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 S e p t e m b e r 3 0 , 2 0 1 4 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 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 s h e h a s o f a m e d i c a l p r a c t i t i o n e r , i s l i k e l y t o c o n t i n u e f o r a t l s a t i s f i e d t h a t t h e e v i d e n c e e s t a b l i s h e s t h a t : • t h e a p p e l l a n t h 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 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 A P P E A L # I 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 ) 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 t w o E m p l o y m e n t a n d A s s i s t a n c e fo r P e r s o n s w i t h 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 t h a t t h e a s e v e r e p h y s i c a l i m p a i r m e n t t h a t , i n t h e o p i n i o n 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 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 r v i c e s o f a n a s s i s t a n c e a n i m a l t 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
P ART E -Su mmary of F a c ts T h e evi d ence be f o re the mi nis try a t the ti m e of the reconsi Di sabiliti es ( P WD) App l ication comp rised of the ap pl phys ician re port (PR) a nd a n ass e ss o r r epo rt (AR) both d gen eral p rac titioner wh o h ad known t h e ap pell a nt since The e viden ce a l s o inclu d ed th e following : 1 ) C on sultat i o n Rep ort by an i n ternis t dat ed August 2) Le tter of con sultat i o n by a respirologist dated 3 ) Conf i rmat i o n of A p plic ation for Me dical B e nefits da 4) Reque st for Reconsid e ra t io n dated Septemb pra c titioner d ated September 1 5, 20 14, u nd ated frie n d who ha d pr evio usly b een a clie nt of t h e appellant' 16, 20 14 fr om anoth er frie nd. Di a g nos es In the P R, the appell ant wa s d ia g n osed b y the g eneral obstru c tive pul mo n ary d i se ase], obstructi ve sleep a moo d disorde r-dep ress ion with a n ons et befo re 2007 Ment al Imp a ir ment I n the PR, the appel lant's ge n e r a l prac titio ner r epor • In terms of hea lth histor y, t he a ppe llan t 's depre [medicat i on] t ri als; li m its en er g y, c oncentra t io • R e garding the d eg ree and cou rse of impairment: "we've tried d epre ss ion; n eve r re ally remits . " • The appellant does no t ha ve dif fi cul ties with co • The app ellan t exp erienc es sig n ificant deficits ar eas of e m o t iona l dis t urban ce, motivation, an gen eral practitioner d i d not ad d a ny comme nt • In the a ddition a l c omm en t s to the A R , th e ge ner been hospitalized for hypoxemia and has seen a at tac hed. In the AR, the general practiti oner indicated that: • The appellant's mood disorder limits her energy, memory, concentration, focus, interests. • The appellant has a good ability to communicate in all areas. • There is a major impact in 1 of 14 listed areas of cognitive wi th motivati on. There is a moderate impact in the area of memory. i mpac t in t he remaining areas of functi oning. any additio n al comments . In her self-report, the appellant wrote that: • She has very limited breathing which limits the places she can go and what type of activities she can do. I n h er Re qu e st for Reconsideration, th e appell ant w ro I APPEAL# dera ti o n d ecisi o n included the Person With ican t i n f o rmation d ate d M ay 22, 2 014 , a ate d May 15, 20 14 an d co m p leted b y a Oc tober 2007. 30, 2013 ; Nov ember 8 , 20 13; ted M arch 4, 2014; and, er 16, 20 14 attac hing letters fro m the ge n e ral letter s fro m th e a ppe ll a nt' s d a u ghter and a s, as well as a lette r d ate d S eptember pra c tit ione r with severe COPD [c hr oni c pnea, ex erti on a l hypoxemia, fibromyalg ia, an d . t e d th at: ssion is " moderate an d refractory to many med n, memo ry. " so man y tre atm e nt s for mmu ni ca tio n. in her co g ni t iv e a nd emotional f unc t i oning i n th e d atten tio n o r sustain ed c o ncentra tion . The s. al p ra ct i t i one r wrote tha t the ap pe llan t ha s n internist and respirologist, with c o nsults a nd emotional f u ncti oning, namely There is minimal or no The general practitioner did not elaborate with t e that:
• S h e i s c o n s t a n t l y t i r e d f r o m h e r s l e e p a p n e a • H e r b a c k p a i n d o e s n o t a l l o w h e r t o s i t , s t a n d h e r a l r e a d y d e p r e s s e d s t a t e o f m i n d a s s h e a c t i v e l i f e . • T h e m e n t a l a n d e m o t i o n a l t o l l [ o f n o t b e i n g a o v e r w h e l m i n g . • H e r f i b r o m y a l g i a i s a g g r a v a t e d b y s t r e s s a n d • S h e a n d h e r d o c t o r h a v e g o n e t h r o u g h e n d l e d e p r e s s i o n u n d e r c o n t r o l b u t t o n o a v a i l . I n t h e l e t t e r d a t e d S e p t e m b e r 1 5 , 2 0 1 4 , t h e g e n e r a l • T h e a p p e l l a n t h a s r e f r a c t o r y d e p r e s s i o n n o t t r e a t m e n t s . • T h i s l e a d s t o d i ff i c u l t y w i t h e n e r g y l e v e l s , f o c p u b l i c . • H e f e e l s t h a t t h e a p p e l l a n t i s c o m