is unable to prepare food when she is experiencing panic. • The appellant describes herself as inert during anxiety prone periods.
APPEAL# I Daily Living Activities (DLA) In the PR, the general practitioner indicated that: • The appellant has not been prescribed any medications and/or treatments that interfere with her daily living activities. • The appellant is continuously restricted with the DLA of personal self care, basic housework, daily shopping, mobility inside and outside the home, and use of transportation. • The appellant is not restricted with the remaining listed DLA, namely: meal preparation, management of her medications, management of finances and social functioning. • Asked to describe the nature and extent of the assistance required by the appellant with DLA, the general practitioner wrote: "assistance required for bathing, daily housework and shopping, mobility in and out of the house." In the AR, the nurse reported that: • The appellant is independent with moving about indoors and outdoors, taking significantly longer than typical outdoors as "syncope makes ambulation difficulty." She uses an assistive device with climbing stairs as the nurse noted that she requires railings. • The appellant is independently able to perform every task of the listed DLA, with the exception of feeding self/regulating diet, for which the appellant requires periodic assistance and the nurse wrote "as previously noted." In the previous section of the AR relating to impacts to cognitive and emotional functioning, the nurse wrote: "anxiety disorder suppresses appetite she is unable to prepare food when experiencing panic." The appellant takes significantly longer than typical with the tasks of dressing, grooming, bathing (note: "requires shower chair as she has fallen in bath"), and transfers in/out of bed and on/off of chair. • For basic housekeeping, the appellant requires continuous assistance from another person with doing laundry (note: "requires assistance lifting and transferring") and requires periodic assistance from another person with basic housekeeping (note: "requires assistance with any momentous movements and lifting"). • Regarding shopping, the appellant is independent with the tasks of going to and from stores (note: "able to drive; standing and movement cause syncope"), reading prices and labels, making appropriate choices, paying for purchases (note: "experiencing financial difficulties"). The appellant takes significantly longer than typical carrying purchases home, with no additional comments by the nurse. • The appellant is independent with meal planning, cooking and safe storage of food and takes significantly longer than typical with food preparation (note: "cooking requires increased time secondary to breaks"). • The appellant independently manages all tasks of personal finances, namely banking, budgeting and paying rent and bills, as well as all tasks of managing her medications (filling/refilling prescriptions, taking as directed and safe handling and storage). • There is no assessment for the appellant's use of transportation facilities. • The nurse provided additional comments that "AOL's have consumed energy that client feels draining. She is experiencing swelling and muscle fatigue that is discouraging from attempting to complete necessary tasks." • The appellant is independent in all 5 aspects of social functioning, Namely: making appropriate social decisions (note: "avoids social situation"), developing and maintaining relationships, interacting appropriately with others, dealing appropriately with unexpected demands (note: "budgeting energy is difficult to predict"), and securing assistance from others. • The appellant has marQinal functioninQ with her immediate and extended social networks. The
APPEAL# I nurse commented: "anxiety and decreased energy forces client to withdraw from social situations/interactions." • In response to a request to describe the support/supervision required to maintain the appellant in the community, the nurse wrote: "if there were more supports in home to assist with AOL, more energy would be available to have meaningful social interactions." In her Request for Reconsideration, the appellant wrote that: • She is able to drive herself to the store to do shopping but she needs assistance going to/from the vehicle and needs assistance in the store with lifting/carrying items. • Basic housekeeping is continuously assisted as she cannot stand for long periods without getting dizzy and she cannot lift anything. Her daughters do the housework. Her doctor shows in the report that she cannot lift anything. Need for Help In the PR, when asked what assistance the appellant needs with DLA, the general practitioner responded that assistance is required for bathing, daily housework and shopping, mobility in and out of the home. The nurse reported in the AR that the appellant lives with her children, both adult and teenagers, some of whom "have impairments that decrease ability to help in home" and that "children offer appropriate, age-related assistance." Asked to describe what assistance would be necessary if help is required but none is available, the nurse wrote: "assistance with basic housekeeping (cleaning, laundry), would help conserve energy. Assistance with tasks that require standing. Client would like to secure more affordable housing that is safe and accessible."
