I PART C -DECISION UNDER APPEAL The decision under appeal is the Ministry of Social Development and Poverty Reduction's ("ministry") reconsideration decision dated July 19, 2018, in which the ministry found that the appellant is not eligible for designation as a Person with Disabilities ("PWD") under section 2 of the Employment and Assistance for Persons with Disabilities Act ("EAPWDA"). The ministry found that the appellant meets the age and duration requirements but was not satisfied that: • the appellant has a severe mental or physical impairment; • the appellant's impairment, in the opinion of a prescribed professional, directly and significantly restricts his ability to perform daily living activities ("DLA") either continuously or periodically for extended periods; and • as a result of restrictions caused by the impairment, the appellant requires an assistive device, the significant help or supervision of another person, 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 A R T E S U M M A R Y O F F A C T S T h e e v i d e n c e a n d d o c u m e n t a t i o n b e f o r e t h e m i n i s t e r a t a s i n t h e m i n i s t r y ' s R e c o r d o f d e c i s i o n ] : 1 . I n f o r m a t i o n f r o m t h e m i n i s t r y ' s r e c o r d i n d i c a t i n g t h e P 2 0 1 7 ] a n d d e n i e d o n M a y 2 9 , 2 0 1 8 . T h e a p p e l l a n t s u b m 2 0 1 8 [ e x t e n s i o n o f t i m e h a d b e e n g r a n t e d b y t h e m i n i s t r U p o n r e v i e w i n g s e c t i o n 2 E ( p a g e 1 1 ) o f t h e M e d i c a l R e c o m p l e t e d b y 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 s e s i g n a t u r e a b l a c k w e r e c o m p l e t e d b y p a t i e n t . " T h e a d j u d i c a t o r c o n t a n o t e s w e r e w r i t t e n b y t h e a p p e l l a n t a s o p p o s e d t o t h e p h a l t e r n a t e v e r s i o n o f t h e P W D a p p l i c a t i o n ( " P W D A p p . 2 " ) t h e r e p o rt s a r e i d e n t i c a l e x c e p t s e c t i o n 2 E i s c o m p l e t e d m i n i s t ry r e l i e s o n t h e M R i n P W D A p p . 2 i n d e t e r m i n i n g e 2 . T h e R F R , s i g n e d b y t h e a p p e l l a n t o n J u n e 2 0 , 2 0 1 8 , r 3 . T h e a p p e l l a n t ' s P W D a p p l i c a t i o n c o m p r i s e d o f : • a s e l f r e p o r t ( " S R " ) d a t e d A u g u s t 1 8 , 2 0 1 7 ; • a M R d a t e d O c t o b e r 1 7 , 2 0 1 7 , s i g n e d b y D r . L . p a s t 1 2 m o n t h s [ c o m m e n t , " p r e v i o u s f a m i l y p h y • a n A s s e s s o r R e p o r t ( " A R " ) d a t e d N o v e m b e r 1 0 o n l y m e e t i n g w i t h t h e a p p e l l a n t w a s f o r t h e a s s e i n t e r v i e w w i t h t h e a p p e l l a n t ; • S t a t e m e n t s i n t h e C o m m e n t s s e c t i o n o f t h e A R , S u m m a ry o f r e l e v a n t e v i d e n c e f ro m t h e a p p l i c a t i o n : D i a g n o s e s I n t h e M R , D r . L . i n d i c a t e s t h e f o l l o w i n g c o n d i t i o n s : l e ft s b i l a t e r a l p n e u m o t h o r a c e s [ o n s e t J u l y 1 9 9 6 ] . U n d e r A d d i t m o o d d i s o r d e r p r e e x i s t e n t t o s e v e r e t r a u m a s u s t a i n e d i n F u n c t i o n a l s k ill s I n t h e S R , t h e a p p e l l a n t s t a t e s t h a t h i s m u l t i p l e i n j u r i e s d d u e t o f a t i g u e , s t i ff n e s s , a n d s o r e n e s s t h r o u g h o u t t h e d a f a t i g u e , a n d n e e d i n g a l o t o f b r e a k s a n d r e c o v e r y fo r d a i p l a t e i n h i s b a c k ] a s w e l l a s l e g , a n k l e , a n d h i p p a i n s l o w d u e t o h i s a n k l e b e i n g " h i g h e r a n d f u s e d " . T h e a p p e l l a n t c i r c u l a t i o n p r o b l e m s . T h e a p p e l l a n t r e p o r t s t h a t h e h a s s w o r s e n i n g a ft e r t h e a c c i d e n t . T h e i n fo r m a t i o n i n t h e M R i n d i c a t e s t h e a p p e l l a n t c a n w a s t e p s u n a i d e d ; l i ft 5 -1 5 p o u n d s [ c o m m e n t , " a v e r a g e " ] , T c a n r e m a i n s e a t e d f o r 1 -2 h o u r s [ c o m m e n t , " l a y d o w n a c o m m u n i c a t i o n b u t s h o w s s i g n i f i c a n t d e f i c i t s w i t h c o g n i t i [ e x p r e s s i o n i s u n d e r l i n e d ] , M e m o ry [ u n d e r l i n e d ] , E m o ti o n I n t h e M R , u n d e r A d d i t i o n a l C o m m e n t s , D r . L . s t a t e s t h a a n d m o t o r i c i m p a i r m e n t s . . . s h o w s m a r k e d a t r o p h y o f l e f t p a s t e m p l o y m e n t [ k e e p i n g u p w i t h t h e w o r k a n d f o l l o w i n g m e n t a l f a t i g u e a n d p h y s i c a l i m p a i r m e n t .I t h e r e c o n s i d e r a t i o n c o n s i s t e d o f [ p a n e l n o t e : i n s a m e o r d e r W D a p p l i c a t i o n w a s r e c e i v e d o n N o v e m b e r 2 2 , 2 0 1 8 [ s i c -i t t e d a 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 ( " R F R " ) o n J u l y 1 6 , y ] . T h e m i n i s t r y r e v i e w e d t h e R F R o n J u l y 1 9 , 2 0 1 8 . p o rt ( " M R " ) , t h e a d j u d i c a t o r f o u n d t h a t t h i s p a g e w a s n o t p p e a r s o n t h e f o r m ( " D r . L . " ) . D r . L . w r o t e : " N . B . n o t e s i n c t e d D r . L . t o s e e k c l a r i f i c a t i o n a n d t o d e t e r m i n e w h i c h y s i c i a n . O n A p r i l 1 9 , 2 0 1 8 , t h e m i n i s t ry r e c e i v e d a n w i t h t h e M R c o m p l e t e d b y D r . L . T h e m i n i s t ry n o t e s t h a t i n A p p . 2 a n d t h e a p p e l l a n t ' s c o m m e n t s a r e r e m o v e d . T h e l i g i b i l i t y f o r P W D d e s i g n a t i o n . e q u e s t i n g a n e x t e n s i o n o f t i m e t o p r o v i d e f u r t h e r f o r m s . w h o i n d i c a t e s s h e h a d s e e n t h e a p p e l l a n t z e r o t i m e s i n t h e s i c i a n , D r . _ l e f t p r a c t i c e " ] ; , 2 0 1 7 , c o m p l e t e d b y a R e g i s t e r e d N u r s e ( " R N " ) w h o s e s s m e n t . T h e R N b a s e d t h e a s s e s s m e n t o n a n o ff i c e w r i t t e n a n d s i g n e d b y D r . L . c i a t i c n e rv e p a l s y , m u l t i p l e s e v e r e l o w e r l i m b f r a c t u r e s a n d i o n a l C o m m e n t s , D r . L . n o t e s t h a t t h e a p p e l l a n t r e p o rt s a J u l y 1 9 9 6 , i n a n a c c i d e n t i n v o l v i n g a 9 0 f o o t f a l l . i d n o t h e a l c o m p l e t e l y . E v e ry d a y l i f e i s a c h a l l e n g e f o r h i m y . T h e a p p e l l a n t d e s c r i b e s b e i n g s l o w e d d o w n b y p a i n a n d l y a c t i v i t i e s . T h e a p p e l l a n t r e p o rt s t h a t b a c k p a i n [ f r o m a h i m d o w n . T h e a p p e l l a n t d e s c r i b e s n e rv e p a i n i n h i s t o e s r e p o r t s t h a t t h e o r t h o t i c l i f t i n h i s s h o e s o m e t i m e s c a u s e s t r u g g l e d w i t h d e p r e s s i o n t h r o u g h o u t m u c h o f h i s l i f e , w i t h i t l k 2 t o 4 b l o c k s u n a i d e d o n a f l a t s u r f a c e ; c l i m b 5 o r m o r e h e b o x f o r 1 5 t o 3 5 p o u n d s i s c r o s s e d o u t . T h e a p p e l l a n t ft e r t h a t " ] . T h e a p p e l l a n t h a s n o d i ff i c u l t i e s w i t h v e a n d e m o t i o n a l f u n c t i o n i n t h e a r e a s o f L a n g u a g e a l d i s t u r b a n c e , M o ti v a t i o n , a n d M o t o r a c t i v i t y . t t h e a p p e l l a n t " p r e s e n t s w i t h n o t i c e a b l e a m b u l a t o r y l o w e r l i m b . " D r . L . i n d i c a t e s t h e a p p e l l a n t h a d d i ff i c u l t i e s i n s c h e d u l e s ] . T h e a p p e l l a n t ' s d i ff i c u l t i e s a r e i n p a r t d u e t o
I n t h e A R [ s e c t i o n s c o m p l e t e d b y t h e R N ] , t h e a p p e l l a n t ' [ s p e a k i n g , r e a d i n g , w r i t i n g , a n d h e a r i n g ] . F o r t h e 6 a c t i v u s e s a n a s s i s t i v e d e v i c e f o r W a l k i n g I n d o o r s , W a l k i n g O 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 S t a n d i n g . W i t h t h e u s e L i ft i n g , a n d w i t h C a r ry i n g a n d h o l d i n g [ c o m m e n t : " i m p a i r R e g a r d i n g 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 n a l F u n c ti o n i r e s t r i c t s o r i m p a c t s h i s f u n c t i o n i n g a s f o l l o w s : • N o i m p a c t f o r 9 o u t o f 1 3 a r e a s : B o d il y f u n c t i o n s , C o n s E x e c u t i v e , M o t o r a c t i v i t y , L a n g u a g e , P s y c h o t i c s y m p t o m i s p r o v i d e d f o r O t h e r e m o t i o n a l o r m e n t a l p r o b l e m s ; • M i n i m a l i m p a c t : [ n o a r e a s a r e c h e c k e d ] ; • M o d e r a t e i m p a c t f o r 4 a r e a s : E m o t i o n , A t t e n t i o n / c o n c e • M a j o r i m p a c t : [ n o a r e a s a r e c h e c k e d ] ; • U n d e r C o m m e n t s , D r . L s t a t e s t h a t s h e i s a w a r e o f t h e f a t i g u e b u t " c a n n o t m a k e a s t a t e m e n t t o t h e d e g r e e o f h i a n h e d o n i a ) , m e m o ry f u n c t i o n a n d d e g r e e o f d e p r e s s i o n . p o i n t i n t i m e . " D r . L i n d i c a t e s t h e a p p e l l a n t ' s p h y s i c a l i m D LA I n t h e S R , t h e a p p e l l a n t r e p o rt s r e s t r i c t i o n s w i t h m e a l s d [ c o m m e n t : " n e e d h e l p w i t h m a k i n g b r e a k f a s t " ] . T h e a p p e o f t h e c l e a n i n g a n d m o s t o f t h e e r r a n d s a n d s h o p p i n g . T t o b e o n h i s f e e t f o r v e r y m u c h t i m e " i s t o o m u c h p h y s i c a o v e r w h e l m i n g a s h e t r i e s t o d e t e r m i n e w h a t h e c a n a n d t o r e s t m o r e t h e n e x t d a y b e c a u s e o f f a t i g u e . I n t h e M R , D r . L i n d i c a t e s t h e a p p e l l a n t h a s n o t b e e n p r h i s a b i l i t y t o p e r f o r m D L A I n t h e A R , t h e R N s t a t e s t h a t t h e a p p e l l a n t ' s l e f t n e r v e p a d i s o r d e r i m p a c t h i s a b i l i t y t o m a n a g e D L A T h e R N p r o v i • T h e a p p e l l a n t u s e s a n a s s i s t i v e d e v i c e f o r 5 o f t h e 8 a c [ " a s s i s t a n c e o f c h a i r " ] , B a t h i n g [ " w i t h b e n c h i n s h o w e r " ] , o f c a n e " ] . 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 T o i l e t i n g , F e • T h e a p p e l l a n t r e q 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 b o t h B a s i c H o u s e k e e p i n g [ c o m m e n t : " w i f e d o e s a l l " ] . • 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 3 o f t h e 5 a r e a s l i s t e a p p r o p r i a t e c h o i c e s , a n d P a y i n g fo r p u r c h a s e s . T h e a p p f r o m s t o r e s [ " a l w a y s w i t h w i f e " ] a n d C a r ry i n g p u r c h a s e s c o m m e n t s , t h e R N s t a t e s t h a t t h e a p p e l l a n t h a s a n i n c r e b a c k . T h e R N c o m m e n t s : " n o t e d t o b e i n d e p e n d e n t w i t h g r e a t a s s i s t a n c e f r o m w i f e a n d m o b i l i t y a i d s . " • T h e a p p e l l a n t r e q 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 a l l o p r e p a r a t i o n , C o o k i n g [ c o m m e n t : " w i f e d o e s a l l " ] , a n d S a f 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 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 [ c o m m e n t s : " d e p e n d s : d u e t o p a i n n e e d s h e l p i n l i f t i n g , c • 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 a l l a r e a s o f P a y R e n t [ c o m m e n t : " o n l i n e " ] ; a n d w i t h a l l a r e a s o f M e d i c a t i o n s : F h a n d l i n g a n d s t o r a g e . • T h e a p p e l l a n t u s e s a n a s s i s t i v e d e v i c e fo r a l l a r e a s o f T " w i t h c a n e " ] , U s i n g p u b l i c t r a n s i t [ c o m m e n t : " w i t h c a n e , b s c h e d u l e s / a r r a n g i n g t r a n s p o r t a t i o n [ c o m m e n t : " w i t h c a n e • 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 4 o f t h e 5 a r e a s l i s t e d s A b il i t y t o C o m m u n i c a t e i s r a t e d a s g o o d i n a l l a r e a s i t i e s l i s t e d i n M o b il i t y a n d P h y s i c a l A b il i t y , t h e a p p e l l a n t u t d o o r s , C l i m b i n g S t a irs , L i ft i n g , a n d C a r ry i n g a n d h o l d in g . o f a n a s s i s t i v e d e v i c e , 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 e d b y w e a k n e s s i n l o w e r l i m b s " ] . n g , t h e R N i n d i c a t e s t h e a p p e l l a n t ' s m e n t a l i m p a i r m e n t c i o u s n e s s , I m p u l s e c o n t ro l , I n s i g h t a n d j u d g m e n t , s , a n d O t h e r n e u ro p s y c h o l o g i c a l p ro b l e m s . N o i n f o r m a t i o n n t r a t i o n , M e m o ry , a n d M o t i v a t i o n ; a p p e l l a n t ' s m o o d d i s o r d e r [ d e p r e s s i o n ] a n d h i s t o r y o f s i m p a i r m e n t o f c o n c e n t r a t i o n , m o t i v a t i o n ( p o s s i b l e D r . L a d d s , " I t r u s t t h e s e f u n c t i o n s a r e a f f e c t e d a t t h i s p a i r m e n t i m p a i r s h i s a b i l i t y t o p e rf o r m p h y s i c a l t a s k s . u e t o h i s a d d i t i o n a l s t i f f n e s s a n d s o r e n e s s i n t h e m o r n i n g l l a n t s t a t e s t h a t h i s w i f e c o o k s a l l o f t h e m e a l s a n d d o e s a l l h e a p p e l l a n t r e p o r t s t h a t d o i n g a n y t h i n g t h a t r e q u i r e s h i m l l y t o h a n d l e . " T h e a p p e l l a n t r e p o r t s t h a t m a n y d a y s a r e c a n n o t d o p h y s i c a l l y . I f h e t r i e s t o d o t o o m u c h , h e n e e d s e s c r i b e d a n y m e d i c a t i o n s o r t r e a t m e n t s t h a t i n t e rf e r e w i t h l s y / w e a k n e s s i n l o w e r l i m b s , a n d h i s m e n t a l f a t i g u e / m o o d d e s t h e f o l l o w i n g i n f o r m a t i o n f o r s p e c i f i c D L A : t i v i t i e s l i s t e d f o r P e r s o n a l C a r e : D r e s s i n g a n d G r o o m i n g a n d T r a n s f e r s i n / o u t o f b e d a n d o n / o ff c h a i r [ " a s s i s t a n c e e d i n g s e l f , a n d R e g u l a t i n g d i e t . o f t h e a r e a s l i s t e d f o r B a s i c H o u s e k e e p i n g : L a u n d r y a n d d f o r S h o p p i n g : R e a d i n g p r i c e s a n d l a b e l s , M a k i n g e l l a n t r e q 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 G o i n g t o a n d h o m e [ " w i f e t a k e s h e a v y i t e m s " ] . U n d e r A d d i t i o n a l a s e d r i s k f o r f a l l s d u e t o h i s f u s e d a n k l e a n d c h r o n i c s o r e s o m e a c t i v i t i e s , h o w e v e r , v e r y d e l a y e d i n p r o c e s s , w i t h f t h e a c t i v i t i e s i n d i c a t e d fo r M e a l s : M e a l p l a n n i n g , F o o d e s t o r a g e o f f o o d [ " w i f e d o e s m a j o r i t y " ] . T h e a p p e l l a n t r t h a n t y p i c a l w i t h F o o d p r e p a r a t i o n a n d C o o k i n g o o k i n g " ] . a n d B i ll s : B a n k i n g , B u d g e t i n g , a n d P a y r e n t a n d b i l l s i l l i n g / r e f i l l i n g p r e s c r i p t i o n s , T a k i n g a s d i r e c t e d , a n d S a f e r a n s p o rt a t i o n : G e tt i n g i n a n d o u t o f a v e h i c l e [ c o m m e n t : u t u s e s o w n v e h i c l e m o s t o f t h e t i m e " ] , a n d U s i n g t r a n s i t " ] . f o r S o c i a l 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