p l e t e l y a n d t h i s i s a s e v e r e d i s a b i l i t y a s a r e s u l t o f t h e n u c o n t e n d w i t h o n a d a i l y b a s i s . I n h e r l e t t e r , t h e a p p e l l a n t ' s d a u g h t e r w r o t e t h a t : • T h r o u g h h e r c h i l d h o o d s h e w a t c h e d t h e a p p e s e v e r e s c i a t i c a p a i n . I n h e r y o u n g e r y e a r s , s f i g h t i t a n d k e e p o n w i t h d a i l y l i f e . • I n t h e l a s t f e w y e a r s , s h e h a s w a t c h e d t h e a p h e a l t h . • B e c a u s e o f t h e p a i n a n d f r u s t r a t i o n o f n o t b e m e n t a l s t a t e b e c o m e s s i g n i f i c a n t l y w o r s e . • S h e h a s s e e n t h e a p p e l l a n t g o f o r 7 t o 1 0 d a n o t a n s w e r t h e p h o n e , a l l o w a n y o n e i n t h e h o • H e r m e n t a l s t a t e h a s g o t t e n t o t h e p o i n t t h a t f o o d c a n t u r n i n t o a m a j o r i s s u e . T h e r e a r e t i c o p e w i t h . • S h e h a s s e e n t h e a p p e l l a n t l e a v e h e r b i l l s u n i m p o r t a n t t o p a y s o s h e p a y s n o t h i n g . • S h e i s t h e a p p e l l a n t ' s m a i n s u p p o r t s y s t e m a p h y s i c a l a n d , m a i n l y , h e r m e n t a l c a p a b i l i t i e s . a p p e l l a n t i s i n , s h e d o e s n o t f e e l t h a t t h e a p p a n d s h e d e s p e r a t e l y n e e d s m o r e f i n a n c i a l h e i s u n d e r . H e r c o n c e n t r a t i o n a n d d e c i s i o n m a s i t u a t i o n . • T h e f a c t o f h a v i n g t o g o o n o x y g e n n o w h a s t a n x i e t y a n d d e p r e s s i o n . I n h e r l e t t e r , t h e a p p e l l a n t ' s f r i e n d , w h o h a d p r e v i o u s • S h e h a s n o t i c e d t h e a p p e l l a n t ' s h e a l t h d e c l i n i p h y s i c a l h e a l t h b u t a l s o h e r m e n t a l h e a l t h . • T h e a p p e l l a n t c a n q e t v e ry d e p r e s s e d a n d w i A P P E A L # I , w h i c h f u e l s h e r d e p r e s s i o n . o r l i e f o r a n y d u r a t i o n o f t i m e , w h i c h a g g r a v a t e s f r e q u e n t l y f e e l s u n a b l e t o h e l p h e r s e l f l i v e a f u l l , b l e t o s p e n d t i m e o u t s i d e w i t h h e r f a m i l y ] i s h e r d e p r e s s i o n i s a g g r a v a t e d b y h e r p a i n . s s c o m b i n a t i o n s o f m e d i c a t i o n s t o g e t h e r 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 : r e s o l v e d b y c o u n s e l i n g a n d m e d i c a t i o n u s , c o n c e n t r a t i o n a n d d e a l i n g w i t h t h e g e n e r a l p e r m a n e n t l y d i s a b l e d f r o m w o r k . H e f e e l s t h a t m e r o u s m e d i c a l f a c t o r s t h a t t h e a p p e l l a n t h a s t o l l a n t s u f f e r w i t h d e p r e s s i o n a n d a n x i e t y a n d h e s e e m e d t o h a v e t h e s t r e n g t h a n d s t a m i n a t o p e l l a n t g o d o w n h i l l i n h e r p h y s i c a l a n d m e n t a l i n g a b l e t o f u n c t i o n i n t h e w a y s h e w a n t s , h e r y s j u s t g o i n g f r o m t h e b e d t o t h e c o u c h . S h e w i l l u s e , h a v e a s h o w e r , o r e a t p r o p e r l y . e v e n h a n g i n g a p i c t u r e o r d e c i d i n g w h a t t o b u y f o r m e s t h a t a n y d e c i s i o n m a k i n g i s m u c h f o r h e r t o p a i d a s s h e c a n n o t d e c i d e w h i c h i s t h e m o s t n d c a r e g i v e r a n d s h e i s c o n c e r n e d a b o u t h e r I n t h e p h y s i c a l a n d m e n t a l c o n d i t i o n t h e e l l a n t w o u l d q u a l i f y f o r e m p l o y m e n t i n a n y s e c t o r l p t o m a k e e n d s m e e t a n d r e l i e v e t h e s t r e s s s h e k i n g w o u l d c a u s e p r o b l e m s i n a n y e m p l o y m e n t o t a l l y s e n t h e r o n a l o o p o f c o n f u s i o n , f r u s t r a t i o n , l y b e e n a c l i e n t o f t h e a p p e l l a n t , w r o t e t h a t : n g o v e r t h e p a s t y e a r q u i t e q u i c k l y ; n o t j u s t h e r l l e i t h e r n o t l e a v e h e r h o u s e o r h e r b e d f o r d a v s a t
I APPEAL# a time. In her letter dated September 16, 2014, the appellant's other friend wrote that: • She has known the appellant for nearly 3 years and has seen the appellant's illnesses increasingly affect her life during that time. • She has answered phone calls for the appellant when she has been in bed for 3 days with no motivation or strength to move farther than her couch. This throws her depression into overdrive and she really struggles to push through. 