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 " m i n i s t r y " ) r e c o n s i d e r a t i o n d e c i s i o n o f O c t o b e r 2 4 t h r e e o f f i v e s t a t u t o r y r e q u i r e m e n t s o f s e c t i o n 2 o D i s a b i l i t i e s A c t ( " E A P W D A " ) f o r d e s i g n a t i o n a s a t h a t t h e a p p e l l a n t m e t t h e a g e r e q u i r e m e n t a n d t h a p p e l l a n t ' s i m p a i r m e n t i s l i k e l y t o c o n t i n u e f o r a t l s a t i s f i e d t h a t : • t h e e v i d e n c e e s t a b l i s h e s t h a t t h e a p p e l l a n t • 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 " ) 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 t h a t • a s a r e s u l t o f t h o s e r e s t r i c t i o n s , t h e a p p e l l a a n o t h e r p e r s o n , a n a s s i s t i v e d e v i c e , o r t h e 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 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 E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )� P P E A L # I 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 , 2 0 1 4 , w h i c h f o u n d t h a t t h e a p p e l l a n t d i d n o t m e e t f t h e E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s W i t h p e r s o n w i t h d i s a b i l i t i e s ( " P W D " ) . T h e m i n i s t r y f o u n d a t 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 t h e e a s t t w o y e a r s . H o w e v e r , t h e m i n i s t r y w a s n o t 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 r e , i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l , o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s ; a n d 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 p e r v i s i o n o f 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 . a b il i t i e s A c t ( " E A P W D A " ) , s e c t i o n 2 a b 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# PART E -Summar of Facts The information before the ministry at the time of reconsideration included the following: • The appellant's PWD application form consisting of the appellant's self-report (dated June 23, 2014) along with a physician's report ("PR") and assessor's report ("AR") both signed by the appellant's specialist in obstetrics and gynecology (the "specialist"), dated June 24, 2014. • A Work Absence Certificate from the appellant's current general practitioner (the "GP"), dated October 16, 2014, stating that the appellant had been assessed with chronic pain, anxiety, and depression, and that "Her symptoms will likely continue to disable her for the next 2 years." • The appellant's Request for Reconsideration form dated October 14, 2014. • The appellant's two-page written reconsideration submission dated October 9, 2014. • A one-page letter from the appellant's mother dated October 13, 2014. • Receipts for various prescriptions. • A Medical Certificate -Absence from Work or School from the appellant's former childhood physician, dated March 4, 2014. The former childhood physician referenced mobility-related issues of chronic pain affecting mood, stamina, restfulness and endurance. He indicated the appellant would be getting an MRI on March 31, 2014. • A prescription form dated November 27, 2011 indicating a diagnosis of scoliosis, with symptoms of flat feet and knee/hip/back pain. • A Request for Massage Therapy dated November 25, 2011 wherein the appellant's former childhood physician provided a diagnosis of chronic mechanical back pain. • Receipts for chiropractic treatment, massage and physiotherapy. • A referral letter from the specialist, dated June 11, 2014. • A Request for Physiotherapy signed by the appellant's former childhood physician, dated January 30, 2013, related to a diagnosis of vaganismus. • A letter from the ministry to the specialist, dated September 29, 2014 noting that someone other than the specialist had included information in the PWD application form, and asking the specialist to confirm his endorsement of the contents (the "Enquiry Letter"). Admissibility of Additional Information In her Notice of Appeal, the appellant wrote that: • She is in crippling pain for the majority of every day. • The pain prevents her from doing household chores and caring for herself. • Her mobility is severely restricted because the pain is overwhelming. • She is not on any pain medications because she cannot afford medications that may help her. Prior to the hearing, the appellant submitted to the Tribunal office a letter from the GP dated November 13, 2014. In this letter, the GP wrote that the appellant continues to have significant disability and remains unable to work because of: • Chronic foot and calf pain due to Achilles tendinitis/plantar fasciitis which makes walking or prolonged standing difficult and at times impossible; • Chronic vulvar pain which makes sitting painful; and • Persisting anxiety and depression. EAAT 003( 10/06/01)