[comment: "extra cautious after incident"]; Able to develop and maintain relationships; Interacts appropriately with others; and Able to deal appropriately with unexpected demands. The appellant requires periodic support/supervision with Able to secure assistance from others [comment: "wife is only support"]. The RN indicates the appellant has good functioning with his immediate social network and marginal functioning with his extended social networks [comment: "is at baseline prior to incident"]. The RN does not describe any support/supervision that is required to maintain the appellant in the community. The section for Additional Comments [including identification of any safety issues] is not completed. Need for help • In the SR, the appellant indicates his wife helps him with DLA by doing a lot of the household tasks. The appellant has had custom made orthotics, lifts, and braces over the years but they have not helped him enough due to his ankle being at a higher angle and fused. The appellant reports that his shoe lifts also cause his foot to lean outwards, resulting in circulation problems. • In the MR, Dr. L. indicates the appellant requires a high shoe orthotic [left foot, 2.5 inch]; "sometimes ankle brace custom plastic mold with leg strap". The appellant walks with a cane for support. • In the AR, the RN states that the appellant's wife is the only person who helps him with DLA ["does everything together with wife"]. The RN check marks cane, braces, and bathing aid ["chair'] as assistive devices the appellant routinely uses [comments: "left leg brace -longer walks; always using cane"]. The RN indicates the appellant needs a grab rail for toileting. The RN check marks No, the appellant does not have an assistance animal. 4. A hospital Transfer Summary dictated by a Medical Doctor on May 8, 1996. The report indicates the appellant suffered a 90-foot fall that resulted in "severe and multiple injuries" including left leg, ankle, and spinal fractures for which he had surgery. The report states that it was difficult to obtain a thorough neurological examination due to the severity of the appellant's injuries. A subsequent neurological examination revealed left-sided nerve palsy. 5. The appellant's second PWD application comprised of: • an SR dated August 18, 2017 [identical to the original SR]; • a MR ('second MR") dated October 17, 2017 and signed by Dr. L., with additions/changes aswell as comments initialed by Dr. L.; and • an AR dated November 10, 2017 and completed by the RN [identical to the original AR]. Summary of additional or amended evidence from the second MR: • Under Health History [section BJ, the comment that indicated some sections were completed by the appellant is deleted. • The information on assistive devices [item 4 of section BJ is initialed by Dr. L. • Under Functional Skills (section D), items 3 and 4 [limitations in lifting, and the length of time the appellant can remain seated] are left blank. • Under Functional Skills, a comment [with Dr. L's signature] is added to item 6 indicating significant deficits with cognitive and emotional function: "patient is affected by easy fatigability from physical and emotional strain." • Under Additional Functional Skills Comments, there is information written on a sticky note regarding the appellant's ability to lift and remain seated: "lifting limits on average 5-15 pounds, variable on better days to 15-35 pounds. Seating average 1-3 hours -variable on levels of pain." • Section E -Daily Living Activities is now completed. Dr. L. checks that the appellant's impairment directly restricts his ability to perform DLA. She indicates that the appellant is independent with 7 out of the 1 O DLA listed on the form: Personal self-care, Meat preparation, Basic housework, Mobility inside the home, Mobility outside the home, Use of transportation, and Management of finances. • Dr. L. indicates the appellant is periodically restricted with Daily shopping, and Social functioning [comments: "Shopping: depends on degree of soreness. Fluctuating"; and Social functioning: "can become stressed and overwhelmed."]; • Dr. L. adds her signature to Additional Comments -section F of the MR.
6. A letter dated February 27, 2018 from a ministry adjudicator, indicating the PWD application was returned to the appellant as it was incomplete. The ministry notes that much of the information in the MR is self-reported and has not been confirmed by a physician or a nurse practitioner. The ministry notes that page 11 was left blank. The ministry explains that ii requires the MR to be completed in its entirety by a physician. The letter includes the appellant's hand-written notation: "corrections have been completed inside forms." 7. The ministry's Denial Decision Summarywith attached letter, dated May 29, 2018. 8. A letter from a General Practitioner ("Dr. K.") dated July 16, 2018, confirming the extent of the appellant's injuries which include a fused left ankle [with shortened length], curled toes, atrophied left leg and hip muscles, and fused vertebrae and metal plate in the middle of the appellant's back. Dr. K. describes ankle and nerve pain and circulation problems in the toes, exacerbated by bearing extra weight. Dr. K. states that a weak left hip causes additional aches and pains and the appellant's back condition impairs lifting and leads to more back pain. Dr. K. reports that the appellant has struggled with depression throughout his life. The appellant practices meditation to treat his depression and physical pain. Dr. K. notes that the appellant has a leg brace which supports the ankle from leaning outwards toward the left side. 9. A 7-page hand-written submission from the appellant [dated July 2018] in which he states his argument for the reconsideration and reiterates his restrictions due to pain and mobility limitations in his ankle, foot, and back. The appellant provides the following additional information regarding the application process and his functional restrictions: • The doctor that filled out the original PWD forms [Dr. L.] was a replacement for his original doctor who left the practice. Dr. L. was in transition, short on time [rushed the appellant through appointments] and was always late to return the forms. The appellant reports that he has a new doctor [Dr. K.]. • The appellant states that he suffered from depression before and after his accident. He currently has Post traumatic Stress Disorder ("PTSD") from multiple emotional traumas including the accident itself. He cannot withstand very much stress. • The appellant states that he walks with a cane for support at all times and his right ankle is also sore from bearing extra weight on the right side, especially when walking, or standing to make meals, do dishes, clean house or do personal care activities. The appellant reports that his ankle and nerve pain is significant enough to impair daily walking. Even when sitting, he has sharp pains in his left foot because of the extra pressure it bears. The appellant states that the plate in his back causes re-strain on lifting and his ankle brace causes blistering if he walks with it for too long. • The appellant describes an "average day" in which he loses sleep and requires 45 minutes to an hour to "unwind my body from aches and pains to finally sleep." The appellant then needs to sleep until 11 :00 or 11 :30 AM and when he gets up he feels surges of pain and needs his wife to support him to the bathroom. The appellant's wife serves him breakfast in bed and it takes about 3 to 4 hours on average before his body starts to feel a little better. The appellant states that he lays down to rest throughout the day; he over-exerts himself very easily; and walking a very short distance can cause issues. 10. A letter from Dr. L. dated September 27, 2018, requesting an extension of time for completion of the PWD forms. Dr. L. has taken over the practice of the appellant's previous physician and needs time to review the patient's chart/records. 11. A letter from the ministry adjudicator, dated July 17, 2017, and addressed to Dr. L. and the RN who completed the AR. The adjudicator states that page 11 of the PWD application is not complete, and there is information written on the form by the client. The adjudicator asks Dr. L. to initial if she agrees with the information. The adjudicator notes that in the AR [pages 17 and 19] there is information crossed out and re-written and it is unclear who provided the information. The adjudicator asks Dr. L. to confirm if the physician or assessor provided the information.
Additional information The panel accepts the appellant's Notice of Appeal [with hand-written statement] as argument. Prior to the hearing, the appellant filed two packages of documents with the Tribunal. The first package, dated September 26, 2018, consists of the following document: 1.A 12-page Occupational Therapy assessment dated September 26, 2018. An Occupational Therapist ("OT") conducted a cognitive assessment based on referrals from a psychiatrist and from Dr. K. [the appellant's new General Practitioner]. The OT states that the appellant was previously on disability assistance in another province. The assessment summarizes the appellant's background, indicating that his difficulties originate from an accident in 1996 involving a 90-foot fall. The OT describes the appellant's subsequent physical disability including his struggles with fatigue. The OT confirms that the appellant walks with a cane at all times and that his ankle brace causes skin problems with prolonged use. The OT indicates the appellant likely suffered a head injury in his fall/accident. The appellant reported a concussion or cranial injury but could not recount the details and did not have any reports or imaging results. The OT notes the appellant's cognitive difficulty in explaining his PWD application to date. The OT states that she agrees with Dr. K.'s re-assessment of the appellant's cognitive and emotional function, indicating moderate to severe impacts in the areas of bodily, emotional, and social functions. The OT agrees with Dr. K.'s observation that the appellant likely had "reduced cognitive comprehension" of the questions in the AR and underestimated the severity/impact of his impairment. The OT describes the following cognitive deficits, observed by both the OT and the intake nurse at the assessment: • slow monotone speech, verbal perseveration, and poverty of thought; • slow processing speed and difficulty with word-finding and completing own sentences; • poor/vague historian, tangential and off-topic responses; • confusion [the appellant mistook the nurse for the psychiatrist despite explanation]; • difficulty answering questions [written and verbal] without prompts. It took the appellant over an hour to complete one page of a questionnaire; and • reduced working memory within the same conversation [the appellant repeated himself and forgot where he wrote or stored information to compensate for his memory deficit]. The OT summarizes findings from various cognitive assessment tools/standardized tests that she used to assess the appellant's mental functions. The OT explains that the test results indicate the appellant's cognitive functioning is impacted below the norms in the following areas: • memory: the appellant had problems with immediate recall and delayed recall; he showed a "moderate-to severely reduced" working memory for instructions; • executive function: the appellant's score was in the "borderline cognitive range" indicating difficulties with organization and planning [delayed and inconsistent ability to detect and correct his own errors and follow rules and constraints]. The appellant's inductive reasoning skills worsened as the volume of tasks increased. The appellant required a high degree of repetition and clarification of instructions for problem solving tasks and exhibited prolonged processing, rehearsal, and planning attempts before he could proceed with the task. • financial ability: the appellant could identify coins and bills but had difficulty with calculating/identifying change. The appellant required extra processing time to interpret a sample credit card bill [he eventually found 83% of the targets while verbalizing confusion 50% of the time]. The appellant indicated he does not use credit cards. The appellant was able to discriminate between different types offinancial records, and fill out a sample cheque correctly [with extra time].