APPEAL# I PART F -Reasons for Panel Decision The issue on the appeal is whether the ministry's reconsideration decision, which found that the appellant is not eligible for designation as a person with disabilities (PWD), was reasonably supported by the evidence or was a reasonable application of the applicable enactment in the circumstances of the appellant. The ministry found that the appellant does not have a severe mental or physical impairment and that her daily living activities (DLA) are not, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods and that, as a result of those restrictions, it could not be determined that 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 DLA. The criteria for being designated as a PWD are set out in Section 2 of the EAPWDA as follows: Persons with disabilities 2 (1) In this section: "assistive device" means a device designed to enable a person to perform a daily living activity that, because of a severe mental or physical impairment, the person is unable to perfonn; "daily living activity" has the prescribed meaning; "prescribed professional" has the prescribed meaning. (2) The minister may designate a person who has reached 18 years of age as a person with disabilities for the purposes of this Act if the minister is satisfied that the person has a severe mental or physical impairment that (a) in the opinion of a medical practitioner is likely to continue for at least 2 years, and (b) in the opinion of a prescribed professional (i) directly and significantly restricts the person's ability to perform daily living activities either (A) continuously, or (B) periodically for extended periods, and (ii) as a result of those restrictions, the person requires help to perform those activities. (3) For the purposes of subsection (2), (a) a person who has a severe mental impairment includes a person with a mental disorder, and (b) a person requires help in relation to a daily living activity if, in order to perform it, the person requires (i) an assistive device, (ii) the significant help or supervision of another person, or (iii) the services of an assistance animal. (4) The minister may rescind a designation under subsection (2). Section 2(1 )(a) of the EAPWDR defines DLA for a person who has a severe physical or mental impairment as follows: Definitions for Act 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;
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P a n e l D e c i s i o n A 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 n o t " s e v e r e " i m p a i r m e n t . A n " i m p a i r m e n t " i s a m e d i c a l a b i l i t y t o f u n c t i o n i n d e p e n d e n t l y o r e f f e c t i v e l y . T o a m u s t c o n s i d e r b o t h t h e n a t u r e o f t h e i m p a i r m e n t a n d e v i d e n c e d b y 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 n d t h e d e g r e s t r i c t e d . I n m a k i n g i t s d e t e r m i n a t i o n t h e m i n i s t r y m t h a t o f t h e a p p e l l a n t . H o w e v e r , t h e l e g i s l a t i o n i s c l e t h e e v i d e n c e f r o m a p r e s c r i b e d p r o f e s s i o n a l i n t h i a s o t h e r s p e c i a l i s t p h y s i c i a n s a n d t h e n u r s e . T h e g e n e r a l p r a c t i t i o n e r , w h o h a s k n o w n t h e a p p e l l a a n d t h y r o i d d i s o r d e r w i t h a n o n s e t o f J u n e 2 0 0 6 , a n 2 0 0 8 . I n t h e r e c e n t l e t t e r d a t e d O c t o b e r 1 0 , 2 0 1 4 , t a n d s e t s o u t t h a t t h e a p p e l l a n t h a s p a i n i n h e r k n e e s T h e p a i n i s p r e s e n t m o s t d a y s a n d i s w o r s e i n t h e w a n k l e s s w e l l m o s t d a y s . I n t h e l e t t e r d a t e d A u g u s t 1 i s n o w t a k i n g m e d i c a t i o n s f o r l u p u s a n d c o n t i n u e s w u a l i , n e c k a i n a n d l o w b a c k a i n . T h e a e l l a n t A P P E A L # I o f r e s i d e n c e i n a c c e p t a b l e s a n i t a r y c o n d i t i o n ; i r m e n t , i n c l u d e s t h e f o l l o w i n g a c t i v i t i e s : i n a n c e s ; c t i v e l y . p a i r m e n t i s e s t a b l i s h e d b y h e r e x p e r i e n c e o f p a i n , r , a n d p i t u i t a r y d y s f u n c t i o n . T h e a d v o c a t e a r g u e d h e p h y s i c i a n 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 i c h m e a n s t h a t s h e r e q u i r e s a s s i s t a n c e w i t h r e q u i r e d f o r m o b i l i t y " i n a n d o u t o f t h e h o m e . " T h e i t e m s w h e n d r e s s i n g , s h e c a n o n l y l i f t l i g h t i t e m s n l y c a r r y l i g h t g r o c e r i e s w h e n s h o p p i n g . 