Ministry of Social Development and Poverty Reduction

Appeal Number 2023-0237 Part C – Decision Under Appeal The decision under appeal is the Ministry of Social Development and Poverty Reduction (ministry) reconsideration decision dated January 17, 2022, which determined the appellant was not eligible for the Persons with Disabilities (PWD) designation.

Specifically, the ministry determined:  The appellant does not have a severe physical or mental impairment;  The impairment does not directly and significantly restrict daily living activities continuously or periodically for extended periods; and  The appellant does not require an assistive device, the significant help of another person, or the services of an assistance animal to perform the daily living activities.

Additionally, the ministry determined that the appellant is not one of the prescribed classes of persons who may be eligible for the PWD designation on alternative grounds. As there was no information or argument on this point, the panel considers it not to be an issue in this appeal.

Part D – Relevant Legislation Employment and Assistance for Persons with Disabilities Act, (Act) section 2

Employment and Assistance for Persons with Disabilities Regulation (Regulation), section 2 and 2.1

Relevant sections of the legislation can be found in the Schedule of Legislation at the end of this decision.

        EAAT003 (30/08/23) 2

Appeal Number 2023-0237 Part E – Summary of Facts The panel notes, although there is a large gap between the reconsideration decision (January 17, 2022) and the date the Notice of Appeal was received, (August 8, 2023), the appellant provided information to demonstrate that he submitted the Notice of Appeal on January 27, 2022, confirming the Notice of Appeal was submitted timely.

Relevant Evidence Before the Minister at Reconsideration Request for Reconsideration (December 14, 2021) - summary The appellant states he was in a physical education accident when he was in school. A classmate hit his head and he lost his hearing on his right side. He remembers falling and could feel a high pitch ringing in his right ear. He was taken to the hospital and was diagnosed with nerve damage.

Since that incident, the appellant states he’s been deaf in his right ear, has tinnitus (ringing in the ear), and migraine headaches. In addition, shortly after this he was diagnosed with Crohn’s disease, which has worsened over the years due to the stress his head injury continues to cause; he has ended up in the hospital many times as a result. The appellant states his Crohn’s disease has also affected his bile ducts which has caused Primary Sclerosing Cholangitis (liver disease).

He states he went from being a normal kid to his life turning upside down, which has permanently affected his mental health. He also states, this was all stated in his PWD application, backed up by his doctor.

The appellant also stated he is still going to school as a part-time student, to eventually make something of himself. The PWD designation was supposed to help him get on his feet one day, not as a long-term solution. He adds that simple tasks such as studying, taking notes and processing information are greatly impacted with his tinnitus. Concentrating with a constant high pitch noise in one’s head is a challenge. Even trying to get a good night sleep has become more difficult.

In addition, the appellant states the PWD designation was designed to help people with health issues and if he must fight to get it approved there is a failure in the system. In addition, he states he has been approved for disability through student aid BC and doesn’t understand why the ministry is kicking him around when his situation seems so black and white.

Letter to the Appellant from the Ministry (December 7, 2021) -denying eligibility for PWD designation         EAAT003 (30/08/23) 3

Appeal Number 2023-0237

PWD Application Self-Report (September 19, 2021) The appellant states he has a few different health issues that affect him daily. He has unilateral hearing loss, is deaf in his right ear and suffers from severe tinnitus. He doesn’t hear any normal sound in his right ear but has constant tinnitus, so severe that he often finds himself in a battle of not losing himself in the tinnitus. It feels like his left ear is keeping him here and his right ear is trying to take him away to another dimension. Also, because of the nerve damage to his right ear, he suffers from chronic headaches, which occur multiple times a week. The headaches make it nearly impossible to stick to a routine; The pain is so severe that he must go into a dark room and lay there doing absolutely nothing. Due to his hearing loss, daily tasks like crossing the street become more complicated. A car may be coming from his right side, but he will assume it’s coming from his left as that’s the only remaining hearing he has. He also has Crohn’s disease and receives regular infusions for it. The Crohn’s disease makes it hard to leave his home for long periods of time since he doesn’t have control over his bowel movements and doesn’t want to risk having an accident.