T h e O T a s s e s s m e n t s u m m a r i z e s " c o l l a t e r a l i n f o r m a t i o n " c o r r o b o r a t e s t h e a p p e l l a n t ' s c o g n i t i v e d i f f i c u l t i e s i n t h e a i n s i g h t / j u d g m e n t , r e d u c e d p r o c e s s i n g s p e e d [ t h i n k i n g a n r e q u i r e s " e x t e n s i v e e x t r a t i m e " ] . T h e s p o u s e h a s k n o w n i n d i c a t e t h e a p p e l l a n t ' s c o g n i t i o n c h a n g e d a ft e r h i s a c c i d T h e s p o u s e d e s c r i b e s t h e a p p e l l a n t ' s n e e d f o r a s s i s t a n c S h o p p i n g a n d M e a l s : T h e s p o u s e r e p o rt s t h e a p p e l l a n t i g r o c e r y s h o p s a l o n e b e c a u s e t h e a p p e l l a n t h a s d i f f i c u l t y i t e m , d u r i n g w h i c h t i m e s h e o b t a i n s a l l o f t h e r e m a i n i n g o r i n t o o m u c h p a i n t o f i n d a s e c o n d i t e m , a n d t h e i n c r e a D L A l a t e r i n t h e d a y . 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 a s p o u s e d o e s t h e l i f t i n g a n d c a r r y i n g . T h e a p p e l l a n t a l s o s c a n n i n g a n d p r i n t e d d e t a i l s f o r t o o l o n g a n d o f t e n c h o o s a t t e n t i o n i s f o c u s e d o n a s p e c i f i c i d i o s y n c r a t i c d e t a i l . " T w o u l d n o t e a t w h o l e s o m e m e a l s o r e ff e c t i v e l y t r a c k h i s d t o e a t f o o d s f r o m t h e k i t c h e n b u t d u e t o h i s p h y s i c a l p a i n 2 0 m i n u t e s t o c h o p f o o d o r c o o k . T r a n s p o rt a t i o n : T h e s p o u s e i n d i c a t e s t h a t a l t h o u g h t h e a a n d f o c u s t o i n t e r p r e t a b u s s c h e d u l e d u e t o h i s r e d u c e d i n t h e a p p e l l a n t ' s a b i l i t y t o r e a d a n d w r i t e : h e " g l o s s e s o v a p p e l l a n t c a n " l o s e h i s t r a i n o f t h o u g h t / g o o ff o n t a n g e n t t h e a p p e l l a n t i s a c a u t i o u s , n o n a g g r e s s i v e d r i v e r , s h e d a p p e l l a n t h a s " n e a r m i s s e s " w h i l e d r i v i n g . T h e a p p e l l a n t n u m e r o u s t i m e s " b y a l e r t i n g h i m t o h a z a r d s . T h e s p o u s e c o n c e n t r a t i o n , t h i n k i n g s p e e d a n d r e a c t i o n t i m e , p l u s f a t S o c i a l F u n c t i o n i n g : T h e s p o u s e r e p o rt s t h a t t h e a p p e l l a n n e i g h b o u r h o o d / s t o r e a c q u a i n t a n c e s " o n l y . T h e s p o u s e i n p a t i e n c e w i t h h i m " d u e t o h i s v e r b a l r e p e t i t i o n a n d e x t r a t h e a p p e l l a n t h a s d i ff i c u l t y d e t e c t i n g a n d r e s p o n d i n g t o s c o g n i t i v e a n d p h y s i c a l p e rf o r m a n c e s l o w s d o w n f u r t h e r . " c l o s e u p a n d i n c u b a t e f o r a w h i l e . " H o u s e k e e p i n g : T h e s p o u s e r e p o r t s t h a t t h e a p p e l l a n t c a w i p i n g u p a c o u n t e r s p i l l , " b u t n o t s t a n d a r d h o u s e c l e a n i n e m p t y i n g a f u l l l o a d o f d i s h e s , o r s t o o p i n g / l o a d i n g / g r a b b t h a t c a r r i e s o v e r i n t o t h e s u b s e q u e n t d a y ( s ) a n d r e n d e r s T h e s p o u s e i n d i c a t e s t h e a p p e l l a n t i s l a r g e l y i n d e p e n d e n M e d i c a t i o n s : T h e a p p e l l a n t p r e f e r s t o a v o i d p r e s c r i p t i o n p a i n r e l i e f " a n d w o u l d l i k e l y b e i n d e p e n d e n t w i t h p r e s c r i p P a y i n g b i l l s a n d b a n k i n g : T h e s p o u s e i n d i c a t e s t h e a p p e m a t t e r s a n d m o s t o f t h e i r b i l l s a r e o n t h e a u t o p a y m e n t s r e m e m b e r h i s P I N n u m b e r a n d h e p r e f e r s t o u s e d e b i t w c o u n t i n g o u t c h a n g e . T h e s p o u s e r e p o r t s t h a t t h e a p p e l l a f r u g a l i t y a n d j u d g m e n t w i t h f i n a n c i a l d e c i s i o n s , e x c e p t a t s k i l l s . P e r s o n a l c a r e : T h e s p o u s e r e p o r t s t h a t t h e a p p e l l a n t t o i l b a t h e r a t h e r t h a n s h o w e r d u e t o p a i n a n d f a t i g u e w i t h s t a I g a r n e r e d f r o m t h e a p p e l l a n t ' s s p o u s e ( " t h e s p o u s e " ) w h o r e a s o f m e m o ry , fo c u s / c o n c e n t r a t i o n , r e a s o n i n g , d s p e e c h ] , a n d r e d u c e d o r g a n i z a t i o n a l s k i l l s [ t h e a p p e l l a n t t h e a p p e l l a n t fo r 6 y e a r s a n d r e p o rt s t h a t f a m i l y m e m b e r s e n t . e w i t h v a r i o u s D L A a s a r e s u l t o f h i s c o g n i t i v e i m p a i r m e n t : s u n a b l e t o m e a l p l a n a n d c r e a t e s h o p p i n g l i s t s . S h e f i n d i n g i t e m s : " l a k e s h i m t h e w h o l e s t o r e v i s i t " t o f i n d o n e g r o c e r i e s . A ft e r fi n d i n g o n e i t e m , t h e a p p e l l a n t i s t o o t i r e d s e d f a t i g u e a n d p a i n p r e v e n t s h i m f r o m e n g a g i n g i n o t h e r f u l l b a g o f g r o c e r i e s w i t h o u t i n c r e a s e d p a i n / f a t i g u e s o t h e h a s d i ff i c u l t y w i t h c o m p a r i s o n s h o p p i n g : " g e t s l o s t i n t h e e s a n u n h e a l t h y o r m o r e e x p e n s i v e o p t i o n b e c a u s e h i s h e s p o u s e b e l i e v e s t h a t w i t h o u t h e r g u i d a n c e , t h e a p p e l l a n t i e t T h e s p o u s e r e p o r t s t h a t t h e a p p e l l a n t c a n o b t a i n r e a d y a n d f a t i g u e , h e c a n n o t t o l e r a t e s t a n d i n g i n o n e p l a c e f o r p p e l l a n t d o e s n o t t a k e t h e b u s , h e w o u l d n e e d e x t r a l i m e c o n c e n t r a t i o n a n d m e m o ry . T h e s p o u s e d e s c r i b e d d e f i c i t s e r p a g e s a n d f o r g e t s c o n t e n t o f w h a t h e h a s r e a d " . T h e s " w h e n w r i t i n g s o m e t h i n g . T h e s p o u s e i n d i c a t e s t h a t w h i l e o e s m o s t o f t h e d r i v i n g o r " b a c k s e a t d r i v e s " b e c a u s e t h e a d m i t t e d t h a t h i s s p o u s e " p r e v e n t e d s m a l l a c c i d e n t s a t t r i b u t e s t h e a p p e l l a n t ' s d i f f i c u l t i e s w i t h d r i v i n g t o r e d u c e d i g u e a n d / o r p a i n . t h a s n o c l o s e f r i e n d s . T h e c o u p l e h a s a f e w " l o o s e d i c a t e s t h e a p p e l l a n t i s k i n d a n d r e s p e c t f u l b u t o t h e r s l o s e l i m e i t t a k e s t o e x p r e s s h i m s e l f . " T h e s p o u s e r e p o r t s t h a t o c i a l c u e s . A s t h e a p p e l l a n t ' s l e v e l o f s t r e s s i n c r e a s e s , h i s W h e n f a c e d w i t h p e r s o n a l s t r e s s o r s , t h e a p p e l l a n t t e n d s t o n p e rf o r m s h o r t l i g h t t a s k s s u c h a s p i c k i n g u p c l o t h e s o r g s u c h a s c l e a n i n g f l o o r s , t h e b a t h r o o m , w a s h i n g o r i n g f u l l l o a d s o f l a u n d r y w i t h o u t u n d u e p h y s i c a l s u ff e r i n g t h e c l i e n t t e m p o r a r i l y c o n f i n e d t o b e d . " t w i t h t h e r e m a i n i n g D L A : m e d i c a t i o n s b u t i s a b l e t o s a f e l y s t o r e a n d t a k e A d v i l f o r t i o n m e d i c a t i o n s . " l l a n t r e q u i r e s e x t r a t i m e t o c o g n i t i v e l y t r a c k f i n a n c i a l y s t e m f o r e a s e . T h e a p p e l l a n t i s a b l e t o c o n s i s t e n t l y h e n p a y i n g f o r p u r c h a s e s a s t h i s i s e a s i e r f o r h i m t h a n n t m o n i t o r s h i s b a n k a c c o u n t s o n l i n e a n d e x e r c i s e s s t o r e s w h e r e h e d o e s n o t a l w a y s e x e r c i s e b u d g e t i n g e t s a n d w a s h e s h i m s e l f i n d e p e n d e n t l y , b u t h e c h o o s e s t o n d i n g .