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T h e m i n i s t r y a r g u e d t h a t f o r e r t h a n t y p i c a l o r f o r w h i c h s h e r e q u i r e s p e r i o d i c o w l o n g e r i t t a k e s t h e a p p e l l a n t o r h o w o f t e n o r i n i t s e l f d e t e r m i n e P W D e l i g i b i l i t y o r e s t a b l i s h a c o n d i t i o n t h a t r e s u l t s i n r e s t r i c t i o n s t o a p e r s o n ' s s s e s s t h e s e v e r i t y o f a n i m p a i r m e n t , t h e m i n i s t r y t h e e x t e n t o f i t s i m p a c t o n d a i l y f u n c t i o n i n g a s r e e t o w h i c h t h e a b i l i t y t o p e r f o r m D L A i s u s t c o n s i d e r a l l t h e r e l e v a n t e v i d e n c e , i n c l u d i n g a r t h a t t h e f u n d a m e n t a l b a s i s f o r t h e a n a l y s i s i s s c a s e , t h e a p p e l l a n t ' s g e n e r a l p r a c t i t i o n e r a s w e l l n t f o r 4 y e a r s , d i a g n o s e d t h e a p p e l l a n t w i t h l u p u s d p i t u i t a ry d y s f u n c t i o n w i t h o n s e t o f S e p t e m b e r h e g e n e r a l p r a c t i t i o n e r w h o c o m p l e t e d t h e P R , f e e t , h a n d s , s h o u l d e r s , n e c k a n d l o w e r b a c k . i n t e r a n d i n d a m p a n d c o l d w e a t h e r . H e r f e e t a n d 2 , 2 0 1 4 , t h e n e u r o l o g i s t w r o t e t h a t t h e a p p e l l a n t i t h l e g p a i n w h i c h h a s a n a c h i n g o r b u r n i n g h a d b e e n " l o s i n f e e l i n i n h e r h a n d s " a n d t h e
p e r i o d i c a l l y s w e l l a n d a c h e . T h e n e u r o l o g i s t r e p o r t r e f l e x e s , n o w e a k n e s s o r w a s t i n g , a n d t h a t s h e " p u c o m p l a i n e d o f p a i n r e l a t e d t o a n o l d f r a c t u r e . " H e r p e r f o r m e d , s h e h a d f u l l r a n g e o f m o t i o n o f a l l t h e j o c o l o r c h a n g e o r s y n o v i t i s i n h e r j o i n t s . T h e n e u r o l o a n e u r o l o g i c d i s o r d e r a n d h e b e l i e v e s t h e a p p e l l a n t c o m p l a i n t s a s p a r t o f t h a t . I n h e r R e q u e s t f o r R e c o r e c e n t l y b e e n d i a g n o s e d w i t h d e g e n e r a t i v e d i s c d i s D e c e m b e r 1 5 , 2 0 1 3 , t h e M R I o f t h e a p p e l l a n t ' s s p i n a n d n o e v i d e n c e o f n e r v e r o o t i m p i n g e m e n t . I n t h e O c t o b e r 2 5 , 2 0 1 3 , i t w a s i n d i c a t e d t h a t t h e a p p e l l a n I n t e r m s o f h e a l t h h i s t o r y , t h e g e n e r a l p r a c t i t i o n e r w f u r t h e r t h a n 2 t o 4 b l o c k s d u e t o p a i n a n d f e e l i n g d i z i s o u t w a l k i n g . I n t h e l e t t e r d a t e d O c t o b e r 1 0 , 2 0 1 4 a p p e l l a n t r e q u i r e s s o m e o n e t o b e w i t h h e r w h e n s h t h a t t h e e v i d e n c e i s n o t c l e a r w h e t h e r t h i s r e l a t e s t o o r s o m e o t h e r s y m p t o m , t h e r e a s o n t h e a p p e l l a n t f e w r o t e i n h e r R e q u e s t f o r R e c o n s i d e r a t i o n t h a t s h e c d i z z y b u t t h e r e i s n o f u r t h e r i n f o r m a t i o n p r o v i d e d . A a p p e l l a n t i s c 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 m o b i l i t y i n s t h e A R t h a t t h e a p p e l l a n t i s i n d e p e n d e n t w i t h w a l k i n r e q u i r e s r a i l i n g s w i t h s t a i r s " a n d t a k e s s i g n i f i c a n t l y l " s y n c o p e m a k e s a m b u l a t i o n d i f f