Ministry of Social Development and Poverty Reduction

Appeal Number 2024-0021 Part C – Decision Under Appeal The decision under appeal is the reconsideration decision of the Ministry of Social Development and Poverty Reduction (“Ministry”). The Ministry decided that the Appellant did not meet all of the requirements of section 2 of the Employment and Assistance for Persons with Disabilities Act for person with disabilities designation (PWD). The Ministry found that the Appellant met the age and duration requirements, but did not meet the following:

• the Appellant has a severe physical and/or mental impairment; • the Appellant’s daily living activities are directly and significantly restricted either continuously or periodically for extended periods; and

• because of those restrictions, the Appellant needs an assistive device, significant help or supervision from another person, or needs an assistance animal.

The Ministry also found that the Appellant is not qualified for PWD designation on alternative grounds, which includes: a person who is in palliative care; a person who received At Home Program payments through the Ministry of Children and Family Development; a person who gets or ever got Community Living BC for community living support; and a person who is considered disabled under section 42(2) of the Canadian Pension Plan Act.

EAAT003 (17/08/21) 2

Appeal Number 2024-0021 Part D – Relevant Legislation Employment and Assistance for Persons with Disabilities Act (the Act), section 2

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

The complete legislation is found at the end of this decision in Appendix A.

EAAT003 (17/08/21) 3

Part E – Summary of Facts Evidence at the time of Reconsideration

Appeal Number 2024-0021

The Appellant’s PWD application that includes: • A Medical Report dated September 11, 2023 which was completed by the Appellant’s doctor and who has seen the Appellant 1 time in the last 12 months. • An Assessor’s Report dated August 24, 2023, which was completed by the Appellant’s social worker. The social worker had known the Appellant for 2 weeks at the time the Assessor’s Report was completed and seen him 2-10 times. This report was complete by an office interview with the Appellant. • The PWD application also included the Appellant’s self-report dated September 11, 2023.

Request for Reconsideration, dated December 11, 2023, which indicated, in part, the following about the Appellant: • Unable to lift anything over 10 pounds with the right hand because he can not grip with it since the tendon in right wrist was injured. • It is unknown if all the plywood was removed from the wrist. • He must wear a brace on the right hand 12 hours a day and that is meant to straighten the joint in the finger. • He does not have assistance nearby and is unable to complete some daily activities. • He has not discussed mental health issues with the doctor because his is constantly getting support from online friends. • This sudden shift into mobility impairments and inability to do daily living activities impacts his well-being. He is not able to all the tasks or chores he needs to do to remain healthy.

The following medical reports were submitted by the Appellant: • August 30, 2023, Clinical Outpatient Report; • July 26, 2023, Orthopedic Surgery Clinic Note; • July 10, 2023, Anesthesiology Consult, index finger; • December 14, 2022, Orthopedic Surgery Clinic Note, right wrist; • December 14, 2022, X-ray Report for your right wrist; • November 22, 2022, Orthopedic Operative Report, right wrist; and • July 29, 2022, Ultrasound Report, right wrist.

*The panel notes that the medical reports submitted by the Appellant do not speak to the severity of the Appellant’s physical or mental impairment, functional ability, ability to perform daily living activities and need for help with daily living activities.

EAAT003 (17/08/21) 4

Appeal Number 2024-0021

The information in the PWD application including the following:

Sefl-Report The Appellant stated the following about his impairment in the self-report: • Unable to bend two of the joints on the index finger on the right (dominant) hand. • A cut tendon in the index finger, and this has left him with less than 50% range of motion in that finger. • He had a rubber tube inserted from the tip of the finger to the center of the hand. • This surgery resulted in scarred tissue that causes constant pain. • Unable to sleep properly due to constant physical pain; this affects his thoughts. • He is lucky to sleep more that a few hours even though he tried and spend day and night trying to sleep. • He was told by several doctors that he nearly died because of the wrist injury. • The wrist injury occurred at work and Worksafe BC has rejected any claim related to the tendon damage and ignoring the possibility that there may still be wood splinters in the wrist. • This experience has left him shaken; he has lost a sense of trust and security. • Unable to do many basic tasks like wash dishes, open bottles and jars or open doors with out setting down anything being carried. • It is difficult to wash himself. • Unable to do most sports and leisure activities and he has gained weight. • He can not sleep due to the pain and this effecting his thoughts. • He feels depressed and with the lack of sleep, he spends all day laying in bed in pain trying to sleep. • The ability to think and remember is impaired due to the combination of pain, lack of sleep and pain medication. • Rolling over in bed causes pain. • He has to use the left hand to move the blankets and pillows so that the right hand doesn’t touch anything except the elevated pillow it rests on.

