Ministry of Social Development and Poverty Reduction

Decision Information

Decision Content

PART C -DECISION UNDER APPEAL The decision under appeal is the reconsideration decision of the Ministry of Social Development and Poverty Reduction (the ministry) dated November 5, 2018, which held that the appellant did not meet 3 of the 5 statutory requirements of section 2 of the Employment and Assistance for Persons with Disabilities Act for designation as a pers on with disabilities (PWD). The ministry found that the appellant met the age and duration requirements, but was not satisfied that: the evidence establishes that the appellant has a severe physical or mental impairment; the appellant's daily living activities (DLA) are, in the opinion of a prescribed professional, directly and significantly restricted either continuously or periodically for extended periods; and as a result of those restrictions, 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
PART E -SUMMARY OF FACTS The information before the ministry at the time of reconsideration included the following: 1. Appellant's PWD application dated June 29, 2018 comprised of the appellant's Self-Report letter dated May 25 2018 (SR) a Medical Report (MR) and an Assessor Report (AR), both completed by the appellant's general practitioner (the "Physician") dated June 19, 2018 2. Appellant's Request for Reconsideration form dated October 02, 2018 (RFR) requesting an extension of time to submit further documentation 3. Appellant's RFR statement dated October 31, 2018 (the "RFR Statement") 4. Letter from the Physician dated October 31, 2018 (the "Letter") 5. Statement prepared by the appellant's advocate and signed by the Physician dated October 31, 2018 (the "Physician's Statement") Summary of relevant evidence Diagnoses In the MR, the Physician indicates that the appellant has been diagnosed with chronic derangement left arm (biceps rupture) and chronic pain left shoulder/upper arm, date of onset for both conditions being April 2014. The Physician indicates that the appellant has been a patient for 3 years and he has been seen once in the past 12 months. In the AR, the Physician indicates that the appellant's impairments that impact his ability to manage DLA are chronic pain and d isability left arm. In the Letter, the Physician indicates that the appellant suffers from chronic pain as a result of a chronic left shoulder derangement that is inoperable. The Physician indicates that as a result of his disability the appellant is unable to obtain and maintain employment. The Physician also indicates that the appellant suffers from chronic depression as a result of his disability. Physical Impairment In the MR for Functional Skills, the Physician indicates that the appellant is able to walk 4+ blocks unaided on a flat surface, climb 5+ steps unaided, is unable to lift With his left arm, and has no limitations with respect to being seated. In the health history portion of the MR, the Physician indicates that the appellant has a derangement of the left shoulder/upper arm as a result of a biceps muscle rupture in April 2014. The Physician indicates that the appellant has developed chronic pain syndrome of the left upper limb and has limited strength/usage of the left arm as a result. In Part F -Additional Comments, the Physician indicates that there are no surgical options available to the appellant. The Physician indicates that chronic pain leads to very limited physical activity or exertion and that the appellant is unable to lift objects or obtain/manage firewood for heat. The Physician indicates that the appellant has one to four episodes of severe pain daily that require a recovery period. In the AR the Physician indicates that the appellant is independent with walking indoors, walking outdoors, climbing stairs, and standing but requires continuous assistance from another person with lifting and carrying and holding explaining that the appellant has pain, weakness, and limited range of motion and cannot use his left arm. The Physician indicates that the appellant requires assistance to lift or carry anything. In the SR, the appellant says that he has left shoulder pain almost constantly and any kind of movement can cause pain. He states that he has to be constantly aware of his movements and if he puts too much weight on one side the pain is severe. The appellant says that the pain feels like a "hot poker' in the ligament of his shoulder. The
appellant says that two or three times per day his shoulder is aggravated resulting in intense pain that requires him to sit and rest for about an hour to recover. The appellant says that he cannot sleep on his left side or on his back. He says that if he moves in the night he wakes up and it takes an hour or more to get back to sleep. In the RFR Statement, the appellant says that he has constant pain in his shoulder, arm and hand and is extremely limited in what he can do with his left arm/hand. The appellant says that he cannot do any activities that require two hands. He says that if he sleeps on his left shoulder, his whole left arm goes "dead" and his shoulder is in pain so he has to sleep on his right side with a pillow to prop up his left arm to relieve pressure on it. The appellant says that when he sits or walks he has to prop up his arm and have it supported so there is no pressure on it. Mental Impairment In the MR, the Physician indicates that the appellant does not have any difficulties with communication. The Physician did not check off the box stating yes to indicate that the appellant has significant deficits with cognitive and emotional function but did indicate that the appellant has deficits