Medical Report (October 18, 2021) The appellant’s doctor lists the following diagnoses related to the appellant’s impairment. A - Diagnosis Date of onset – month/year Crohn’s disease 11/2013 Hearing loss 05/2014 Tinnitus 05/2014 Anxiety Headaches - migraine

Health History The doctor writes that the appellant was diagnosed with Crohn’s disease in November 2013. He gets multiple bowel movements and recurrent abdominal pain and previously required multiple visits to the emergency department due to his pain. The appellant was admitted to the hospital in January 2020 and his colonoscopy revealed that his Crohn’s disease progressed to involve his colon. His symptoms have affected his daily life and prevent him from being outside his home for prolonged periods.

        EAAT003 (30/08/23) 4

Appeal Number 2023-0237 The doctor also writes that since the appellant’s head injury, he’s had profound hearing impairment on his right side as well as tinnitus and headaches. His tinnitus gets worse with loud noise and affects his communication/interaction with others. When he gets severe headaches, he is unable to do anything and needs to stay in a dark room.

The doctor provided the following responses to the questions below. o Has the appellant been prescribed any medications and/or treatments that interfere with his ability to perform daily living activities? - No o Does the appellant require prostheses or aids for his impairment? - Yes, hearing aid

Degree and Course of Impairment The doctor provided the following responses to the questions below. o Is the impairment likely to continue for two years or more from today? - Yes a) Crohn’s disease is chronic – entyvio infusion helps with his symptoms. b) Deafness – wears hearing aid on right side.

Functional Skills o How far can this person walk unaided on a flat surface? 4+ blocks o How many stairs can this person climb unaided? 5+ steps o What are the person’s limitations in lifting? no limitations o How long can this person remain seated? no limitation o Are there difficulties with communication? yes, deafness in right ear and tinnitus o Are there any significant deficits with cognitive and emotional function? yes, language (auditory) and emotional disturbance Right-sided hearing impairment. The appellant’s multiple medical conditions have contributed to him feeling anxious and at times depressed.

Frequency of Contact o How long has the appellant been your patient? since March 2018 o How often have you seen this appellant in the past 12 months? 11 or more times

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Appeal Number 2023-0237

Assessor Report (October 19, 2021) The doctor provided the following responses to the questions below.

Living Environment The doctor indicated the appellant lives with family, friends or caregiver.

Mental or Physical Impairment o What are the applicant’s mental or physical impairments that impact his ability to manage daily living activities? Hearing loss in right ear and uncontrolled bowel movements which affects his interaction with others as well as restriction in time he can spend outside his house.

Ability to Communicate Please indicate the level of ability in the following areas speaking reading writing hearing

Mobility and Physical Ability Indicate the assistance required related to impairment (that directly restricts the applicant’s ability to manage in the following areas). Walking indoors Walking outdoors Climbing stairs Standing Lifting Carrying and holding

Good

x x x

Satisfactory

Poor

x

Unable

Explain

right-sided hearing loss

        EAAT003 (30/08/23) 6 I n d e p e n d e n t P e r i o d i c a s s i s t a n c e f r o m a n o t h e r p e r s o n C o n t i n u o u s a s s i s t a n c e f r o m a n o t h e r p e r s o n o r u n a b l e U s e s a s s is t i v e d e v ic e T a k e s s i g n i f ic a n t ly l o n g e r t h a n t y p i c a l E x p l a i n a n d s p e c i f y d e v ic e