Regarding functional skills, the spouse reports the appellant's motivation to be moderately impacted by his post injury challenges but any abnormal thought processes ("he can go down spiritual or philosophical tracks") have a minimal impact on his function as they tend to avoid those conversations. From a physical standpoint, the spouse reports that the appellant takes several hours to get out of bed in the morning due to severe morning stiffness, fatigue, and nerve/joint pain. The appellant suffers from poor sleep due to pain. The spouse reports that when the appellant walks, he must either use a cane or hold onto furniture or her arm. The OT provides her overall impression: the appellant scored within normal to borderline cognitive functioning on the formal screening tests, depending on the function that was being assessed. On more complex executive tasks, the appellant demonstrates "moderate to severe" deficits in concentration, working memory, short-term memory, and processing speed, but basic attention was sufficient. The appellant's impairments "moderately to severely impair" his executive problem-solving; in particular, organizing errands, going shopping, and planning meals, especially as the volume of data increases. The OT finds that the appellant's reasoning, insight, and judgment "were only partial", and are compounded by his memory deficits. In terms of his social functioning, the OT states that although the appellant makes efforts to be methodical and thorough, he experiences "extreme inefficiencies that at times may be beyond reasonable accommodation, e.g .... in many social environments." The OT notes that the appellant has lost social connections and supports as a result of his impairment. The OT notes that the appellant's ability to drive safely is also a concern and she recommends an Enhanced Road Evaluation. The OT provides her professional opinion in the language of the PWD application. Regarding the functional skills and DLA set out in the MR and AR, the OT finds that the appellant has impairments as follows: Functional skills Communication: impaired due to "post-traumatic cognitive impairments"; and impaired due to the appellant's problems with memory [working memory and short term memory], processing speed, executive function, and insight. • Ability to communicate: Speaking and Reading are poor due to cognition; Writing is satisfactory/poor due to cognition; and Hearing is satisfactory [comment: "not formally tested"]. Mobility and Physical ability: impaired due to chronic pain, neurological left leg weakness and leg length discrepancy, fused ankle; • Walking indoors: needs periodic assistance and uses an assistive device [cane]; • Walking outdoors: needs periodic assistance and uses an assistive device [cane and leg brace]; • Climbing stairs: needs periodic assistance and uses an assistive device [cane and rail]; • Standing: needs periodic assistance and uses an assistive device [cane, counter, furniture]; • Lifting: needs periodic assistance and uses an assistive device [cane, cart]; [comment: "weighVheight dependent"]; • Carrying and holding: needs periodic assistance and uses an assistive device [cane, bag, pack]; [comment: "weighVheight dependent"]. Cognitive function: impacted in the areas of executive function, language, memory, and sustained concentration. The OT notes social isolation and indicates she will defer to the psychiatrist's opinion regarding any thought disorder or impacts on emotion and motivation. The OT assesses the impacts listed in the AR as follows: • Bodily impact: moderate impact on sleep, toileting; • Consciousness: no impact • Emotion: [comment: "defer to Psychiatry"]; • Impulse control: minimal impact [comment: "some trouble with assessment session, re-directable"]; • Insight and judgment moderate impact • Attention/Concentration: major impact • Executive: major impact • Memory: major impact • Motivation: [comment: "defer to Psychiatry"];
• Motor activity; [comment: "defer to Psychiatry to distinguish any mental health contributions from physical contributions]; • Language; moderate impact; • Psychotic symptoms: [c omment: "defer to Psychiatry"]; • Other emotional problems: [comment: "defer to Psychiatry"]. DLA The OT reports that the appellant is continuously restricted with the following DLA: Personal Self-Care, continuously restricted by pain/weakness/fatigue [comment: "must go slow, skip on worse days"]: • Dressing: uses an assistive device and takes significantly longer [comment: "chair to sit for majority"]; • Grooming: uses an assistive device [comment: "must use chair and sit"]; • Bathing: uses an assistive device and takes significantly longer [comment: "grab bars and shower chair recommended"]; • Toileting: uses an assistive device plus countertop for stability [comment: "grab bar or safety frame recommended"]; • Feeding self independent; • Regulating diet needs continuous assistance [comment: "cognitively from wife for healthy meal planning"]; • Transfers (bed); uses an assistive device [comment: "cane, other hand on bed, or bedside table]; • Transfers (chair): uses an assistive device -cane and armrest; Meal preparation, continuously restricted by cognition [memory, speed, executive], and pain, weakness, fatigue; • Meal planning: needs continuous assistance [comment: "wife -cognitively"]; • Food preparation: needs continuous assistance [comment: "wife (physically and cognitively) -unless pre prepared/no prep. required"]; • Cooking; needs continuous assistance [comment: "wife -physically and cognitively"]; • Safe storage; needs periodic assistance [comment: "wife -cognitively tracking and disposing"]. Basic Housework, continuously restricted by pain/weakness/fatigue [comment: "cannot do most, without being rendered non-functional (in bed) for day(s) afterward"]; • Laundry; needs continuous assistance from partner [comment: "full loads too much weight to stoop, carry, lift, twist with"]; • Basic housekeeping; needs continuous assistance due to pain, weakness, fatigue. Daily shopping, continuously restricted by cognition [memory, speed, executive], and pain/weakness/fatigue; • Going to and from stores: needs continuous assistance, uses an assistive device [comment: "with wife"]; • Reading prices and labels: needs continuous assistance from his wife [comments: "will miss details, perseverate on one detail, trouble with good decision-making from what he reads. Trouble scanning majority, stuck on one."]; • Making appropriate choices [shopping]: needs continuous assistance [comment: "wife must re-direct him in store re: planning and purchase choices"]; • Paying for purchases; independent; • Carrying purchases home: needs continuous assistance and uses an assistive device [comment: "wife carries, unless one small object only -with cane"]. Mobility inside home, continuously limited by pain/weakness [comments: "takes hours to de-stiffen before can get out of bed in AM ... Must use cane or hold furniture/partner, reduced mobility amount over course of day"]; Mobility outside home, continuously restricted by pain/weakness/fatigue [comment: "to overdo, results in bedridden days"];
U s e o f t r a n s p o rt a t i o n , c o n t i n u o u s l y r e s t r i c t e d c o g n i t i v e l y , w o r k i n g m e m o ry [ c o m m e n t s : " m u s t h a v e s p o u s e i n c a r ' b E n h a n c e d R o a d A s s e s s m e n t t h r o u g h R o a d S a f e t y B C " ] ; • V e h i c l e t r a n s f e rs : 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 f r • U s i n g p u b li c tra n s i t [ c o m m e n t : " n o t u s i n g a s s i s • U s i n g t r a n s i t s c h e d u l e s : [ c o m m e n t : " n o t u s i n g T h e O T r e p o rt s t h a t t h e a p p e l l a n t i s p e r i o d i c a l l y r e s t r i c t e M a n a g e m e n t o f f i n a n c e s : p e r i o d i c a l l y r e s t r i c t e d b y c o g n i f i n a n c i a l t a s k a s s i s t c o m p l e x " ] ; • B a n k i n g : i n d e p e n d e n t [ o n l i n e ] ; • B u d g e t i n g : n e e d s p e r i o d i c a s s i s t a n c e f r o m h i s w a t s t o r e / i n e x e c u t i o n " ] ; • P a y r e n t a n d b ill s : n e e d s p e r i o d i c a s s i s t a n c e [ c o m e m o r y / e x e c u t i v e , a n d i n t e r m i t t e n t c h e c k i n f r o m T h e O T r e p o rt 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 w i t h t h M e d i c a t i o n s : • F i ll i n g p re s c ri p t i o n s : [ c o m m e n t : " u n a b l e t o c o m m • M e d i c a t i o n s a s p re s c r i b e d : i n d e p e n d e n t ; • M e d i c a t i o n h a n d l i n g a n d s t o ra g e : i n d e p e n d e n t . S o c i a l f u n c t i o n i n g D LA T h e O T d o e s n o t s p e c i f i c a l l y c o m m e n t o n t h e D L A o f S o p r o v i d e s c o m m e n t s f o r e a c h a r e a o f s o c i a l f u n c t i o n i n g l i s • S o c i a l d e c i s i o n s : [ c o m m e n t : " i n d e p e n d e n t " ] ; • D e v e l o p a n d m a i n t a i n r e l a t i o n s h i p s : n e e d s p e r i o • I n t e r a c t s a p p r o p r i a t e l y : n e e d s c o n t i n u o u s s u p p o c o n v e r s a t i o n t o s u b t l e c u e s , r e q u i r e s o v e rt r e d i r • D e a l w i t h u n e x p e c t e d d e m a n d s : n e e d s p e r i o d i c • S e c u r e a s s i s t a n c e f r o m o t h e r s : n e e d s p e r i o d i c s t i m e s e e k s o u t h e l p " ] ; • M e n t a l f u n c t i o n i m p a c t o n i m m e d i a t e s o c i a l n e t w • M e n t a l f u n c t i o n i m p a c t o n e x t e n d e d s o c i a l n e t w o H e l p t o p e rf o r m D L A T h e O T r e p o rt s t h a t " c u r r e n t A D L h e l p c o m e s f r o m s p o u s l e g b r a c e , a n d o rt h o t i c . A s h o w e r c h a i r , g r a b b a r s i n t h e r e c o m m e n d e d . 2 . T h e s e c o n d p a c k a g e s u b m i t t e d o n a p p e a l , d a t e d O c t o • a 3 p a g e h a n d w r i t t e n s u b m i s s i o n f r o m t h e a p p e l l a n t w • a 2 p a g e s e l f a s s e s s m e n t q u e s t i o n n a i r e [ p a r t i a l l y i l l e g i b • a f a x f r o m D r . K . t o t h e m i n i s t r y d a t e d S e p t e m b e r 1 8 , 2 a n d t o M e n t a l H e a l t h f o r a n a s s e s s m e n t o f h i s f u n c t i o n a l • a p s y c h i a t r i c c o n s u l t r e p o r t s i g n e d b y a p s y c h i a t r i s t o n d e p r e s s i o n t h a t w o r s e n e d i n t h e a ft e r m a t h o f h i s 1 9 9 6 a c n o t i n g t h a t h e d o e s n o t h a n d l e s t r e s s w e l l a n d h i s d e p r e s r e p o r t s c o m m u n i c a t i n g w i t h a n i m a l s " i n t h e i r o w n c o d e " a m e s s a g e s d i r e c t e d t o h i m " w h e n w a t c h i n g t e l e v i s i o n o r l i d u e t o p r o c e s s i n g s p e e d , r e a c t i o n t i m e , c o n c e n t r a t i o n , a c k s e a t d r i v i n g ' t o p r e v e n t a c c i d e n t s . R e c o m m e n d o m h i s w i f e a n d u s e s a n a s s i s t i v e d e v i c e [ c a n e ] ; t i v e d e v i c e c a n e " ] ; p o s s i b l e p e r i o d i c a s s i s t a n c e c o g n i t i v e l y ' ' ] . d w i t h t h e f o l l o w i n g D L A : t i v e i m p a i r m e n t [ c o m m e n t : " d e p e n d s o n c o m p l e x i t y o f i f e [ c o m m e n t : " c l i e n t m o n i t o r s o n l i n e , b u t p o o r e r c h o i c e s m m e n t : " i n f o r m o f a u t o p a y m e n t s e t u p t o c o m p e n s a t e f o r p a rt n e r " ] ; e f o l l o w i n g D L A : e n t " ] ; c i a l F u n c t i o n i n g a s i i i s d e s c r i b e d i n t h e M R . T h e O T t e d i n t h e A R : d i c s u p p o r t f r o m h i s w i f e ; rt f r o m t h e o t h e r p a rt y [ c o m m e n t : " t r o u b l e a d j u s t i n g e c t i o n " ] ; s u p p o rt a n d e x t r a t i m e ; u p p o r t [ c o m m e n t : " i m p a c t e d b y i n s i g h t a t t i m e s , r e s t o f o r k : " G o o d " ; r k s : " M a r g i n a l " . e o n l y . " T h e a p p e l l a n t ' s a s s i s t i v e d e v i c e s i n c l u d e a c a n e , s h o w e r a n d b y t h e t o i l e t , a n d a c a r a s s i s t h a n d l e a r e b e r 5 , 2 0 1 8 , c o n s i s t s o f t h e f o l l o w i n g d o c u m e n t s : h i c h t h e p a n e l a c c e p t s a s a r g u m e n t o n a p p e a l ; l e ] r e g a r d i n g t h e a p p e l l a n t ' s m e n t a l h e a l t h s y m p t o m s ; 0 1 8 , s l a t i n g t h a t t h e a p p e l l a n t h a s b e e n r e f e r r e d t o a n O T l i m i t a t i o n s ; a n d S e p t e m b e r 2 8 , 2 0 1 8 . T h e a p p e l l a n t r e p o r t s l o n g s t a n d i n g c i d e n t . T h e a p p e l l a n t a l s o d e s c r i b e s P T S D s y m p t o m s , s i o n w o r s e n s w i t h p h y s i c a l p a i n a n d s t r e s s . T h e a p p e l l a n t n d h a v i n g p a r a n o r m a l e x p e r i e n c e s i n c l u d i n g " s p e c i a l s t e n i n g t o t h e r a d i o . S o c i a l l y , t h e a p p e l l a n t r e p o rt s t h a t h e
