PIP claim 2nd time with new conditions

tifo

Hi

I have a thread on here from a previous claim which went up to tribunal but I wasn't successful. I still suffer from my eye conditions, gout and other issues but at the time the DWP and tribunal said they were not enough for a PIP award. I still disagree but anyway the judge said she doesn't believe me.

Recently i've been diagnosed with osteoarthritis in the knees, the left knee is stiff and limited in movement for the past month and the right knee is also stiff but not as much. I've had the x-rays etc and it could be due to age or gout which used to affect the left knee sometimes. I also now have pains in my fingers esp when I do tasks using them, for example keyboard. More so in the right hand. It's the joints.

My cholesterol is at 5 (2 years ago it was 5.5) and the GP says this is now considered high when previously it wasn't as they use different criteria and wants to put me on statins, though this is not a basis for the claim.

My BP is also slightly high and i've been put on medication for this.

So this month 3 new outcomes.

So, should I make another PIP claim because of osteoarthritis? The other existing conditions will be secondary. I see that the award success rate for osteoarthritis or generalised osteoarthritis is high at around 72%. My other conditions have not gone away as they're for life which I said in my previous claim, though my gout hasn't flared up much this year.

Thanks

tifo

I'd like help from an agency this time as I think I may have made newbie mistakes last time and tried too hard to get all the info to the DWP (claim, MR) and tribunal, esp since the DWP used both my WCA and PIP medical reports in both tribunals and I had to argue against 2 reports (hence double the writing I had to do) and the DWP rep and judge at the tribunal kept jumping from one report to the other, with me having to keep up with the relevant report. I thought this was unfair but the tribunal didn't see anything wrong with it.

I've been told to be concise and not waffle which can happen when one tried too hard.

Albus_Scope

Heya @tifo PIP is awarded based on how your illnesses effect you day to day, it's not based on any diagnosis. But there's no time limit on when you can reapply.

I've found the best way of setting up your application is writing about each descriptor that applies to you, then what the issue is, preferably with real world examples of issues with consequences and then the tick box you chose.

tifo

Hi, i've started my claim with DWP, made the phone call yesterday which is 3 months from new condition.

Also been to see Shelter who are our local benefits advisors and they were totally useless as before, they just give you the descriptors and ask to fill your own form.

chiarieds

Hi @tifo - I'm sorry Shelter weren't much help. You could try the following to see if there's a Welfare Rights Office near you:

https://advicelocal.uk/welfare-benefits

As mentioned by Albus, PIP is not about any diagnosis, but rather how your disability affects certain activities of daily living &/mobility. PIP is also about how you are the majority of the time.

Try & give a couple of recent, detailed examples as to the difficulty you face for each applicable descriptor, i.e. when did it happen, where, what happened, did anyone see this, & were there any consequences to attempting/doing an activity such as pain or fatigue?

Say if you can do each applicable activity 'reliably,' i.e. safely, to an acceptable standard, repeat as often as one would reasonably expect, or if it takes you much longer than someone without a disability.

Try keeping a diary for a week or so to help show where you may have difficulty/need support, etc. Just complete a few questions at a time, & you can always add extra pages at the end. Ensure you put your name & National Insurance number on each page. You can also ring the PIP enquiry line on 0800 121 4433 to ask for extra time to complete the form, & you will be given another 2 weeks without question. Keep a copy of everything 'just in case,' & get a free Certificate of Posting from your Post Office when sending the form off.

This is also worth reading through:

https://www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-2-the-assessment-criteria

tifo

I've had my telephone assessment and it was about 1 hr 30 mins .... the appointment was late by 1 hr 10 mins .... but they did call 10 mins before the appointment time to ask if it can be 45 mins late, then called again at that time to say it will be another 10-15 mins. I said that's fine.

The assessor went through each condition and how it affects me and asked about each medication and any side affects (I don't know of any). I think it went OK but i know they'll catch me out on many things, for example i said i go shopping when i can and they'll say this means you can walk X metres or I said i drive a manual car when i can (and don't drive when i can't) but they'll say i'm ok driving a manual car for mobility. But the assessor did prompt me many times and i said "oh, i didn't think of that".

