P A R T C D E C I S I O N U N D E R A P P E A L T h e d e c i s i o n u n d e r a p p e a l i s t h e M i n i s t ry o f S o c i a l D e v e r e c o n s i d e r a t i o n d e c i s i o n o f N o v e m b e r 1 4 , 2 0 1 8 , w h i c h f r e q u i r e m e n t s o f s e c t i o n 2 o f t h e E m p l o y m e n t a n d A s s i s t d e s i g n a t i o n a s a p e r s o n w i t h d i s a b i l i t i e s ( " P W D " ) . T h e m r e q u i r e m e n t , t h a t i n t h e o p i n i o n o f a m e d i c a l p r a c t i t i o n l e a s t t w o y e a r s , a n d t h a t t h e a p p e l l a n t h a s a s e v e r e i m p • 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 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 • a s a r e s u l t o f t h o s e r e s t r i c t i o n s , t h e a p p e l l a n t r p e r s o n , a n a s s i s t i v e d e v i c e , o r t h e s e r v i c e s o f a n P A R T D R E L E V A N T L E G I S L A T I O N E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b i l i t i e s E m p l o y m e n t a n d A s s i s t a n c e f o r P e r s o n s w i t h D i s a b i l i t i e s l o p m e n t a n d P o v e r t y R e d u c t i o n ( t h e " m i n i s t r y " ) o u n d t h a t t h e a p p e l l a n t d i d n o t m e e t t w o o f f i v e s t a t u t o r y a n c e f o r P e r s o n s W i t h D i s a b i l i t i e s A c t ( " E A P W D A " ) f o r i n i s t r y f o u n d t h a t t h e a p p e l l a n t m e t t h e a g e e r t h e a p p e l l a n t ' s i m p a i r m e n t i s l i k e l y t o c o n t i n u e f o r a t a i r m e n t . H o w e v e r , t h e m i n i s t ry w a s n o t s a t i s f i e d t h a 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 r i o d i c a l l y fo r e x t e n d e d p e r i o d s ; a n d e q u i r e s t h e s i g n i f i c a n t h e l p o r s u p e r v i s i o n o f a n o t h e r a s s i s t a n c e a n i m a l . A c t ( " E A P W D A " ) , s e c t i o n 2 R e g u l a t i o n ( " E A P W D R " ) , s e c t i o n 2
P A R T E S U M M A R Y O F F A C T S T h e i n f o r m a t i o n b e f o r e t h e m i n i s t r y a t t h e t i m e o f r e c o n • 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 f o r m c o n s i s t i n m e d i c a l r e p o r t ( " M R " ) c o m p l e t e d b y a g e n e r a l p a s s e s s o r' s r e p o rt ( " A R " ) a l s o c o m p l e t e d b y t h e p b a s e d h i s r e p o r t s o n a n o ff i c e i n t e rv i e w w i t h t h • T h e m i n i s t r y ' s D e n i a l D e c i s i o n S u m m a ry d a t e d O • 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 f o r m d a t e d N o v e a d d r e s s e d " T o W h o m I t M a y C o n c e r n " ( t h e " N o f r o m t h e A R w h i c h h a d b e e n r e v i s e d b y t h e p h y • A c o p y o f t h e a p p e l l a n t ' s t e m p o r a r y d r i v e r ' s l i c e • P r o g r e s s n o t e s f r o m a m e d i c a l c l i n i c f r o m J a n u a • A " s e rv i c e s c e r t i f i c a t e " f r o m a n i n s u r a n c e c o m p a p p e l l a n t h a s a d i a g n o s i s o f m a j o r d e p r e s s i o n . • A l e t t e r t o t h e a p p e l l a n t f r o m a w o r k r e l a t e d i n s t h e a p p e l l a n t h a d i n c u r r e d a p s y c h o l o g i c a l c o n d p a i n a c c e p t e d o n h e r c l a i m . • A l e t t e r t o t h e a p p e l l a n t f r o m t h e w o r k r e l a t e d i n d i c a t i n g h e r c h r o n i c l o w b a c k p a i n i s c o n s i d e r e • T h r e e p a g e s o f f o r m s s h o w i n g t h e a p p e l l a n t ' s a b I n h e r 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 d e c i s i o n c o n c e r n i n g D L A , n o t i n g t h e m i n i s t ry " i s e x p e c t i f o r m s . " T h e a p p e l l a n t a t t a c h e d a w r i t t e n s t a t e m e n t d a t c o m p l e t e d a n d s i g n e d b y t h e p h y s i c i a n ( " S e c t i o n 2 E " ) ( t t h e o r i g i n a l a p p l i c a t i o n a s d o i n g s o w a s u n n e c e s s a r y i f h 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 i n p e r s o n a l c a r e h o m e , a n d u s e o f t r a n s p o r t a t i o n ; p e r i o d i c a l l y r e s t r i c t e d r e s t r i c t e d i n m a n a g e m e n t o f f i n a n c e s . W i t h r e s p e c t t o t w a x e s a n d w a n e s . " T h e p h y s i c i a n a l s o i n d i c a t e s a r e s t r i c e m o t i o n a l + p h y s i c a l f a t i g u e a n d s o c i a l l y w i t h d r a w " , b u t o r p e r i o d i c . T h e p h y s i c i a n d o e s n o t p r o v i d e a n y f u r t h e r f r e q u e n c y o r 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 h e d e g r e p r o v i d e d . T h e a p p e l l a n t n o t e d t h e p h y s i c i a n d i d n o t a n s i t . S h e e x p l a i n e d t h a t s h e u s e s a c a n e t o w a l k a n y d i s t a n h e r w i t h t h e s t a b i l i t y t h a t s h e n e e d s . S h e a l s o r e l i e s o n h g r o c e r y b a g s a n d l a u n d r y , c o o k m e a l s t h a t a r e n o t p r e p i n a c a r w h e n s h e c a n s h i f t p o s i t i o n ) , a n d d o v a c u u m i n g l e a n o v e r . S h e s t a t e s t h a t i f h e r d a u g h t e r i s n o t a v a i l a b l e A t t h e h e a r i n g , t h e a p p e l l a n t d e s c r i b e d t h a t s h e h a s s e v a c c i d e n t i n 2 0 1 3 . W i t h r e s p e c t t o t h e r e a s o n a b l e n e s s o f i g n o r e h e r s u b m i s s i o n s , o n l y r e l y i n g o n w h a t h e r d o c t o r u s e s a c a n e . S h e s u b m i t t e d t h a t i t i s n o t r e a s o n a b l e t h a t f r o m a l l t h e d i s a b i l i t i e s s h e s u f f e r s . H e r a d u l t d a u g h t e r m a p p e l l a n t ' s p e r s o n a l i t y d u e t o h e r d i s a b i l i t i e s , s a y i n g t h a I s i d e r a t i o n i n c l u d e d t h e f o l l o w i n g : g o f t h e a p p e l l a n t ' s s e l f r e p o r t f o r m d a t e d J u l y 3 1 , 2 0 1 8 ; a r a c t i t i o n e r ( t h e " p h y s i c i a n " ) o n J u l y 2 6 , 2 0 1 8 ; a n d a n h y s i c i a n o n J u l y 2 6 , 2 0 1 8 . T h e p h y s i c i a n i n d i c a t e d t h a t h e e a p p e l l a n t . c t o b e r 1 1 , 2 0 1 8 . m b e r 6 , 2 0 1 8 , i n c l u d i n g a s t a t e m e n t f r o m t h e a p p e l l a n t v . 6 S e l f R e p o r t " ) . T h e a p p e l l a n t a l s o a t t a c h e d t w o p a g e s s i c i a n ; n c e i s s u e d J u l y 2 4 , 2 0 1 8 . r y 2 0 1 8 t o J u n e 2 0 1 8 . a n y s i g n e d b y t h e p h y s i c i a n a n d i n d i c a t i n g t h a t t h e u r a n c e c l a i m c o m p a n y , d a t e d M a y 1 8 , 2 0 1 7 , c o n f i r m i n g i t i o n a s a c o n s e q u e n c e o f t h e p e r m a n e n t c h r o n i c b a c k i n s u r a n c e c l a i m c o m p a n y , d a t e d A u g u s t 2 2 , 2 0 1 8 , d p e r m a n e n t e f f e c t i v e M a r c h 9 , 2 0 1 8 . s e n c e s f r o m w o r k a n d n o t i n g r e a s o n s f o r a b s e n c e s . p p e l l a n t s t a t e d t h a t s h e d i s a g r e e d w i t h t h e m i n i s t r y ' s n g m o r e a n s w e r s t h e n j u s t t h e a n s w e r s a s k e d o n t h e e d N o v e m b e r 1 9 , 2 0 1 8 , a t t a c h i n g S e c t i o n 2 E o f t h e M R h i s s e c t i o n h a d n o t b e e n c o m p l e t e d b y t h e p h y s i c i a n i n e c o m p l e t e d t h e A R ) . I n S e c t i o n 2 E t h e p h y s i c i a n s t a t e s , m e a l p r e p a r a t i o n , d a i l y s h o p p i n g , m o b i l i t y o u t s i d e t h e i n b a s i c h o u s e w o r k a n d m o b i l i t y