I APPEAL# The appellant also provided oral testimony at the appeal hearing, as detailed in the review of the evidence below. The appellant's oral testimony, Notice of Appeal and the November 13, 2014 letter from her GP include information that is consistent with, and tends to corroborate, information that was before the ministry regarding the diagnoses of vulvar pain, anxiety and depression. There was no direct medical confirmation of foot/calf pain before the ministry at reconsideration, but ankle pain was a condition that had been raised by the appellant and was considered by the ministry at reconsideration. The ministry's position was that it had no objection to admission of the November 13, 2014 letter into evidence. For the foregoing reasons, the panel has admitted (with one exception) the above-noted additional information as oral and written testimony in support, in accordance with section 22(4) of the Employment and Assistance Act. The one noted exception is that there was no information previously before the ministry about the head injury or vertigo referred to by the appellant in her oral testimony. That information cannot be said to be "in support" of the information and records that were before the ministry at the time of reconsideration. Accordingly, the panel has not admitted that information as evidence. The ministry relied on its reconsideration decision and submitted no new information. * * * The panel reviewed the evidence as follows: Diagnoses • In the PR the specialist (who at the time of completing the PWD application had seen the appellant once) diagnosed the appellant with vulvodynia, with onset in 2002. He commented that "She reports that the pain from this condition is severe enough to restrict her ability to move. She is in constant discomfort. She is also unable to perform her physical therapy due to the pain." • Other documents detailed elsewhere herein provide additional diagnoses of scoliosis, mechanical back pain, Achilles tendonitis/plantar fasciitis, and anxiety/depression. Physical Impairment • In terms of physical functional skills, the specialist reported in the PR that the appellant can walk for less than one block unaided on a flat surface, climb 5+ stairs unaided, has no limitations in lifting, and can remain seated for less than 1 hour. • In the AR the specialist reported that the appellant takes significantly longer than typical with walking indoors and outdoors, commenting that she "takes a lot of breaks" and "can't walk a full kilometer." The specialist also indicated that the appellant takes significantly longer than typical with carrying/holding, commenting "difficult due to pain." Finally, the specialist indicated that the appellant is independent with standing and lifting. • During her oral testimony, the appellant responded to a question from the panel regarding the ministry's Enquiry Letter, stating that when the specialist was completing the PR and AR, he had asked the appellant to write the answers to some of the questions. In reply to the Enquiry Letter, the specialist initialed each page of the AR and PR to signify his endorsement of what the a ellant had written on those forms. EAAT 003(10/06/01)
APPEAL# � • The appellant's written comment in the section of the AR dealing with mobility and physical ability was "depending on level of pain periodic assistance from another person is required for carrying items, or delivering groceries, etc." • In his June 11, 2014 referral letter, the specialist wrote that the appellant's vulvodynia is "severe and debilitating enough [that] she be referred to the chronic pain clinic." He noted that the GP had already referred the appellant to the chronic pain clinic. In her self-report the appellant wrote that: • Simply wearing underwear or pants causes her pain to increase. • At least a few times a week the pain becomes intolerable to the point where she has to lay down to let the pain subside. • She is tired most of the day due to sleep disturbance. • Toileting is difficult and painful. In her written reconsideration submission of October 9, 2014 the appellant wrote that: • The vulvodynia is "by far the cause of the most severe pain." • She was treated in high school for major depression and generalized anxiety. • Two years ago she sustained an ankle injury which results in her beginning to limp noticeably after 5-10 minutes due to ankle pain. An MRI on her ankle was inconclusive. • Laser therapy seemed to be helping to reduce her ankle pain but "this only treated the symptoms and not the problem since the pain always returned within 2-3 days." • She ceased chiropractor and massage therapy for her back, knee and hip pain because the vulvodynia makes her unable to lie in the prone position which is required for these therapies. Since ceasing the therapies the pain has returned to the level it was before treatment. • Her former childhood physician had originally misdiagnosed her with vaganismus. • She is not restricted in how much she can lift, but she can't carry things that require both hands since her ankle affects her balance. If she can put the items in a backpack she can carry as much as the average person. However, the more she carries the more difficult and painful it is to walk. • As of May 2014 the GP put the appellant on an 18 month wait list for the pain clinic. • She was prescribed one pain medication that interacted with her anti-depressant. • Other pain medication has either been not tolerated by her body or is ineffective. • Medical marijuana reduced pain but left her unable to perform the most basic tasks. • Her physical and mental issues interact with each other. In her oral testimony the appellant stated that: • If she walks as much as a block it leaves her in such pain that she can't do anything the rest of the day. How far she can walk depends on the time of day because the pain fluctuates. • The condition of vulvodynia is progressive and once the pain is triggered it will remain for most of the day and usually continues to build. • Sitting causes her pain to build. • Her mother does her grocery shopping depending on her availability. • She had a severe head injury a while ago which her GP suspects is causing vertigo. • She was hospitalized for three months in high school for mental health issues. EAAT 003( 10/06/01)