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 can walk less than 1 block and climb 2 to 5 steps unaided. In the AR, the general practitioner reported that: • The appellant uses an assistive device for walking indoors and outdoors and for climbing stairs, namely: "oxygen tank and tubing required." • The appellant is independently able to perform every task of the personal care DLA, namely: dressing, grooming, bathing, toileting, feeding self and regulating diet, and transferring in/out of bed and on/off of a chair. • The appellant requires periodic assistance from another person with doing her laundry and basic housekeeping, for which she uses an assistive device, described as: "daughter may help; wears oxygen." • For shopping, the appellant is independently able to read prices and labels, make appropriate choices and pay for purchases while requiring an assistive device for going to and from stores ("oxygen") and periodic assistance from another person for carrying purchases home. The general practitioner added: "no safety issues other than running out of oxygen if caught out too long." • The appellant is independent in performing all of the applicable tasks of each remaining DLA, namely: managing meals, paying rent and bills, medications and transportation. • The appellant is also independent in all 5 aspects of social functioning, including making appropriate social decisions, developing and maintaining relationships, interacting appropriately with others, dealing appropriately with unexpected demands, and securing assistance from others. • The appellant's level of functioning with her immediate and extended social networks is assessed as good in both areas. In her self-report, the appellant wrote that: • She has very limited breathing which limits her movement in exercise, housework, etc. In her Request for Reconsideration, the appellant wrote that: • She is in great need of help and support in order to have a safe and healthy life style. • Her illnesses affect her daily life to the point that she has a difficult time doing everything from sleeping through the night to keeping her house clean and in order. • Motivation and concentration are hard to sustain and she struggles with the smallest of tasks without stoppinq to use an oxyqen tank. Simply havinq a shower is enough to take her breath
I APPEAL# and requires a 20 to 30 minute oxygen session to regain her strength. • There are many days when she requires help. She has to call her daughter or other family to help her with laundry, vacuuming or dishes as repetitive motion aggravates her fibromyalgia. • She had to leave the last two jobs she had because she could not keep up with the expectations they had for her in keeping up with the daily associated tasks. • ln not being able to secure employment, it has been difficult to make ends meet. In the letter dated September 15, 2014, the general practitioner reported: • He has been the appellant's family physician for the past 7 years. • He concurs that the appellant "is not always severely disabled enough to be unable to complete her AOL's";" however, it is not possible for her to work outside the home." • She has to wear oxygen at times through the day. • The unpredictable nature of her pain leads to her availability and reliability (for work) to be unpredictable as well. • She has obstructive sleep apnea and the treatment device (CPAP) does not work exactly as it should each and every night, which can result in daytime somnolence. This affects her ability to work outside the home, and also affects her ability to do her AOL's. • She also has refractory depression not resolved by counseling and medication treatments. This leads to difficulty with energy levels, focus, concentration and dealing with the general public. Sometimes this also affects her ability to complete her AOL's. • He feels that the appellant is completely and permanently disabled from work. In her letter, the appellant's daughter wrote that: • The appellant no longer keeps her home clean. Junk is piling up, and the carpets are stained and dirty to the point that she removed them because she was worried about the appellant's lungs and breathing. • She and a couple friends go to the appellant's home once or twice a week to help out with cleaning floors and bathrooms, changing the bed, laundry, etc. • Because of the pain the appellant is in and the lack of oxygen due to COPO, she sometimes has difficulty having a shower, cleaning her home, or just going for a walk. • When the pain is too much for the appellant to function, the friends help keep her home up to a clean and safe living standard, pick up her groceries, do laundry, etc. In her letter, the appellant's friend, who had previously been a client of the appellant, wrote that: • She has helped the appellant tidy her house, grocery shop and has visited her to "boost her spirits." She has helped with simple tasks such as folding laundry or vacuuming, sweeping, dusting, loading the dishwasher and putting away dishes because the appellant is in too much pain to accomplish these tasks. • She feels that as the appellant's physical pain and dependency on the oxygen has increased, the appellant "may not be able to perform her regular activities of daily living;" ... "with the need of her oxygen and other help she cannot keep up with employment or gain employment." In her letter dated September 16, 2014, the appellant's other friend wrote that: • She has seen the appellant "in tears, stressed and in pain, struggling to keep the laundry under control." • The appellant "struggles to make ends meet as she can no longer meet the physical demands of qainful employment."