i n s i d e t h e h o m e ; a n d n o t h e p e r i o d i c r e s t r i c t i o n s , t h e p h y s i c i a n w r i t e s " c o n d i t i o n t i o n t o s o c i a l f u n c t i o n i n g , w r i t i n g " M o o d + p a i n c a u s e s h e d o e s n o t i n d i c a t e i f t h e s o c i a l r e s t r i c t i o n i s c o n t i n u o u s c o m m e n t s o n t h e d e g r e e o f r e s t r i c t i o n s s u c h a s t h e e o f h e r c o n t i n u o u s i m p a i r m e n t s , o r a n y a s s i s t a n c e w e r t h e q u e s t i o n c o n c e r n i n g a s s i s t a n c e , s o s h e a n s w e r e d c e s , a n d u s e s a c a r t w h e n s h o p p i n g a s t h e c a r t p r o v i d e s e r 1 9 y e a r o l d d a u g h t e r t o h e l p h e r l i f t i t e m s s u c h a s a c k a g e d , d r i v e ( a s i t i s l e s s p a i n f u l f o r t h e a p p e l l a n t t o b e a n d c l e a n t h e b a t h r o o m b e c a u s e t h e a p p e l l a n t c a n n o t t o h e l p h e r t h e n t h e s e j o b s d o n o t g e t d o n e . e r a l d i s a b i l i t i e s , m e n t a l a n d p h y s i c a l , o r i g i n a t i n g i n a w o r k t h e m i n i s t ry ' s d e c i s i o n , s h e s a i d t h e m i n i s t r y s e e m e d t o s a i d , a n d t h a t t h e m i n i s t ry d i d n o t a c k n o w l e d g e t h a t s h e t h e m i n i s t r y c o u l d f i n d t h a t h e r D L A w e r e n o t a f f e c t e d o v e d o u t o f t h e h o m e b e c a u s e o f c h a n g e s t o t h e t s h e i s t o o s e n s i t i v e , g e t s a n g r y t o o e a s i l y a n d d e p e n d s
o n h e r d a u g h t e r t o o m u c h . H o w e v e r , s h e e x p l a i n e d t h a t o f t h e c o o k i n g a n d c l e a n i n g . H e r d a u g h t e r c l e a n s t h e t u b t h e c o u n t e r a n d s i n k . H e r d a u g h t e r d o e s t h e v a c u u m i n g d a u g h t e r d o e s n ' t c o o k , t h e a p p e l l a n t e a t s m o s t l y p r e p a r W h e n t h e d a u g h t e r d o e s n ' t c l e a n , t h i n g s d o n ' t g e t d o n e h o u r a t a t i m e , a s s h e n e e d s t o m o v e a r o u n d s o h e r b a c s t a y c l o s e t o h o m e . S h e s a i d h e r a b i l i t y t o d o d a i l y a c t i v i f e w w e e k s a g o s h e w a s t r y i n g t o w o r k b u t s h e i s n o w o n c o n s i s t s o f g e t t i n g u p , h a v i n g c o f f e e , s i t t i n g o n t h e c o u c o n l y d o e s s m a l l l o a d s o f l a u n d r y . S h e n e e d s h e l p w i t h t h a p p e l l a n t c l a r i f i e d t h a t s h e c a n w a l k w i t h o u t a c a n e w i t h l e a n i f s h e n e e d s t o . S h e c a n m a k e i t o u t o f h e r c o n d o b u f o r a w a l k o u t d o o r s w h e r e t h e r e a r e n o p l a c e s t o r e s t s h t h a t s h e c a n w a l k u p / d o w n s t a i r s , b u t t h e r e i s a d a n g e r s o m e t i m e s a c h a l l e n g e d u e t o a n x i e t y ( s h e d e s c r i b e d h o h o m e d u e t o a n x i e t y ) , b u t s h e c a n d o i t i f s h e c a n u s e a c a n l i ft t h e m . S h e l i m i t s h e r s e l f t o a f e w i t e m s a t a t i m e A t t h e h e a r i n g , t h e m i n i s t ry e x p l a i n e d t h a t w h i l e t h e a p p t h a t s h e m e e t s a l l t h e c r i t e r i a f o r P W D d e s i g n a t i o n . I n r e r e p r e s e n t a t i v e e x p l a i n e d t h a t , i n a s s e s s i n g a n a p p l i c a t i o s u b m i t t e d t h a t t h e w r i t t e n e v i d e n c e s t a t e s t h e a p p e l l a n a n s w e r q u e s t i o n s i n t h e M R a n d A R t h a t w o u l d h e l p t o a r e s t r i c t i o n s t o D L A . T h e m i n i s t r y a f f i r m e d t h e i m p o r t a n c t o t h e m i n i s t r y ' s d e c i s i o n . I n r e s p o n s e t o a q u e s t i o n f r o m l e a v e s a p e r s o n u n a b l e t o w a l k m o r e t h a n 1 -2 b l o c k s , s i t s i g n i f i c a n t i m p a c t o n D L A , t h e m i n i s t r y s a i d t h e f r e q u e n r e s t r i c t i o n t o D L A . I n r e s p o n s e t o a n o t h e r q u e s t i o n , w i t h f u n c t i o n i n g m i g h t h a v e t o b e " v e r y d i s r u p t e d " i n o r d e r t A s p e r s e c t i o n 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 d a t e d N o v e m b e r 1 9 , 2 0 1 8 a n d S e c t i o n 2 E o f t h e M R t h a a p p e l l a n t ' s o r a l e v i d e n c e a s b e i n g i n f o r m a t i o n i n s u p p o r a p p l i c a t i o n b e f o r e t h e m i n i s t r y a t r e c o n s i d e r a t i o n . A s t h A R , S e c t i o n 2 E p r o v i d e s a d d i t i o n a l r e s p o n s e s , a n d t h e a i n f o r m a t i o n i n h e r o r i g i n a l s e l f r e p o r t . T h e p a n e l a s s e s s e d t h e e v i d e n c e t h a t w a s b e f o r e t h e m i D i a g n o s e s I n t h e M R t h e p h y s i c i a n d i a g n o s e d t h e a p p e l l a n t w i t h d e a n x i e t y d i s o r d e r , f i b r o m y a l g i a , s l e e p a p n e a , a n d n o n a l c " p r o g r e s s i v e . " H e w r i t e s t h a t t h e m e d i c a l c o n d i t i o n s a r e m u s c u l o s k e l e t a l e f f e c t s ; a n d a r e a f f e c t i n g D L A . H e a l s o n P h y s i c a l I m p a i r m e n tI h e r d a u g h t e r i s n o w l i v i n g w i t h h e r a g a i n a n d d o e s m o s t a n d t o i l e t i n t h e b a t h r o o m b u t t h e a p p e l l a n t c a n m a n a g e a n d a n y t h i n g e l s e i n v o l v i n g b e n d i n g o v e r . W h e n h e r e d m e a l s s o s h e d o e s n ' t h a v e t o l e a n o v e r t h e c o u n t e r . . T h e a p p e l l a n t d o e s d r i v e , b u t i s l i m i t e d t o a b o u t a ½ k d o e s n o t h u r t . A l s o , h e r h i g h a n x i e t y m a k e s h e r w a n t t o t i e s d e p e n d s o n t h e a c t i v i t y a n d h e r s t r e s s l e v e l . U n t i l a m e d i c a l l e a v e a s s h e h a d a p a n i c a t t a c k . H e r t y p i c a l d a y h , a n d t r y i n g t o d o a l i t t l e b i t a t a t i m e . F o r e x a m p l e , s h e i n g s l i k e p u t t i n g u p t h e C h r i s t m a s d e c o r a t i o n s . T h e i n t h e h o u s e , w h e r e s h e k n o w s s h e h a s p l a c e s t o s i t o r i l d i n g t o h e r c a r w i t h o u t u s i n g h e r c a n e , b u t i f s h e g o e s e b r i n g s t h e c a n e o r a v o i d s g o i n g o u t . S h e a l s o c l a r i f i e d o f h e r t r i p p i n g s o s h e u s e s t h e h a n d r a i l i n g . S h o p p i n g i s w s h e h a s s o m e t i m e s h a d t o s t o p s h o p p i n g a n d r e t u r n c a r t a n d d i s t r i b u t e h e r p u r c h a s e s o v e r s e v e r a l b a g s s o s h e t o k e e p t h e l o a d l i g h t e r . e l l a n t h a s a s e v e r e d i s a b i l i t y , t h e e v i d e n c e d i d n o t s h o w s p o n s e t o q u e s t i o n s f r o m t h e a p p e l l a n t , t h e m i n i s t r y n , t h e m i n i s t r y r e l i e s o n w h a t i s w r i t t e n . T h e m i n i s t r y t c a n d o m a n y t h i n g s b y h e r s e l f a n d t h e d o c t o r d i d n o t s s e s s t h e s i g n i f i c a n c e o f t h e a p p e l l a n t ' s i m p a i r m e n t s o n e o f t h e m e d i c a l o p i n i o n ( o v e r t h e a p p e l l a n t ' s s e l f r e p o r t s ) t h e p a n e l c o n c e r n i n g h o w a s e v e r e i m p a i r m e n t t h a t l e s s t h a n 1 h o u r a n d n o t w a l k s t a i r s c o u l d n o t h a v e a c y a n d d u r a t i o n o f n e e d o r s u p p o rt s p e a k s t o d e g r e e o f r e s p e c t t o s o c i a l f u n c t i o n i n g , t h e m i n i s t r y s a i d s o c i a l o b e a s i g n i f i c a n t r e s t r i c t i o n t o D L A . c t , t h e p a n e l a d m i t t e d t h e a p p e l l a n t ' s w r i t t e n s t a t e m e n t t w a s s u b m i t t e d w i t h t h e n o t i c e o f a p p e a l , a s w e l l a s t h e t o f i n f o r m a t i o n t h a t w a s i n t h e a p p e l l a n t ' s P W D e p h y s i c i a n h a s a l r e a d y a n s w e r e d s i m i l a r q u e s t i o n s o n t h e p p e l l a n t ' s o r a l e v i d e n c e p r o v i d e s f u r t h e r d e t a i l s o f n i s t r y a t r e c o n s i d e r a t i o n a s f o l l o w s : g e n e r a t i v e d i s c d i s e a s e , m a j o r d e p r e s s i o n , g e n e r a l o h o l i c s t e a t o h e p a t i t i s . H e r c o n d i t i o n s a r e " i n d e f i n i t e " a n d s y s t e m i c ; c a u s e f a t i g u e , c o g n i t i v e e f f e c t s a n d o t e s t h a t t h e a p p e l l a n t u s e s a c a n e w h e n w a l k i n g .