Mental Im p a i r ment • In the P R the s pecial i st indicated that the appellant indicated th at the appellant h as s ignificant d areas of emotional disturbance (depression/ concentr ati o n. He commented "the pain she feels affects h • In the AR the appell ant (subs e qu e ntly initia led " c hroni c pain impacts moo d , atte nti on." • In the AR the specialist reported t he appellant's ability t respects. He indicated t h a t the appell ant suffers a c ognitive and e m otional func tio n : b odily fu nctions. categ ori es: consciousness, emotion, atte ntion/concen minimal or no impact in the remaining 9 ca tegori • In com menting on the impacts on cognitive and emot " S p e nd s a lot of time in bathroom b ecause of pain." D L A In t he PR the s p ecia list i ndicate d t ha t : • T h e app e ll ant has not been prescr ib ed any medica • T h e app e ll ant is not restric t ed in t he DLA o f m anag ement of medicat ion s. • The app e llan t is con tinuously restri cted with the DL m o bili t y indoo r s a nd ou t d oors, and use of trans • T he app e ll ant is p eriodica l ly restr icted with the of mobi lity indoo r s and o u td oo rs. • T he s p e cialist p r o vided no r esp onse with res f u n cti o ning. • I n this section of the PR th e app ellan t provi de m ean "w hen pain inc reas es past m ana geabl In t he AR t he spe c ia list r epo r ted that: • The app ellant ind e pendently manages a ll aspects of the DLA of personal self-care, meal preparation, manage personal finances, and manage personal medications. • The appellant requires periodic assistance with t appellant indicating she takes twice as long as typical to perform thi • With r e s pect t o the DLA of daily shopping, the appell tasks of going to/from stores and carrying purchases home, several rest breaks." She independently manages the other tasks. • The appe lla n t indepe ndently manages m os t tasks the appellant commented in the AR that she • With respect to the DLA social functioning , the specialist indicated the appellant independently manages all tasks except that she i s "unable has marginal functioning in terms of both her immediate and extended social functioning, commenting "pain restricts this." In response to a question regarding the help required by the appellant with respect to social function ing, the specialist wr on a re ular basis." EAAT 003(10/06/01) APPEAL# I has n o di f ficulties with co mmuni cat i on. He efi ci ts with co gnitive and emot ional function in the a nxiety) , motivat io n , and at te n tion/sustained er emot ionally. " by the specialist) described her impairment as o comm un i c ate as being good i n all major impact in one of 14 catego r ies of He indicated m oderate impacts in four tration, an d motor ac t ivity. He re por te d e s . ional function the specialist wrote tions o r treatmen t s that int e rf ere w i t h DLA; pers onal self -ca re, meal p rep ara tion, or A of d a ily shopping, t he outd oor aspec t s o f portation. DLA of basic h ousewor k and the i n si d e asp e c t p ec t to t he DLA managem e nt of fi n a nc es or so cial d a com ment explaining the term "perio dic" t o e level s, u n able to per form giv en task s. " he DLA basic houseke eping, with the s DLA. a n t requires periodic assistance with the described as "if alone, must take related to t he DL A use of transportation, but requires transportation to t h e b u s stop. t o main t ain a re l a tio n shi p. " He reported that she ote "D oe s n' t need any as sistance
In her letter of Octob er 13, 2104 the appell ant's mothe • In t h e past t wo years she h a s i ncreasin gl y b appo intmen ts and to he l p w i t h g r o cery shop • T he app ellant' s p a i n and depres sion f requently h ous ework. • The appe lla nt's soc ial l if e has co m e t o a com • Ho p efully the pain clinic w ill he l p with he r ph In r es p onse t o quest ion s f rom the pa nel, t h e app ellant • Her mot her helps he r with D LA one to th ree • T he MRI of her ankle was inc onc l us ive she w vulv ody n i a and he r ankle. • T he specia l ist had aske d her if she coul d as can wa l k abou t t wo to three mi nu t e s wi th o u t p • S h e do es go shopping on her own abou t once • He r GP tol d her th at there are some pain me cost t ho usands of d o l lars, which she cannot affo the pain cli nic. H e lp • I n the PR th e spec ialist reported th at the app impai rment. In the AR he comm e nted that a cane t h e a ppe llant does not hav e an ass i s tance a • In t h e AR th e spe cialist ind ic at e d th at th e app EAAT 003(10/06/01) I AP PEAL# r wrote that: een required to dri ve the a p pellant to ping. leave her un able to c ook, shop, and comp lete p l ete halt. y s ical di sabilit i es. stated t h at : t i me s per week. ill be at tending the pa in c l inic f or bot h mu ch as a kil om e tre and she ha d said "no". Sh e ai n . a week . She mostly sta ys at home. dic ations tha t ma y be able t o h elp her but the y will rd. The cost ma y be covered once sh e gets to e llant d oes n o t require p ro s theses o r aid s for her "wil l help wi t h bal ance." He indicated tha t nimal. e llant's mother he lps her once per week .