i c u l t . " 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 r e q w i t h s t a n d i n g a n d n o t e d " p a i n i n l e g a n d b a c k , s w e l r e l a t i n g t o a 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 b a t h b e n c h a s b e i n g r o u t i n e l y u s e d b y t h e a p p e l l a n a p p e l l a n t r e q u i r e s a n a i d f o r h e r i m p a i r m e n t a s s h e h a n d r a i l s o n t h e s t a i r s . T h e p a n e l f i n d s t h a t a r a i l i n d e f i n i t i o n f o r a n " a s s i s t i v e d e v i c e s " a s i t n o t " a d e v i c t h a t , b e c a u s e o f 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 R e q u e s t f o r R e c o n s i d e r a t i o n , t h e a p p e l l a n t w r o t e t h h e r " a p a r t m e n t i s t o o n a r r o w " ; h o w e v e r , t h e p a n e l f i a c a n e o r a w a l k e r i s n o t u s e d b y t h e a p p e l l a n t f o r o F o r f u n c t i o n a l s k i l l s , t h e a p p e l l a n t i s a s s e s s e d i n t h e c a n c l i m b 2 t o 5 s t a i r s u n a i d e d , s h e c a n d o n o l i f t i n g t h e l e t t e r d a t e d O c t o b e r 1 0 , 2 0 1 4 , t h e g e n e r a l p r a c t a p p e l l a n t i s u n a b l e t o c a r r y s u c h i t e m s a s h e a v y p a b a g s b u t s h e c a n p r e p a r e s m a l l e r i t e m s o f f o o d w h i r e p o rt e d t h a t t h e a p p e l l a n t t a k e s s i g n i f i c a n t l y l o n g e r c a r r y i n g a n d h o l d i n g , w i t h a c o m m e n t t h a t s h e i s " a b l a u n d r y . " T h e p a n e l f i n d s t h a t a l t h o u g h t h e i n i t i a l a s l i f t i n g , b o t h t h e g e n e r a l p r a c t i t i o n e r a n d t h e n u r s e a l w e i g h t b u t t h e a m o u n t h a s n o t b e e n d e f i n e d b y t h e a r a u e d t h a t t h e g e n e r a l p r a c t i t i o n e r i n d i c a t e d t h a t t h A P P E A L # I e d t h a t t h e a p p e l l a n t h a s n o r m a l d e e p t e n d o n t o u t f u l l p o w e r o f h e r r i g h t w r i s t d o r s i f l e x o r b u t t o n e w a s n o r m a l , t e s t s o f c o o r d i n a t i o n w e r e w e l l i n t s i n h e r u p p e r l i m b s , t h e r e w a s n o s w e l l i n g , g i s t ' s i m p r e s s i o n i s t h a t h e c a n n o t f i n d e v i d e n c e o f h a s d i f f u s e m y o f a s c i a l p a i n a n d v i e w s h e r h a n d n s i d e r a t i o n , t h e a p p e l l a n t w r o t e t h a t s h e h a s e a s e a n d , a s s e t o u t i n t h e R e p o r t d a t e d e i n d i c a t e d m i l d l e f t s i d e d f o r a m i n a l n a r r o w i n g e n d o c r i n o l o g y R e p o r t s d a t e d A p r i l 2 5 , 2 0 1 4 a n d t ' s a m b u l a t i o n i s n o r m a l . r o t e i n t h e P R t h a t t h e a p p e l l a n t c a n n o t w a l k z y . S h e n e e d s s o m e o n e t o b e w i t h h e r w h e n s h e t h e g e n e r a l p r a c t i t i o n e r r e i t e r a t e d t h a t t h e e i s o u t s i d e o f t h e h o u s e ; h o w e v e r , t h e p a n e l f i n d s t h e a p p e l l a n t ' s r e p o r t e d f e e l i n g d i z z y , o r a n x i o u s , e l s d i z z y a n d h o w o f t e n i t o c c u r s . T h e a p p e l l a n t a n n o t s t a n d " f o r l o n g p e r i o d s " w i t h o u t g e t t i n g l t h o u g h t h e g e n e r a l p r a c t i t i o n e r i n d i c a t e d t h a t t h e i d e a n d o u t s i d e t h e h o m e , t h e n u r s e i n d i c a t e d i n g i n d o o r s , s h e i s " f i n e w i t h s h o r t d i s t a n c e s , o n g e r t h a n t y p i c a l w i t h w a l k i n g o u t d o o r s a s u i r e s c o n t i n u o u s 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 l i n g g e n e r a l l y o c c u r s . " I n t h e s e c t i o n o f t h e A R s s i s t i v e d e v i c e s , t h e n u r s e h a s i d e n t i f i e d o n l y a t . T h e g e n e r a l p r a c t i t i o n e r r e p o r t e d t h a t t h e u s e s a s h o w e r c h a i r i n t h e s h o w e r a n d s h e h a s g o n t h e s t a i r s d o e s n o t f a l l w i t h i n t h e p r e s c r