evident in the area of emotional disturbance {depression) related to his injury and chronic pain. In the AR, the Physician indicates that the appellant's ability to communicate in the areas of speaking, reading, writing, and hearing is good. For cognitive and emotional functioning the Physician indicates that the appellant has major impact to emotion (depression due to pain) and motivation (pain), moderate impact to bodily functions, and no impact in the areas of consciousness, impulse control, insight and judgment, attention/concentration, executive, memory, motor activity, language, psychotic symptoms, other neuropsychological problems and other emotional or mental problems. In the Letter, the Physician indicates that the appellant suffers from chronic depression as a result of his disability. In the RFR Statement, the appellant says that he suffers from depression because of his injury and the chronic pain. The appellant also says that he has no motivation for anything. In the MR, the Physician indicates that the appellant has not been prescribed medications that interfere with his ability to perform DLA. In the AR, the Physician indicates that with respect to personal care the appellant is independent with toileting, transfers (in/out of bed), and transfers (on/off chair) but takes significantly longer (2-3 x longer) than typical with dressing, grooming, bathing, feeding self and regulating diet. The Physician indicates that the appellant requires continuous assistance from another person with laundry and basic housekeeping explaining that he is unable to do laundry or housekeeping. The Physician indicates that with respect to shopping, the appellant is independent with going to and from stores, reading prices and labels, making appropriate choices and paying for purchases but requires periodic assistance and takes significantly longer than typical (2-3x longer) with carrying purchases home. The Physician indicates that the appellant's left arm pain and weakness limits his physical activities and that he is very limited with lifting and carrying. With respect to meals, the Physician indicates that the appellant is independent with meal planning and safe storage of food but requires continuous assistance and takes significantly longer than typical (2-3x longer) with food preparation and cooking, explaining that the appellant needs help in the kitchen The Physician indicates that the appellant is independent with all aspects of paying rent and bills, medications and transportation. The Physician indicates that the appellant is independent with all aspects of social functioning but has marginal functioning with his immediate and extended social networks. In the SR, the appellant says that without help from his roommate he would not be able to do jobs around his house
t h a t r e q u i r e t w o h a n d s s u c h a s s w e e p i n g t h e f l o o r , c h o p p h a n d s t o w a s h h i s h a i r c a n t r i g g e r p a i n a n d h e c a n o n l y u t o w a s h h i s h a i r . T h e a p p e l l a n t s a y s t h a t p u tt i n g o n c l o t h s a y s t h a t h e h a s t o b e c a r e f u l w h e n h e i s c o o k i n g a n d l i ft p r e p a r a t i o n t a k e s a b o u t 4 5 m i n u t e s f o r b r e a k f a s t o r l u n c l o n g a s t h e a v e r a g e p e r s o n a n d t h a t h e i s u n a b l e t o m o p d i ff e r e n t d i r e c t i o n s . T h e a p p e l l a n t s a y s t h a t h e i s u n a b l e g o e s g r o c e r y s h o p p i n g h e h a s l o u n p a c k h i s g r o c e r i e s f r o f g r o c e r i e s . I n t h e R F R S t a t e m e n t , t h e a p p e l l a n t s a y s t h a t h e n e e d s m o p p i n g , c l e a n i n g t h e b a t h r o o m , l i ft i n g / c a r ry i n g , p e e l i n g T h e a p p e l l a n t s a y s t h a t h e h a s t o k e e p h i s a r m p r o p p e d T h e a p p e l l a n t s a y s t h a t d r e s s i n g t a k e s h i m 2 -3 t i m e s l o n c a r e f u l l y a b o u t e v e r y m o v e m e n t t o a v o i d " t w e a k i n g " h i s a T h e a p p e l l a n t s a y s t h a t b e c a u s e o f h i s d e p r e s s i o n h e h a m u c h b e c a u s e o f p a i n a n d d e p r e s s i o n . T h e P h y s i c i a n S t a t e m e n t i n d i c a t e s t h a t h e h a s r e a d t h e n o t s u r p r i s e d b y t h e d e t a i l s t h a t t h e a p p e l l a n t d e s c r i b e s . t h e a p p e l l a n t ' s c o n d i t i o n t o e x p e r i e n c e t h e t y p e s o f r e s t r i d e s c r i b e s . T h e P h y s i c i a n s a y s t h a t h e d o e s n o t h a v e t h e h i s p a t i e n t s f o r t h e i r i n f o r m a t i o n t o g e t h e r w i t h h i s k n o w l e t h e a p p e l l a n t ' s i n f o r m a t i o n a s a c r e d i b l e d e s c r i p t i o n o f t h N e e d f o r H e l p I n t h e M R , t h e P h y s i c i a n i n d i c a t e s t h a t t h e a p p e l l a n t d o e I n t h e A R , t h e P h y s i c i a n c o m m e n t s t h a t t h e a p p e l l a n t n e r o o m m a t e f o r c h o r e s a n d f i r e w o o d . T h e P h y s i c i a n i n d i c a d e v i c e s a n d d o e s n o t h a v e a n a s s i s t a n c e a n i m a l . A d d i t i o n a l i n fo r m a t i o n p r o v i d e d I n h i s N o t i c e o f A p p e a l d a t e d N o v e m b e r 1 5 , 2 0 1 8 , t h e a p d e c i s i o n w a s r e a s o n a b l e a n d h e b e l i e v e s t h a t h e m e e t s P r i o r t o t h e h e a r i n g t h e a p p e l l a n t p r o v i d e d a s i x p a g e s u b c o n t a i n i n g t h e f o l l o w i n g d o c u m e n t s : 1 . M e d i c a l D o c u m e n t A u t h o r i z i n g t h e u s e o f C a n n a M e d i c a l P u r p o s e s R e g u l a t i o n s ( t h e M e d i c a l D o c M e d i c a l D o c u m e n t a u t h o r i z e s t h e a p p e l l a n t t o u s m o n t h s . 