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 i s a p p e a l i s w h e t h e r t h e m i n i s t r y ' s d 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 b y t h e e v i d e n c e o 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 t h e a p p e l l a n t . I d e t e r m i n i n g t h a t t h e a p p e l l a n t d o e s n o t h a v e a s e v 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 h e a p p e l l a n t ' s r e s t r i c t h e r f r o m p e r f o r m i n g D L A e i t h e r c o n t i n u o u s a r e s u l t o f t h o s e r e s t r i c t i o n s t h e a p p e l l a n t d o e s n o t T h e r e l e v a n t l e g i s l a t i o n i s a s f o l l o w s : E A P W D A : 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 a c t i v i t y t h a t , b e c a u s e o f a s e v e r e m e n t 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 y " h a s t h e p r " 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 ( 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 d i s a b i l i t i e s f o r t h e p u r p o s e s o f t h i s A c t i f m e n t a l o r p h y s i c a l i m p a i r m e n t t h a t ( a ) i n t h e o p i n i o n o f a m e d i y e a r s , a n d ( b ) i n t h e o p i n i o n o f a p r e s c ( i ) d i r e c t l y a n d s i g n i l i v i n g a c t i v i t i e s e i t h e ( A ) c o n t i n u o u ( B ) p e r i o d i c a ( i i ) a s a r e s u l t o f t h o t h o s e a c t i v i t i e s . ( 3 ) F o r t h e p u r p o s e s o f s u b s e c t i o n ( 2 ) , ( a ) a p e r s o n w h o h a s a s e v m e n t a l d i s o r d e r , a n d ( b ) a p e r s o n r e q u i r e s h e l p i p e r f o r m i t , t h e p e r s o n r e q u ( i ) a n a s s i s t i v e d e v i c ( i i ) t h e s i g n i f i c a n t h e ( i i i ) t h e s e r v i c e s o f a E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )I A P P E A L # e c i s i o n t o d e n y t h e a p p e l l a n t d e s i g n a t i o n a s a 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 l i c a b l e n p a r t i c u l a r , w a s t h e m i n i s t r y r e a s o n a b l e i n 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 n d t h a t i n t h e i m p a i r m e n t s d o n o t d i r e c t l y a n d s i g n i f i c a n t l y l y o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s , a n d t h a t a s r e q u i r e h e l p t o p e r f o r m D L A . 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 a i l y l i v i n g 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 a b l e t o e s c r i b e d m e a n i n g ; e p r e s c r i b e d m e a n i n g . w h o h a s r e a c h e d 1 8 y e a r s o f a g e a s a p e r s o n w i t h t h e m i n i s t e r i s s a t i s f i e d t h a t t h e p e r s o n h a s a s e v e r e c a l p r a c t i t i o n e r i s l i k e l y t o c o n t i n u e f o r a t l e a s t 2 r i b e d p r o f e s s i o n a l f i c a n t l y r e s t r i c t s t h e p e r s o n ' s a b i l i t y t o p e r f o r m d a i l y r s l y , o r l l y f o r e x t e n d e d p e r i o d s , a n d s e r e s t r i c t i o n s , t h e p e r s o n r e q u i r e s h e l p t o p e r f o r m e r e m e n t a l i m p a i r m e n t i n c l u d e s a p e r s o n w i t h a n r e l a t i o n t o a d a i l y l i v i n g a c t i v i t y i f , i n o r d e r t o i r e s e , l p o r s u p e r v i s i o n o f a n o t h e r p e r s o n , o r n a s s i s t a n c e a n i m a l .
E A P W D R s e c t i o n 2 ( 1 ) : 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 ( a ) i n r e l a t i o n t o a p e r s o m e n t a l i m p a i r m e n t , m e a ( i ) p r e p a r e o w n m ( i i ) m a n a g e p e r s o ( i i i ) s h o p f o r p e r s ( i v ) u s e p u b l i c o r ( v ) p e r f o r m h o u s e a c c e p t a b l e s a n i t a ( v i ) m o v e a b o u t i ( v i i ) p e r f o r m p e r s ( v i i i ) m a n a g e p e r s ( b ) i n r e l a t i o n t o a p e r s o f o l l o w i n g a c t i v i t i e s : ( i ) m a k e d e c i s i o n s ( i i ) r e l a t e t o , c o m ( 2 ) F o r t h e p u r p o s e s o f t h e A c t , " p r e s c r ( a ) a u t h o r i z e d u n d e r a n e ( i ) m e d i c a l p r a c t i ( i i ) r e g i s t e r e d p s y ( i i i ) r e g i s t e r e d n u ( i v ) o c c u p a t i o n a l ( v ) p h y s i c a l t h e r a ( v i ) s o c i a l w o r k e r ( v i i ) c h i r o p r a c t o r , ( v i i i ) n u r s e p r a c t i ( b ) a c t i n g i n t h e c o u r s e o b y ( i ) a n a u t h o r i t y , a I n d e p e n d e n t S c h o ( i i ) a b o a r d o r a f d e f i n e d i n s e c t i o n i f q u a l i f i c a t i o n s i n p s y c h o l o g y a r e a c o n d i S e v e r e P h y s i c a l I m p a i r m e n t T h e a p p e l l a n t ' s p o s i t i o n i s t h a