Diagnoses In the Medical Report, the doctor diagnosed the Appellant with trauma on the right index finger with tendon involvement and traumatic injury on the right wrist. The onset of the trauma was not indicated.

Health History The doctor said the following about the Appellant’s condition: • Severe injury right index finger with very limited movement.

EAAT003 (17/08/21) 5

Appeal Number 2024-0021 • Had several surgeries – not able to use 2 nd and 3 rd fingers on right hand. • Also limited movement with right wrist due to injury. • Cannot use right hand – no grip. • Medications and/or treatments that interfere with the ability to perform daily living activities have not been prescribed. • No prostheses or aids are not required for the impairment.

Degree and Course of Impairment The Appellant’s impairment is likely to last 2 or more years from the date of the PWD application and commented: the Appellant “will still require further surgery that will improve right hand function – outcome still has to be determined”.

Physical Impairment In the Medical Report, the doctor said the following about the Appellant: • Can walk 4+ blocks unaided on a flat surface, climb 5+ steps unaided, cannot lift and can remain seated with no limitation. • The Appellant is “not able to use right hand and right wrist due to pain and very limited function”.

In the Assessor’s Report the social worker stated the following about the Appellant: • “Right had and wrist injury, depression and anxiety”. • Walking indoors/outdoors, climbing stairs and standing are performed independently. • Periodic assistance is required with lifting and carrying/holding: “only with left hand”.

Mental Impairment In the Medical Report the doctor said the following about the Appellant: • There are not difficulties with communication. • There are no significant deficits with cognitive and emotional function.

In the Assessor Report, the social worker said the following about the Appellant: • “Right had and wrist injury, depression and anxiety”. • Hearing is good. Writing is poor (“must write only [with] left hand – even though [he] was right-handed”). Speaking and reading are satisfactory (“loses concentration on communication – too tired because [of] medication and lack of sleep”) • There are major impacts on daily functioning with cognitive and emotional functioning in the area of bodily function.

EAAT003 (17/08/21) 6

Appeal Number 2024-0021 • There are moderate impacts on daily fun ctioning with cognitive and emotional functioning in the areas of emotion (“worries”), attention/concentration, motivation, motor activity (“stomach”), and psychotic symptoms. • There are either minimal or no impacts on daily functioning with cognitive and emotional functioning with all other listed areas. • “Poor eating habits, poor hygiene due to lacking motivation, sleep disturbance every night. Confused at times, thoughts are fuzzy. Inappropriate anxiety, worries often and depressed. Often mind wonders, loses focus, poor short-term memory, solving problems is difficult. Often no longer has motivation and has lost interest. Tension in his stomach often. Delusional due to current situations”.

Daily Living Activities In the Medical Report, the doctor said the following about the Appellant: • Personal self-care, meal preparation and basic housework are continuously restricted. • It is unknow if daily shopping is performed independently or is restricted either continuously or periodically. • All other listed daily living activities are performed independently.

In the Assessor Report, the social worker said the following about the Appellant: • He independently performs pay rent/bills, medications and transportation. • With personal care, he requires continuous assistance with the tasks of dressing, grooming and bathing (“100% of days low motivation, too depressed, only use [of] left hand”), and regular diet (“100% of days unable to, too depressed and anxious”). All other tasks of personal care are performed independently. • With basic housekeeping, he requires periodic assistance with the task of laundry (“only use of left hand”) and continuous assistance with the task of basic housekeeping (“90% of days not motivated, too depressed, anxiety”). • With shopping the task for carrying purchases home requires periodic assistance (“only with left hand”) and periodic assistance with the task of going to/from stores (“90% of time not motivated too depressed, high anxiety”). All other listed tasks of shopping are performed independently. • “Because his right hand and wrist are in constant pain and stuck in certain position it is impossible to use it for any gripping, writing or lifting when doing personal care, housekeeping or shopping. Another barrier is depression and anxiety causing significantly lower motivation, and fatigue due to lack of sleep. • With meals, he requires periodic assistance with food preparation and cooking (“only use [of] left hand”). All other tasks of meals are performed independently.

EAAT003 (17/08/21) 7

Appeal Number 2024-0021 • With social functioning the tasks of able to develop and maintain relationships, able to deal appropriately with unexpected demands and able to secure assistance from others require continuous assistance. All other task of social functioning are performed independently. He has marginal functioning with immediate social networks (“fluctuates in quality, distant”) and good functioning with extended social networks. • The Appellant’s daily living activities “are significantly restricted due to two injuries to this right hand and wrist. The one to his hand happened at age of 12 and wrist injury happened at work in 2022. His hand and wrist are now stuck in a claw position. Any movement will send shooting pain up his arm. He is now experiencing depression, anxiety and constantly worrying. He has stomach problems due to stress and sleepless nights due to constant pain”.