i b e d e d e s i g n e d t o e n a b l e a p e r s o n t o p e r f o r m a D L A e n t , t h e p e r s o n i s u n a b l e t o p e r f o r m . " I n h e r a t s h e d o e s n o t h a v e a w a l k e r o r a c a n e b e c a u s e n d s t h a t t h e r e i s n o e x p l a n a t i o n p r o v i d e d f o r w h y u t d o o r m o b i l i t y . P R a s a b l e t o w a l k 2 t o 4 b l o c k s u n a i d e d , s h e , a n d s h e c a n r e m a i n s e a t e d l e s s t h a n 1 h o u r . I n i t i o n e r w r o t e t h a t , w i t h r e s p e c t t o l i f t i n g , t h e n s f u l l o f w a t e r f o r c o o k i n g o r h e a v y s h o p p i n g c h d o n o t w e i g h v e r y m u c h . I n t h e A R , t h e n u r s e t h a n t y p i c a l w i t h l i f t i n g ( n o t e : " u n a b l e " ) a n d w i t h l e t o c a r r y l i g h t g r o c e r i e s , u n a b l e t o c a r r y s e s s m e n t 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 c a n d o n o s o r e p o r t t h a t t h e a p p e l l a n t i s a b l e t o l i f t s o m e p r e s c r i b e d p r o f e s s i o n a l s . A l t h o u g h t h e a d v o c a t e e a p p e l l a n t r e a u i r e 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 6
APPEAL# I out of 10 DLA, the panel finds that the general practitioner indicated that there are continuous restrictions in 5 DLA, with moving about indoors and outdoors being one DLA, and that the degree of assistance required with each DLA, if any, is detailed in the AR. The panel finds that while the assessments of the appellant's functional skills varies between the prescribed professionals, the appellant remains independent with her mobility while taking longer with walking outdoors, and her physical ability is in the middle of the range. In the absence of evidence from the appellant's general practitioner regarding any exacerbated impacts to the appellant's physical functioning which may account for the discrepancies, the panel finds that the ministry reasonably determined that there is not sufficient evidence to establish that the appellant has a severe physical impairment, pursuant to section 2(2) of the EAPWDA. Severe Mental Impairment The appellant's position is that a severe mental impairment is established by the evidence of the impacts from her anxiety disorder. The ministry's position is that there is insufficient evidence to establish that the appellant has a severe mental impairment. The ministry argued that the general practitioner assessed the appellant with significant deficits in her cognitive and emotional functioning in 3 areas but reported that the impacts were all minimal or no impact. The ministry argued that the appellant's communication is good and the appellant is independent in all areas of social functioning. Panel Decision In the PR, the general practitioner diagnosed the appellant with anxiety disorder and wrote that the appellant gets anxiety attacks when she is in a stressful situation, especially with strangers or several people. In the letter dated October 10, 2014, the general practitioner indicated that the appellant suffers from frequent anxiety attacks which cause problems at the time with memory and concentration but she does not have a permanent neurological deficit. The general practitioner reported that the appellant has significant deficits in her cognitive and emotional functioning in the areas of memory, emotional disturbance and attention or sustained concentration and the nurse assessed these as having a minimal impact on the appellant's daily functioning. With respect to the two DLA that are specific to mental impairment -make decisions about personal activities, care or finances (decision making), and relate to, communicate or interact with others eff ectively (social functioning), the evidence indicates that the appellant is not significantly restricted in either. With respect to decision making, the nurse reported in the AR that the appellant independently manages her finances (budgeting and paying rent and bills) and her medications (takin g as directed and safe handling). She is