In the MR the physician states the appellant can walk 1 to 2 blocks unaided, cannot climb any stairs unaided, can lift 5 to 15 lbs, and remain seated less than 1 hour. In the AR the physician indicated that the appellant is independent in walking indoors but takes twice as long, uses an assistive device when walking outdoors, uses handrails for walking up stairs, she is unable to stand for extended lengths of time, and needs periodic assistance with lifting, carrying and holding as her maximum is 5 kg. In the revised pages of the AR submitted at reconsideration, the physician provides the following additional comments: "She has a permanent partial disability according to [worker's insurance company]. She has been restricted by inability to sit, stand extensively, no low level bending, no walking > 14 minutes without walking aid or rest break." In her self report, the appellant describes how she is restricted in standing, sitting, and lifting and "cannot walk very far without either having somewhere to sit down or using a cane for support"; she has poor balance and trips over small obstacles. Her fibromyalgia gives her pain. Mental Impairment In the MR the physician notes there are no difficulties with communication, but then says the cause of difficulties is cognitive. He also notes significant deficits with cognitive and emotional function in the areas of consciousness, executive, memory, emotional disturbance, motivation, and attention or sustained concentration. In the AR the physician reported that the appellant's handwriting has deteriorated but otherwise her ability to communicate is good. With respect to cognitive and emotional functioning, the physician reports no impact to consciousness, insight and judgement, language, p sychotic symptoms, other neuropsychological problems and other emotional or mental problems. He reports minimal impact to impulse control, executive, and motor activity, and moderate impact to motivation. He reports a major impact to bodily functions (underlining sleep disturbance), emotion, attention/concentration, and memory. In her self report, the appellant says her depression makes her isolate herself; she struggles to motivate herself; making decisions can be difficult; and she has had thoughts of suicide. Her anxiety makes her feel nauseous, dizzy and gives her blurry vision and chest pain. Her sleep apnea contributes to not sleeping well and makes her anxiety and depression worse. In the AR the physician reports that the appellant takes significantly longer with dressing, grooming, bathing, and toileting but does not state how much longer than typical. He states that she is independent in feeding, regulating diet, and transfers in/out of bed or chair. He states that she takes significantly longer to do laundry and basic housekeeping (that she does smaller loads or paces herself) but again does not state how much longer it takes her. The physician states the appellant is independent in shopping but needs continuous assistance to carry purchases home. He also reports that the appellant is independent in meal planning, food storage, using transit schedules and all aspects of paying rent and bills and medications. He reports that it takes the appellant significantly longer than typical to prepare and cook food, noting that she has difficulty leaning over counter, but not stating how much longer it takes her. He also notes that it takes her significantly longer than typical getting in/out of a vehicle or using public transit), but again does not say how much longer it takes her. He says she cannot walk to the bus sto p . In the AR, the physician states that the appellant is independent in all areas of social functioning, but "must isolate herself due to anxiety" and the physician describes her as having marginal functioning in her immediate and extended social networks. In a revised page of the PWD application submitted with the appellant's
reconsideration request, the physician changed some of his answers from "independent" to "periodic support/supervision". Specifically, for "appropriate social decisions" and "able to develop and maintain relationships" the physician writes, "she is undergoing counselling". A document prepared by the physician for a disability insurer and dated April 13, 2017 notes that the appellant was seeing a counsellor; medical records submitted with the revised page note counselling "continues" on February 28, 2018 and counselling is noted again on June 20 and 28, 2018, but otherwise there is no indication of the frequency and duration of that support or supervision. With respect to "able to deal appropriately with unexpected demands" he writes, "she struggles when her routine suddenly changes" but does not describe the support required or frequency and duration of that support. In the letter she submitted along with the revised pages, the appellant stated that the changes were made following a meeting with her doctor to discuss her disabilities. The "approaches and information" section of the pages is unchanged from "office interview with the applicant. The physician does not indicate any new or further assessments (e.g., home assessments) undertaken prior to completing these revised pages. In her self report, the appellant describes her overall quality of life as very poor. She states that her personal care is difficult and takes longer; and she cannot prepare meals anymore as standing in one spot and bending over the kitchen counter for any length of time increases her back pain. In her Nov. 6 self report, the appellant disagreed with the physician's statement in the PWD application that she is independent in regulating her diet and meal planning, stating that she can't cook meals so she buys ready-to-eat prepared foods. She said everyday is a struggle for her. In the MR the physician does not answer the question concerning help required, but he notes the appellant requires a cane when walking and a cart when shopping. In the AR the physician described that the appellant receives assistance from family and uses a cane for walking. He does not describe what assistance is required from family, nor does he answer the question with respect to help or supervision needed for social functioning. In her self report, the appellant states that when all of her symptoms are happening at the same time, she goes to her family for help to make decisions. She says that she cannot walk far without her cane.