2 . S t a t e m e n t o f t h e a p p e l l a n t d a t e d N o v e m b e r 2 8 , i n f o r m a t i o n r e g a r d i n g h i s c o n d i t i o n . T h e a p p e l l a n t i m e s p e r d a y d e p e n d i n g o n t h i s a c t i v i t y . T h e a p t o s i t d o w n , l e a n f o r w a r d , c r a d l e h i s a r m a n d w a i m o r e . T h e a p p e l l a n t s a y s t h a t h i s r o o m m a t e i s n h i s h o m e , w h i c h h a s m a d e t h i n g s e v e n m o r e d i f f h i m j u s t t o b r i n g i n t h r e e s t i c k s o f f i r e w o o d w e i g h f o u r h o u r s t o r e c o v e r a f t e r t h a t t a s k . T h e a p p e l l a i n f i r e w o o d . T h e a p p e l l a n t s a y s t h a t h e u s e s c a n i n g o r c a r ry i n g f i r e w o o d . T h e a p p e l l a n t s a y s t h a t l i f t i n g h i s s e h i s r i g h t h a n d t o w a s h h i s h a i r s o i t t a k e s t w i c e a s l o n g e s , e s p e c i a l l y h i s j e a n s , i s l i k e h a r d l a b o u r . T h e a p p e l l a n t i n g i t e m s s u c h a s a f r y p a i n i s d i ff i c u l t . H e s a y s t h a t m e a l h . 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T h e P h y s i c i a n s a y s t h a t h e a c c e p t s e t y p e s o f l i m i t a t i o n s a p e r s o n i n h i s c o n d i t i o n w o u l d f a c e . s n o t r e q u i r e a n y p r o s t h e s e s o r a i d s f o r h i s i m p a i r m e n t . e d s h e l p f r o m h i s r o o m m a t e a n d f r i e n d s a n d r e l i e s o n h i s t e s t h a t t h e a p p e l l a n t d o e s n o t r o u t i n e l y u s e a n y a s s i s t i v e p e l l a n t s t a t e s t h a t h e d o e s n o t b e l i e v e t h e m i n i s t r y ' s t h e c r i t e r i a t o q u a l i f y f o r P W D d e s i g n a t i o n . m i s s i o n d a t e d N o v e m b e r 2 9 , 2 0 1 8 ( t h e " S u b m i s s i o n " b i s f o r M e d i c a l P u r p o s e s u n d e r t h e A c c e s s t o C a n n a b i s f o r u m e n t ) c o m p l e t e d b y t h e P h y s i c i a n o n M a y 4 , 2 0 1 8 . T h e e a m a x i m u m o f f i v e g r a m s o f m a r i j u a n a p e r d a y fo r 1 2 2 0 1 8 ( t h e " A p p e a l S t a t e m e n t " ) p r o v i d i n g a d d i t i o n a l t s a y s t h a t h e h a s u n b e a r a b l e l e ft s h o u l d e r / a r m p a i n 1 -4 p e l l a n t s a y s t h a t w h e n h e h a s t h i s u n b e a r a b l e p a i n h e h a s t f o r t h e p a i n t o s u b s i d e , w h i c h t y p i c a l l y t a k e s o n e h o u r o r o w v e r y u n w e l l a n d u n a b l e t o h e l p w i t h t h e t a s k s a r o u n d i c u l t . T h e a p p e l l a n t d e s c r i b e s t h e c h a l l e n g i n g p r o c e s s f o r i n g a p p r o x i m a t e l y 7 p o u n d s a n d t h a t i t t o o k a p p r o x i m a t e l y n t s a y s t h a t h e a s k s a n y o n e c o m i n g t o h i s h o u s e t o b r i n g n a b i s d a i l y t o c o n t r o l t h e p a i n . T h e a p p e l l a n t s a y s t h a t h e
d o e s n o t s e e t h e P h y s i c i a n v e r y o ft e n b e c a u s e t i s n o t m u c h t h e P h y s i c i a n c a n d o f o r h i m . 3 . D o c u m e n t t i t l e d P W D e l i g i b i l i t y c r i t e r i a : J u d i c i a l R t h e a p p e l l a n t ' s a d v o c a t e a n d c o n t a i n i n g i n f o r m a A p p e a l T r i b u n a l , 2 0 0 9 B C S C 1 4 6 1 ( " H u ds o n " ) . A t t h e h e a r i n g t h e a p p e l l a n t d e s c r i b e d t h a t t h e p a i n i n h i s b o d y t h a t i n c r e a s e s w i t h m o v e m e n t . T h e a p p e l l a n t s t a t e c a n n o t h o l d m o r e t h a n 2 -3 p o u n d s , c a n n o t h o l d h i s a r m s s u r g e r y . H e h a s t r i e d a b r a c e b u t t h a t d i d n o t p r o v i d e m u p a i n c o n t r o l a n d h a s t o d o w h a t a c t i v i t i e s h e c a n w i t h o n e t w o h a n d l e s a n d h a s b r o k e n n u m e r o u s g l a s s e s . T h e a p i s a p r i s o n . A t t h e h e a r i n g , t h e a p p e l l a n t ' s a d v o c a t e r e v i e w e d t h e S u a n d l i m i t a t i o n s a r e s u ff i c i e n t t o d e m o n s t r a t e t h a t t h e a p p H u d s o n . A d m i s s i b i l i t y o f N e w I n f o r m a t i o n T h e m i n i s t r y d i d n o t o b j e c t t o t h e a p p e l l a n t ' s n e w i n f o r m a t e s t i m o n y , t h e M e d i c a l D o c u m e n t , a n d t h e A p p e a l S t a t e m 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 m i n i s t ry a t 2 2 ( 4 ) o f t h e E m p l o y m e n t a n d A s s i s t a n c e A c t . I n p a r t i c u l i n f o r m a t i o n r e g a r d i n g h i s p h y s i c a l c o n d i t i o n , p a i n a n d a b T h e p a n e l h a s a c c e p t e d t h e i n f o r m a t i o n i n t h e N o t i c e o f A t h e E l i g i b i l i t y E x c e r p t a s a r g u m e n t . w o s p e c i a l i s t s h a v e t o l d h i m t h e y c a n n o t o p e r a t e a n d t h e r e e v i e w s e t s s t a n d a r d s ( E l i g i b i l i t y E x c e r p t ) c o m p l e t e d b y t i o n r e g a r d i n g H u d s o n v E m p l o y m e n t a n d A s s i s t a n c e l e f t s h o u l d e r i s l i k e h a v i n g a h e a d a c h e i n t h a t p a rt o f h i s d t h a t h e i s r i g h t h a n d e d b u t t h a t w i t h h i s l e ft h a n d h e s t r a i g h t o u t a n d t u r n t h e m a n d t h a t h i s h a s n o o p t i o n s f o r c h r e l i e f . T h e a p p e l l a n t s a y s t h a t h e u s e s c a n n a b i s f o r h a n d . T h e a p p e l l a n t s a y s t h a t h e c a n n o t h o l d a p o t w i t h p e l l a n t s a y s t h a t h e i s d e p r e s s e d a n d f e e l s l i k e h i s h o u s e b m i s s i o n a n d a r g u e d t h a t t h e n u m b e r o f e p i s o d e s o f p a i n e l l a n t 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 a s s e t o u t i n t i o n . T h e p a n e l h a s a d m i t t e d t h e a p p e l l a n t ' s o r a l e n t i n t o e v i d e n c e a s i t i s e v i d e n c e i n s u p p o r t o f t h e t i m e o f r e c o n s i d e r a t i o n , i n a c c o r d a n c e w i t h s e c t i o n a r , t h e n e w i n fo r m a t i o n s u p p o rt s t h e a p p e l l a n t ' s i l i t y t o p e r f o r m D L A . p p e a l , t h e a d v o c a t e ' s o r a l a r g u m e n t , t h e S u b m i s s i o n , a n d A T T A C H E X T RA P A G E S I F N E C E S S A R Y
