mandatory reconsideration decision

Can anyone help with the following please?

I used the benefits and work guides and I was awarded the enhanced rate for mobility (12 points) and standard rate for daily living (11 points); I only required 1 more point in order to be awarded the enhanced rate of daily living

I received the medical report before I requested a mandatory reconsideration (4 pages). I gave the reasons why I should be awarded a higher descriptor due to the physical assistance I need all of the time.

In the medical report the HP states that I have difficulties with the majority of the activities and records that I have reduced power and mobility in upper/lower limbs and reduced power in both legs, reduced grip/pinch grip in both hands and that I have breathlessness attempting the activities. The HP also validates all this information by confirming throughput the medical report that what she has stated is also based on her own observations. I believe this in itself confirms that I would naturally require help and assistance with preparing food, managing therapy, washing and bathing, managing toilet needs and dressing and undressing.

The HP only gave me 2 points for needing an aid for the above activities. I did not dispute zero points for communicating, reading and understanding signs, engaging with other people and making budgeting decisions. However, I wanted the following noted: - in terms of taking nutrition the HP has not recorded that I have problems with chewing and swallowing food which causes me to choke. The HP has not recorded that I have been unable to use public transport for over ten years and that whilst I can follow a local route I panic in unfamiliar places the traffic delays due to double incontinence.

I received the mandatory reconsideration decision a couple of days ago and they have upheld their original decision. The DM has not commented on any of the 5 points I elaborated on and the reasons why I should be awarded the higher points.

From what I understand they have not changed the decision as they believe my needs vary most of the time. The DM states that the available evidence supports the use of aids to manage the disputed activities most of the time. The DM records there is no medical evidence available to indicate the need for assistance with physiotherapy within my home. (I have osteoarthritis in my back and am stiff every morning and after any activity) I have been given exercises to do every day just to help me out of bed. The DM cannot consider difficulties with washing and changing clothes when managing incontinence as these are considered separately and do not come within the scope of managing toilet needs. The DM states that they have considered the evidence available looked at the areas in dispute and are still satisfied the descriptor awarded are correct.

The DM also states that the evidence indicates my medical conditions cause me substantial difficulties with moving around and they stated I am still entitled to the enhanced rate of mobility. However after requesting they have extended my review date from 3 to 5 years.

I believe that I have given enough information in the request for a mandatory reconsideration. In my application form I gave specific examples and always stated that I need physical help with all of the daily activities listed above.

I made the decision not to mention in my mandatory reconsideration the following:
As soon as I arrived at the medical the HP said a couple of times that she tried contacting me to bring my appointment forward as she had a cancellation. Whilst the HP seemed very nice I felt the medical was rushed and that she was in a hurry. The HP did not allow me to elaborate on my answers at the medical and kept saying “Just answer the question”. My sister in law, who is one of my carers was present. There was also long periods of silence whilst the HP typed up the report and on every daily activity she recorded “ It is reasonable to suggest she needs to use an aid or appliance to be able to complete this task safely and repeatedly majority of the time”.
I feel if I now mention these issues they will wonder why I did not mention it in my mandatory reconsideration.

I compared the HP medical report with the account I gave of my circumstances on my claim form. One example is that in my application I wrote that I could not get on and off the toilet without support, but the healthcare professional noted in their report the above in bold which awarded either 1 or 2 points for the above mentioned activities.

My questions are: -
DO I need to further elaborate on the information I have already given or should I keep the appeal short by just referring the tribunal to my application form, a statement from one of my sister-in-law’s and my mandatory reconsideration request?

I believe I have given enough information and I do strongly feel that neither the HP or DM have fully understood, possibly not even read how my complex degenerative medical conditions/disability affect my daily living. I will ask to be present at the hearing and thought that I could elaborate further at the tribunal.

I am sorry for the very lengthy summary and would be most grateful for any guidance on the above please. Thank you

Gordon,

I very much appreciate your speedy response.
Sorry I could not get back to you sooner but I have had problems with my computer. I have answered your queries and concerns in bold paragraph by paragraph.

You do not need to go into detail in your request for an appeal, see the PIP Appeal guide for links to the form that you need to complete and instructions on how to do so.
Is it better to complete the form or can I put my appeal in writing with all the information that is needed required on the form? I have not been sent the form by DWP so if it is better to complete the form can I request this when I telephone to advise them that I will be appealing against their MR decision?

So I would wait to make a decision about what additional information you should or should not include until you have seen the full DWP submission to the Tribunal Service, they will prepare this and send you a copy once they have been notified of the appeal. In the decision letter it mentions that my appeal is to be addressed direct to the tribunal. So is it better that when I telephone to advise about my appeal I also ask them to first provide me with what information that have considered in upholding their original decision?

Although you state that you need assistance rather than aids, have you explained in the PIP2 or MR request why aids would not be of assistance for those PIP activities that have been suggested? Yes, I explained in my application form the aids I have difficulties with and the ones I currently use. I also sent the details in the post of all my medical conditions/medication/ aids previously used/ aids currently used as the HP would not take it from me at the medical assessment.

One of the issues raised appears to be how much you are affected and for what periods, this suggests a fluctuating condition, are you happy that you have made full use of the terms "reliably" and "on the majority of days"? Yes, on checking my application form I have clearly stated that I was unable to carry out the activities safely, reliably and in a timely fashion. However, I did not repeat this in my MR. The HP has recorded however on the medical report at the bottom of the page re History: - Reports having all bad days in a week consisting of physical pain and above symptoms (the affects was listed on the form).

Attending the appeal will imply some capabilities are you happy that doing so will not contradict any of the limitations that you have specified in the PIP2. If I have understood this correctly, I do not believe so, as I attended the medical assessment. The HP confirms in her report that what I have said at the medical is consistent with my questionnaire.

A tribunal is not like a Court case, there is no presenting of yours or the DWP's case, the panel will ask you questions about your problems, there will be an opportunity at the end of the hearing for you to raise any issues that your feel haven't been covered.
So I remember the issues to raise, I will be taking a list of matters that I want mentioned at the tribunal hearing.

It's of course up to you but I see no value in raising issues from the assessment, the panel will have little interest and doing so is unlikely to contribute to your receiving a higher award. Thank you, I agree.

Although you have retained the Enhanced Mobility award I would not have expected this to be due your problems using Public Transport or due to your incontinence issues when out, so I would be careful in how you justify the award if asked at the Tribunal. This is not in relation to the enhanced mobility award this was in relation to Planning & following a journey. The HP did not ask whether I can cope with small disruptions to travel nor was I asked whether I become anxious when on unfamiliar routes? I am sure that I have seen in one of the information guides that ‘A person should only be considered able to follow an unfamiliar journey if they are capable of using public transport’. As the HP did not record what I had said under this activity, I wanted it recorded that I have been unable to use public transport for over 10 years and that I get anxious and panic travelling on unfamiliar routes because I suffer with incontinence and that I always need to know where the toilet is situated.

Thank you once again Gordon and I look forward to hearing your further advice.