N e e d fo r H e l p I n t h e P R , w h e n a s k e d w h e t h e r t h e a p p e l l a n t r e q u i r p r a c t i t i o n e r w r o t e : " y e s , o x y g e n c o n c e n t r a t o r , t a n k , 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 i n t h e A R t h a t t h e f o r D L A i s p r o v i d e d b y f a m i l y , f r i e n d s , a n d c o m m u n a b r e a t h i n g d e v i c e ( " C P A P " ) a n d o x y g e n a s a s s i s t i v I n h e r N o t i c e o f A p p e a l d a t e d O c t o b e r 1 5 , 2 0 1 4 , t h 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 a n d w r o t e t h a t a i s s u e s , h e d o e s n o t l i v e i n h e r h o u s e a n d s e e p e r s o s h e h a s p e r i o d s ( s h o r t o n e s ) w h e r e s h e n e e d s n o h s o m e t h i n g . W i t h w i n t e r c o m i n g , h e l p w i l l b e n e e d e d w o o d s t o v e s m o k e . 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 : • S h e b e l i e v e s t h a t t h e m i n i s t r y d i d n o t t a k e h e t i m e s w h e n s h e w i l l g o 1 0 d a y s w i t h o u t g e t t i n a t t e m p t e d s u i c i d e . • S h e h a s f i b r o m y a l g i a a n d o s t e o a r t h r i t i s i n h e p a i n m e d i c a t i o n r e q u i r e d s o s h e i s i n c o n s t a n • W h e n s h e i s i n p a i n , h e r d e p r e s s i o n i s w o r s e m a y b e f o l l o w e d b y a w e e k w h e r e s h e c a n d • S h e i s w o r r i e d t h a t h e r o x y g e n l e v e l s w i l l b e c g e t b a c k u p . H e r d a u g h t e r h a d a n a l a r m s y s f a l l s . • H e r d a u g h t e r n o w c o o k s d i n n e r f o r h e r e v e r y w i t h s u p e r v i s i o n . • E v e r y d a y s o m e o n e c o m e s t o h e l p h e r c l e a n a n d t h e o t h e r f r i e n d c o m e s t w i c e a w e e k f o r v • T h e r e a r e t h r e e p e o p l e w h o c o m e a n d c h e c k • I n t h e s u m m e r , s h e w a s c o n f i n e d t o t h e h o u s a n d , i f s h e h a d t o g o o u t , s h e h a d t o w e a r a m a w a y f r o m t h e c o l d s o s h e n e e d s m o r e h e l p i g r o c e r i e s a n d c l e a r h e r d r i v e w a y , f o r e x a m p l e • H e r n e i g h b o r w i l l a s k a n d h e l p h e r w i t h o u t d o • S h e i s c o n c e r n e d b e c a u s e i f s h e c a n n o t m a k b e t a k e n a w a y . • H e r d o c t o r k n o w s h e r h e a l t h h i s t o r y b u t h e d o p e o p l e t o k n o w h o w m u c h s h e c a n n o t d o s o s • W i t h h e r d e p r e s s i o n , s h e c a n e x p e r i e n c e p e r d a y s t o 2 w e e k s . S h e w i l l n o t a n s w e r t h e p h o • S h e u s e s t h e o x y g e n t w o t i m e s p e r d a y , i n t h b e c o m e s w i n d e d , s h e w i l l a l s o u s e i t d u r i n g t h • S h e h a s g o o d d a y s a n d b a d d a y s . S h e w i l l b w i l l " s e t i n . "A P P E A L # I e s a n a i d f o r h e r i m p a i r m e n t , t h e g e n e r a l t u b i n g , m a s k , n a s a l p r o n g s . " a p p e l l a n t l i v e s a l o n e a n d t h e a s s i s t a n c e r e q u i r e d i t y s e r v i c e a g e n c i e s . T h e a p p e l l a n t r o u t i n e l y u s e s e d e v i c e s . a p p e l l a n t e x p r e s s e d h e r d i s a g r e e m e n t w i t h t h e l t h o u g h h e r d o c t o r k n o w s o f a l l o f h e r h e a l t h n a l l y t h e p a i n a n d l i m i t a t i o n s s h e h a s . A l t h o u g h e l p , m o s t d a y s s h e