also reported as independent in the decision-making components of the DLA of daily shopping (making appropriate choices), meal preparation (meal planning and food storage), and with making appropriate social decisions as part of her social functioning. Regarding the DLA of social functioning, the appellant is assessed by the general practitioner as not restricted in social functioning and, by the nurse, as independent in developing and maintaining relationships, interacting appropriately with others, and securing assistance from others. The appellant is also assessed with a good or satisfactory ability to communicate. Given the absence of reported impacts to the appellant's mental or social functioning, the panel finds that the ministry reasonabl determined that a severe mental im airment was not established under Section 2 2 of
APPEALf I the EAPWDA. Restrictions in the ability to perform DLA The appellant's position is that her physical and mental impairments directly and significantly restrict her ability to perform DLA on an ongoing basis to the extent that she requires the significant assistance of another person, namely her children. The advocate argued that the general practitioner indicated in the PR that the appellant requires continuous assistance for 6 out of 10 listed DLA. The ministry's position is that the information from the prescribed professionals does not establish that impairment significantly restricts DLA either continuously or periodically for extended periods. The ministry argued that for those tasks that take the appellant longer or for which she requires periodic assistance, there is not sufficient information to allow the ministry to determine that assistance is required for extended periods. Panel Decision Section 2(2)(b) of the EAPWDA requires that a prescribed professional provide an opinion that an applicant's severe impairment directly and significantly restricts her DLA, continuously or periodically for extended periods. In this case, the general practitioner and the registered nurse are the prescribed professionals. DLA are defined in Section 2(1) of the EAPWDR and are also listed in the PR and, with additional details, in the AR. Therefore, a prescribed professional completing these forms has the opportunity to indicate which, if any, DLA are significantly restricted by the appellant's impairments continuously or periodically for extended periods. In the appellant's circumstances, the general practitioner reported in the PR that the appellant has not been prescribed any medications and/or treatments that interfere with her DLA and she is continuously restricted with 5 of the listed DLA, namely personal self care, basic housework, daily shopping, mobility inside and outside the home, and use of transportation. Asked to describe the nature and extent of the assistance required by the appellant with DLA, the general practitioner wrote: "assistance required for bathing, daily housework and shopping, mobility in and out of the house." The general practitioner reported that the appellant is not restricted with the remaining listed DLA, namely: meal preparation, management of her medications, management of finances and social functioning. In assessing the degree of assistance required with each DLA, the nurse indicated in the AR that the appellant is independent with moving about indoors and outdoors, taking significantly longer than typical outdoors as "syncope makes ambulation difficulty." For personal care, the appellant is independently able to perform every task of the listed DLA, with the exception of feeding self/regulating diet, for which the appellant requires periodic assistance as the appellant "is unable to prepare food when experiencing panic." The appellant takes significantly longer than typical with the tasks of dressing, grooming, bathing, and transfers in/out of bed and on/off of chair. The general practitioner clarifies in the October 10, 2014 letter that these tasks take at least twice as long to complete, and "sometimes longer than this," and the panel finds that the ministry reasonably concluded that this is not sufficient evidence of significant restrictions in these tasks. The nurse reported that the appellant requires continuous assistance from another person with doing laundry and requires periodic assistance from another person with basic housekeeping In the letter dated October 10, 2014, the eneral ractitioner indicated that the a ellant re uires hel with