Help In the Medical Report the doctor said that the Appellant does not require any prostheses or aids for her impairment.

In the Assessor Report, the social worker said the Appellant: • Family and community service agencies provided help with daily living activities (“mother (distance), WorkBC”). • Assistance is not provided through the uses of assistive devices or an assistance animal.

Evidence At Appeal

A Notice of Appeal was submitted on January 8, 2024 and stated that “There has been a misunderstanding I have been told by doctors that I can’t work, I am confused because I can’t use my hand to work”.

The panel found that the Notice of Appeal is the Appellant’s argument and accepted it accordingly.

Evidence Prior to the Hearing

Prior to the hearing, the Appellant submitted the following information: • A letter dated February 14, 2024. (*this document is described in detail below). • A copy of a prescription dated February 12, 2024. • A second Medical Report dated February 12, 2024 which was completed by a different doctor than the one who completed the original Medical Report. The

EAAT003 (17/08/21) 8

Appeal Number 2024-0021 second doctor had seen the Appellant 0 times before completing the Medical Report. (*this document is described in detail below) • A letter of support from the Appellant’s Social Worker dated February 8, 2024. *this document is described in detail below. • A second copy of the Clinical Outpatient Report dated August 30, 2023.

February 14, 2024 letter stated, in part, the following: • “The wrist injury occurred at work and I am currently going through a WCAT appeal process because of it. I conflated these 2 processes and focused work-related information when filling out my PWD application”. • “I have a cut tendon with a hunter(rubber) rod in the Index finger of my right hand I am unable to bend the last joint in my finger and can get about 10% of the range of motion in the second joint with about 80% in the 3rd joint that connects it to my hand”. • “My wrist has chunks of plywood inside of it against my tendon and on top of the artery and it has about 70% of its previous range of motion”. • “I am in nearly constant pain that gets much worse when I use my right hand. I have been told by several [doctors] I have plywood still inside of my wrist against my tendon and on top of the artery and because of that if I don’t stop moving the wrist when it hurts, I will permanently lose more mobility in the wrist than I already have”. • “The pain causes difficulty sleeping and that results in impaired mental functioning and causes irritability. I often feel as if I am in a fog and upon reflection many of my actions are reflecting this haziness. I am often unable to follow through on plans and or have to delay them due to being too tired despite having spent all night in bed trying to sleep” • “I am unable to perform basic hygiene and self care in several ways”. • He is unable to shave properly or fold his laundry. • “I am often not smelling the greatest as even doing the washing is a long drawn out and painful process to the point, I put it off as long as possible”. • “am unable to do dishes without pain and extreme effort to the point where I cook and eat from a single pot that goes uncleaned...”. • “I am forced to use my left hand for things like taps and faucets. At the grocery store I am often forced to set the basket down to pick up items from the shelves the cart is very [hard] to steer with one hand so I am left having to take many small trips to carry things with one hand”. • He cannot shovel the snow. • “Trying to lift/carry anything with my right hand beyond the weight of a bag of chips is to much and rapidly causes increasing pain”.

EAAT003 (17/08/21) 9

Appeal Number 2024-0021 • “Intensive movement causes increased p ain even without added weight”.

Second Medial Report stated the following:

Diagnoses In the second Medical Report, the doctor diagnosed the Appellant with right wrist/forearm injury (onset 2022) and right finer tip/tendon laceration (onset 2004).

Health History The doctor said the following about the Appellant’s condition: • A description of the Appellant’s right hand’s medical history, including an injury on the finger at age 10 and the subsequent surgery left scar tissue and stiffness. Another surgery in 2022 to remove a foreign object from the wrist. • Medications and/or treatments that interfere with the ability to perform daily living activities have not been prescribed. • The appellant needs a brace for the right hand/wrist and compression bandage for his impairment.

Physical Impairment In the second Medical Report, the doctor said the following about the Appellant: • Can walk 4+ blocks unaided on a flat surface, climb 5+ steps unaided, cannot lift (due to right hand/wrist) and can remain seated with no limitation: “pain with lifting movements with right hand and wrist”.

Mental Impairment In the second Medical Report the doctor said the following about the Appellant: • There are not difficulties with communication. • There are no significant deficits with cognitive and emotional function.