x x x x x x

Appeal Number 2023-0237

Cognitive and Emotional Functioning For each item indicate to what degree the applicant’s mental impairment restricts his functioning. If impact is episodic or varies over time, Impact on Daily Functioning please explain No Minimal Moderate Major impact impact impact impact Bodily functions (e.g. eating problems, x toileting problems, poor hygiene, sleep disturbance Consciousness (e.g. orientation, x alert/drowsy, confusion Emotion (e.g. excessive or inappropriate x anxiety, depression etc. Impulse control (e.g. inability to stop x doing something or failing to resist doing something) Insight and judgement (e.g. poor x awareness of self and health condition (e.g. grandiosity, unsafe behavior) Attention/concentration (e.g. x distractible, unable to maintain concentration, poor short term memory) Executive (e.g. planning, organizing, x sequencing, abstract thinking, problem-solving, calculations) Memory (e.g. can learn new information, x names etc., and then recall that information, forgets over-learned facts) Motivation (e.g. lack of initiative, loss of x interest) Motor activity (e.g. increased or x decreased goal-oriented activity, coordination, lack of movement, agitation, ritualistic or repetitive actions, bizarre behaviours, extreme tension)

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Language (e.g. expression or comprehension problems (e.g. inability to understand, extreme stuttering, mute, racing speech disorganization of speech) Psychotic symptoms (e.g. delusions, hallucinations, disorganized thinking) Other neuropsychological problems (e.g. visual/spatial problems, psychomotor problems, learning disabilities etc.) Other emotional or mental problems

Appeal Number 2023-0237 x

x

x

x

Daily Living Activities Indicate the assistance required related to impairment(s) that directly restrict the applicant’s ability to manage in the Explain/ following areas. Describe Dressing x Grooming x Bathing x Toileting x Uncontrolled bowel movement if no access to toilet Feeding self x Regulating diet x Transfers (in/out of bed) x Transfers (on/off chair) x Basic Housekeeping Laundry x Basic housekeeping x Shopping Going to/from stores x Hearing impairment Reading prices and labels x Making appropriate choices x         EAAT003 (30/08/23) 8 I n d e p e n d e n t P e r i o d i c A s s i s t a n c e f r o m a n o t h e r p e r s o n C o n t i n u o u s a s s i s t a n c e f r o m a n o t h e r p e r s o n o r u n a b l e U s e s a s s i s t i v e d e v i c e 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

Paying for purchase

x x

Appeal Number 2023-0237

Additional Comments (type and amount of assistance and any safety issues) The doctor writes the appellant does not have issues with toileting but if he does not have access to a toilet, he can have uncontrolled bowel movements due to his Crohn’s. His safety can be at risk when walking on the road due to his hearing impairment.

Indicate the assistance required related to impairment(s) that directly restrict the applicant’s ability to manage in the following areas. Meals Meal planning x Food preparation x Cooking x Safe storage of food (ability, x not environmental) Pay rent and bills Banking x Budgeting x Pay rent and bills x Medications Filling/refilling prescriptions x Taking as directed x Safe handling and storage x Transportation Getting in and out of a x vehicle Using public transit

        EAAT003 (30/08/23) 9 I n d e p e n d e n t P e r i o d i c A s s i s t a n c e f r o m a n o t h e r p e r s o n C o n t i n u o u s a s s i s t a n c e f r o m a n o t h e r p e r s o n o r u n a b l e U s e s a s s i s t i v e d e v i c e 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 E x p l a i n / D e s c r i b e

Using transit schedules and arranging transportation

x

x

Loud noise aggravates tinnitus

Appeal Number 2023-0237 Additional Comments (description of type and amount of assistance and any safety issues) The doctor writes there is some safety risk related to hearing impairment when using public transit.

Social Functioning – only complete if applicant has an identified mental impairment Indicate the assistance required related to impairment(s) that directly restrict the applicant’s ability to manage in the following areas. Appropriate social decisions x (including avoiding situations dangerous to self or others, good social judgement) Able to develop and x maintain relationships Interacts appropriately with x In noisy environments, others (e.g. understands he may not be able to and responds to social cues, interact with others due problem solves in social to his hearing context) impairment Able to deal appropriately x with unexpected demands Able to secure assistance x from others Describe how the mental impairment impacts the applicant’s relationship with his  immediate social network (partner, family, friends) The doctor checked, “good functioning – positive relationships, assertively contributes to these relationships”  extended social networks (neighbourhood contacts, acquaintances, storekeepers, public officials etc.) The doctor checked, “marginal functioning – little more than minimal acts to fulfill basic needs”

        EAAT003 (30/08/23) 10 I n d e p e n d e n t P e r i o d i c s u p p o r t / s u p e r v i s i o n C o n t i n u o u s s u p p o r t / s u p e r v i s i o n E x p l a i n / D e s c r i b e

Appeal Number 2023-0237 Comments: If the applicant requires help, as indicted, please describe the supportive/supervision required which would help to maintain him in the community The doctor writes that the appellant tends to avoid gatherings due to his hearing impairment/tinnitus.