PART F -REASONS FOR PANEL DECISION The issue on this appeal is whether the ministry's decision to deny the appellant designation as a PWD was reasonably supported by the evidence or was a reasonable application of the applicable enactment in the circumstances of the appellant. In particular, was the ministry reasonable in determining that in the opinion of a prescribed professional the appellant's impairments do not directly and significantly restrict her from performing DLA either continuously or periodically for extended periods, and that as a result of those restrictions the appellant does not require help to perform DLA? The relevant legislation is as follows: EAPWDA: 2 (1) In this section: "assistive device" means a device designed to enable a person to perform a daily living activity that, because of a severe mental or physical impairment, the person is unable to perform; "daily living activity" has the prescribed meaning; "prescribed professional" has the prescribed meaning. (2)The minister may designate a person who has reached 18 years of age as a person with disabilities for the purposes of this Act if the minister is satisfied that the person has a severe mental or physical impairment that (a)in the opinion of a medical practitioner is likely to continue for at least 2 years, and (b) in the opinion of a prescribed professional (i)directly and significantly restricts the person's ability to perform daily living activities either (A) continuously, or (B) periodically for extended periods, and (ii) as a result of those restrictions, the person requires help to perform those activities. (3) For the purposes of subsection (2), (a)a person who has a severe mental impairment includes a person with a mental disorder, and (b)a person requires help in relation to a daily living activity if, in order to perform it, the person requires (i)an assistive device, (ii)the significant help or supervision of another person, or (iii) the services of an assistance animal.
I EAPWDR section 2(1): 2 (1) For the purposes of the Act and this regulation, "daily living activities", (a)in relation to a person who has a severe physical impairment or a severe mental impairment, means the following activities: (i)prepare own meals; (ii) manage personal finances; (iii) shop for personal needs; (iv) use public or personal transportation facilities; (v) perform housework to maintain the person's place of residence in acceptable sanitary condition; (vi) move about indoors and outdoors; (vii) perform personal hygiene and self care; (viii)manage personal medication, and (b)in relation to a person who has a severe mental impairment, includes the following activities: (i) make decisions about personal activities, care or finances; (ii) relate to, communicate or interact with others effectively. Majority Reasons of Panel Members In the reconsideration decision, the ministry was satisfied that the information provided establishes both a severe physical impairment and a severe mental impairment. Determining a severe physical or mental impairment requires weighing the evidence provided against the nature of the impairment and its reported functional skill limitations. In both the MR and AR sections of the PWD application, the ministry defines impairment" as "a loss or abnormality of psychological, anatomical or physiological structure or functioning causing a restriction in the ability to function independently, effectively, appropriately or for a reasonable duration." The panel adopts the ministry's definition of impairment. To assess the severity of an impairment, the ministry must consider the nature of the impairment and the extent of its impact on daily functioning. Restrictions in the Ability to Perform Daily Living Activities 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 for 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 impairment and the restriction. 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, 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.
A c c o r d i n g l y , i n c i r c u m s t a n c e s w h e r e t h e e v i d e n c e i n d i c a f o r t h e m i n i s t r y t o r e q u i r e e v i d e n c e o f t h e d u r a t i o n a n d t h i s l e g i s l a t i v e c r i t e r i o n i s m e t . D L A a r e d e f i n e d i n s e c t i o n 2 ( 1 ) o f t h e E A P W D R , a n d a r e 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 t o c h e c k m a r k e d b o x e s a n d l e g i s l a t i o n , d o n o t i n c l u d e t h e a b i l i t y t o w o r k . I n 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 , t h e m i n i s t ry s t a t e d t h a t , i m p a i r m e n t , i t r e l i e d u p o n t h e e v i d e n c e i n t h e M R a n d t t h a t t h e a p p e l l a n t ' s s y m p t o m s c a u s e f a t i g u e , c o g n i t i v e a t h e a p p e l l a n t r e q u i r e s t h e u s e o f a c a n e w h e n w a l k i n g , t s t a i r s , l i f t b e t w e e n 5 -1 5 l b s . u n a i d e d a n d r e m a i n s e a t e d a p p e l l a n t t a k e s 2 t i m e s l o n g e r t o w a l k i n d o o r s , t h a t s h e w h e n c l i m b i n g s t a i r s . T h e m i n i s t r y n o t e d t h a t t h e a p p e l l p e r i o d i c a s s i s t a n c e w i t h l i f t i n g , c a r r y i n g a n d h o l d i n g , a s k i l o g r a m s . I n 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 h a s a s e v e r e m e n t a l i m e v i d e n c e i n t h e M R a n d t h e A R . T h e m i n i s t r y a c c e p t e d t h d e f i c i t s w i t h c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n t h e a r e d i s t u r b a n c e , m o t i v a t i o n a n d a t t e n t i o n o r s u s t a i n e d c o n c d i f f i c u l t i e s w i t h c o m m u n i c a t i o n d u e t o c o g n i t i v e i s s u e s a c o m m u n i c a t i o n a r e a s , i n c l u d i n g s p e a k i n g , r e a d i n g a n d h T h e s p e c i f i c f u n c t i o n a l i m p a i r m e n t s n o t e d b y t h e M i n i s t s e v e r e p h y s i c a l i m p a i r m e n t a n d a s e v e r e m e n t a l i m p a i r m E A P W D R , w h i c h t h e M i n i s t r y a c k n o w l e d g e d a t t h e h e a r i a n d m e n t a l i m p a i r m e n t s , w h i l e s i g n i f i c a n t e n o u g h t o s u p n o t s e v e r e e n o u g h t o s u p p o r t a d e c i s i o n t h a t t h e i m p a i r T h e m i n i s t r y a l s o c o n c l u d e d t h a t w h e r e , i n t h e p h y s i c i a n a p p e l l a n t t a k i n g s i g n i f i c a n t l y l o n g e r t o p e r f o r m D L A , t h e t h e m i n i s t r y w a s n o t a b l e t o d e t e r m i n e i f t h a t a d d i t i o n a l I n s e c t i o n s 4 a n d 5 o f 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 , w h e r c o n s i d e r i n g w h e t h e r t h e a p p e l l a n t r e q u i r e s t h e h e l p o f a a p p e l l a n t ' s u n d i s p u t e d n e e d t o u s e a c a n e . S e c t i o n 2 o f t h e E A P W D A d o e s n o t r e q u i r e t h a t a m a j o r i o r d e r f o r t h e m i n i s t ry t o f i n d a s i g n i f i c a n t i m p a i r m e n t o f b e d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t e d ( H u d s o n v . B r i t is h 2 0 0 9 B C S C 1 4 6 1 ) . S o l o n g a s t h e o p i n i o n o f 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 m e a p p l i c a n t / a p p e l l a n t m a y a l s o b e t a k e n i n t o a c c o u n t i n a n a t u r e a n