l a u n d ry d u e t o h e r i n a b i l i t y t o c a r r y " h e a v i e r i t e m s . " w r o t e t h a t b a s i c h o u s e k e e p i n g i s c o n t i n u o u s l y a s s i s g e t t i n g d i z z y a n d s h e c a n n o t l i f t a n y t h i n g , a s r e p o r t h o u s e w o r k ; h o w e v e r , t h e p a r t i c u l a r l i m i t a t i o n s w i t h t h e p r e s c r i b e d p r o f e s s i o n a l s , a s p r e v i o u s l y d i s c u s s R e g a r d i n g s h o p p i n g , t h e a p p e l l a n t i s a s s e s s e d b y t t a k e s s i g n i f i c a n t l y l o n g e r t h a n t y p i c a l c a r r y i n g p u r c h n u r s e . T h e a p p e l l a n t i s r e p o r t e d t o b e i n d e p e n d e n t f o o d 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 t h a n t y p i c a l w i t h i n c r e a s e d t i m e s e c o n d a r y t o b r e a k s " ) . I n t h e l e t t 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 i s u n a b l e t o c a r r y s u c h s h e c a n p r e p a r e s m a l l e r i t e m s o f f o o d w h i c h d o n o t T h e n u r s e 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 n d e p e n d e n t l y a s a l l t a s k s o f m a n a g i n g h e r m e d i c a t i o n s a n d t h e r e o f t r a n s p o r t a t i o n f a c i l i t i e s . T h e n u r s e p r o v i d e d a d d i e n e r g y t h a t c l i e n t f e e l s d r a i n i n g . S h e i s e x p e r i e n c i n f r o m a t t e m p t i n g t o c o m p l e t e n e c e s s a r y t a s k s . " W i t h m e n t a l i m p a i r m e n t d e c i s i o n m a k i n g a n d s o c i a l f u n a p p e l l a n t i s n o t s i g n i f i c a n t l y r e s t r i c t e d i n e i t h e r , a s p T h e p a n e l f i n d s t h a t t h e e v i d e n c e d e m o n s t r a t e s t h a a s s i s t a n c e a n d t h o s e t a s k s t h a t t a k e l o n g e r o r r e q u r e s t r i c t i o n s t o l i f t i n g , p e r i o d s o f d i z z i n e s s o r p a n i c , a t h e a p p e l l a n t ' s m e n t a l o r s o c i a l f u n c t i o n i n g . T h e r e f o c o n c l u d e d t h a t t h e r e i s n o t e n o u g h e v i d e n c e f r o m t h a p p e l l a n t ' s i m p a i r m e n t s i g n i f i c a n t l y r e s t r i c t s h e r a b i l 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 r e b y n o t s a t i s fy t h e E A P W D A . H e l p t o p e rf o r m D L A 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 s h e r e q u i r e s t h e s i g n D L A . 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 i t h a s n o t b e r e s t r i c t e d , i t c a n n o t b e d e t e r m i n e d t h a t s i g n i f i c a n t h e a c k n o w l e d g e d t h a t t h e p r e s c r i b e d p r o f e s s i o n s i n d i c b e n c h a s a n a s s i s t i v e d e v i c e . P a n e l 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 r e q u i r e s t h a t , a s a b i l i t y t o p e r f o r m D L A , a p e r s o n r e q u i r e s h e l p t o p e r s u b s e c t i o n ( 3 ) a s t h e r e q u i r e m e n t f o r a n a s s i s t i v e d a n o t h e r p e r s o n , 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 n t h e P R , w h e n a s k e d w h a t a s s i s t a n c e t h e a p p e l l a r e s o n d e d t h a t a s s i s t a n c e i s r e u i r e d f o r b a t h i n , d A P P E A L # I I n h e r R e q u e s t f o r R e c o n s i d e r a t i o n , t h e a p p e l l a n t t e d a s s h e c a n n o t s t a n d f o r l o n g p e r i o d s w i t h o u t e d b y h e r d o c t o r , a n d h e r d a u g h t e r s d o t h e t h e a p p e l l a n t ' s l i f t i n g h a v e n o t b e e n r e p o r t e d b y e d . h e n u r s e a s i n d e p e n d e n t w i t h a l l t a s k s a