I did mention my OCD which i hadn't thought to put on the form, this was when asked about mixing with people and being in public spaces. But this affects me a lot, if i touch anything, i have to wash my hands with handwash immediately or am worked up until i do, for example letters come and i put them inside and immediately go wash my hands, i explained that i think about the journey the letters have taken and how much bacteria or germs they've collected or if i shake hands with someone then i'm worked up until i can wash my hands because i think how many germs or bacteria the person had on their hands and what they've touched etc etc, for public spaces i said i don't like to meet new people because i have low self esteem and confidence or want to see anyone i know and literally hide so i don't have to meet them (this is true), i don't like sitting on public seats because i don't know what dirt and germs are on them and never use public transport, the assessor asked when was the last time i used public transport and i said a train 6 years ago as it was at the time my eye condition was very bad and i couldn't get a lift but i had to go to a court hearing (my mortgage provider was totally unhelpful). In the end the assessor said i should go see my GP about the OCD. At home i always have at least 5 handwash bottles so i don't run out!

I asked about the possible outcome but the assessor said it will be for the DWP case manager to decide, they can't tell me. I said "you must have an idea" but they wouldn't say. I got a text from DWP PIP an hour later saying they've received the report and will let me know within 8 weeks. I thought that was quick and take it as bad news as the assessor may have just ticked boxes and given 0 points for everything, like last time.

tifo

should i ask for the assessment report, which may tell me what points i've got, or wait for the decision, which could be many weeks?

If the assessment report gives points then i'll know the outcome and can plan an MR appeal or tribunal, but it was more for me to be able to make an appointment with Shelter because they take so long. If i wait for the decision letter (if it's a straight no and 0 points then in the past we've had it in 2 weeks) then ask Shelter i could wait 4 weeks from that, whereas if i ask Shelter now and see them in 4 weeks i haven't got the longer wait. I say this because i'd like them to help with an MR or tribunal rather than go it alone again.

Albus_Scope

Hey @tifo thank you for the update. The questions do tend to be worded very carefully. for the walking ones, I ended up replying "I could walk x meters, but not repeatedly and I'd be in pain" else I knew the assessor would just tick yes.

It's definitely worth calling to ask for a copy of your report. But please don't focus on it when writing your MR. You need to be focusing on letting them know where you think you should have got points, how many and why. With real life scenarios and consequences where possible. Best of luck, I know how draining it can all be.

tifo

https://forum.scope.org.uk/discussion/comment/995367#Comment_995367

From the assessment and looking at criteria i didn't realise OCD was such a big thing. I'll make a GP appointment and take it from there, even though i didn't put it in my form we did discuss it in detail at the assessment and i'll have medical evidence for the MR or tribunal.

For those that may say i'm clutching at straws, this is not true. I've genuinely had OCD about dirt and germs for many years (and was worse in covid times) but didn't think it was bad enough to see a GP about, but going through the assessment questions i now realise that it is. Washing hands constantly, if i touch anything remotely dusty i have to go wash my hands with handwash immediately, not sitting on public seats or not using public transport for the same reason, not sitting on grass at a picnic, not wanting to touch public door handles (i use my little finger in the corner of the handle where i think most people don't touch it) etc all point to a real issue.

tifo

Received my PIP letter, got 0 points on everything whereas previously i got 2 points for 'managing therapy' (i can't put my eye drops in as blind eye).

I'm still waiting for the assessment report but the case manager says things (you can, you said) which i can't and didn't. Apparently driving a car means everything is fine (my answer was 'only when i can' and 'i don't always drive'). And because i answered all the questions i have no mental or cognitive issues.

Time for MR ..... hope the assessment report comes soon.

tifo

The decision letter was sent the day after the assessment so the case manager seems to have just agreed with the assessment report and 0 points across all descriptors and not spent time looking at the claim ...... I think.

tifo

i've asked maximus for the assessment recording or transcript ….

tifo

Some extracts from the decision notes:

Mostly it's a repeat of the descriptors and then "I decided that you can manage these activities".