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 I s s u e o n A p p e a l 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 r y ' 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 d e s i g n a t i o n a s a P W D w a s r e a s o n a b l y s u p p o r t e d b y t h e e v i d e n c e o r w a s a r e a s o n a b l e a p p l i c a t i o n o f t h e a p p l i c a b l e e n a c t m e n t i n t h e c i r c u m s t a n c e s o f t h e a p p e l l a n t . I n p a r t i c u l a r , w a s t h e m i n i s t ry r e a s o n a b l e w h e n c o n c l u d i n g i i w a s n o t s a t i s f i e d t h a t : a s e v e r e p h y s i c a l o r m e n t a l i m p a i r m e n t w a s e s t a b l i s h e d ; t h e a p p e l l a n t ' s d a i l y l i v i n g a c t i v i t i e s ( D L A ) a r e , 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 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 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 t h o s e r e s t r i c t i o n s , i n t h e o p i n i o n o f a p r e s c r i b e d p r o f e s s i o n a l , t h e a p p e l l a n t r e q u i r e s h e l p , a s i i i s d e f i n e d i n t h e l e g i s l a t i o n , t o p e rf o r m D L A ? R e l e v a n t L e g i s l a ti 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 rf o r m a d a i l y l i v i n g a c t i v i t y t h a t , b e c a u s e o f a 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 fo 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 r f 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 i 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 rv 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 r v i c e s o f a n a s s i s t a n c e a n i m a l . ( 4 ) T h e m i n i s t e r m a y r e s c i n d a d e s i g n a t i o n u n d e r s u b s e c t i o 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 fo l l o w i n g a c t i v i t i e s : ( i ) n r e o 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 fi 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 rt 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 fi 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 ff e c t i v e l y . ( 2 ) F o r t h e p u r p o s e s o f t h e A c t , " p r e s c r i b e d p r o f e s s i o n a l " m e a n s a p e r s o n w h o i s ( a ) a u t h o r i z e d u n d e r a n e n a c t m e n t t o p r a c t i c e t h e p r o f e s s i o n o f ( i ) m e d i c a l p r a c t i t i o n e r , ( i i ) r e g i s t e r e d p s y c h o l o g i s t , ( i i i ) r e g i s t e r e d n u r s e o r r e g i s t e r e d p s y c h i a t r i c n u r s e , ( i v ) o c c u p a t i o n a l t h e r a p i s t , ( v ) p h y s i c a l t h e r a p i s t , ( v i ) s o c i a l w o r k e r , ( v i i ) c h i r o p r a c t o r , o r ( v i i i ) n u r s e p r a ct i t i o n e r , o r ( b ) a c t i n g i n t h e c o u r s e o f t h e p e r s o n ' s e m p l o y m e n t a s a s c h o o l p s y c h o l o g i s t b y ( i ) a n a u t h o r i t y , a s t h a t t e r m i s d e fi n e d i n s e c t i o n 1 ( 1 ) o f t h e I n d e p e n d e n t S c h o o l A c t , o r ( i i ) a b o a r d o r a f r a n c o p h o n e e d u c a t i o n a u t h o r i t y , a s t h o s e t e r m s a r e d e fi n e d i n s e c t i o n 1 ( 1 ) o f t h e S c h o o l A c t , i f q u a l i fi c a t i o n s i n p s y c h o l o g y a r e a c o n d i t i o n o f s u c h e m p l o y m e n t . ( 3 ) T h e d e fi n i t i o n o f " p a r e n t" i n s e c t i o n 1 ( 1 ) a p p l i e s fo r t h e p u r p o s e s o f t h e d e fi n i t i o n o f " d e p e n d e n t c h i l d " i n s e c t i o n 1 ( 1 ) o f t h e A c t . P a n e l D e c i s i o n S e v e rit y o f I m p a i r m e n t T h e l e g i s l a t i o n p r o v i d e s t h a t t h e d e t e r m i n a t i o n o f s e v e r i t y o f a n i m p a i r m e n t i s a t t h e d i s c r e t i o n o f t h e m i n i s t e r , t a k i n g i n t o a c c o u n t a l l o f t h e e v i d e n c e i n c l u d i n g t h a t o f t h e a p p e l l a n t . H o w e v e r , t h e l e g i s l a t i o n i s a l s o c l e a r t h a t t h e f u n d a m e n t a l b a s i s f o r t h e a n a l y s i s i s t h e e v i d e n c e f r o m a p r e s c r i b e d p r o f e s s i o n a l r e s p e c t i n g t h e n a t u r e o f t h e i m p a i r m e n t a n d i t s i m p a c t o n d a i l y f u n c t i o n i n g . W h i l e t h e l e g i s l a t i o n d o e s n o t d e f i n e " i m p a i r m e n t " , t h e M R a n d A R d e f i n e " i m p a i r m e n t " a s a " l o s s o r a b n o r m a l i t y o f p s y c h o l o g i c a l , a n a t o m i c a l o r p h y s i o l o g i c a l s t r u c t u r e o r f u n c t i o n i n g c a u s i n g a r e s t r i c t i o n i n t h e a b i l i t y t o f u n c t i o n i n d e p e n d e n t l y , e f f e c t i v e l y , a p p r o p r i a t e l y o r f o r a r e a s o n a b l e d u r a t i o n . " W h i l e t h i s i s n o t a l e g i s l a t i v e d e f i n i t i o n , a n d i s t h e r e f o r e n o t b i n d i n g o n t h e p a n e l , i t r e f l e c t s t h e l e g i s l a t i v e i n t e n t a n d p r o v i d e s a n a p p r o p r i a t e a n a l y t i c a l f r a m e w o r k f o r a s s e s s i n g t h e d e g r e e o f i m p a i r m e n t r e s u l t i n g f r o m a m e d i c a l c o n d i t i o n . W h e n c o n s i d e r i n g t h e e v i d e n c e p r o v i d e d r e s p e c t i n g t h e s e v e r i t y o f i m p a i r m e n t , t h e m i n i s t r y m u s t e x e r c i s e i t s d e c i s i o n m a k i n g d i s c r e t i o n r e a s o n a b l y b y w e i g h i n g a n d a s s e s s i n g a l l o f t h e r e l e v a n t e v i d e n c e .