n e e d s s o m e o n e t o h e l p d o a s s h e i s h o u s e b o u n d b e c a u s e o f t h e c o l d a n d r m e n t a l c o n d i t i o n i n t o c o n s i d e r a t i o n . T h e r e a r e g o u t o f b e d o r o f f t h e c o u c h . S h e o n c e r n e c k a n d l o w e r b a c k a n d s h e c a n n o t a ff o r d t h e t p a i n . . O n h e r " g o o d " d a y s , t h e n s h e i s o k a y , b u t t h i s o n o t h i n g . o m e s o l o w t h a t s h e m i g h t f a l l a n d n o t b e a b l e t o t e m i n s t a l l e d s o t h a t s h e c a n c a l l f o r h e l p i f s h e n i g h t a n d s t a y s s o t h a t t h e a p p e l l a n t c a n s h o w e r . O n e f r i e n d h e l p s w i t h t h e l a u n d r y a n d t i d y i n g a c u u m i n g . o n h e r e v e r y m o r n i n g . e b e c a u s e o f t h e s m o k e o u t s i d e d u e t o f o r e s t f i r e s a s k o u t s i d e . S h e h a s a l s o b e e n a d v i s e d t o s t a y n t h e w i n t e r . S h e h a s t o h a v e s o m e o n e g e t h e r . o r c h o r e s , i f n e e d e d . e i t t o s o m e a p p o i n t m e n t s , h e r h o m e o x y g e n m a y e s n o t l i v e i n h e r h o u s e . S h e a l s o d o e s n o t w a n t h e h a s t e n d e d t o d o w n p l a y h e r l i m i t a t i o n s . i o d s w h e r e s h e d o e s n o t l e a v e t h e h o u s e f o r 1 0 n e o r d o a n y t h i n g . e m o r n i n g a n d a g a i n i n t h e e v e n i n g . I f s h e e d a y . e f i n e f o r 2 t o 3 w e e k s a n d t h e n h e r d e p r e s s i o n
• She has not re s ponded well to the med i cations that have bee Ov er th e years, s h e has seen p sycholo g i s ts heal t h and she has been on many different anti-depressan • On a good day , she will think she sh o uld see so she has tried all their therapies and nothing works. • F or paying her rent and bills, there are time s because sometime s she will just let things go. h er lights will be shut off, for exampl e . Her daughter will "ride • When she took th e PWD application in to her doctor, he did no should be focused o n-either the phy s ical or th w ay , she could not go to wo r k . She h ad t o leave he • S he ha s not told her doctor how oft en she needs help from a finan c i al help so she can get the p ain m edica herself. A dmissib ilit y of Ne w In for m ati on The mi nis t ry did n ot ra i se an obj e c tion t o the admiss i n fo r m ation provides a ddi tion al de t a il r egard ing th e appellant's orig inal P WD applicatio n, the pane l has ad m itt e d this ad i n forma t i on and r ecord s that were befo re the mini s t ry w ith Section 22( 4) o f th e Employme nt a nd Assist ance Th e mi nistry relie d o n it s reconsiderati on d eci s i on, as summarized at the hearin A PPEAL# I n prescri bed for de pression . a nd psychiatrists a nd she ha s visited with mental ts bu t nothing has helped. m eone and she will drop into mental hea lth but when her daughter has to deal wi th this for he r She will keep pu tting off payin g a bill and then he r " u ntil the bi ll i s paid. t know which disability he e mental health i s sues. He agreed th at, either r previous employment on stress le a ve . nother pe rs on. She a lso needs tions and then she will be ab le to do more f or i b ilit y o f th e ap pel la nt's oral testimony . As thi s impa irme nts, as a ddressed in the ditional informati on as bein g i n suppo rt of at th e t ime of reconsider at ion, i n acc ordance Act. g .