a l w a y s f e l t l i k e t h e " o d d o n e o u t " , a n d h i s r e l a t i o n s h i p w i T h e p s y c h i a t r i s t r e p o rt s " s o m e p s y c h o m o t o r s l o w i n g " o n a ff e c t t h a t i s c o n s t r i c t e d , a n d a t h o u g h t p r o c e s s t h a t i s q a p p e l l a n t " d o e s n o t c l e a r l y d e m o n s t r a t e f r a n k d e l u s i o n a l b e l i e f s a n d t h e p o s s i b i l i t y o f i d e a s o f r e f e r e n c e . T h e p s y c j u d g m e n t r e g a r d i n g h i s d i ff i c u l t i e s " a l t h o u g h h i g h e r l e v e l s s u g g e s t e d b y t h e r e c e n t O T r e p o rt " w h i c h s h o u l d b e r e f e T h e p s y c h i a t r i s t c o n c l u d e s t h a t t h e a p p e l l a n t p r e s e n t s w p o s s i b l y u n s p e c i f i e d t r a u m a a n d s t r e s s r e l a t e d d i s o r d e r i m p a i r m e n t o f / i m p a c t o n m o t i v a t i o n a n d m o t o r a c t i v i t y , m s y m p t o m s , a n d n o s i g n i f i c a n t i m p a i r m e n t w i t h r e s p e c t t o 3 . A l e t t e r t o t h e m i n i s t r y f r o m D r . K . d a t e d A u g u s t 1 7 , 2 0 n o t i n g t h a t t h e a p p e l l a n t ' s l e ft l e g , f o o t , a n d b a c k d i s a b i l i m o b i l i t y o f w a l k i n g a n d l i ft i n g . " T h e a p p e l l a n t n e e d s t o w i m b a l a n c e s i n h i s b o n e s . T h e a p p e l l a n t " s h o u l d n o t d o p p r e s s u r e o n t h e p l a t e i n t h e b a c k , h i p , a n d l e g m i s a l i g n m p a i n l e v e l s , b u t l e s s t h a n 5 p o u n d s a t a t i m e i s r e c o m m e D r . K . s t a t e s t h a t t h e a p p e l l a n t i s l i m i t e d i n t h e a m o u n t o q u i c k l y ; t h e a p p e l l a n t h a s t o l i e d o w n t o c o n t r o l t h e p a i n . a p p e l l a n t o v e r d o e s h i s a c t i v i t i e s , h e f e e l s p a i n a n d n a u s e e l o n g a t e d w a l k i n g a n d t a s k s t h a t n o r m a l l y t a k e ( h i m ) m u l o n g e r' ' t o c o m p l e t e d a i l y t a s k s i n c l u d i n g p e r s o n a l o r h o m f r o m h i s w i f e t h r o u g h o u t t h e d a y . D r . K . e x a m i n e d t h e o r i g i n a l A R a n d e x p l a i n s t h a t t h e a p t h e f u n c t i o n s t h a t a r e l i s t e d . D r . K . s t a t e s t h a t b o d i l y f u n s l e e p d i s t u r b a n c e a n d b a t h r o o m p r o b l e m s , e t c . " D r . K . i n m o d e r a t e t o m a j o r ' ' i m p a c t , a n d p s y c h o t i c s y m p t o m s " c a a ff i l i a t e d t o P T S D s y m p t o m s . " D r . K . i n d i c a t e s t h a t t h e d " m o d e r a t e t o m a j o r , d e p e n d i n g o n w h a t h e i s g o i n g t h r o u h i n d r a n c e t o s o c i a l f u n c t i o n i n g . " A d m i s s i b ili ty o f O T a s s e s s m e n t T h e m i n i s t ry o b j e c t s t o a d m i t t i n g t h e a s s e s s m e n t i n t o e v i n t h e a p p e l l a n t ' s ( t h r e e ) P W D a p p l i c a t i o n s u p t o t h a t p o i i n f o r m a t i o n t h a t i s n o t i n s u p p o rt o f t h e i n f o r m a t i o n t h e m t h a t t h e a s s e s s m e n t d o e s n o t c o v e r a n y n e w i n j u r i e s a n d h i s i m p a i r m e n t s . T h e p a n e l fi n d s t h a t t h e O T a s s e s s m e n t i s i n s u p p o r t o f t t h e r e c o n s i d e r a t i o n . T h e O T a s s e s s m e n t c o v e r s t h e s a m i n j u r i e s s u s t a i n e d i n a 9 0 -fo o t f a l l a s w e l l a s f a t i g u e a n d d i m p a c t s t h e D L A o f S o c i a l F u n c ti o n i n g . W h i l e t h e O T p r o a l w a y s c o r r o b o r a t e o r s u b s t a n t i a t e t h e f i n d i n g s i n t h e M R t h a t a r e i d e n t i c a l t o t h e o n e s l i s t e d i n t h e o r i g i n a l r e p o rt s . s p e c i f i c a r e a s o f 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 [ e x e c u P W D a p p l i c a t i o n a n d 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 . D r . L . d o e s n o t s p e c i f i c a l l y r e f e r t h e a p p e l l a n t fo r a n O T a p o s s i b i l i t y o f f u rt h e r a s s e s s m e n t : i n t h e M R , D r . L . a c c e p c o n c e n t r a t i o n , m o t i v a t i o n , m e m o ry , a n d d e g r e e o f d e p r e t h h i s w i f e [ m a r r i e d i n 2 0 1 3 ] i s " b e t t e r n o w " . a m e n t a l s t a t u s e x a m , w i t h s p e e c h t h a t i s n o t p r e s s u r e d , u i t e c i r c u m s t a n t i a l . T h e p s y c h i a t r i s t s t a t e s t h a t t h e t h o u g h t c o n t e n t ' ' b u t t h e r e i s " o d d n e s s " t o s o m e o f h i s h i a t r i s t f i n d s t h e a p p e l l a n t t o h a v e a p p r o p r i a t e i n s i g h t a n d o f i n s i g h t a n d j u d g m e n t m a y b e l i m i t e d o r i m p a i r e d a s r r e d t o f o r d e t a i l s o n t h e a p p e l l a n t ' s c o g n i t i v e f u n c t i o n i n g . i t h s i g n s a n d s y m p t o m s o f M a j o r D e p r e s s i v e D i s o r d e r a n d w i t h l i k e l y " m a j o r e m o t i o n a l i m p a c t , m i l d t o m o d e r a t e i l d i m p a i r m e n t w i t h r e s p e c t t o p o s s i b l e p s y c h o t i c i m p u l s e c o n t r o l . " 1 8 . D r . K . d e s c r i b e s t h e a p p e l l a n t ' s p h y s i c a l i n j u r i e s , t i e s a r e " s i g n i f i c a n t s e v e r e p h y s i c a l i n j u r i e s t h a t d o r e s t r i c t a l k w i t h a c a n e t o h e l p s t a b i l i z e a n d s u p p o rt t h e r o l o n g e d l i f t i n g o f m u c h w e i g h t b e c a u s e o f t h e p a i n a n d e n t . " T h e a p p e l l a n t c a n l i ft 5 t o 1 5 p o u n d s d e p e n d i n g o n n d e d t o k e e p p a i n l e v e l s l o w e r . f t i m e h e c a n s t a n d a n d s i t . N e rv e a n d j o i n t p a i n d e v e l o p S i tt i n g f o r t o o l o n g c a u s e s b a c k a n d h i p p a i n . I f t h e a . T h e a p p e l l a n t n e e d s h i s w i f e t o h e l p h i m " d o d a i l y c h l o n g e r t h a n a v e r a g e . " T h e a p p e l l a n t t a k e s " m u c h e c a r e . T h e a p p e l l a n t t h e r e f o r e n e e d s " c o n t i n u o u s h e l p " p e l l a n t d i d n o t f u l l y u n d e r s t a n d t h e e x a m p l e s fo r e a c h o f c t i o n s " s h o u l d b e m o d e r a t e l o m a j o r i m p a c t o n h i s l e g , d i c a t e s t h a t E m o t i o n [ d e p r e s s i o n , f o r e x a m p l e ] " s h o u l d b e n v a ry f r o m m i n i m a l t o m o d e r a t e o n l e s s c o m m o n , m a j o r , u r a t i o n o f p e r i o d i c r e s t r i c t i o n s t o s o c i a l f u n c t i o n i n g i s g h , P T S D s y m p t o m s t h r o u g h t o d e p r e s s i o n c a n b e a r e a l i d e n c e . T h e m i n i s t ry a r g u e s t h a t t h e O T w a s n o t i n v o l v e d n t a n d s t a t e s t h a t t h e a s s e s s m e n t c o n t a i n s a l o t o f n e w i n i s t r y h a d a t t h e 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 a r g u e s i s s i m p l y a m o r e t h o r o u g h a n d c o m p l e t e e x a m i n a t i o n o f h e i n fo r m a t i o n a n d r e c o r d s t h a t w e r e b e f o r e t h e m i n i s t ry a t e m e d i c a l c o n d i t i o n s a s s e t o u t i n t h e P W D a p p l i c a t i o n : e p r e s s i o n a n d a n " i d e n t i f i e d m e n t a l i m p a i r m e n t " t h a t v i d e s m o r e t h o r o u g h a n d d e t a i l e d a s s e s s m e n t s t h a t d o n o t a n d A R , t h e O T a s s e s s e s f u n c t i o n a l s k i l l s a n d a b i l i t i e s F o r e x a m p l e , t h e a b i l i t y t o c o m m u n i c a t e , a s w e l l a s t i v e t a s k s , m e m o ry , e t c . ] , w e r e a s s e s s e d i n t h e o r i g i n a l s s e s s m e n t o f h i s f u n c t i o n i n g , b u t s h e l e a v e s o p e n t h e t s t h a t t h e a p p e l l a n t ' s f u n c t i o n s i n a r e a s s u c h a s s s i o n a r e a ff e c t e d b u t i n d i c a t e s s h e i s u n a b l e t o m a k e a
s t a t e m e n t o n t h e d e g r e e o f h i s i m p a i r m e n t i n t h o s e a r e a o f i m p a i r m e n t . T h e p a n e l a d m i t s t h e a s s e s s m e n t u n d e r ( " E A A " ) a s e v i d e n c e i n s u p p o rt o f t h e i n f o r m a t i o n a n d r e b e i n g a p p e a l e d w a s m a d e . A d m i s s ib ili ty o f a d d i t i o n a l rep o rt s T h e m i n i s t ry d i d n o t o b j e c t t o t h e o t h e r a d d i t i o n a l d o c u m a s s e s s m e n t q u e s t i o n n a i r e , a n d t h e f a x / l e t t e r f r o m D r . K . b e f o r e t h e m i n i s t r y a t t h e r e c o n s i d e r a t i o n . W h i l e t h e s e r e t h e a p p e l l a n t ' s f u n c t i o n s , t h e y a d d r e s s t h e s a m e m e d i c a D r . K . p r o v i d e s a n e x p l a n a t i o n f o r t h e d i s c r e p a n c i e s i n t h [ i n c l u d i n g t h e a s s e s s m e n t b y t h e O T ] a r e i n t e n d e d t o p r o P W D a p p l i c a t i o n . T h e p a n e l a d m i t s t h e p s y c h i a t r i c c o n s D r . K . u n d e r s e c t i o n 2 2 ( 4 ) o f t h e E AA a s e v i d e n c e i n s u p m i n i s t e r w h e n t h e d e c i s i o n b e i n g a p p e a l e d w a s m a d e . O r a l t e s t im o n y A t t h e h e a r i n g , b o t h p a rt i e s p r e s e n t e d t h e i r a r g u m e n t s a a l l o f t h e o r a l s u b m i s s i o n s a s a r g u m e n t i n s u p p o r t o f t h e d e c i s i o n u n d e r a p p e a l w a s m a d e . I s . T h e O T a s s e s s m e n t p r o v i d e s i n f o r m a t i o n o n t h e d e g r e e s e c t i o n 2 2 ( 4 ) o f t h e E m p l o ym e n t a n d A s s i s t a n c e A c t c o r d s t h a t w e r e b e f o r e t h e m i n i s t e r w h e n t h e d e c i s i o n e n t s . T h e p a n e l f i n d s t h a t t h e p s y c h i a t r i c c o n s u l t , s e l f a r e i n s u p p o r t o f t h e i n f o r m a t i o n a n d r e c o r d s t h a t w e r e p o r t s p r o v i d e a d i ff e r e n t o r m o r e d e t a i l e d a s s e s s m e n t o f l c o n d i t i o n s / i m p a i r m e n t s a s t h e o r i g i n a l P W D a p p l i c a t i o n . e f i n d i n g s a n d i n d i c a t e s t h a t t h e n e w a s s e s s m e n t s v i d e c l e a r e r , m o r e t h o r o u g h a s s e s s m e n t s i n s u p p o r t o f t h e u l t , s e l f a s s e s s m e n t q u e s t i o n n a i r e , a n d t h e f a x/ l e t t e r f r o m p o rt o f t h e i n f o r m a t i o n a n d r e c o r d s t h a t w e r e b e f o r e t h e n d d i d n o t i n t r o d u c e a n y n e w e v i d e n c e . T h e p a n e l a c c e p t s s u b m i s s i o n s t h a t w e r e b e f o r e t h e m i n i s t e r w h e n t h e A TT A C H E X T R A P A G E S I F N E C E S S A R Y
I 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 a p p e a l i s w h e t h e r t h e m i n i s t ry ' s d 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 P W D d e s i g n a t i o n i 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 r 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 l e g i s l a t i o n 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 . W a s t h e m i n i s t ry r e a s o n a b l e i n f i n d i n g t h a t t h e f o l l o w i n g c r i t e r i a i n s e c t i o n 2 o f t h e E A P W D A w e r e n o t m e 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 o r 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 i m p a i r m e n t , i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l , d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s h i s 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 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 • a s a r e s u l t o f r e s t r i c t i o n s c a u s e d b y t h e i m p a i r m e n t , t h e a p p e l l a n t r e q u i r e s a n a s s i s t i v e d 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 a n o t h e r p e r s o n , 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 p e rf o r m D L A . T h e m i n i s t r y b a s e d i t s r e c o n s i d e r a t i o n d e c i s i o n o n t h e f o l l o w i n g l e g i s l a t i o n : 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 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 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 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 p e rf 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 e s c r i b e d m e a n i n g ; " p r e s c r i b e d p r o f e s s i o n a l " h a s t h e p r e s c r i b e d m e a n i n g . ( 2 ) T h e m i n i s t e r m a y d e s i g n a t e a p e r s o n w h o h a s r e a c h e d 1 8 y e a r s o f a g e a s a p e r s o n w i t h d i s a b i l i t i e s f o r t h e p u r p o s e s o f t h i s A c t i f t h e m i n i s t e r i s s a t i s fi e d t h a t t h e p e r s o n i s i n a p r e s c r i b e d c l a s s o f p e r s o n s o r t h a t t h e p e r s o n h a s a s e v e r e m e n t a l o r p h y s i c a l i m p a i r m e n t t h a t ( a ) i n t h e o p i n i o n o f a m e d i c a l p r a c t i t i o n e r o r n u r s e 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 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 r i b e d p r o f e s s i o n a l ( i ) d i r e c t l y a n d s i g n i fi 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 l i v i n g a c t i v i t i e s e i t h e r ( A ) c o n t i n u o u s l y , o r ( B ) p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s , a n d ( i i ) a s a r e s u l t o f t h o s e r e s t r i c t i o n s , t h e p e r s o n r e q u i r e s h e l p t o p e rf o r m 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 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 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 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 p e rf o r m i t , t h e p e r s o n r e q u i r e s ( i ) a n a s s i s t i v e d e v i c e , ( i i ) t h e s i g n i f i c a n t h e l p o r s u p e r v i s i o n o f a n o t h e r p e r s o n , o r ( i i i ) t h e s e rv i c e s o f a n a s s i s t a n c e a n i m a l . ( 4 ) T h e m i n i s t e r m a y r e s c i n d a d e s i g n a t i o n u n d e r s u b s e c t i o n ( 2 ) . E A P W D R D e f i n i t i o n s f o r A c t 2 ( 1 ) F o r t h e p u r p o s e s o f t h e A c t a n d t h i s r e g u l a t i o n , " d a i l y l i v i n g a c t i v i t i e s " , ( a ) i n r e l a t i o n t o a p e r s o n w h o h a s a s e v e r e p h y s i c a l i m p a i r m e n t o r a s e v e r e m e n t a l i m p a i r m e n t , m e a n s t h e f o l l o w i n g a c t i v i t i e s : ( i ) p r e p a r e o w n m e a l s ; ( i i ) m a n a g e p e r s o n a l f i n a n c e s ; ( i i i ) s h o p f o r p e r s o n a l n e e d s ; ( i v ) u s e p u b l i c o r 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 ; ( v ) p e rf 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 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 ; ( 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 rf 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 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 : ( 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 f i n a n c e s ; ( 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 c t i v e l y .