Severe Physical Impairment The ministry's position is that a diagnosis of a serious medical condition does not in itself determine PWD eligibility or establish a severe impairment and that the information provided does not establish a severe physical impairment. In particular, the reconsideration decision indicates that the functional skills reported by the Physician in the MR with respect to walking unaided, climbing stairs unaided, and no limitation in the duration that the appellant can remain seated are not indicative of a severe physical impairment, particularly as there are no reported restrictions with the appellant's right arm. The reconsideration decision indicates that although the appellant reports that he "tweaks" his left arm one or more times a day and needs to recovery from the intense pain he feels, requiring a rest from 1/2 hour to½ day makes it difficult to determine how often, and for how long, the appellant typically experiences severe pain requiring recovery. The ministry's position is that while the appellant has restrictions when lifting and carrying and holding items with his left arm, a severe impairment to his physical functioning has not been established on the basis that the appellant can complete all aspects of his mobility and the remainder of his physical abilities independently. The appellant's position is that he has a severe physical impairment in his left arm/hand with chronic, unbearable pain. The appellant argues that the evidence provided is sufficient to establish his eligibility for PWD designation. Relying on Hudson, the appellant argues, through his advocate, that as the EAPWDA and EAPWDR do not define the term "severe", any ambiguity with respect to the interpretation of the term "severe" must be resolved in favour of the appellant. The panel notes that although the Physician indicates that the appellant is unable to work, employability is not a criterion for designation of PWD. The panel finds that the ministry was not reasonable in determining that the information provided does not establish that the appellant has a severe physical impairment. In the MR, the Physician indicates that the appellant has chronic derangement left arm from a biceps rupture and chronic left shoulder/upper arm pain. The Physician describes the appellant's condition as a "severe shoulder injury and chronic pain", and notes that the appellant has seen two orthopaedic surgeons and there are no surgical options. While the Physician indicates in the MR, that the appellant can walk 4+ blocks unaided on a flat surface, can climb 2 to 5 steps unaided, and is not limited with respect to his seating duration, the Physician indicates that the appellant is unable to lift with his left arm. Similarly, in the AR, the Physician indicates that the appellant is independent with walking indoors, walking outdoors, climbing stairs and standing but cannot use his left arm due to pain and weakness and requires continuous assistance from another person with lifting and carrying and holding . Although the MR indicates that the appellant has not been prescribed medications and/or treatments that interfere with his ability to perform DLA, the Appeal Statement and the Medical Document indicate that the appellant has been prescribed medical marijuana, which he relies on to help reduce his pain. Although the Physician does not provide information with respect to any limitations with the appellant's right arm/hand, the panel finds that the ministry did not reasonably consider the level of the appellant's chronic pain in combination with his limitations and significant restrictions with activities requiring both arms/hands. While the ministry's position is that it is difficult to determine the appellant's required periods of recovery after his shoulder/arm pain is aggravated, the appellant's information, as supported by the Physician is clear that he has episodes of increased shoulder pain one to four times per day that require at least one hour after each episode to recover. In addition, in the Physician Statement, the Physician confirms that the restrictions and limitations reported by the appellant are reasonable given his condition. In the AR, the Physician indicates that the appellant takes significantly longer than typical (2-3x longer) with many aspects of personal care and meals, and that he cannot do laundry or housekeeping and requires continuous assistance with these tasks. The Physician also explains that the pain and weakness in the appellant's left arm limits the a ellant's h sical activities and that he is ve limited with liftin and car in . Althou h the a ellant is