Daily Living Activities In the second Medical Report, the doctor said the following about the Appellant: • Continuous restrictions with personal self-care, meal preparation, basic housekeeping and daily shopping. • Periodic restrictions with use of transportation and social functioning. Under social functioning, the doctor stated “due to lack of sleep – more irritable and won’t wait to socialize or drive”. • All other areas of daily living activities are performed independently.

February 8, 2024 letter of support, stated, in part, the following about the Appellant:

EAAT003 (17/08/21) 10

Appeal Number 2024-0021 • He is unable to perform tasks of persona l care without grave difficulty. For example, showering due to inability to turn on taps, cannot turn hand to scrub or wash. • Inability to regulate diet or choose healthy foods. • Inability to sleep due to pain and therefore without energy for tasks and chores. • Unable to perform housekeeping and laundry due to wrist pain. He cannot hold items or move them to clean. This causes a mess to build-up and an unhealthy and unsafe environment. • Inability to complete tasks of shopping. Due to pain and low energy and it is overwhelming to carry groceries or items. Due to the lack of sleep, his is unable to focus on shopping. • Inability to cook or prepare meals. • Due to pain, unable to get the necessary amount of sleep to remain healthy. This causes an impact on the energy levels for social functioning. He is irritable and anxious.

Evidence at the Hearing

At the hearing the Appellant stated, in part, the following: • The Ministry’s decision is not reasonable because it did not have all the information it needed as he confused his WorkSafe claim with this application process. • His personal experience does not match the decision. • With Preparing Meals: he cannot afford health food and must go to the food bank at times or gets ready made meals; he has difficulty stirring the contents of a pot when cooking because he has to grip the pot with one hand and stir with the other; and the quality of his food in impacting the quality of his life. • With Managing Finances: he can do the math but relies on others to make ends meet; he can manage his budget when he is rested. • With Shopping: he is unable to use the shopping cart at the store with one hand; he must use multiple shopping baskets; and he is constantly placing the basket on the floor to collect items and place them in the basket with one hand. The process is long and frustrating. • With Transportation: he cannot ride a bike; he can drive when the car is in gear; and he wants to modify his care for left hand driving. • With Housekeeping: it is difficult to manage tasks that require 2 hands; he struggles with sweeping and shovelling; washing pots is difficult so he cleans them by boiling water and rinsing; and he has not found an assistive device that can help him with housework.

EAAT003 (17/08/21) 11

Appeal Number 2024-0021 • With Movement: he struggles with get o n/off his bed or chair because he often uses his right hand; doors, snow and ice are a struggle; and his knee cap pops out of position which causes pain that last for 1-2 days. • With Personal Care: it is difficult to clean his body and he often smells; clothing and bedding is dirty; dishes are dirty; he is bothered by the lack of good hygiene; shaving is not possible; he cannot pay people to help; and he often looks unkept. • With Medication: he is hesitant to take medications but is physically able to do so. • With Decisions: decisions are made in an impaired state; he is not functioning well cognitively; when functioning he cannot sustain it for 8 hours; he needs to sleep for 14 hours to get 8 hours of sleep; and his interactions with others are impacted. • He does not have a family doctor and relies on walk-in clinics. • He previously had a wrist fracture before the current injury. • The December 14, 2022 report indicates limited movement of the right hand and that he is frustrated with the lack of movement. • The August 30, 2023 report indicates that the finger is permanently swollen. It must be kept in a tensor bandage otherwise it will swell up more and is painful. Scar tissue further impedes range of motion. • The Ministry concluded that he does not need aids, but the hand is wrapped in a tensor bandage and is also in a brace to re-shape it. It is unknown how long the brace will need to be worn. He wants a prothesis that will allow him to return to some form of work. • The November 30, 2022 report indicates that a foreign object was removed from his wrist. This was a chunk of plywood and there is still some remaining in the wrist. • He is in constant pain. • The Social Worker does not provide help or support at home. • He used to be driven and now is in a negative mood. He used to be physically active but is limited which has impacted the ability to socialize. He can only do cardio exercises at the gym. • He needs help with cooking and cleaning. At times he will provide neighbours with tech support in exchange for help with his daily living activities. However, generally, if he does not do the tasks, it does not get done. • Laundry is frustrating to complete. He does not have laundry facilities at home and must go to the laundromat. He must gather his clothes and take them there. He cannot fold clothes or iron so he rolls them. When doing laundry, he gets frustrated and he ends up using his right hand which is painful. The process of doing laundry is so long and frustrating that he often puts it off. • The doctors did not assess for any non-physical. Getting a mental health assessment has been difficult.