d e x t e n t o f t h e h e l p r e q u i r e d . W h e r e , f o r e x a m p h y s i c i a n ' s r e p o r t , o r r a i s e s m e d i c a l c o n d i t i o n s t h a t a r e r e a s o n a b l e t o p l a c e l i t t l e w e i g h t o n t h a t e v i d e n c e . H o w e m e d i c a l c o n d i t i o n s a n d s y m p t o m s s e t o u t b y a p r e s c r i b e t e s t h a t a r e s t r i c t i o n a r i s e s p e r i o d i c a l l y , i t i s a p p r o p r i a t e f r e q u e n c y o f t h e r e s t r i c t i o n i n o r d e r t o b e " s a t i s f i e d " t h a t l i s t e d i n t h e M R a n d A R f o r m s , w i t h t h e o p p o r t u n i t y f o r p r o v i d e a d d i t i o n a l n a r r a t i v e . D L A , a s d e f i n e d i n t h e i n 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 h a s a s e v e r e p h y s i c a l h e A R . T h e m i n i s t ry a c c e p t e d t h e o p i n i o n o f t h e p h y s i c i a n n d m u s c u l o s k e l e t a l e ff e c t s . T h e m i n i s t r y a c c e p t e d t h a t h a t s h e c a n w a l k b e t w e e n 1 -2 b l o c k s u n a i d e d , c l i m b n o f o r l e s s t h a t 1 h o u r . T h e m i n i s t ry a l s o a c c e p t e d t h a t t h e r e q u i r e s a c a n e w h e n w a l k i n g o u t d o o r s a n d a h a n d r a i 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 h e n s t a n d i n g a n d t h e a p p e l l a n t i s l i m i t e d t o l i f t i n g a m a x i m u m o f 5 p a i r m e n t , t h e m i n i s t ry s t a t e d t h a t i t h a d r e l i e d u p o n t h e e p h y s i c i a n ' s o p i n i o n t h a t t h e a p p e l l a n t h a s s i g n i f i c a n t a s o f c o n s c i o u s n e s s , e x e c u t i v e , m e m o ry , e m o t i o n a l e n t r a t i o n . T h e m i n i s t r y a c c e p t e d t h a t t h e a p p e l l a n t h a s n d t h a t , w h i l e s h e h a s g o o d a b i l i t i e s i n m o s t e a r i n g , s h e h a s p o o r a b i l i t i e s i n w r i t i n g . r y i n s u p p o r t o f i t 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 h a s a e n t a r e c o m p o n e n t s o f t h e D L A d e f i n e d i n s . 2 o f t h e n g . T h e M i n i s t r y m a i n t a i n e d t h a t t h e a p p e l l a n t ' s p h y s i c a l p o r t t h e d e c i s i o n t h a t t h e i m p a i r m e n t s a r e s e v e r e , w e r e m e n t s w e r e s i g n i f i c a n t r e s t r i c t i o n s o n t h e a p p e l l a n t ' s D L A . ' s o p i n i o n , t h e s e v e r e i m p a i r m e n t s r e s u l t e d i n t h e l a c k o f d e t a i l s o f t h e a d d i t i o n a l t i m e t a k e n m e a n t t h a t t i m e w a s a c t u a l l y s i g n i f i c a n t , a s t h e p h y s i c i a n h a d s t a t e d . e t h e m i n i s t r y r e a c h e s t h e s e c o n c l u s i o n s , a n d i n n a s s i s t i v e d e v i c e , t h e m i n i s t r y d o e s n o t m e n t i o n t h e t y o f D L A m u s t b e d i r e c t l y a n d s i g n i f i c a n t l y r e s t r i c t e d i n t h e a b i l i t y t o p e r f o r m D L A , b u t r a t h e r t h a t 2 o r m o r e D L A C o l u m b i a ( E m p l o y m e n t a n d A s s i s t a n c e A p p e a l T r i b u n a l } , e t s t h e c r i t e r i a i n s . 2 o f t h e E A P W D A , t h e e v i d e n c e o f t h e d e t e r m i n a t i o n o f t h e s e v e r i t y o f t h e i m p a i r m e n t a n d t h e p l e , t h e a p p e l l a n t ' s e v i d e n c e i s c o n t r a d i c t e d b y t h e n o t i d e n t i f i e d i n t h e p h y s i c i a n ' s r e p o r t , i t m a y b e v e r , w h e r e a n a p p e l l a n t ' s s t a t e m e n t i s d e s c r i p t i v e o f d p r o f e s s i o n a l i n t h e M R a n d A R , a n d t h a t s t a t e m e n t
p r o v i d e s i n fo r m a t i o n a b o u t t h e s e v e r i t y o f a n a p p e l l a n t ' a b i l i t y t o p e r fo r m D L A , i t i s n o t r e a s o n a b l e f o r t h e m i n i s t t h e d e t a i l s a r e n o t r e p e a t e d i n t h e p h y s i c i a n ' s r e p o r t . T h " p a t e n t l y u n r e a s o n a b l e " ( H u d s o n v . B r i t i s h C o l u m b i a ( E m I n t h e M R , i n c l u d i n g t h e s e c t i o n d a t e d N o v e m b e r 2 0 , 2 0 t h e A R , t h e p h y s i c i a n h a s i d e n t i f i e d 5 D L A i n w h i c h t h e a c o n t i n u o u s l y . U s i n g t h e D L A d e s c r i p t i o n s i n s . 2 ( 1 ) ( a ) o f t p e r s o n a l n e e d s ; 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 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 . T h e p h y s i c i a n h a s i d e n t i f D L A i s d i r e c t l y r e s t r i c t e d p e r i o d i c a l l y . T h o s e a r e : p e rf o r m i n a c c e p t a b l e s a n i t a r y c o n d i t i o n a n d m o v e a b o u t i n d o o r a n a l y s i s b e c a u s e , i n t h e M R , t h e p h y s i c i a n h a s s t a t e d t h a r e s t r i c t e d p e r i o d i c a l l y a n d h e r a b i l i t y t o m o v e a b o u t o u t W i t h r e s p e c t t o t h e D L A i n E A P W D R s . 2 ( 1 ) ( b ) ( i ) m a k e d 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 s i g n i f i c a n t d e f i c i t s i n c o g n i t i v e a n d e m o t i o n a l f u n c t i o n i n m a j o r i m p a c t o n b o d i l y f u n c t i o n s , s p e c i f i c a l l y s l e e p d i s t u a n d a m o d e r a t e i m p a c t o n m o t i v a t i o n . H e s t a t e s t h a t , w f u n c t i o n i n g " , d e f i n e d a s " l i t t l e s i g n i f i c a n t p a r t i c i p a t i o n / c i n q u a l i t y " . W i t h h e r e x t e n d e d s o c i a l n e t w o r k s h e a l s o s t d e f i n e d a s " l i t t l e m o r e t h a n m i n i m a l a c t s t o f u l f i l l b a s i c n a n x i e t y " . I n t h e a d d i t i o n a l p a g e o f t h e M R d a t e d N o v e m b e r 2 0 , 2 0 f u n c t i o n i n g , t h e a p p e l l a n t ' s c o n d i t i o n " w a x e s a n d w a n e s t o b e b o t h e m o t i o n a l l y a n d p h y s i c a l l y f a t i g u e d a n d s o c i a i s o l a t e h e r s e l f d u e t o a n x i e t y . I n t h e a m e n d e d p a g e o f t h 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 n e e d s p e r i o d i c s u p p o r t a n d d e v e l o p i n g a n d m a i n t a i n i n g r e l a t i o n s h i p s , a n d t o d e a l a p i n d i c a t e s t h a t t h e s u p p o r t / s u p e r v i s i o n t a k e s t h e f o r m o f d e a l w i t h a n x i e t y . O n a p p e a l , t h e a p p e l l a n t d e s c r i b e d a p a n i c a t t a c k a t w o r s a y s t h a t s o m e t i m e s w h e n s h e g o e s o u t , h e r a n x i e t y c a n r e t u r n i n g h o m e . W h i l e i t i s c l e a r t h a t d e p r e s s i o n a n d a n t o f u n c t i o n o u t s i d e t h e h o m e , a s n o t e d a b o v e , i t i s r e a s o f r e q u e n c y o f e p i s o d i c a n x i e t y a n d p a n i c a t t a c k s . T h e r e i s s h o w h o w o ft e n t h e s e e p i s o d e s o c c u r . I n s . 2 ( 1 ) o f t h e E A P W D R , D L A s p e c i f i c a l l y r e l a t i n g t o a p 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 ; a n d e f f e c t i v e l y . T h e d e s c r i p t i o n o f " m a r g i n a l f u n c t i o n i n g " , a b c o m m u n i c a t i n g o r i n t e r a c t i n g w i t h o t h e r s . . I t i s n o t r e a s o m o s t e x t r e m e i m p a c t o n s o c i a l f u n c t i o n i n g c a n b e c o n s i d T h e a p p e l l a n t s t a t e s t h a t s h e i s u n a b l e t o v a c u u m t h e h o s c o n d i t i o n a n d t h e s e v e r i t y o f t h e r e s t r i c t i o n s o n h e r r y t o p l a c e l i t t l e w e i g h t o n t h a t e v i d e n c e o n l y b e c a u s e a t d e t e r m i n a t i o n h a s b e e n h e l d b y t h e c o u r t t o b e p l o y m e n t a n d A s s i s t a n c e A p p e a l T r i b u n a l ) , s u p r a ) . 