n d s h e a s e s h o m e , w i t h n o a d d i t i o n a l c o m m e n t s b y t h e w i t h m e a l p l a n n i n g , c o o k i n g a n d s a f e s t o r a g e o f f o o d p r e p a r a t i o n ( n o t e : " c o o k i n g r e q u i r e s d a t e d O c t o b e r 1 0 , 2 0 1 4 , t h e g e n e r a l p r a c t i t i o n e r i t e m s a s h e a v y p a n s f u l l o f w a t e r fo r c o o k i n g b u t w e i g h v e r y m u c h . m a n a g e s a l l t a s k s o f p e r s o n a l f i n a n c e s a s w e l l i s n o a s s e s s m e n t p r o v i d e d f o r t h e a p p e l l a n t ' s u s e t i o n a l c o m m e n t s t h a t " A O L ' s h a v e c o n s u m e d g s w e l l i n g a n d m u s c l e f a t i g u e t h a t i s d i s c o u r a g i n g r e s p e c t t o t h e t w o D LA t h a t a r e s p e c i f i c t o c t i o n i n g , t h e a v a i l a b l e e v i d e n c e i n d i c a t e s t h a t t h e r e v i o u s l y d i s c u s s e d . t t h e a p p e l l a n t m a n a g e s m o s t o f h e r D L A w i t h o u t i r e p e r i o d i c a s s i s t a n c e a r e t i e d t o u n s p e c i f i e d n d t h e r e a r e n o s i g n i f i c a n t i m p a c t s i d e n t i f i e d t o r 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 e p r e s c r i b e d p r o f e s s i o n a l s t o e s t a b l i s h t h a t t h e i t y t o m a n a g e h e r D L A e i t h e r c o n t i n u o u s l y o r i n g t h e l e g i s l a t i v e c r i t e r i o n o f S e c t i o n 2 ( 2 ) ( b ) ( i ) o f i f i c a n t a s s i s t a n c e o f a n o t h e r p e r s o n t o p e r f o r m e n e s t a b l i s h e d t h a t D L A a r e s i g n i f i c a n t l y l p i s r e q u i r e d f r o m o t h e r p e r s o n s . T h e m i n i s t ry a t e a r e q u i r e m e n t f o r a s h o w e r c h a i r o r a b a t h i n g a r e s u l t 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 n t h e f o r m t h o s e a c t i v i t i e s . H e l p i s d e f i n e d i n e v i c e , 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 i m a l i n o r d e r t o p e r f o r m a D L A . n t n e e d s w i t h D L A , t h e g e n e r a l p r a c t i t i o n e r a i l h o u s e w o r k a n d s h o i n , m o b i l i i n a n d o u t
o f t h e h o m e . T h e g e n e r a l p r a c t i t i o n e r i n d i c a t e d t h a a s s h e u s e s a s h o w e r c h a i r d u e t o f a l l i n g i n t h e s h o h a n d r a i l s o n t h e s t a i r s d o n o t f a l l w i t h i n t h e d e f i n i t i o T h e n u r s e r e p o r t e d i n t h e A R t h a t t h e a p p e l l a n t l i v e " o f f e r a p p r o p r i a t e , a g e r e l a t e d a s s i s t a n c e . " I n t h e s 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 , t h e n u r s e i d e n a p p e l l a n t . A s k e d i f e q u i p m e n t i s r e q u i r e d b u t i s n o t a p p e l l a n t r e q u i r e s a b a t h b e n c h / s h o w e r s t o o l , p l u s o 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 a s d i r e c t a n d s p e r f o r m D LA 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 p e r f o r m D LA 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 d e f 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 A P P E A L # I t t h e a p p e l l a n t r e q u i r e s a n a i d f o r h e r i m p a i r m e n t w e r a n d s h e h a s h a n d r a i l s o n t h e s t a i r s ; h o w e v e r , n o f " a s s i s t i v e d e v i c e , " a s p r e v i o u s l y d i s c u s s e d . s w i t h h e r c h i l d r e n , b o t h a d u l t a n d t e e n a g e r s , w h o e c t i o n o f t h e A R r e l a t i n g t o a s s i s t a n c e p r o v i d e d t i f i e d a b a t h b e n c h a s b e i n g r o u t i n e l y u s e d b y t h e c u r r e n t l y b e i n g u s e d , t h e n u r s e w r o t e t h a t t h e r m i n u s a b a t h b a r . T h e p a n e l f i n d s t h a t t h e i g n i f i c a n t 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 e 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 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 . 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.