t t h e c h r o n i c p a i n o f h c o n s t i t u t e s a s e v e r e p h y s i c a l i m p a i r m e n t . S h e a r g u h e r f r o m c a r i n g f o r h e r s e l f . S h e a l s o a r g u e d t h a t p a i s i n e ff e c t i v e , h a s t o o m a n s i d e e f f e c t s , i n t e r a c t s n E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )A P P E A L # I e g u l a t i o n , " d a i l y l i v i n g a c t i v i t i e s " n w h o h a s a s e v e r e p h y s i c a l i m p a i r m e n t o r a s e v e r e n s t h e f o l l o w i n g a c t i v i t i e s : e a l s ; n a l f i n a n c e s ; o n a l n e e d s ; p e r s o n a l t r a n s p o r t a t i o n f a c i l i t i e s ; w o r k t o m a i n t a i n t h e p e r s o n ' s p l a c e o f r e s i d e n c e i n r y c o n d i t i o n ; n d o o r s a n d o u t d o o r s ; o n a l h y g i e n e a n d s e l f c a r e ; o n a l m e d i c a t i o n , a n d n w h o h a s a s e v e r e m e n t a l i m p a i r m e n t , i n c l u d e s t h e a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r f i n a n c e s ; m u n i c a t e o r i n t e r a c t w i t h o t h e r s e f f e c t i v e l y . i b e d p r o f e s s i o n a l " m e a n s a p e r s o n w h o i s n a c t m e n t t o p r a c t i s e t h e p r o f e s s i o n o f t i o n e r , c h o l o g i s t , r s e o r r e g i s t e r e d p s y c h i a t r i c n u r s e , t h e r a p i s t , p i s t , , o r t i o n e r , o r f t h e p e r s o n ' s e m p l o y m e n t a s a s c h o o l p s y c h o l o g i s t s t h a t t e r m i s d e f i n e d i n s e c t i o n 1 ( 1 ) o f t h e o l A c t , o r r a n c o p h o n e e d u c a t i o n a u t h o r i t y , a s t h o s e t e r m s a r e 1 ( 1 ) o f t h e S c h o o / A c t , t i o n o f s u c h e m p l o y m e n t . * * * * * * * e r v u l v o d y n i a , h e r s c o l i o s i s a n d h e r a n k l e i n j u r y e d t h a t t h e p a i n i s o v e rw h e l m i n g a n d p r e v e n t s i n m e d i c a t i o n i s e i t h e r n o t t o l e r a t e d b y h e r b o d y , e a t i v e l w i t h o t h e r m e d i c a t i o n s , o r i s t o o
e x p ens ive . The m i nis t ry's po s itio n i s that the app e l lant 's phys ical are mo re in keepi ng with a moderate deg ree of i mpair en ough e v iden c e to es tablish a sev er e phy si cal impa Panel Decisi on A diagno s i s of a seriou s me d i cal c ond i tion doe s no s e vere im p a ir m ent . An "im pairme nt " is a medical conditi abi l ity to fu nction ind epen de nt ly or effectively. T o assess t he severity of an impairme nt one must ext ent of i ts impact on dai l y fun ctio n in g a s ev iden c wh ich performin g DLA is restric ted . Th e le gis la tion a t t he discr etion o f the mini s t er, ta k in g i nto acco un al so clea r t h a t the f u n d a men tal basis fo r the analy sis in this case , the specialist, the GP, and the appellan It's cle ar f rom the evidence that pain i s the primary sp eci alist and the G P r efer to s e vere and deb i litati ng rec ons id eratio n sub miss ion t hat vul vody n ia i s "by far sp e cial ist m et wit h the a ppell a nt only once and bas T he a ppell a nt has bee n see i n g the GP f or a b o u t a yea h e r c hi ldh ood phys ician . T he speciali s t conc lu d e d ma d e to the pai n c li nic an d, g iv en an o p portun it y to 20 14 lett er, the GP wro t e th at the app ellant is awai appellant h as said tha t p a in me d icatio n s h ave b e en in bec au s e of pa i n from her vul vod yni a, she ha d to withd p rom ise in reducing b ack and ankle pa i n. Gi v e n the ap com e to a fu ll stop b ecause of excruciating pa in, the co mp rehensive evidence from a presc r i bed pro fe ss that have bee n assessed, to confirm their ine ff e c ti venes prognosis with respect to treatment at the chronic pain clinic. The piecemeal evidence on this point is not sufficient evidence to demonstrate the severity of her chronic pain. As discussed in more detail in these reas ons for decision under the heading Significan to DLA, the limitations to the appellant's physical fu significant restrictions to her ability to manage DLA. Fo r the f oregoing r easons, an d considering the evidence reason ably determined that the evidence falls short of establis physical impairment. Severe Menta l Impairment osition is that she suffers from severe de EAAT 003( 10/06/01) I A PPEAL # fu nctional ski lls, a s re porte d by t he sp e cialist , m ent. T h e min istry arg ued t h at t h e r e is not i rme nt. t in itsel f determine PWD eli g ibi lity or establi sh a o n that results in rest r i cti o n s to a p e rson's consider th e na ture of th e impa i rme nt and the e d b y functional skill l imit ati ons and t he d e