1 8 a n d s u b m i t t e d a s n e w e v i d e n c e a t t h e h e a r i n g , a n d i n p p e l l a n t ' s a b i l i t y t o p e r fo r m t h e D L A i s d i r e c t l y r e s t r i c t e d h e E A P W D R , t h o s e a r e : p r e p a r e o w n m e a l s ; s h o p fo r c i l i t i e s ; 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 ; a n d p e r f o r m i e d 4 D L A i n w h i c h t h e a p p e l l a n t ' s a b i l i t y t o p e r f o r m t h e 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 s a n d o u t d o o r s . ( T h i s l a s t D L A a p p e a r s t w i c e i n t h i s t t h e a p p e l l a n t ' s a b i l i t y t o m o v e a b o u t i n d o o r s i s d o o r s i s r e s t r i c t e d c o n t i n u o u s l y . ) 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 a n d ( i i ) l y , t h e p h y s i c i a n ' s e v i d e n c e i s t h a t t h e a p p e l l a n t h a s g . H e s t a t e s t h a t 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 h a s a r b a n c e , e m o t i o n , a t t e n t i o n / c o n c e n t r a t i o n a n d m e m o r y , i t h h e r i m m e d i a t e s o c i a l n e t w o r k , s h e h a s " m a r g i n a l o m m u n i c a t i o n ; r e l a t i o n s h i p s o f t e n m i n i m a l a n d f l u c t u a t e a t e s t h a t t h e a p p e l l a n t h a s " m a r g i n a l f u n c t i o n i n g " , e e d s " . H e s t a t e s t h a t s h e " m u s t i s o l a t e h e r s e l f d u e t o 1 8 , t h e p h y s i c i a n h a s s t a t e d t h a t , w i t h r e s p e c t t o s o c i a l " a n d , i n c o m b i n a t i o n w i t h h e r p h y s i c a l p a i n , c a u s e s h e r l l y w i t h d r a w n . I n t h e M R h e i n d i c a t e s t h a t s h e h a s t o e M R d e a l i n g w i t h s o c i a l f u n c t i o n i n g , t h e p h y s i c i a n s u p e r v i s i o n t o m a k e 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 a n d p r o p r i a t e l y w i t h u n e x p e c t e d d e m a n d s . T h e p h y s i c i a n c o u n s e l l i n g , a s w e l l a s t h e p r e v i o u s l y n o t e d i s o l a t i o n t o k t h a t r e s u l t e d i n h e r s t o p p i n g h e r p a r t t i m e w o r k , a n d b e v e r y h i g h a n d r e s u l t i n h e r l e a v i n g a s t o r e a n d x i e t y a f f e c t h e r p a i n l e v e l a n d s o m e t i m e s a ff e c t h e r a b i l i t y n a b l e f o r t h e m i n i s t ry t o r e q u i r e e v i d e n c e o f d u r a t i o n a n d n o e v i d e n c e e i t h e r f r o m t h e p h y s i c i a n o r t h e a p p e l l a n t t o r s o n w i t h a s e v e r e m e n t a l i m p a i r m e n t a r e : m a k i n g r e l a t i n g t o , c o m m u n i c a t i n g o r i n t e r a c t i n g w i t h o t h e r s o v e , i n d i c a t e s a s i g n i f i c a n t r e s t r i c t i o n i n r e l a t i n g t o , n a b l e f o r t h e m i n i s t r y t o t a k e t h e p o s i t i o n t h a t o n l y t h e e r e d " s i g n i f i c a n t " . u s e a n d t o c l e a n t h e t u b a n d t o i l e t o f h e r r e s i d e n c e
because back pain prevents her from bending. She says that if a family member cannot do these things for her, the jobs do not get done. The physician has confirmed her back pain and limitations with bending, standing and lifting. A home that is never vacuum ed and never sees the tub and toilet cleaned is not being maintained in an "acceptable sanitary condition". It is not reasonable to suggest that these restrictions are not significant. The appellant states that she cannot prepare meals. She says that all she can do is take a pre-packaged meal out of a box and put it in the microwave because she cannot stand at the counter for an extended time and she cannot lean over the counter, because of the physical impairments that the ministry has determined are severe. These limitations are the same or similar to the functional limitations that prevent her from doing the significant aspects of housework noted above, which are confirmed by the physician. While the appellant is able to 'prepare a meal' in the sense of re-heating prepared food in a microwave, she is not able to prepare the meal itself. It is not reasonable to find that is not a significant restriction. It appears that the ministry did not take into account the appellant's evidence in her self-report because it was not also contained in the physician's report. In its reconsideration decision the ministry stated that the degree of restriction described by the appellant in her self-report was not reported by the physician and had not been outlined in her revised application. Since then the appellant has submitted further evidence from the physician and from herself, about the extent of the impairment of DLA and the help and assistive devices she needs. While the appellant's own evidence of the severity and the extent of the restrictions in her D LA is not all repeated in the physician's report, her evidence of the severity and significance of the restrictions, and the help she needs from assistive devices and others, is consistent with and descriptive of the impairments and restrictions about which the physician has provided his opinion. It is not reasonable to disregard the appellant's evidence for the reasons stated by the ministry. Further, in making its reconsideration decision, the ministry did not have the benefit of the additional evidence admitted at the hearing, which provided significant information about the severity and extent of the restrictions in DLA. Therefore the majority of the panel finds that the ministry's determination that the appellant's severe physical and mental impairments do not directly and significantly restrict her ability to perform DLA either continuously or periodically for extended periods is not reasonably supported by the evidence. Help to Perform Daily Living Activities: 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 physician identifies that the appellant receives the help required for DLA from family. He also identifies that she uses a cane to compensate for her impairment. Although the physician does not describe details of the assistance provided by family members, that is not a legislative requirement w here the rest of the evidence meets the statutory criteria in s.2(2) of the EAPWDA. In this case, the appellant has provided additional evidence in her written statement of November 18, 2018, and in the additional page of the MR provided by the physician regarding restrictions in DLA. The appellant has stated that she cannot vacuum her residence or clean the tub and toilet in the bathroom , and that she cannot prepare her own meals if it involves anything more than putting a pre-packaged meal in the microwave, because she cannot stand and lean over a kitchen counter. The appellant relies on family, usually her daughter, to do the housework that she is unable to do. If her daughter does not do the cleaning, or the meal preparation, "it does