independent in several areas of mobility and physical ability, the panel finds that the ministry was not reasonable in determining that the restrictions to the appellant's left shoulder/arm and resulting chronic pain were not sufficient to establish a severe physical impairment. Taking all of the evidence into account, the panel finds that the ministry was not reasonable in determining that the appellant does not have a severe physical impairment. Severe Mental Impairment The ministry's position is that while the Letter indicates that the appellant has chronic depression, the Physician did not, in the MR, provide a mental health diagnosis giving rise to the appellant's impairment. The ministry's position is that in the MR, the Physician indicates only one significant deficit to the appellant's cognitive and emotional function related to emotional disturbance and in the AR, the Physician indicates major impact to DLA in the areas of emotion (depression) and motivation and one moderate impact in the area of bodily functions (sleep disturbance) due to pain. The ministry's position is that all other areas of cognitive and emotional functioning are reported to not be impacted by his impairment including, but not limited to, impulse control, insight and judgment, attention/concentration, executive, and memory. The ministry also indicates that despite the deficit and impacts noted in the AR, the Physician also indicates that the appellant remains independent in his DLA including making decisions about personal activities, care or finances, and the ability to communicate or interact with others effectively. The appellant's position is that he has chronic depression and severe pain that impacts his emotions and motivation. The appellant's position is that he is limited and does not socialize or go out much because of his high levels of pain. The appellant says that he feels like his house is a prison. Although the MR did not provide a diagnosis of a mental impairment, the Letter confirms the diagnosis of chronic depression. Although the Physician in the MR did not check off the box indicating that the appellant has significant deficits with cognitive and emotional function, the Physician did indicate that the appellant has deficits with emotional disturbance related to injury and chronic pain. Further, in the AR, the Physician indicates major impact in the areas of emotion and motivation and moderate impact to bodily functions. While there are several areas where there is no impact including consciousness, impulse control, insight and judgment, attention/concentration, executive, memory, motor activity, language, psychotic symptoms, other neuropsychological problems and other emotional or mental problems, the panel finds that the ministry was not reasonable in determining that the inf o rmation provided does not establish a severe mental impairment. Although there are only two areas of major impact and one area of moderate impact noted in the AR, the EAPWD legislation does not require that a certain number of areas of major impact must exist before a severe impairment is found. When the information from the appellant and the Physician is read together as a whole the panel finds that the ministry did not reasonably consider all the information. In particular, the reconsideration decision indicates that the appellant is independent in his ability to communicate and interact with others effectively and while that is accurate it fails to consider the impact of the appellant's mental impairment as the Physician confirms that he has marginal functioning with respect to his immediate and extended social networks. Based on the above, the panel finds that the ministry was not reasonable in determining that the information provided does not establish that the appellant has a severe mental impairment. Restrictions in the ability to perform DLA Section 2(2)(b)(i) of the EAPWDA requires that the minister be satisfied that in the opinion of a prescribed professional, a severe mental or physical impairment directly and significantly restricts the appellant's ability to perform DLA either continuously or periodically for extended periods. While other evidence may be considered f o r clarification or support, the ministry's determination as to whether or not it is satisfied that the legislative criteria are met, is dependent upon the evidence from prescribed professionals. The term "directly" means that there must be a causal link between the severe im airmen! and the restriction. The direct restriction must also be si nificant.
Finally, there is a component related to time or duration - the direct and significant restriction may be either continuous or periodic. If periodic, it must be for extended periods. Inherently, any analysis of periodicity must also include consideration of how frequently the activity is restricted. All other things being equal, a restriction that only 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 of the duration and frequency of the restriction in order to be "satisfied" that this l egislative criterion is met DLA are defined in section 2(1) of the EAPWDR and are listed in both the MR and the AR sections of the PW application with the opportunity for the prescribed professional to check marked boxes and provide additional narrative. DLA, as defined in the legislation, does not include the ability to work. The ministry's position is that the information provided is not sufficient to establish that the appellant has a severe impairment that, in the opinion of a prescribed professional, directly and significantly restricts the appellant's ability to perform DLA. In particular, the reconsideration decision indicates that although the AR indicates that the appellant takes longer than typical to complete aspects of personal care, carrying purchases home from shopping, food preparation, the ministry's position is that 2-3 times longer than typical to complete these activities does not