gree to mak es it cle ar that t he d ete r m i na ti on o f s e ve rity i s t a l l of th e ev i de nce . Ho weve r, the legislation i s is the e vidence from a pre sc r i be d pr o f ess iona l t's former chi ld hood ph y sic ian . l i m i t at i on to the a ppella nt' s abil ity to function. The pain, an d the app el lant w r o t e in her the c ause o f the mo st sev ere p ai n." The e d his a s se ssmen t on an o ffice int ervi ew with her . r sin ce she wrote th at sh e chos e to st op see ing h is re p or ts by w r iti ng th a t a ref erral h ad been p r ovide more i n formation i n the N ovember 1 3, ting her con s ulta tion with the pa in clinic. T he e ffecti v e f o r va rious re asons. S he a ls o said r aw fr o m th e rapies that ha d been s howing pell ant's pos i tion th at her li fe has virtu ally panel would expect the re to be some ional to detail the pai n medic a ti ons and the r a p i es s or i n appropriateness, and to provide some t Restrictions n ctio n i n g do not appe ar to h ave transla ted into as a whole, the panel finds that th e ministry hi n g that the appellant has a severe ression and anxiet which are
e x a c e r b a t e d b y h e r p h y s i c a l c o n d i t i o n . 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 e v i d e n c e d o e s n o m i n i s t r y a r g u e d t h a t t h e s p e c i a l i s t ' s e v i d e n c e i n d i c a d i f f i c u l t i e s w i t h c o m m u n i c a t i o n , a n d t h a t t h e r e a r e m a p p e l l a n t ' 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 . P a n e l D e c i s i o n S e c t i o n 2 ( 1 ) ( b ) o f t h e E A P W D R p r e s c r i b e s t w o D L d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r f i n a n c e i n t e r a c t w i t h o t h e r s e f f e c t i v e l y ( s o c i a l f u n c t i o n i n g ) . T h e s p e c i a l i s t ' s e v i d e n c e i n d i c a t e s t h a t t h e a p p e l l a d e c i s i o n m a k i n g i n t h a t s h e i n d e p e n d e n t l y m a n a g e ( m e a l p l a n n i n g ) , d a i l y s h o p p i n g ( m a k i n g a p p r o p r i a t ( f i l l i n g / r e f i l l i n g / t a k i n g a s d i r e c t e d ) , m a n a g e p e r s o n a f u n c t i o n i n g ( a p p r o p r i a t e s o c i a l d e c i s i o n s ) . T h e s p e c i a l i s t ' s e v i d e n c e a l s o i n d i c a t e s t h a t t h e a p f u n c t i o n i n g i n t h a t s h e i n d e p e n d e n t l y m a n a g e s a l m w h e r e t h e s p e c i a l i s t i n d i c a t e d t h e a p p e l l a n t i s n o t i n r e l a t i o n s h i p s t h e s p e c i a l i s t i n d i c a t e d t h a t t h e a p p b a s i s . " T h e s p e c i a l i s t n o t e d t h a t t h e a p p e l l a n t h a 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 , b u t h e i n p a i n r a t h e r t h a n b y a m e n t a l c o n d i t i o n . W i t h r e s p e c t t o t h e i m p a c t s t o c o g n i t i v e a n d e m o t i o i n d i c a t e d r e s t r i c t i o n s c a u s e d b y p a i n r a t h e r t h a n b y C o n s i d e r i n g t h e e v i d e n c e a s a w h o l e , i n c l u d i n g t h e c o m m u n i c a t i o n s k i l l s a r e g o o d i n a l l r e s p e c t s , t h e p d e t e r m i n e d t h a t i t d o e s n o t d e m o n s t r a t e a s e v e r e m S i g n i f i c a n t R e s t r i c t i o n s t o D L A T h e a p p e l l a n t ' s p o s i t i o n i s t h a t h e r c h r o n i c p a i n s i g l i f t / c a r r y / h o l d . S h e a r g u e d t h a t t h e s e f a c t o r s , a l o n g l i m i t h e r a b i l i t y t o p e r f o r m D L A . T h e 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 e v i d e n c e f r o m t h e 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 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 m i n i s t r y s t a t a d d i t i o n a l i n f o r m a t i o n r e g a r d i n g i m p a c t s t o D L A . E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 ): A P P E A L # t e s t a b l i s h a s e v e r e m e n t a l i m p a i r m e n t . T h e t e d t h a t t h e a p p e l l a n t d o e s n o t h a v e a n y i n i m a l t o n o i m p a c t s t o t h e m a j o r i t y o f t h e A t h a t a r e s p e c i f i c t o m e n t a l i m p a i r m e n t m a k e s ( d e c i s i o n m a k i n g ) , a n d r e l a t e t o , c o m m u n i c a t e o r n 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 w i t h r e s p e c t t o s t h e d e c i s i o n m a k i n g a s p e c t s o f m e a l p r e p a r a t i o n e c h o i c e s ) , m a n a g e p e r s o n a l m e d i c a t i o n l f i n a n c e s ( b a n k i n g , b u d g e t i n g ) a n d s o c i a l 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 w i t h