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 f o r PWD designation, 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 impairment and that her 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 f o r 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 perform; "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; (iv) use public or personal transportation facilities;
( v ) p e r f o r m h o u s e w o r k t o m a i n t a i n t h e p e r s o n ' s p l a c e ( v i ) m o v e a b o u t i n d o o r s a n d o u t d o o r s ; ( v i i ) p e r f o r m p e r s o n a l h y g i e n e a n d s e l f c a r e ; ( v i i i ) m a n a g e p e r s o n a l m e d i c a t i o n , a n d ( b ) i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e m e n t a l i m p ( i ) m a k e d e c i s i o n s a b o u t p e r s o n a l a c t i v i t i e s , c a r e o r ( i i ) r e l a t e t o , c o m m u n i c a t e o r i n t e r a c t w i t h o t h e r s e f f e A t r e c o n s i d e r a t i o n , t h e m i n i s t r y w a s s a t i s f i e d t h a t t s e v e r e p h y s i c a l i m p a i r m e n t , b u t w a s n o t s a t i s f i e d t s e v e r e m e n t a l i m p a i r m e n t . S e v e r e M e n t a l I m p a i r m e n t 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 a s e v e r e m e n t a l i m p i m p a c t s f r o m h e r d i a g n o s e d m o o d d i s o r d e r d e p r e s g o n e t h r o u g h e n d l e s s c o m b i n a t i o n s o f m e d i c a t i o n s a v a i l . T h e a p p e l l a n t a r g u e d t h a t s h e i s c o n s t a n t l y t d e p r e s s i o n , a n d h e r b a c k p a i n d o e s n o t a l l o w h e r t a g g r a v a t e s h e r a l r e a d y d e p r e s s e d s t a t e o f m i n d a s f u l l , a c t i v e l i f e . T h e a p p e l l a n t a r g u e d t h a t t h e m e n t t i m e o u t s i d e w i t h h e r f a m i l y i s o v e r w h e l m i n g . 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 r e i s i n s u f f i c i e n t e v s e v e r e m e n t a l i m p a i r m e n t a s a m a j o r i t y o f t h e P W D i m p a i r m e n t . T h e m i n i s t r y a r g u e d t h a t w h i l e t h e g e n s i g n i f i c a n t d e f i c i t s i n h e r c o g n i t i v e a n d e m o t i o n a l f u m i n i m a l o r n o i m p a c t o n d a i l y f u n c t i o n i n g , w i t h t h e e m o d e r a t e i m p a c t t o m e m o r y . T h e m i n i s t r y a r g u e d a p p e l l a n t a s i n d e p e n d e n t i n a l l 5 a r e a s o f s o c i a l f u n f u n c t i o n i n g i n b o t h h e r i m m e d i a t e a n d e x t e n d e d s o P a n e l D e c i s i o n I n t h e P R , t h e g e n e r a l p r a c t i t i o n e r d i a g n o s e d t h e a p g e n e r a l p r a c t i t i o n e r w r o t e t h a t t h e a p p e l l a n t ' s d e p r e m e d i c a t i o n t r i a l s ; l i m i t s e n e r g y , c o n c e n t r a t i o n , m e m d e p r e s s i o n ; n e v e r r e a l l y r e m i t s . " T h e g e n e r a l p r a c s i g n i f i c a n t d e f i c i t s i n h e r c o g n i t i v e a n d e m o t i o n a l f u m o t i v a t i o n , a n d a t t e n t i o n o r s u s t a i n e d c o n c e n t r a t i o n f u n c t i o n i n g i n t h e a r e a o f m o t i v a t i o n , t h e i m p a c t t o m t h e r e m a i n i n g a r e a s o f f u n c t i o n i n g . 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 w a p n e a , w h i c h f u e l s h e r d e p r e s s i o n a n d h e r b a c k p a d u r a t i o n o f t i m e , w h i c h a g g r a v a t e s h e r a l r e a d y d e p r u n a b l e t o h e l p h e r s e l f l i v e a f u l l , a c t i v e l i f e . A t t h e h d a y s a n d b a d d a y s . S h e w i l l b e f i n e f o r 2 t o 3 w e e k e x e r i e n c e e r i o d s w h e r e s h e d o e s n o t l e a v e t h e h 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 ; a i r m e n t , i n c l u d e s t h e f o l l o w i n g a c t i v i t i e s : f i n a n c e s ; c t i v e l y . h e i n f o r m a t i o n p r o v i d e d i s s u f f i c i e n t e v i d e n c e o f a h a t t h e i n f o r m a t i o n p r o v i d e d i s e v i d e n c e o f a a i r m e n t i s e s t a b l i s h e d b y t h e e v i d e n c e o f t h e s i o n . T h e a p p e l l a n t a r g u e d t h a t h e r d o c t o r h a s t o g e t h e r d e p r e s s i o n u n d e r c o n t r o l b u t t o n o i r e d f r o m h e r s l e e p a p n e a , w h i c h f u e l s h e r o s i t , s t a n d o r l i e f o r a n y d u r a t i o n o f t i m e , w h i c h s h e f r e q u e n t l y f e e l s u n a b l e t o h e l p h e r s e l f l i v e a a l a n d e m o t i o n a l t o l l o f n o t b e i n g a b l e t o s p e n d i d e n c e t o e s t a b l i s h t h a t t h e a p p e l l a n t h a s a a p p l i c a t i o n i s f o c u s e d o n t h e a p p e l l a n t ' s p h y s i c a l 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 a p p e l l a n t h a s n c t i o n i n g , t h e s e w e r e m o s t l y a s s e s s e d a s h a v i n g x c e p t i o n o f a m a j o r i m p a c t i n m o t i v a t i o n a n d a 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 a s s e s s e d t h e c t i o n i n g a n d i n d i c a t e d t h a t s h e h a s g o o d c i a l n e t w o r k s . p e l l a n t w i t h m o o d d i s o r d e r d e p r e s s i o n . T h e s s i o n i s " m o d e r a t e a n d r e f r a c t o r y t o m a n y o r y " a n d " w e ' v e t r i e d s o m a n y t r e a t m e n t s f o r t i t i o n e r r e p o r t e d t h a t t h e a p p e l l a n t e x p e r i e n c e s n c t i o n i n g i n t h e a r e a s o f e m o t i o n a l d i s t u r b a n c e , a n d , w h i l e t h e r e i s a m a j o r i m p a c t t o d a i l y e m o r y i s m o d e r a t e w i t h m i n i m a l o r n o i m p a c t i n r o t e t h a t s h e i s c o n s t a n t l y t i r e d f r o m h e r s l e e p i n d o e s n o t a l l o w h e r t o s i t , s t a n d o r l i e f o r a n y e s s e d s t a t e o f m i n d a s s h e f r e q u e n t l y f e e l s 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 s h e h a s g o o d s a n d t h e n h e r d e p r e s s i o n w i l l " s e t i n . " S h e c a n o u s e f o r 1 0 d a s t o 2 w e e k s . S h e w i l l n o t a n s w e r
I APPEAL# the phone or do anything. The appellant's daughter wrote in her letter that she has seen the appellant go for 7 to 10 days just going from the bed to the couch. She will not answer the phone, allow anyone in the house, have a shower, or eat properly. At the hearing, the appellant also stated that she has fibromyalgia and osteoarthritis in her neck and lower back and she cannot afford the pain medication required so she is in constant pain and, when she is in pain, her depression is worse. Given an opportunity to provide further updated information, the general practitioner wrote in his September 15, 2014 letter that the appellant has refractory depression and this leads to difficulty with energy levels, focus, concentration and dealing with the general public. He did not refer to the periods of incapacity as described by the appellant and her daughter but wrote that the unpredictable nature of her pain leads to her availability and reliability (for work) to be unpredictable as well. The appellant stated at the hearing that she was not completely forthcoming with her doctor about her situation because she has tended to downplay her limitations. In his letter, the general practitioner concluded that he feels that the appellant is completely and permanently disabled from work and that this is a severe disability as a result of the numerous medical factors that the appellant has to contend with on a daily basis. However, the ability to work and/or look for work is not one of the criteria for PWD designation in Section 2(2) of the EAPWDA nor is it listed in the definition of daily living activities in Section 2(1) of the EAPWDR. 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 effe ctively (social functioning), the evidence indicates that the appellant is not significantly restricted in either. With respect to decision making, the general practitioner reported in the AR that the appellant independently manages her finances (banking, budgeting, pay rent and bills) and her medications (taking 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. The appellant stated at the hearing that there are times when her daughter has to pay bills for her because sometimes she will just keep putting it off and "let things go." The appellant's daughter wrote in her letter that the appellant's mental state has gotten to the point that even hanging a picture or deciding what to buy for food can turn into a major issue. However, these periods of restrictions to the appellant's decision-making were not confirmed by the general practitioner in his September 15, 2014 letter. Regarding the DLA of social functioning, the appellant is assessed by the general practitioner as independent in developing and maintaining relationships, interacting appropriately with others, and securing assistance from others. The appellant is also assessed with a good ability to communicate in all areas. Given the absence of reported impacts to the appellant's mental or social functioning, the panel finds that the ministry reasonably determined that a severe mental impairment was not established under Section 2(2) of the EAPWDA. Restrictions in the ability to perform DLA The appellant's position is that her severe 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 daughter and her friends, and also the use of a CPAP machine and oxygen as assistive devices. The ministry's position is that the information from the prescribed professional does not establish that
APPEAL# I impairment significantly restricts DLA either continuously or periodically for extended periods. The ministry argued that the general practitioner's comments, in his September 15, 2014 letter, are directed towards whether or not the appellant is employable and not her ability to perform basic DLA. The ministry argued that the general practitioner agreed that the appellant is not always severely disabled enough to be unable to perform DLA. The mini�try argued that the general practitioner has not supported the assessments mad e by the appellant's family and friends regarding her DLA capabilities. 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 exterided periods. In this case, the general practitioner is the prescribed professional. 