Assistance Provided for Applicant

Assistance provided through the use of devices What equipment or devices does the applicant routinely use to help compensate for his impairment? Check appropriate items. The doctor checked - communicative devices – hearing aid.

Please provide details on any equipment or devise used by the applicant: The doctor wrote hearing aid used to mask tinnitus.

Assistance provided by Assistance Animals Does the applicant have an assistance animal? The doctor checked, no.

Approaches and Informational Sources What approaches and information sources did you use to complete this form? The doctor indicated, office interview with applicant and medical chart information.

Frequency of Contact The doctor stated he first met the applicant in March 2018 and has been providing primary care since June 2020.

Report from Registered Audiologist - summary (February 5, 2019) The report states the appellant attended a tinnitus group session on February 1, 2019. He reported the onset of unilateral, right-sided, on-pulsatile tinnitus in 2015. The appellant stated he was hit on the right side of the head in gym class and was knocked to the ground. He now has right-sided hearing loss and tinnitus, which is bothersome when trying to study and interferes with his concentration. He denied difficulties sleeping.

The appellant stated his most recent hearing assessment on August 29, 2018 indicated normal hearing in the left ear and moderate sloping to profound sensorineural hearing loss in the right ear. He reported difficulties hearing with background noise and localizing

        EAAT003 (30/08/23) 11

Appeal Number 2023-0237 sounds. He has a hearing aid, which he sometimes wears; it helps him to hear loud sounds better and decrease the tinnitus intrusiveness a little bit. He also reported sound sensitivity to loud sounds in his right ear, including dishes clattering and hammering sounds - these sounds cause aural fullness, dizziness and otalgia. He also reported a history of migraines.

The audiologist stated he presents with; Tinnitus – Tinnitus Handicap Inventory score 86% Hyperacusis Hearing difficulties, severely intrusive

Letter to Whom It May Concern from Gastroenterology Clinical Nurse (March 16, 2018) The nurse writes that the appellant is being followed for his diagnosis of Crohn’s disease. The unpredictable nature of this illness means that he may have some “off” days even during periods when his condition is under control.

The nurse states Crohn’s disease is a chronic condition that affects the lining of the digestive tract and can have a variety of symptoms such as cramps and abdominal pain, diarrhea, nausea and fatigue. Few of these symptoms are immediately evident to the observer but can be debilitating, nonetheless.

The nurse also stated they encourage the appellant to participate and be included in all school related activities. There will be times when he requires some special considerations. Strenuous physical activity may need to be modified and he may need to use the bathroom urgently and frequently. It would be helpful if the appellant were allowed to leave the classroom as unobtrusively as possible. As well, although he may need to miss school for medical appointments or exacerbations of his symptoms, they desire that the appellant fully participate in school when he is well.

Audiologic Evaluation - summary (July 17, 2015) The evaluation states that after the appellant’s gym incident, his vision went black and he had the feeling he was about to pass out. He experienced: tinnitus, imbalance with standing and Crohn’s disease, and had ear surgery.

Invoice for Hearing Aides (December 1, 2015) Total Due: $3,795

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Appeal Number 2023-0237 Copy of blog – Protecting your hearing means protecting your mental health (no date) The following is highlighted. “Hearing loss and tinnitus (ringing in the ears) can increase one’s risk of developing mental illnesses including depression, anxiety, schizophrenia, and dementia, and can trigger episodes of extreme anger and suicide ideation. Protecting one’s hearing not only prevents or delays hearing loss, but also benefits mental wellness.”