s o c i a l o s t a l l t a s k s r e l a t e d t o t h i s D L A . I n t h e o n e t a s k d e p e n d e n t a b i l i t y t o d e v e l o p a n d m a i n t a i n e l l a n t " d o e s n ' t n e e d a n y a s s i s t a n c e o n a r e g u l a r m a r g i n a l f u n c t i o n i n g w i t h r e s p e c t t o b o t h h e r d i c a t e d t h a t b o t h o f t h o s e a r e a s a r e r e s t r i c t e d b y n a l f u n c t i o n i n g , t h e s p e c i a l i s t ' s c o m m e n t s a g a i n a m e n t a l c o n d i t i o n . s p e c i a l i s t ' s e v i d e n c e t h a t t h e a p p e l l a n t ' s a n e l c o n c l u d e s t h a t t h e m i n i s t ry r e a s o n a b l y e n t a l i m p a i r m e n t . n i f i c a n t l y l i m i t s h e r m o b i l i t y a n d h e r a b i l i t y t o w i t h h e r d e p r e s s i o n / a n x i e t y , t o g e t h e r s i g n i f i c a n t l y s p e c i a l i s t i s n o t s u f f i c i e n t t o d e m o n s t r a t e t h a t t h e l i t y t o p e r f o r m D L A e i t h e r c o n t i n u o u s l y o r e d t h a t t h e e v i d e n c e f r o m t h e G P p r o v i d e d n o
P a n e l D e c i s i o n T h e l e g i s l a t i o n s . 2 ( 2 ) ( b ) ( i ) o f t h e E A P W D A r e q a n d s i g n i f i c a n t r e s t r i c t i o n s o f D L A i n c o n s i d e r a t i o n c a s e t h e a p p e l l a n t ' s s p e c i a l i s t . T h i s d o e s n ' t m e a n r e q u i r e d t o p r o v i d e c l a r i f i c a t i o n o f t h e p r o f e s s i o n a l c l e a r t h a t t h e p r e s c r i b e d p r o f e s s i o n a l ' s o p i n i o n i s f w h e t h e r i t i s " s a t i s f i e d " . T h e l e g i s l a t i o n r e q u i r e s t h a t a s e v e r e i m p a i r m e n t d a b i l i t y t o p e r f o r m D L A e i t h e r c o n t i n u o u s l y o r p e r i o d m e a n s t h a t t h e r e m u s t b e a c a u s a l l i n k b e t w e e n t h r e s t r i c t i o n m u s t a l s o b e s i g n i f i c a n t . F i n a l l y , t h e r e i s d i r e c t a n d s i g n i f i c a n t r e s t r i c t i o n m a y b e e i t h e r c o n t e x t e n d e d t i m e . I n h e r e n t l y , a n y a n a l y s i s o f p e r i o d i c f r e q u e n c y . A l l o t h e r t h i n g s b e i n g e q u a l , a r e s t r i c t i o s i g n i f i c a n t t h a n o n e w h i c h o c c u r s s e v e r a l t i m e s a w e v i d e n c e i n d i c a t e s t h a t a r e s t r i c t i o n a r i s e s p e r i o d i c e v i d e n c e o f t h e d u r a t i o n a n d f r e q u e n c y o f t h e r e s t r c r i t e r i o n i s m e t . I n t h e a p p e l l a n t ' s c a s e , t h e s p e c i a l i s t ' s e v i d e n c e i n m a n a g e a l l t a s k s r e l a t e d t o f o u r o f t h e t e n p r e s c r i b m a n a g e m e n t o f m e d i c a t i o n s , a n d m a n a g e m e n t o f h e a d i n g S e v e r e M e n t a l I m p a i r m e n t t h e p a n e l h a s c i n d e p e n d e n t l y m a n a g e s t h e a d d i t i o n a l D L A o f d e c i R e g a r d i n g t h e D L A o f m o b i l i t y i n d o o r s a n d o u t d o o t o w a l k d i s t a n c e s o u t d o o r s i s l i m i t e d d u e t o t h e o n s W i t h r e s p e c t t o t h e D L A o f b a s i c h o u s e w o r k , t h e s p p e r i o d i c a s s i s t a n c e a n d t h e a p p e l l a n t i n d i c a t e d i t t a R e g a r d i n g d a i l y s h o p p i n g , t h e s p e c i a l i s t i n d i c a t e d t g o i n g t o a n d f r o m s t o r e s a n d c a r r y i n g p u r c h a s e s h a l o n e , s h e h a s t o t a k e s e v e r a l r e s t b r e a k s , a n d i n h s h e c a n c a r r y a s m u c h a s a n a v e r a g e p e r s o n i f t h e a p p e l l a n t c o n f i r m e d t h a t s h e d o e s g o s h o p p i n g o n W i t h r e s p e c t t o t h e D L A o f u s e o f t r a n s p o rt a t i o n , t h s t o p i s t o o f a r f r o m t h e a p p e l l a n t ' s h o m e f o r h e r t o T h e p a n e l n o t e s t h a t t h e r e i s c o n f l i c t i n g e v i d e n c e w r e s t r i c t i o n s t o t h e a p p e l l a n t ' s a b i l i t y t o p e r f o r m D L A b e i n g i n c r i p p l i n g p a i n f o r t h e m a j o r i t y o f e v e r y d a y t h e p e r i o d i c i t y o f s o m e r e s t r i c t i o n s ( w i t h t h e a p p e l l a i n c r e a s e s p a s t m a n a g e a b l e l e v e l s " ) . C o n s i d e r e d i n r e s t r i c t i o n s i d e n t i f i e d b t h e s e c i a l i s t , t h e e v i d e n c e E AA T 0 0 3 ( 1 0 / 0 6 / 0 1 )! A P P E A L # u i r e s t h e m i n i s t e r t o s u b s t a n t i a l l y a s s e s s d i r e c t o f t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l , i n t h i s t h a t o t h e r e v i d e n c e s h o u l