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. The appellant uses oxygen as an assistive device for walking indoors and outdoors and for climbing stairs, and can walk less than 1 block and climb 2 to 5 steps unaided. In the AR, the general practitioner assessed the appellant as independently able to perform every task of the DLA personal care, managing meals, paying rent and bills, medications and transportation. Although the appellant wrote in her Request for Reconsideration that simply having a shower is enough to take her breath and requires a 20 to 30 minute oxygen session to regain her strength, this has not been confirmed by the general practitioner as the prescribed professional. The appellant requires periodic assistance from another person with doing her laundry and basic housekeeping, for which she uses an assistive device, described as: "daughter may help; wears oxygen." For shopping, the appellant is independently able to read prices and labels, make appropriate choices and pay for purchases while requiring an assistive device for going to and from stores ("oxygen") and periodic assistance from another person for carrying purchases home. The general practitioner added: "no safety issues other than running out of oxygen if caught out too long" but does not provide clarification as to how often assistance is required or for how long. The appellant is also assessed as independent in all 5 aspects of social functioning, including making appropriate social decisions, developing and maintaining relationships, interacting appropriately with others, dealing appropriately with unexpected demands, and securing assistance from others. In his September 15, 2014 letter, the general practitioner reported that he concurs that the appellant "is not always severely disabled enough to be unable to complete her AOL's";" however, it is not possible for her to work outside the home." The unpredictable nature of her pain leads to her availability and reliability for work to be unpredictable. She has obstructive sleep apnea and the CPAP does not work as it should each night, which can result in daytime somnolence. This affects her ability to work outside the home, and also affects her ability to do her AOL's. She also has refractory depression which leads to difficulty with energy levels, focus, concentration and dealing with the general public and "sometimes" this also affects her ability to complete her AOL's. He feels that the appellant is completely and permanently disabled from \('/Ork. The panel finds that the Qeneral practitioner, as the prescribed professional, has considered the appellant's restrictions as
they r e lat e to her a b i lity to b e e mployed an d has not de restric tions to h er DLA. Given th e a b s ence of reported impa c ts to t h e ap pellant on t he ex t e nt of n o ted rest r ictions to the D L A of h o m ini stry rea sona bly c o n cluded t h a t t here is n o t enough e establish tha t the app el lant's im p a irm ent sign i fican continuously or period ic ally f or extend ed peri ods, there Sec t i o n 2( 2)( b)(i ) of t he E A PW DA. Help t o perfor m DLA Th e appell a n t's po s ition is that s he requires t h e sign of ass istiv e d evices to pe rf orm DLA. The ministr y ' s posi t i on i s tha t b e cause it ha s n ot b een rest ricte d, i t c a n not b e d ete r m ined t h at sign if ic a nt h a c k n o wled ged th at th e appella n t uses an oxy g en tank P a nel De c i si on Secti on 2(2)(b)(i i) of the EAPWDA r e q uires th at , as a re a bili ty to p e r f orm DLA , a person requi res help to perfor subse ct i o n ( 3 ) as t h e require ment for an ass ist ive d an o ther per son, or the s ervices o f an assist an ce a n I n the PR , when a sked whether the appe l la nt r equi r practiti on e r wr o te: "yes, o xygen concentrat or, t an k , tubing, p ract it io n er r e p orted i n t he AR tha t the appellant li ve prov i d e d by f amily, fri ends, an d communit y se rvic e b reat hing dev ic e ("CP A P " ) and oxygen as a s sisti ve reasonably de t e rm i ned t h at a s dire c t a nd signif icant D LA hav e not be en established , it cannot be de t e rmine DLA as a result of those restri ctions, as defined by Section 2(3)(b) of the EAPWDA. Conclusion Having reviewed and considered all of the evidence and relevant legislation, the panel finds that the ministry's reconsidera tion decision which determined that the appellant was not eligible for PWD designation was reasonably supported by the evid en I APP E AL # fine d the fr eq uen cy or durat i o n of t h e ' s mental or social func t i oning, an d little d etail u sekeepi n g an d sh op pi n g, the panel find s t hat the videnc e from the presc rib ed p rof ess i o na l to tly re strict s her a bility t o m a nage her DL A ei ther b y not s atisf ying the l egis lative crite r i on of if ic a n t a ssi stance of a noth er person and the use es tablis he d tha t D L A a re si g nif icantly elp is re quired fr om other pe rs o n s. Th e m in i s try as a n assist i ve devi c e . sult of di r e ct a nd s i gni fi ca nt r estricti ons in t he m tho s e a ct i v i t i es. He lp is de fined in e v ice , th e significant h e lp or supervisio n of imal in ord er to per form a DLA. es an aid for her i mpairme n t, the g en era l ma sk, nasal pron gs." The gen eral s alo ne and t h e a ssis tan ce req u i red for DLA is ag encies. The app ellant rou tinely u ses a de v i c es . The pane l finds that t he mi nistry re strictions in the appell a nt's a bility to pe rform d th at the appellant requires he lp to perform c e, and therefore confirms the decisio 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.