I Analysis Severe mental or physical impairment To be eligible for the PWD designation, the legislation requires several criteria to be met including the minister being satisfied that the applicant has a severe mental or physical impairment. "Severe" is not defined in the legislation but the diagnosis of a severe medical condition does not in itself establish a severe impairment of mental or physical functioning. To assess the severity of the impairment, the ministry must consider the extent of any impact on daily functioning as evidenced by limitations/restrictions in mental or physical functions, DLA, and whether significant help is required to manage DLA. At the reconsideration, the ministry was not satisfied that the information provided establishes a severe impairment of mental or physical functioning as required under section 2(2) of the EAPWDA. Mental impairment The ministry found that the appellant does not have a severe mental impairment. The ministry bases its conclusion on the inconsistencies in the information between the MR [PWD App. 2] and the AR. The ministry argues that inconsistent information makes it difficult to develop a clear and coherent picture of the degree of impairment. The ministry notes that there is no information in the MR and AR on the frequency or duration of periodic restrictions/periodic support required with social functioning. While Dr. L. indicates the appellant has difficulties in employment situations, the ministry argues that an applicant's employability or ability to work is not taken into consideration in determining eligibility for PWD designation. The panel notes that employability/vocational restrictions are not included in the legislative criteria under section 2 of the EAPWDA. As noted by the ministry, there are inconsistencies between the MR and AR regarding impacts to the appellant's cognitive and emotional functioning. As well, there are inconsistencies in the information within each report. In the MR, Dr. L. indicates significant deficits with cognitive and emotional functioning in the areas of language, emotional disturbance, motivation, and motor activity, but in the AR, the RN assesses a moderate impact for emotion and motivation, and no impact for motor activity. No major impacts are reported for any of the functions listed in the AR. The RN indicates the appellant's mental impairment has no impact on most areas of cognitive and emotional functioning. In the AR, the appellant's ability to communicate is rated as Good in all areas: In the MR, Dr. L. also reports no difficulties with communication. At the same time, Dr. L. checks that the appellant has significant deficits with cognitive and emotional functioning in the area of language [expression]. No explanation is provided for this discrepancy in the information. In the MR, the appellant is periodically restricted with social functioning but there is no information on the frequency and duration of the restriction. Where a function is periodically restricted, the legislation requires evidence to establish that the restriction is for extended periods of time. Dr. L. writes that the appellant becomes "stressed and overwhelmed" but does not state how often that occurs. In the AR, on the other hand, the appellant is independent with most areas of social functioning, with the exception of securing assistance from others for which he requires periodic support. As the ministry noted, there is no information on the frequency/duration of the support the appellant requires. Based on the original PWD medical reports and submissions for the reconsideration, the panel finds that the ministry reasonably concluded there is insufficient evidence of a severe mental impairment under section 2(2) of the EAPWDA. Additional evidence and panel's decision -mental impairment The panel admitted the assessment reports from the OT and psychiatrist as well as the Jetter from Dr. K. which also provides updated assessments on the severity of the appellant's impairments. The appellant, the OT, and Dr. K. offer the following explanations for the discrepancies between the original PWD reports and the new assessments. In his hand-written submissions, the appellant explains that Dr. L. was new [replacing his original doctor], in transition, and pressed for time. The appellant argues that the panel should give the new assessments of his impairments greater weight.
T h e O T i n d i c a t e s t h a t s h e , a n d t h e i n t a k e n u r s e , a n d D r . c o m p r e h e n s i o n " w i t h t h e a s s e s s m e n t s . T h e a p p e l l a n t h a t h o u g h t , d i f f i c u l t y w o r d f i n d i n g a n d a n s w e r i n g q u e s t i o n s ] a s l o w p r o c e s s i n g s p e e d , a n d a r e d u c e d w o r k i n g m e m o ry q u e s t i o n n a i r e ; h e r e q u i r e d f r e q u e n t r e p e t i t i o n o f q u e s t i o n i n f o r m a t i o n t o c o m p e n s a t e f o r h i s m e m o r y d e f i c i t ] . T h e a s s e s s m e n t t e s t s a n d t o o l s s h o w m e m o r y p e r f o r m a r e d u c e d w o r k i n g m e m o r y ] . T h e t e s t s s h o w a " b o r d e r l i n e a s s e s s m e n t s i n d i c a t e a p o o r a b i l i t y t o c o m m u n i c a t e [ " S p a b i l i t y t o w r i t e i s " s a t i s f a c t o r y t o p o o r ' ' d u e t o c o g n i t i o n a s O T a c c e p t s , p r o v i d e s s p e c i f i c e x a m p l e s o f t h e a p p e l l a n t i t e m s i n s t o r e s , p l a n n i n g m e a l s , a n d u s i n g t r a n s p o rt a t i o n i m p a i r m e n t h a s m a j o r i m p a c t s i n t h e a r e a s o f A t t e n t i o n / C i m p a c t f o r L a n g u a g e . T h e a p p e l l a n t ' s c o g n i t i v e i m p a i r m e n t a l s o i m p a c t s h i s s o r e l a t i o n s h i p w i t h h i s w i f e [ t h e a p p e l l a n t r e p o rt s t h a t w a s n t h a t s h e i s h i s o n l y s i g n i f i c a n t r e l a t i o n s h i p . T h e a p p e l l a n t v e r b a l r e p e t i t i o n s a n d t h e e x t r a t i m e i t t a k e s h i m t o e x p r e " o d d b e l i e f s " t h a t i m p a c t h i s c o m m u n i c a t i o n a n d s o c i a l f u i m p a c t s o f d e p r e s s i o n / P T S D s y m p t o m s o n m o t i v a t i o n , m i m p a c t o n i m p u l s e c o n t r o l , a m a j o r i m p a c t o n e m o t i o n i s p r e s e n t a t i o n i s c o n s i s t e n t w i t h M a j o r D e p r e s s i v e D i s o r d e a s s e s s m e n t , n o t i n g t h a t h i g h e r l e v e l s o f i n s i g h t a n d j u d g D r . K . a g r e e s t h a t t h e i m p a c t o f t h e a p p e l l a n t ' s d e p r e s s i o " m o d e r a t e t o m a j o r ' ' b u t D r . K . , w h o s e e s t h e a p p e l l a n t o r e p o r t s a m o d e r a t e t o m a j o r i m p a c t f o r p s y c h o t i c s y m p t o v a r y f r o m m i n i m a l t o m a j o r d e p e n d i n g o n w h a t s t r e s s o r s d u r a t i o n o f p e r i o d i c r e s t r i c t i o n s t o s o c i a l f u n c t i o n i n g , d e s t h a t P T S D s y m p t o m s t h r o u g h t o d e p r e s s i o n c a n b e a " r e I n t h e o r i g i n a l m e d i c a l r e p o rt s , D r . L . i n d i c a t e s s i g n i f i c a n t e m o t i o n a l d i s t u r b a n c e . T h e s e a s s e s s m e n t s c o r r o b o r a t e [ E x e c u t i v e , f o r e x a m p l e ] a r e n o t i m p a c t e d i n t h e M R a n d o r w i t h i n t h e r e p o rt s [ A b i l i t y t o c o m m u n i c a t e , E m o t i o n , a n O T a s s e s s m e n t a n d t h e o t h e r n e w r e p o r t s b e c a u s e t h e y P W D r e p o r t s . T h e O T a s s e s s m e n t , i n p a r t i c u l a r , i s v e r y t i n c l u d i n g d i r e c t o b s e rv a t i o n , c o g n i t i v e t o o l s a n d t e s t s , a n D r . K . T h e e v i d e n c e i n t h e M R a n d A R , o n t h e o t h e r h a n d , i s f r o fi r s t t i m e ; w e r e r e p o r t e d l y i n a r u s h t o c o m p l e t e t h e f o r m s i m p a c t s . I n a d d i t i o n t o b e i n g m o r e d e t a i l e d a n d t h o r o u g h d i s c r e p a n c i e s b e t w e e n t h e o r i g i n a l a n d n e w a s s e s s m e n t a p p e l l a n t w a s l i k e l y c o n f u s e d a b o u t t h e i t e m s i n t h e A R a a n d e m o t i o n a l f u n c t i o n s . I n l i g h t o f a l l o f t h e a d m i s s i b l e e v i d e n c e , t h e p a n e l f i n d s t h a v e a s e v e r e m e n t a l i m p a i r m e n t i s u n r e a s o n a b l e . W h i l e i m p a i r m e n t , t h e a s s e s s m e n t r e a c h e s t h e s e v e r e r a n g e o [ c o m m u n i c a t i o n , e x e c u t i v e f u n c t i o n i n g , a n d m e m o r y i n p f u n c t i o n i n g [ t h e a p p e l l a n t h a s n o f r i e n d s ] .I K . d i r e c t l y o b s e rv e d t h e a p p e l l a n t ' s " r e d u c e d c o g n i t i v e d d i ff i c u l t i e s c o m m u n i c a t i n g [ s l o w s p e e c h , p o v e r t y o f . T h e a p p e l l a n t p r e s e n t e d w i t h c o n f u s i o n , d i s o r g a n i z a t i o n , f o r d e t a i l s [ i t t o o k h i m a n h o u r t o c o m p l e t e o n e p a g e o f a s , a n d h e c o u l d n o t r e m e m b e r w h e r e h e w r o t e o r s t o r e d n c e b e l o w t h e n o r m s [ e s p e c i a l l y a m o d e r a t e t o s e v e r e l y c o g n i t i v e r a n g e " f o r e x e c u t i v e f u n c t i o n s , a n d t h e e a k i n g a n d R e a d i n g d u e t o c o g n i t i o n " ] . T h e a p p e l l a n t ' s w e l l . T h e c o l l a t e r a l e v i d e n c e f r o m t h e s p o u s e , w h i c h t h e ' s c o g n i t i v e i m p a i r m e n t , i n D L A t a s k s s u c h a s s h o p p i n g f o r . T h e O T c o n c l u d e s t h a t t h e a p p e l l a n t ' s c o g n i t i v e o n c e n t r a t i o n , E x e c u t i v e , a n d M e m o r y a n d a m o d e r a t e c i a l a n d e m o t i o n a l f u n c t i o n i n g . T h e a p p e l l a n t h a s a g o o d o t a l w a y s t h e c a s e ] b u t a l l o f t h e a s s e s s m e n t s i n d i c a t e h a s n o f r i e n d s b e c a u s e p e o p l e l o s e p a t i e n c e w i t h h i s s s h i m s e l f . T h e p s y c h i a t r i s t r e p o rt s 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 . W h i l e t h e p s y c h i a t r i s t r e p o r t s m i l d t o m o d e r a t e o t o r a c t i v i t y , a n d p o s s i b l e p s y c h o t i c s y m p t o m s , a n d n o r e p o r t e d . T h e p s y c h i a t r i s t n o t e s t h a t t h e a p p e l l a n t ' s r . T h e p s y c h i a t r i s t a c c e p t s t h e c o g n i t i v e f i n d i n g s i n t h e O T m e n t m a y b e l i m i t e d . n o n h i s e m o t i o n a l f u n c t i o n i n g s h o u l d b e r e r a t e d a s n a m o r e f r e q u e n t b a s i s a s h i s n e w G e n e r a l P r a c t i t i o n e r , m s . D r . K . s t a t e s t h a t t h e i m p a c t o f P T S D s y m p t o m s c a n t h e a p p e l l a n t i s f a c i n g . D r . K . p r o v i d e s i n f o r m a t i o n o n t h e c r i b i n g t h e d u r a t i o n a s " m o d e r a t e t o m a j o r ' ' . D r . K n o t e s a l h i n d r a n c e " t o s o c i a l f u n c t i o n i n g . d e f i c i t s w i t h l a n g u a g e [ e x p r e s s i o n ] , m e m o r y a n d t h e f i n d i n g s i n t h e n e w r e p o r t s . W h i l e o t h e r f u n c t i o n s A R , o r a r e a s s e s s e d w i t h c o n f l i c t i n g i n f o r m a t i o n b e tw e e n d S o c i a l F u n c t i o n i n g ] , t h e p a n e l g i v e s m o r e w e i g h t t o t h e a r e m o r e d e t a i l e d a n d c o m p r e h e n s i v e t h a n t h e o r i g i n a l h o r o u g h , a n d e m p l o y s a v a r i e t y o f a s s e s s m e n t t e c h n i q u e s d c o l l a t e r a l i n f o r m a t i o n f r o m t h e s p o u s e , i n t a k e n u r s e , a n d m p r e s c r i b e d p r o f e s s i o n a l s w h o m e t t h e a p p e l l a n t f o r t h e ; a n d d i d n o t p r o v i d e c o n s i s t e n t i n f o r m a t i o n o n f u n c t i o n a l , t h e n e w r e p o r t s c o n t a i n p l a u s i b l e e x p l a n a t i o n s f o r t h e s . D r . K . i n d i c a t e s t h a t d u e t o a c o g n i t i v e i m p a i r m e n t , t h e n d u n d e r e s t i m a t e d t h e s e v e r i t y o f i m p a c t s o n h i s c o g n i t i v e h a t 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 t h a t t h e a p p e l l a n t d o e s n o t s o m e o f t h e O T ' s f i n d i n g s i n d i c a t e a m o d e r a t e l e v e l o f f i m p a i r m e n t i n m o s t a r e a s o f c o g n i t i v e f u n c t i o n i n g a r t i c u l a r ] w i t h a n a s s o c i a t e d s e v e r e i m p a c t o n s o c i a l