d n ' t b e f a c t o r e d i n a s e v i d e n c e , b u t t h e l e g i s l a t i v e l a n g u a g e m a k e s i t u n d a m e n t a l t o t h e m i n i s t r y ' s d e t e r m i n a t i o n a s t o 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 a p p e l l a n t ' s 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 t e r m " d i r e c t l y " e s e v e r e i m p a i r m e n t a n d t h e r e s t r i c t i o n . T h e d i r e c t a c o m p o n e n t r e l a t e d t o t i m e o r d u r a t i o n . T h e i n u o u s o r p e r i o d i c . I f i t i s p e r i o d i c i t m u s t b e f o r a n i t y m u s t a l s o i n c l u d e c o n s i d e r a t i o n o f t h e n t h a t o n l y a r i s e s o n c e a y e a r i s l e s s l i k e l y t o b e e e k . A c c o r d i n g l y , i n c i r c u m s t a n c e s w h e r e t h e a l l y , i t i s a p p r o p r i a t e f o r t h e m i n i s t r y t o r e q u i r e i c t i o n i n o r d e r t o b e " s a t i s f i e d " t h a t t h i s l e g i s l a t i v e d i c a t e s t h a t t h e a p p e l l a n t i s i n d e p e n d e n t l y a b l e t o e d D LA : p e r s o n a l s e l f c a r e , m e a l p r e p a r a t i o n , f i n a n c e s . F o r t h e r e a s o n s g i v e n a b o v e u n d e r t h e o n c l u d e d t h a t t h e e v i d e n c e i n d i c a t e s t h e a p p e l l a n t s i o n m a k i n g a n d s o c i a l f u n c t i o n i n g . r s , t h 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 a p p e l l a n t ' s a b i l i t y e t o f p a i n . e c i a l i s 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 r e q u i r e s k e s h e r t w i c e a s l o n g a s t y p i c a l t o d o t h i s a c t i v i t y . h a t t h e a p p e l l a n t r e q u i r e s p e r i o d i c a s s i s t a n c e i n o m e . T h e a p p e l l a n t c o m m e n t e d t h a t i f s h e ' s e r r e c o n s i d e r a t i o n s u b m i s s i o n s h e c o n f i r m e d t h a t i t e m s a r e i n a b a c k p a c k . I n h e r o r a l t e s t i m o n y t h e h e r o w n a b o u t o n c e a w e e k . e o n l y l i m i t i n g f a c t o r a p p e a r s t o b e t h a t t h e b u s b e a b l e t o w a l k t o i t . i t h r e s p e c t t o t h e t i m e o r d u r a t i o n o f t h e . I n h e r N o t i c e o f A p p e a l t h e a p p e l l a n t r e f e r r e d t o , h o w e v e r b o t h s h e a n d t h e s p e c i a l i s t r e f e r r e d t o n t w r i t i n g t h a t " p e r i o d i c " m e a n s " w h e n p a i n c o n t e x t w i t h t h e m o d e r a t e n a t u r e o f t h e d o e s n o t r o v i d e a c o m e l l i n i c t u r e o f h o w
of ten th e ap pellan t ex p e r i ence s s ig nifi c ant restriction Based on the foregoin g analysis , the panel c onclud the ev idence i s insuffici ent to show o n t he bal ance per fo rm her DLA i s sig ni f icantly restrict e d e i ther contin Hel p w ith DLA Th e a p pell ant's p o sition is that s he requires help w T h e ministr y' s positio n is that sin c e i t h a s no t b ee n signi fica ntly r e s tricted, i t cann ot be determined t hat signifi Pa ne l D e cision A find ing that a s evere imp airme n t dir e ctly an d s ign DLA eithe r continu o u sly or per i o di call y f or a n exte " help" as defined by s ecti o n 2(3)( b ) of th e EA PWD p r e condit ion ha s not been sa ti sfi e d on th e bala n ce of p Acc ord i ngly, th e panel finds th at th e mi nistr y rea sona th e appel lant requires help with DLA as d efined b y Co nclus io n The pa nel ackn owl edges th a t the ap pell a nt' s me dic H owe ve r, ha v in g rev i e w e d an d cons i dered al l of the evidence and th f inds t hat t he mi nist ry' s d ec isio n find ing the appellant ap plicat ion of the l egislati on i n t he cir c umstances of t min is try's decision. EAAT003(10/06/01) 'APPEAL# s to D L A es that the mi ni stry rea s o nabl y d e t erm ined that of p ro bab il ities tha t the a p pe llan t's abil ity to uously or perio dically f or e xt e nded periods. it h DLA due to the r e s trict ion s s he e xpe r i ence s. e st a bli shed that the a p pell ant's DLA are cant help is req uir e d f rom ot her persons. ific ant l y re s tric t s a p erso n's abil ity to manage her nd e d p eri od i s a precondition t o a pe r so n requi ring A . For the re a sons pr ovi ded above, t h at ro b a b i l i t ies in this case. bl y concluded it c o u l d n ot be d etermined th at s e c t i on 2(3 )(b ) of th e EAP W DA. al con di t i o ns a ffect he r ab i lit y t o fun ction . e rele vant l e gis lat io n, the panel inel igibl e fo r PWD de si gnation is a reasonable he ap pellant. The p an e l the refo re c o n f irms th e
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