n o t g e t d o n e " . S h e n e e d s a c a n e t o w a l k a n y m o r e t h a n a m i n i m a l d i s t a u s e a c a r t w h e n s h e s h o p s , b e c a u s e o f h e r l i m i t a t i o n s i n p l a c e o f a c a n e t o s t e a d y h e r w h e n s h e i s s h o p p i n g i t i t h e s a m e t i m e a n d s h e c a n n o t u s e a c a n e a n d c a r r y a s h p h y s i c i a n s a y s t h a t t h e a p p e l l a n t w o u l d n o t b e a b l e t o w w a l k s u p s t a i r s . T h e m i n i s t r y t o o k t h e p o s i t i o n t h a t a c a r t i s n o t a n " a s s i s 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 c a r r y i t e m s . T h e a p p e l l a c a r ry i t e m s , e i t h e r w i t h i n o r o u t s i d e t h e s t o r e . T h e r e fo r s t a t u t e , b e i n g " 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 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 a n a s s i s t i v e d e v i c e , a n d a p p e l l a n t d o e s n e e d a c a n e , w h W i t h r e s p e c t t o h e r s e v e r e m e n t a l i m p a i r m e n t s o f d e p r c o u n s e l l i n g s i n c e s o m e t i m e b e f o r e A p r i l 2 0 1 7 . C o u n s e l l s e v e r e m e n t a l i m p a i r m e n t s i n t e r a c t w i t h h e r s e v e r e p h y h e r r e s t r i c t i o n s i n D L A . H e r i m p a i r e d l e v e l o f s o c i a l f u n c D L A t h a t t h e a p p e l l a n t c a n n o t p e r f o r m , m o v i n g o u t o f t H a v i n g f o u n d t h a t t h e a p p e l l a n t ' s s e v e r e p h y s i c a l a n d m a b i l i t y t o p e r f o r m m o r e t h a n 2 D L A e i t h e r c o n t i n u o u s l y h e l p f r o m f a m i l y m e m b e r s t o d o t h e t h i n g s s h e i s u n a b l e d e c i s i o n t h a t i t c a n n o t b e d e t e r m i n e d t h a t s i g n i f i c a n t h e 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 i d e n c e . I n 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 , t h e m i n i s t r y s t a t e d t h a t s i g n i f i c a n t l y r e s t r i c t e d , i t c a n n o t b e d e t e r m i n e d t h a t s i g T h e m a j o r i t y o f t h e p a n e l f i n d s t h a t t h e d e t e r m i n a t i o n t s u p p o r t e d b y t h e e v i d e n c e , i t f o l l o w s t h a t t h e d e c i s i o n t b e d e t e r m i n e d , i s a l s o 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 a p p l i c a b l e e n a c t m e n t . C o n c l u s i o n T h e m a j o r i t y o f 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 w a s n o t e l i g i b l e f o r 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 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 , a n d t h e r e f o r e a p p e a l . D i s s e n t i n g R e a s 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 LA T h e a p p e l l a n t ' s p o s i t i o n i s t h a t t h e e v i d e n c e s h e h a s p r o p r o v e s t h a t h e r D LA a r e " m a r k e d l y r e s t r i c t e d . " S h e p o i n I n c e o u t d o o r s . T h e p h y s i c i a n c o n f i r m e d t h a t s h e n e e d s t o t h e a m o u n t o f w e i g h t s h e c a n l i ft . T h e c a r t a l s o t a k e s t h e s n o t p o s s i b l e t o u s e b o t h t h e c a n e a n d a s h o p p i n g c a r t a t o p p i n g b a s k e t . I f h e r c a r w a s n o t a v a i l a b l e t o h e r , t h e a l k t o t h e b u s s t o p . S h e n e e d s t o u s e a h a n d r a i l w h e n s h e t i v e d e v i c e " a s d e f i n e d i n t h e E A P W D A . T h e c a rt i s n t , b e c a u s e o f 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 , i s u n a b l e t o e , i t w o u l d s e e m t h a t a c a r t c a n m e e t t h e d e f i n i t i o n i n t h e 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 p e r f o r m . " I n a n y e v e n t , t h e r e i s n o q u e s t i o n t h a t a c a n e i s e n e v e r s h e l e a v e s h e r h o u s e . e s s i o n a n d a n x i e t y , t h e a p p e l l a n t h a s b e e n r e c e i v i n g i n g i s , b y i t s n a t u r e , p e r i o d i c s u p p o r t . T h e a p p e l l a n t ' s s i c a l i m p a i r m e n t s t o i n c r e a s e h e r p h y s i c a l p a i n a n d t h u s t i o n r e s u l t e d i n h e r d a u g h t e r , w h o i s h e r p r i m a ry h e l p i n h e h o u s e f o r s e v e r a l m o n t h s . e n t a l i m p a i r m e n t s 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 h e r o r p e r i o d i c a l l y f o r e x t e n d e d p e r i o d s , a n d t h a t s h e r e c e i v e s t o d o , t h e m a j o r i t y o f 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 l p i s r e q u i r e d f r o m o t h e r p e r s o n s o r a n a s s i s t i v e d e v i c e i s b e c a u s e i t h a d n o t b e e n e s t a b l i s h e d t h a t D L A a r e n i f i c a n t h e l p i s r e q u i r e d f r o m o t h e r p e r s o n s o r a d e v i c e . h a t D L A a r e n o t s i g n i f i c a n t l y r e s t r i c t e d i s n o t r e a s o n a b l y h a t t h e n e e d f o r s i g n i f i c a n t h e l p o r a n a s s i s t i v e a i d c a n n o t e v i d e n c e a n d i s n o t 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 s i d e r a t i o n d e c i s i o n , w h i c h d e t e r m i n e d t h a t t h e a p p e l l a n t s u p p o rt e d b y t h e e v i d e n c e a n d i s n o t a r e a s o n a b l e t h e d e c i s i o n i s r e s c i n d e d . T h e a p p e l l a n t i s s u c c e s s f u l i n t h e o n s o f P a n e l C h a i r v i d e d f r o m h e r p h y s i c i a n a n d t h r o u g h h e r s e l f r e p o r t s t s t o n e w e v i d e n c e f r o m t h e p h y s i c i a n i n d i c a t i n g
continuous restriction in personal self care, meal preparation, daily shopping, mobility outside the home and use of transportation. The ministry's position is that the evidence from the physician does not establish that in the opinion of a prescribed professional the appellant's impairments directly and significantly affect the appellant's ability to perform DLR. The ministry points to the AR where the physician reports the appellant is independent in several DLA; and says that while the AR notes continuous assistance is needed for carrying purchases home from shopping, the physician provides no information to understand the duration or degree of other restrictions or the assistance the appellant requires, nor the additional time required to complete other tasks on her own. The ministry acknowledges the appellant has severe impairments but says the evidence does not show a significant restriction to the ability to perform DLA. Decision of Pone/ Choir For a PWD designation, it is not enough to show a severe impairment. The legislation requires that the ministry be satisfied that, in the opinion of a prescribed professional, a severe impairment, directly and significantly restricts the appellant's ability to perform DLA either continuously or periodically for extended periods. The word "directly" indicates that there must be a causal link between the severe impairment and the restriction. In circumstances where the evidence indicates that DLA are directly restricted, it is appropriate for the ministry to require evidence as to whether the restriction is continuous or periodic and -if periodic-of how frequently the restriction arises and how long it lasts. This information can help in determining whether an applicant's ability is restricted "significantly." The