I Moderate to major impacts are also reported for emotional functioning due to the appellant's depression and PTSD symptoms. The psychiatrist reports a major impact on emotion. In the original PWD application, Dr. L. indicates significant deficits with cognitive and emotional function due to emotional disturbance. Based on this analysis of the information in its entirety, the panel finds that the ministry's determination of no severe mental impairment under section 2(2) of the EAPWDA is not reasonably supported by the evidence. Physical impairment The ministry found that the appellant does not have a severe physical impairment. The ministry bases its conclusion on the assessments of functional skills in the MR [PWD APP. 2] and the AR. The ministry argues that the ability to walk 2 to 4 blocks unaided, and climb 5 or more steps unaided [as noted in the MR] is not indicative of a severe impairment of physical functioning. The ministry argues the information in the MR for lifting and remaining seated [sticky note included with the report] was provided by the appellant rather than Dr. L. In any event, the ministry argues that the ability to lift 5 to 15 pounds and remain seated for 1 to 3 hours does not establish a severe impairment of physical functioning. The ministry notes the contradiction between being able to walk and climb steps unaided and the information in the MR that indicates the appellant has noticeable ambulatory impairments and uses a cane and an orthotic to walk. The ministry argues that restrictions to employment, as noted in the MR, are not considered in determining eligibility for PWD designation. As with a mental impairment, employability/vocational restrictions are not included in the legislative criteria under section 2 of the EAPWDA. The ministry argues that the information in the AR also does not establish a severe physical impairment. The appellant presents with left nerve palsy and weakness in his lower limb and uses an assistive device with walking indoors, walking outdoors, and climbing stairs. At the same time, the RN reports the appellant is independent with lifting, and with carrying/holding [while using assistive devices] and the appellant is independent with standing. The ministry notes there is no description in the AR of the assistive devices used for lifting and carrying; how much weight the appellant can lift is not described; and the RN does not explain the discrepancy between the MR and AR for walking ad climbing stairs ["unaided" versus use of assistive devices]. Based on the original PWD medical reports and submissions for the reconsideration, the panel finds that the ministry reasonably concluded there is insufficient evidence of a severe physical impairment. The appellant's ability to walk 2 to 4 blocks and climb 5 or more steps, etc. are on the moderate to high ends of the rating scales. The panel finds that the ministry's determination of no severe physical impairment under section 2(2) of the EAPWDA is reasonably supported by the evidence. Additional evidence and panel's decision -physical impairment As with a mental impairment, the appellant, the OT, and Dr. K. offer explanations for the discrepancies in the assessments of physical functions between the original PWD reports and the new assessments. The appellant maintains that the original assessments were rushed. In addition, he reports being confused about the questions on functional skills. For example, when asked how many blocks he could walk unaided, the appellant explains that he did not understand that "aided" includes an assistive device [his cane] as well as help from another person. The OT notes that the AR indicates no impact for many areas of functioning despite the appellant's detailed self-reports describing his functional limitations. The appellant argues that the panel should give the new assessments of his impairments greater weight. The OT indicates that the appellant uses a cane at all times. He also uses a leg brace when walking outdoors. The appellant is therefore unable to walk or climb stairs "unaided" as stated in the MR. With the collateral information from the spouse, the OT initially concludes that the appellant needs continuous assistance with mobility inside and outside the home. The spouse indicates that due to severe morning stiffness, fatigue, and nerve/joint pain, it takes the appellant several hours to get out of bed and he suffers poor sleep due to pain. The spouse indicates the appellant can do DLA involving short/.light activities only.
I Later on in the assessment, the OT indicates the appellant needs periodic assistance with all of the physical functions listed in the PWD forms: Walking indoors, Walking outdoors, Climbing stairs, Standing, Lifting, and Carrying/holding, The appellant relies on a cane for all of these functions and also holds onto the counter or other structures. The OT notes that the appellant's: ability to lift is weight/height dependent. There is no explanation for the discrepancy in the OT's assessments within her report [continuous assistance with walking versus periodic assistance with walking and all physical functional skills]. The OT does not indicate how far the appellant can walk or how much weight he can lift. In the original assessments, the appellant is able to walk 2 to 4 blocks, climb 5 or more steps, lift 5 to 15 pounds, and remain seated for 1 to 3 hours. The OT confirms that the appellant uses an assistive device for all of these activities. The OT assessment indicates the appellant needs a day or more of recovery time if he overdoes his activities. The assessment does not describe how much activity or which activities result in the appellant "overdoing it." Dr. K. indicates the appellant is restricted with walking and lifting due to his severe physical injuries. Dr. K. reports that the appellant's left leg, foot, and back problems cause "significant movement limitations" and "restrictions to duration of lifting." The appellant needs a cane to walk and while he can lift 5 to 15 pounds depending on his pain levels, he "should not do prolonged lifting of much weight." To keep pain levels from increasing, Dr. K. recommends lifting of less than 5 pounds. Dr. K. reports that the appellant is limited in the amount of time he can be on his feet or remain seated ["nerve and joint pain occurs in a short enough time and requires him to lay down"]. Tasks involving "elongated walking" take the appellant "much longer than average." Sitting "too long" causes back and hip pain. The appellant takes "much longer" to complete daily tasks and requires continuous help from his wife throughout the day. Dr. K. reports that the appellant suffers pain if he overdoes his activities. The new assessment by Dr. K. does not indicate the length of time the appellant can stand or sit, what distance he can walk, how many stairs he can climb; how much longer it takes the appellant to walk places; or how much activity he can withstand before he experiences pain and needs to lie down. Considering all of the admissible evidence, there are still inconsistencies within the new assessments as well as a lack of information on distance, weight, and duration for specified functional skills. The panel finds that the ministry reasonably concluded that the information provided does not establish a severe physical impairment. The panel finds that the ministry's determination of no severe physical impairment under section 2(2) of the EAPWDA is reasonably supported by the evidence. Restrictions in the ability to perform DLA Subsection 2(2)(b)(i) of the EAPWDA requires the ministry to be satisfied that, in the opinion of a prescribed professional, a severe impairment directly and significantly restricts a person's ability to perform DLA either continuously, or periodically for extended periods. In this case, the prescribed professionals are Dr. L who filled out the MR, the RN who completed the AR., and Dr. K. who provided information for the reconsideration. The term "directly" means there must be a causal link between the severe impairment and the restriction to DLA. The direct restriction must also be significant. Finally, there is a component related to time or duration: the direct and significant restriction may be either continuous or periodic. If periodic, the restriction must be for extended periods. Inherently, an analysis of periodic restrictions must also include how frequently the activity is restricted. All other things being equal, a restriction that arises once a year is less likely to be significant than one that occurs several times a week. Accordingly, in circumstances where the evidence indicates that a restriction arises periodically, it is appropriate for the ministry to require evidence on the duration and frequency of the restriction in order to be satisfied that this criterion is met. DLA are defined in section 2(1) of the EAPWDR and are also listed in the MR, with additional details in the AR. Therefore, a medical practitioner completing these forms has the opportunity to indicate which, if any, DLA are significantly restricted by the appellant's impairments either continuously or periodically for extended periods and to provide additional narrative. DLA, as defined in the legislation, does not include the ability to work.
T h e m i n i s t r y a r g u e s 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 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 t i n u o u s l y , o r p e r i o d i c a l l y i n d e p e n d e n t w i t h m o s t D L A . D r . L i n d i c a t e s t h e a p p e l l a d e s c r i b e t h e d e g r e e o f t h e r e s t r i c t i o n , o t h e r t h a n " f l u c t u a i n d i c a t e s t h e a p p e l l a n t h a s n o t b e e n p r e s c r i b e d a n y m e d p e rf o r m D L A . I n t h e A R , t h e R N n o t e s t h e a p p e l l a n t i s a t a n i n c r e a s e d t h o u g h " v e r y d e l a y e d " , w i t h s o m e a c t i v i t i e s . D L A r e q u i r e n o t e d b y t h e m i n i s t r y , t h e R N d o e s n o t d e s c r i b e h o w l o n T h e a p p e l l a n t i s d e s c r i b e d a s i n d e p e n d e n t w i t h s o m e a r c h a i r ] f o r m o s t o f t h e l i s t e d a c t i v i t i e s . T h e a p p e l l a n t i s i n d r e n t a n d b i ll s , a n d M e d i c a t i o n s , a n d m o s t a r e a s o f S o c i a [ c a n e ] f o r a l l a r e a s o f Tra n s p o rt a t i o n . T h e a p p e l l a n t r e q u H o u s e k e e p i n g [ h i s w i f e d o e s t h e l a u n d r y a n d h o u s e k e e p h i m , a n d c a r r i e s h e a v i e r i t e m s ] a n d a l l a r e a s o f Me a l s [ h 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 w i t h o n e a r e a o f S o c i a l F u n f r o m o t h e r s ] . T h e A R i n d i c a t e s t h e 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 M e a l s ] , a n d w i t h t w o s h o p p i n g a c t i v i t i e s , a n d u s e s a n a s n o t e s t h a t t h e r e s t r i c t i o n s i n t h e A R a r e i n c o n s i s t e n t w i t h r e s t r i c t i o n s w i t h P e r s o n a l C a r e , B a s i c H o u s e k e e p i n g , M e n e e d s o n l y p e r i o d i c a s s i s t a n c e w i t h D a i l y S h o p p i n g . I n l e x p l a i n e d b y 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 , t h e p a n e l f i n d e n o u g h i n f o r m a t i o n i n t h e o r i g i n a l P W D a p p l i c a t i o n t o e s t h e l e g i s l a t i o n . B a s e d o n t h e o r i g i n a l a s s e s s m e n t s b y p r e r e a s o n a b l y d e t e r m i n e d t h e c r i t e r i a i n s e c t i o n 2 ( 2 ) ( b ) ( i ) o f A d d i t i o n a l e v i d e n c e a n d p a n e l ' s d e c i s i o n R e s t r i c t i o n s t T h e a p p e l l a n t a g a i n n o t e s t h a t t h e o r i g i n a l a s s e s s o r s w e q u e s t i o n s o n t h e f o r m s . A t t h e h e a r i n g , t h e a p p e l l a n t a d d b e f o r e a n d w h e n g o i n g o v e r t h e D L A o n t h e f o r m , s h e a s y o u ? " T h e a p p e l l a n t a r g u e s t h a t t h e a s s e s s m e n t s b y t h e w e i g h t t h a n t h e o r i g i n a l P W D r e p o r t s . T h e O T r e r a t e s m o s t D L A a s c o n t i n u o u s l y r e s t r i c t e d a n d p e r f o r m t h e a c t i v i t y . D u e t o h i s m e n t a l i m p a i r m e n t , D L A a n d U s e o f t r a n sp o r t a t i o n ] 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 w i t h m e m o r y , a n d e x e c u t i v e f u n c t i o n a s w e l l a s h i s s l o w a b i l i t y t o p e r f o r m t h e s e D L A . T h e s p o u s e p r o v i d e d c o l l a t p r e p a r a t i o n [ h e c a n m a k e p r e p r e p a r e d m e a l s o n l y ; h e c d e s c r i b e s t h e a p p e l l a n t ' s r e s t r i c t i o n s w i t h s h o p p i n g [ i n o r d l i s t ] ; a n d u s e o f t r a n s p o rt a t i o n [ t h e a p p e l l a n t n e e d s t h e s t h e r e f o r e d o e s m o s t o f t h e d r i v i n g ] . I n t h e O T a s s e s s m e n t , M e a l p re p a r a t i o n a n d S h o p p in g a i m p a i r m e n t s [ d u e t o p a i n , w e a k n e s s , a n d f a t i g u e ] . P e r s o t h e h o m e a r e c o n t i n u o u s l y r e s t r i c t e d b y h i s p h y s i c a l l i m i t p h y s i c a l D L A . T h e O T r e p o rt s t h a t t h e a p p e l l a n t i s p e r i o d i c a l l y r e s t r i c t e c o m p l e x i t y o f t h e t a s k . T o c o m p e n s a t e f o r d e f i c i t s w i t h m u o w i t h a u t o m a t i c o a v m e n t s a n d h e u s e s h i s d e b i t c a r d f I 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 t o c o n f i r m t h a t D L A a r e f o r e x t e n d e d p e r i o d s . I n t h e M R , t h e a p p e l l a n t i s n t i s p e r i o d i c a l l y r e s t r i c t e d w i t h S h o p p i n g b u t d o e s n o t t i n g " . D r . K . d o e s n o t s t a t e w h a t h e l p i s r e q u i r e d . D r . L . i c a t i o n s o r t r e a t m e n t s t h a t i n t e rf e r e w i t h h i s a b i l i t y t o r i s k f o r f a l l s d u e t o h i s f u s e d a n k l e b u t i s i n d e p e n d e n t , " g r e a t a s s i s t a n c e " f r