establish a significant restriction in these areas. The ministry's position is that although the Physician indicates that t he appellant requires continuous assistance with basic housekeeping, laundry, food preparation and cooking, when this information is considered within the context of the entire application, it is not clear that the appellant requires continuous assistance with all elements of these activities, as the appellant indicates that he is able to complete activities which do not require the use of both arms. The reconsideration decision notes that the appellant says that he is able to make simple meals in the kitchen without assistance or complete the laundry one item at a time, and although that may take 2-3 times longer, the ministry does not consider that to confirm a significant degree of restriction. The ministry's position is that while it is acknowledged that the appellant does require assistance with tasks requiring the use of both hands, it has not been established that the appellant is significantly restricted in his overall ability to complete DLA without assistance. The reconsideration decision says that although the Physician indicates that the appellant has marginal social functioning with his immediate and extended social networks, he is independent in all areas of social functioning, so the ministry's position is that based on the evidence, it cannot be established that the appellant is significantly restricted in his social functioning activities. The appellant's position is that relying on the Hudson decision, he must demonstrate that his impairments directly and significantly restrict his ability to perform at least two DLA The appellant's position is that the evidence demonstrates that he experiences continuous, significant restrictions in the areas of mobility (lifting/carrying), personal care, meal preparation, housework, shopping and making decisions about personal activities, care or finances. The panel finds that the ministry was not reasonable in determining that the assessments provided are not indicative of a severe level of impairment that directly and significantly restricts the appellant's DLA either continuously or periodically for extended periods as required by EAPWDA section 2(2)(b). In the reconsideration decision, the ministry notes that the Physician did not complete the DLA page of the MR. The ministry notes that while this information is not required, it can be useful in determining restrictions to the appell ant's DLA The panel notes, however, that the instructions in Section 2 - Medical Report, Part E - DLA state the following: "Note: If you are complete the Assessor Report - Section 3, in addition to this Medical Report, do not complete this page (Part E)". The panel finds that it is not reasonable for the ministry to indicate that it would have been useful for the Physician to complete that page, when the application instructions clearly tell him not to do so. While the reconsideration decision indicates that the informat ion does not establish that the appellant requires continuous assistance with all elements of basic housekeeping, laundry, food preparation, and cooking, the EAPWD legislation does not require that continuous assistance is required with all aspects of each DLA EAPWDA section 2(2l(bl(i) reauires that the annellant must Provide information from a Prescribed Professional demonstratina
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 t o h i s a b i l i t y t o p e r f o r m p e r i o d s . T h e i n f o r m a t i o n p r o v i d e d i n d i c a t e s t h a t t h e a p p h o u s e k e e p i n g , 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 a n d t h a t h e w i t h d r e s s i n g , g r o o m i n g , b a t h i n g , f e e d i n g s e l f , r e g u l a t i n g c o o k i n g . T h e i n f o r m a t i o n p r o v i d e d b y t h e a p p e l l a n t a n d s u p p o rt f o r t h e a p p e l l a n t ' s r e p o r t e d r e s t r i c t i o n s a n d l i m i t a A l t h o u g h t h e a p p e l l a n t s a y s t h a t h e c a n m a k e s o m e s i m 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 w a s u n r e a s o n a b l e i n d e t e r m o f E A P W D A s e c t i o n 2 ( 2 ) ( b ) ( i ) w e r e n o t m e t . A l t h o u g h t h e e x p l a i n s t h a t i t t a k e s h i m 4 5 m i n u t e s t o p r e p a r e a s i m p l e p u t t i n g o n j e a n s i s l i k e " h a r d l a b o u r " , a n d t h a t h e c a n n o t w h e n t h e e v i d e n c e i s r e a d t o g e t h e r a s a w h o l e a n d a n y a m i n i s t r y w a s n o t r e a s o n a b l e i n d e t e r m i n i n g t h a t t h e l e g i s H e l p t o p e rf o r m D L A S e c t i o n 2 ( 2 ) ( b ) ( i i ) o f t h e E A P W D A r e q u i r e s t h a t , a s a r e s p e rf o r m D L A , a p e r s o n r e q u i r e s h e l p t o p e rf o r m t h o s e a c r e q u i r e m e n t f o r a n a s s i s t i v e d e v i c e , t h e s i g n i f i c a n t h e l p o a s s i s t a n c e a n i m a l i n o r d e r t o p e r f o r m D L A . T h e r e c o n s i d e r a t i o n d e c i s i o n n o t e s t h a t t h e P h y s i c i a n i n d r o o m m a t e f o r c h o r e s a n d f i r e w o o d . H o w e v e r , t h e m i n i s t 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 d e t e r m i T h e a p p e l l a n t ' s p o s i t i o n i s t h a t h e r e q u i r e s h e l p f r o m h i s t h a n t y p i c a l t o p e rf o r m s o m e D L A a n d t h a t h e i s u n a b l e t c a r r y a n y i t e m s t h a t r e q u i r e t w o h a n d s . I n t h e A p p e a l S t u n w e l l a n d i s u n a b l e t o h e l p s o h e i s n o t a b l e t o r e l y o n h u s i n g a b r a