legislation (s. 2(2)(b) of the EAPWDA) refers to "daily living activities" (as defined in s. 2(1) of the EAPWDR) collectively. While the plural "daily living activities" "dictates that there must be evidence from a prescribed professional indicating a direct and significant restriction on at least two daily living activities" (Hudson, supra at para. 43; emphasis added), a significant restriction in one (or more) of the listed activities of DLA may not always lead to the conclusion that an applicant's ability to perform DLA as a whole is significantly restricted. The minister needs to be satisfied on a reasonable assessment of the evidence before it-including evidence on all the various activities of DLA-that, in the opinion of a prescribed professional, the ability of the appellant to perform DLA is significantly restricted. In making that assessment, it is appropriate for the ministry to give more weight to the evidence of the prescribed professional than to the self reports of the appellant, as the legislation indicates the minister must be satisfied concerning the professional's opinion. In the original AR, the physician states the appellant is independent in most DLA, (including all areas of social functioning), though for some DLA it takes the appellant significantly longer than typical. The physician does not explain how much longer than typical. The only DLA for which the physician notes continuous assistance is in carrying purchases home, but he provides no further information about the degree of restriction or the help required. (The appellant herself described that she can carry purchases so long as the weight of bags is manageable.) Both the AR and the revised pages of the PWD Application submitted at reconsideration indicate that the appellant has marginal social functioning with her immediate and extended social networks. "Marginal functioning" is the middle option provided between "good functioning" and "very disrupted functioning", indicating that there is some restriction in this area, but whether marginal functioning is a significant restriction to DLA depends on the case. Accordingly, comments and explanation from the prescribed professional can provide critical insight as to how significant the restriction is for a particular applicant. Here, while the revised pages note the appellant needs some periodic support or supervision (counselling), the physician does not indicate the degree or duration of the support needed. The new evidence from the physician on appeal (Section 2E of the MR) indicates continuous or periodic restrictions in all areas of DLA except management of medications and finances (for social functioning the new evidence does not say whether the restriction is periodic or continuous). However, the physician provides no comments to help explain the restrictions; this is especially problematic considering his
original evidence in the AR is that the tasks under most of these areas are completed by the appellant independently, though some take her longer than typical. He does not explain the reason for his change in opinion. While the appellant described in her written submission on appeal that she had the physician fill out this form because the reconsideration decision indicated this information could be useful, the physician does not give evidence about the reason for his change in opinion. For example, he provides no indication that his revised opinion is the result of further assessments (e.g., home assessment) or further consideration or consultation about the appellant's condition. Given the now conflicting evidence between Section 2E of the MR and the original AR and the lack of any explanation from the physician for the apparent change in the physician's opinion, it is difficult to assess the physician's opinion about the appellant's restrictions concerning DLA. And again, even on the new evidence, for periodic restrictions, it is not clear how often and for how long she is restricted and may require help. All the physician writes is that her condition waxes and wanes. Overall, the evidence from the physician shows that the appellant faces some restrictions in DLA as a result of her severe impairment. Indeed, it would be unusual for someone with a severe mental or physical impairment not to experience some restrictions in DLA. Nevertheless, the ministry must be satisfied that that in the opinion of the prescribed professional, the appellant's severe impairment directly and significantly restricts her ability to perform DLA. Here, the evidence shows the appellant being independent in most listed components of DLA. Where she needs help, the lack of detail around the frequency and duration of that help, and conflicting evidence make it difficult to conclude that she is, in the opinion of a prescribed professional, significantly restricted in her ability to perform DLA. Therefore, it was reasonable for the ministry to conclude there is not enough evidence to show that the appellant has a severe impairment that in the opinion of a prescribed professional significantly restricts her ability to perform DLA continuously or periodically for extended periods. Help with DLA The appellant's position is that without help, her DLA do not get done, and that she requires a cane for walking any distance. The ministry's position is that since it has not been established that the appellant's DLA are significantly restricted, it cannot be determined that significant help is required from other persons. Decision of Panel Chair Both the appellant and the physician note that the appellant uses a cane for walking outside the home. On appeal, the appellant said she uses the cane for walking distances outside the home where she has no place to rest or lean if needed. Regardless, a finding that a severe impairment directly and significantly restricts a person's ability to manage her DLA either continuously or periodically for an extended period is a precondition to a person requiring "help" as defined by section 2(3)(b) of the EAPWDA. For the reasons provided above, the evidence falls short of satisfying that precondition. Accordingly, I find that the ministry reasonably concluded it could not be determined on the evidence that the appellant requires help with DLA as defined by section 2(3)(b) of the EAPWDA. Conclusion Having reviewed and considered all of the evidence and the relevant legislation, and for the reasons provided above, the Panel chair finds that the ministry's decision finding the appellant ineligible for PWD designation is reasonably supported by the evidence. I would confirm the ministry's decision.
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 ) □ 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 � 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 ) � 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 ) � P A R T H S I G N A T U R E S P R I N T N A M E K a t h y G r a n t S I G N A T U R E O F C H A I R D A T E ( Y E A R J M O N T H / O A Y ) 7 /. , n; , . /rt . . 2 0 1 8 / 1 2 / 1 7 P R ! N T N A M E S u s a n F e r g u s o n S I G N A T U R E O F M E M B E R O A T E ( Y E A R/ M O N T H / D A Y ) ' :. • c � .f'- ;:=: c; i ,; � --2 0 1 8 / 1 2 / 1 7 P R I N T N A M E C a r m e l l e D i e l e m a n 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 J M O N T H I D A Y ) ( � J � z � 2 0 1 8 / 1 2 / 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.