o m h i s w i f e a n d h i s m o b i l i t y a i d s . A s g i t t a k e s t h e a p p e l l a n t t o p e rf o r m h i s D L A . e a s o f P e r s o n a l C a r e b u t u s e s a n a s s i s t i v e d e v i c e [ c a n e o r e p e n d e n t w i t h m o s t a r e a s o f S h o p p in g , a l l a r e a s o f P a y l F u n c t i o n in g . T h e a p p e l l a n t u s e s a n a s s i s t i v e d e v i c e 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 b o t h a r e a s o f B a s ic i n g ] , tw o a r e a s o f S h o p p i n g [ h i s w i f e a l w a y s s h o p s w i t h i s w i f e d o e s a l l / m a j o r i t y o f l i s t e d a c t i v i t i e s ] . T h e a p p e l l a n t c t i o n i n g [ h i s w i f e i s h i s o n l y s u p p o r t i n s e c u r i n g a s s i s t a n c e w i t h a l l a c t i v i t i e s fo r t w o D L A [ B a s i c h o u s e k e e p i n g a n d s i s t i v e d e v i c e f o r m a n y p h y s i c a l a c t i v i t i e s . T h e m i n i s t r y t h e i n f o r m a t i o n i n t h e M R w h e r e D r . L . i n d i c a t e s n o a l s , a n d T r a n s p o rt a t io n . D r . L . i n d i c a t e s t h e a p p e l l a n t i g h t o f t h e i n c o n s i s t e n c i e s i n t h e i n f o r m a t i o n , w h i c h a r e n o t 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 d e t e r m i n e d t h e r e i s n o t t a b l i s h t h a t D L A a r e s i g n i f i c a n t l y r e s t r i c t e d a s r e q u i r e d b y s c r i b e d p r o f e s s i o n a l s , 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 t h e E A P W D A a r e n o t m e t . o D L A r e p r e s s e d fo r l i m e a n d h e d i d n o t u n d e r s t a n d t h e e d t h a t D r . L . h a d n e v e r f i l l e d o u t a P W D a p p l i c a t i o n k e d " l e a d i n g q u e s t i o n s " s u c h a s " y o u c a n d o t h a t , c a n ' t O T , t h e p s y c h i a t r i s t , a n d D r . K . s h o u l d b e g i v e n m o r e i n d i c a t e s t h e a p p e l l a n t r e q 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 t o l i s t e d i n t h e M R a n d A R [ M e a l p r e p a ra t i o n , D a il y s h o p p i n g , s t r i c t e d o n a c o n t i n u o u s b a s i s . T h e a p p e l l a n t ' s d e f i c i t s p r o c e s s i n g s p e e d a n d d e l a y e d r e a c t i o n t i m e i m p a c t h i s e r a l i n f o r m a t i o n a b o u t t h e a p p e l l a n t ' s r e s t r i c t i o n s w i t h m e a l a n n o t m e a l p l a n w i t h o u t c o n t i n u o u s a s s i s t a n c e ] . S h e a l s o i n a t e a m o u n t o f t i m e l o c a t e o n e i t e m f r o m t h e s h o p p i n g p o u s e t o " b a c k s e a t d r i v e " t o a l e r t h i m t o h a z a r d s a n d s h e r e a l s o c o n t i n u o u s l y r e s t r i c t e d b y t h e a p p e l l a n t ' s p h y s i c a l n a l c a r e , B a s i c h o u s e w o r k , a n d M o b i lit y i n s i d e a n d o u t s i d e a t i o n s . T h e a p p e l l a n t r e l i e s o n a n a s s i s t i v e d e v i c e f o r a l l d i n t h e m a n a g e m e n t o f f i n a n c e s , d e p e n d i n g o n t h e e m o ry a n d h a n d l i n g c u r r e n c y , t h e a p p e l l a n t ' s b i l l s a r e s e t o r o u r c h a s e s . T h e a n n e l l a n t i s a b l e t o b u d a e t w i t h h i s o n -
I line account but executes poorer choices in stores due to his cognitive impairment. The appellant is independent with managing medications but does not use prescription medicine. The new evidence establishes that Social Functioning is also directly and significantly restricted by the appellant's cognitive and emotional impairments. According to the OT, the appellant is independent with social decisions and needs only periodic support in developing and maintaining relationships, but the appellant does not interact appropriately with others without continuous support from the other party. The collateral information from the spouse, which the OT accepts, indicates significant deficits with social functioning. The appellant has no friends due to his cognitive impairment. The appellant has difficulty reading social cues and he tends to isolate himself. All of the evidence indicates that the appellant's only significant relationship and source of support is his wife. Dr. K. indicates that PTSD symptoms through to depression can be a "real hindrance" to social functioning and the periodic restrictions to social functioning [as reported in the MR] should be characterized as "moderate to major." The psychiatrist does not delve into the appellant's social functioning but indicates that the appellant always felt like "the odd one out' and the appellant's "odd beliefs" [communicating with animals "in their own code" and often seeing spirits] impact his communication and social functioning. In the original PWD medical reports, Dr. L. assesses Social Functioning as periodically restricted. She does not describe how often the restriction occurs. The AR indicates the appellant is independent with most areas of Social Functioning but his wife is his only support and he has marginal functioning with his extended social networks. The panel gives more weight to the OT assessment and the other new information for the following reasons: the new reports provide a more thorough assessment of DLA The OT assessment in particular is detailed and comprehensive. The OT employs a variety of assessment techniques including direct observation, cognitive tools and tests, and collateral information from the spouse, intake nurse, and Dr. K. The evidence in the MR and AR, on the other hand, is from prescribed professionals who met the appellant once; were reportedly in a rush to complete the forms; and did not provide consistent information on restrictions to DLA In light of all of the admissible evidence, the panel finds that the ministry's determination that the appellant's DLA are not significantly restricted due to a severe impairment is unreasonable. The BC Supreme Court decision in Hudson v. British Columbia Employment and Assistance Appeal Tribunal [2009 BCSC 1461] states that there must be evidence from a prescribed professional indicating a direct and significant restriction on at least two DLA. Not all DLA need to be affected by the severe impairment. The additional evidence from prescribed professionals indicates the appellant's severe impairment of cognitive and emotional functioning directly and significantly restricts the DLA of Meals, Shopping, and Transportation {continuously]. The new evidence also indicates significant and continuous restrictions with Social Functioning in the area of relate to, communicate or interact with others effectively.as set out in set out in section 2(1)(b) of the EAPWDR. While Pay Rent and Bills, and Medications are not significantly restricted, the appellant relies on accommodations for financial transactions [automatic bill payments, for example] and the evidence indicates that the only medication he takes is Advil for pain. Based on this analysis of the information in its entirety, the panel finds that the ministry's determination of no significant restrictions to DLA under section 2(2)(b)(i) of the EAPWDA is not reasonably supported by the evidence. Help to perform DLA Section 2(2)(b)(ii) of the EAPWDA requires that, as a result of direct and significant restrictions in the ability to perform DLA, a person requires help to perform those activities. Help is defined in subsection (3) as the requirement for an assistive device, the significant help or supervision of another person, or the services of an assistance animal in order to perform DLA The MR and AR indicate the appellant uses a number of aids to assist him with DLA, including a cane, leg brace, high shoe orthotic and bathing aids ["chair"]. The RN indicates the appellant needs grab bars for toileting. Both reports indicate the appellant's wife provides assistance with DLA
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 e n 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 l p i s r e q u i r e d . U n d e r t h e l e t o D L A i s a p r e c o n d i t i o n f o r n e e d i n g h e l p t o p e r f o r m D L 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 r e s t r i c t i o n s t o D L A w e r e n o t m e d i c a l r e p o r t s , t h e p a n e l a l s o f i n d s t h a t t h e m i n i s t r y r e 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A a r e n o t m e t A d d i t i o n a l e vid e n c e a n d p a n e l ' s d e c i s i o n N e e d f o r h e l p T h e O T i n d i c a t e s t h a t d u e t o t h e a p p e l l a n t ' s s e v e r e m e n s p o u s e w i t h M e a l s , S h o p p i n g , a n d T r a n s p o rt a t i o n , a n d t h e O T a n d o t h e r p r e s c r i b e d p r o f e s s i o n a l s i n d i c a t e s t h a T h e s p o u s e d o e s t h e m e a l p l a n n i n g , c o o k i n g , a n d s h o p a p p e l l a n t n e e d s c o n t i n u o u s s u p p o r t w i t h i n t e r a c t i n g a p p v e r b a l e x p l a n a t i o n s a n d r e p e t i t i o n , g o b e y o n d r e a s o n a b a p p e l l a n t u s e s a n a s s i s t i v e d e v i c e f o r a l l p h y s i c a l D L A A s n o t e d e a r l i e r , t h e p a n e l g i v e s m o r e w e i g h t t o t h e O T m o r e s u ff i c i e n t a n d m o r e r e l i a b l e . T h e O T p r o v i d e s a c o n e e d fo r h e l p , w i t h c o r r o b o r a t i o n f r o m v a r i o u s s o u r c e s . b a s e d o n r u s h e d , o n e t i m e a s s e s s m e n t s b y D r . L a n d 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 f r o m h i s w i f e a n d f r o m a s s i s t T h e p a n e l f o u n d t h a t t h e m i n i s t r y ' s d e c i s i o n o n D L A i s u 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 , c o n s i d e r e d i n i t s e n t i r e u n r e a s o n a b l e . 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 c r i t e r i a f o a r e m e t C o n c l u s i o n T h e p a n e l f i n d s t h a t t h e m i n i s t r y ' s r e c o n s i d e r a t i o n d e c i s P W D d e s i g n a t i o n , i s n o t 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 s u c c e s s f u l o n a p p e a l .I 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 r e s t r i c t e d , i t c a n n o t b e g i s l a t i o n , c o n f i r m a t i o n 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 A A s t h e p a n e l f o u n d 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 s t a b l i s h e d b y t h e i n f o r m a t i o n p r o v i d e d i n t h e o r i g i n a l a s o n a b l y c o n c l u d e d t h a t t h e c r i t e r i a f o r h e l p u n d e r s e c t i o n t a l i m p a i r m e n t , h e n e e d s c o n t i n u o u s a s s i s t a n c e f r o m h i s w i t h s p e c i f i c a r e a s o f S o c i a l F u n c t i o n in g . T h e e v i d e n c e f r o m t t h e s e D L A a r e s i g n i f i c a n t l y r e s t r i c t e d . p i n g d u e t o t h e a p p e l l a n t ' s c o g n i t i v e i n e ff i c i e n c i e s . T h e r o p r i a t e l y w i t h o t h e r s a s h i s m e m o r y p r o b l e m s a n d l e n g t h y l e a c c o m m o d a t i o n b y o t h e r s . T h e O T r e p o rt s t h a t t h e ' s a s s e s s m e n t s , f i n d i n g t h e e v i d e n c e i n h e r r e p o r t t o b e m p r e h e n s i v e a s s e s s m e n t o f t h e a p p e l l a n t ' s r e s t r i c t i o n s a n d B y c o n t r a s t , t h e r e c o r d i n d i c a t e s t h a t t h e M R a n d A R a r e h e R N . I n a n y e v e n t , a l l o f t h e p r o fe s s i o n a l s i n d i c a t e t h a t i v e d e v i c e s t o p e r f o r m t h e m a j o r i t y o f D L A n r e a s o n a b l e b a s e d o n t h e t o t a l i t y o f e v i d e n c e . A c c o r d i n g l y , t y , m a k e s t h e m i n i s t ry ' s d e t e r m i n a t i o n o n h e l p r s i g n i f i c a n t h e l p u n d e r s e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A i o n , w h i c h d e t e r m i n e d 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 i d e n c e . T h e p a n e l r e s c i n d s t h e d e c i s i o n . T h e a p p e l l a n t i s
A P P EA L N O . 2 0 1 8 -0 0 2 9 0 P A R T G O R D E R T H E P A N E L D E C I S I O N I S : ( C h e c k o n e ) i)3J U N A N I M O U S □ B Y M A J O R I T Y T H E P A N E L □ C O N F I R M S T H E M I N I S T R Y D E C I S I O N i:8J R E S C I N D S T H E M I N I S T R Y D E C I S I O N I f t h e m i n i s t r y d e c i s i o n i s r e s c i n d e d , i s t h e p a n e l d e c i s i o n r e f e r r e d b a c k t o t h e M i n i s t e r f o r a d e c i s i o n a s t o a m o u n t ? □ Y e s □ N o L E G I S L A T I V E A U T H O R I T Y F O R T H E D E C I S 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 A c t S e c t i o n 2 4 ( 1 ) ( a ) D o r S e c t i o n 2 4 ( 1 ) { b ) D a n d S e c t i o n 2 4 ( 2 ) ( a ) D o r S e c t i o n 2 4 ( 2 ) ( b ) l)3J P A R T H S I G N A T U R E S P R I N T N A M E M a r g a r e t K o r e n S I G N A T U R E O F C H A I R D A T E ( Y E A R/ M O N T H/ D A Y ) 2 0 1 8 -1 0 -1 0 P R I N T N A M E S t e p h a n i e K o r o u r S I G N A T U R E O F M E M B E R D A T E ( Y E A R / M O N T H / D A Y } 2 0 1 8 -1 0 -1 0 P R I N T N A M E S u s a n M a c k e y S I G N A T U R E O F M E M B E R D A T E ( Y E A R/ M O N T H / D A Y } 2 0 1 8 -1 0 -1 0 ' --� · :-C u 4 ~ -" ;;;:. ::- EAA T 0 0 3 ( 1 7 / 0 8 / 1 7 )
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.