c e f o r h i s l e ft s h o u l d e r / a r m b u t i t d i d n o t p r o v i h e r e q u i r e s h e l p w i t h s w e e p i n g , m o p p i n g , h e a v y l i ft i n g , b c l e a n i n g t h e b a t h t u b , a n d c a r ry i n g p u r c h a s e s h o m e . I n t h e M R , t h e P h y s i c i a n i n d i c a t e s t h a t t h e a p p e l l a n t d o e I n t h e A R , t h e P h y s i c i a n c o m m e n t s t h a t t h e a p p e l l a n t n e a l s o i n d i c a t e s t h a t t h e a p p e l l a n t r e q u i r e s c o n t i n u o u s a s s p r e p a r a t i o n a n d c o o k i n g a n d p e r i o d i c a s s i s t a n c e w i t h c a i n c l u d e d t h e f a c t t h a t t h e r e w e r e n o s u r g i c a l r e m e d i e s a v A 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 w a s u n r e a s o n a b l e i n i m p a i r m e n t t h a t d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t s h i s a b i l f o r a n e x t e n d e d p e r i o d o f t i m e , t h e n e c e s s a r y p r e c o n d i t i o A s 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 o f t h e P h y s i c i a n c o n D L A , 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 d e c i s i o n t h a t t h e s e c t i o n 2 ( 3 ) ( b ) w a s n o t r e a s o n a b l e . C o n c l u s i o n H a v i n g r e v i e w e d a n d c o n s i d e r e d a l l o f t h e e v i d e n c e a n d d e c i s i o n f i n d i n g t h e a p p e l l a n t i n e l i g i b l e f o r P W D d e s i g n 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 m i n i s ! ' s d e c i s i o n a n d t h e a e l l a n t i s s u c c e s s f u l i n h i s D L A e i t h e r c o n t i n u o u s l y o r p e r i o d i c a l l y f o r e x t e n d e d 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 l a u n d r y , b a s i c t a k e s s i g n i f i c a n t l y l o n g e r t h a n t y p i c a l ( 2 -3 t i m e s l o n g e r ) d i e t , c a r r y i n g p u r c h a s e s h o m e , m e a l p l a n n i n g , a n d t h e P h y s i c i a n i s c o n s i s t e n t a n d t h e P h y s i c i a n i n d i c a t e s h i s t i o n s . p l e m e a l s a n d f o l d s o m e l a u n d r y o n e i t e m a t a t i m e , t h e i n i n g t h a t t h i s s t a t e m e n t m e a n s t h a t t h e l e g i s l a t i v e c r i t e r i a a p p e l l a n t s a y s t h a t h e c a n m a k e s i m p l e m e a l s , h e a l s o b r e a k f a s t o r a s i m p l e l u n c h . T h e a p p e l l a n t s a y s t h a t m o p , s w e e p , o r l i f t a n y h e a v y i t e m s . T h e p a n e l f i n d s t h a t m b i g u i t y r e s o l v e d i n f a v o u r o f t h e a p p e l l a n t , t h a t t h e l a t i v e c r i t e r i a o f E A P W D A s e c t i o n 2 ( 2 ) ( b ) w a s n o t m e t . u l t o f d i r e c t a n d s i g n i fi c a n t re s t r i c tio n s i n t h e a b i l i t y t o t i v i t i e s . H e l p i s d e f i n e d i n s u b s e c t i o n ( 3 ) a s t h e r s u p e rv 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 i c a t e s t h a t t h e a p p e l l a n t r e c e i v e s a s s i s t a n c e f r o m h i s 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 s t a b l i s h e d n e d t h a t h e l p i s r e q u i r e d . r o o m m a t e a n d f r i e n d s b e c a u s e i t t a k e s h i m m u c h l o n g e r o l i ft a n d c a r r y i t e m s m o r e t h a n 2 o r 3 p o u n d s a n d c a n n o t a t e m e n t t h e a p p e l l a n t s a y s t h a t h i s r o o m m a t e i s n o w i s r o o m m a t e f o r h e l p . T h e a p p e l l a n t s a y s t h a t h e h a s t r i e d d e m u c h a s s i s t a n c e o r p a i n r e l i e f . T h e a p p e l l a n t s a y s t h a t r i n g i n g i n f i r e w o o d , l i ft i n g p o t s o r p a n s w i t h t w o h a n d l e s , s n o t r e q u i r e a n y p r o s t h e s e s o r a i d s f o r h i s i m p a i r m e n t . e d s h e l p f r o m h i s r o o m m a t e a n d f r i e n d s . T h e P h y s i c i a n i s t a n c e w i t h D L A o f l a u n d ry , b a s i c h o u s e k e e p i n g , f o o d r r y i n g p u r c h a s e s h o m e . T h e P h y s i c i a n ' s e v i d e n c e a i l a b l e t o t h e a p p e l l a n t . d e t e r m i n i n g t h a t t h e a p p e l l a n t d o e s n o t h a v e a s e v e r e i t y t o m a n a g e h i s D L A e i t h e r c o n t i n u o u s l y o r p e r i o d i c a l l y n i s s a t i s f i e d . f i r m s t h a t t h e a p p e l l a n t r e q u i r e s s i g n i f i c a n t h e l p t o p e r f o r m a p p e l l a n t d i d n o t s a t i s f y t h e l e g i s l a t i v e c r i t e r i a o f E A P W D A t h e r e l e v a n t l e g i s l a t i o n , t h e p a n e l f i n d s t h a t t h e m i n i s t r y ' s t i o n i s n o t r e a s o n a b l e b a s e d o n t h e e v i d e n c e a n d i s n o t a c e s o f t h e a p p e l l a n t . T h e p a n e l t h e r e f o r e r e s c i n d s t h e a e a L
I PART G -ORDER THE PANEL DECISION IS: (Check one) 12'.]UNANIMOUS BY MAJORITY THE PANEL CONFIRMS THE MINISTRY DECISION 12'.JRESCINDS THE MINISTRY DECISION If the ministry decision is rescinded, is the panel decision referred back to the Minister for a decision as to amount? Yes No LEGISLATIVE AUTHORITY FOR THE DECISION: Employment and Assistance Act Section 24(1 )(a) 12'.:l or Section 24{1 )(b) 12'.:l and Section 24(2)(a) D or Section 24(2)(b) 12'.:l PART H -SIGNATURES PRINT NAME Helene Walford SIGNATURE OF CHAIR DATE (YEAR/MONTH/DAY) 2018/12/18 ,._.,,_ LJ.--# PRINT NAME Wendy Marten SIGNATURE OF MEMBER DATE {YEAR/MONTH/DAY) 2018/12/18 rf PRINT NAME William Reid /!/2' '.lj DATE (YEAR/MONTH/DAY) SIGNATURE OF MEMBER w vff &:.-'f , '\. }�< 2018/12/18
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