"You drive a car which requires a reasonable level of upper and lower limb strength, grip, range of movement and core stability as well as competent level of reading ability, memory, cognition and concentration". I said I drive when i can which is not always.

"When engaging with the assessor you coped well, was not anxious or withdrawn and did not need any prompting". I tried to answer the best i could and many times asked her to repeat the question.

"There is no evidence of any prescribed anxiolytic medication and you do not receive any specialist input for your mental health. Your functional history report shows no abandoned journeys and no panic attacks leaving the home. Your assessment showed you have no cognitive impairments and you possess adequate memory and concentration. During the assessment you coped well with adequate rapport. You communicated clearly and effectively without the need for prompting and with no signs of overwhelming psychological distress". Basically saying i'm on no anxiety medication and have no mental or memory issues. Nothing about my OCD and how i said it affects me in terms of going out (i don't most times) and especially how i am at home and in public spaces and the routines that i have to do with a lot of things.

"The functional history report shows you report being able to walk 30 minutes without stopping at a normal pace 4 or 5 times a week which is the majority of days". This is in response to shopping when in reality nobody, not even able bodied people, walk around a supermarket non stop for 30 mins, everyone pauses and stops at many stages in their shop to browse or pick up items. And many times it's not 30 minutes of non stop walking in a shop as it might be a quick 5 minutes in and out. It does not specifically state 'shopping' but i know it is because the assessor said i can walk around a supermarket for 30 minutes and it was also stated in my previous claim.

"You only take analgesia for your severe gout flare ups, you report flare ups 12 times a year and there is no evidence of any specialist input. I decided you can stand and then move more than 200 metres". Obviously i can't with severe or mild gout and i don't take medication only for a flare up, i'm on constant medication for it which helps but doesn't stop it.

There's no mention of how osteoarthritis is affecting me (stiff, painful left knees but more in the left) in terms of movement or bathing, which i mentioned i can't bend it to wash my lower legs or lift my feet to wash them. The assessor specifically asked this. The same applies to dressing/undressing. With gout movement and bathing has a different difficulty. My GP said use the same medication for osteoarthritis as for gout.

Lots of other things were asked and replied to and there's no mention here. I'll see in the assessment report when i receive it.

OverlyAnxious

Hi,

A lot of that is just the usual cut & paste rubbish they use across many assessments.

However, as you can drive and have a driving licence, that does show limb mobility and cognitive ability. It does not matter if you 'can't always drive' for this statement. I feel you may have given similar answers for other questions too, which has allowed the assessor to make assumptions which may or not be correct. PIP is about the majority of the time, so if you only get flare ups once a month, that doesn't create entitlement to PIP. You need to make it clear what you are unable to do reliably for more than 50% of the days in a month.

With regards to OCD, the descriptors don't cover that well at all. I've had considerable limitation from severe OCD symptoms for many years but even at tribunal the OCD only added 2 points to the Daily Living side. I would focus more on your physical conditions personally.

tifo

I received the assessment report at the weekend after 2 weeks and it's disappointing reading.

Whilst the assessor has stated most of what I said, not all, in most of the activities she's used the fact that I have a driving license as a reason that I can do that activity, this is stated in bathing, therapy, dressing, toilet use, going on a journey. It states that because I have adequate vision and limb movement to move I should be able to carry out the activity reliably. So because I can drive I can bathe without aid or help, can put eye drops without help, can dress without help, can go to to the toilet without help and can go on any journey I like anywhere without help.

And because I can walk for shopping for 30 mins without stopping I can walk anywhere for more than 200 metres.

And because my partner accompanies me to hospital visits then I should be able to engage with people without any problems.

What i've said above is all in the report.

By that logic when i can't drive then i should not be able to carry out that activity?

She wrote in the notes about my anxiety and OCD but has totally ignored these for the descriptors, i think citing later that they're not diagnosed even though we discussed them in detail in the assessment.

She's only cited 1 hospital letter as evidence and none of the photos, and then the GP record and my previous PIP report from 2021 and the current PIP form and the current PIP form.

What does VB, MOD and OPD mean? They're not in the 'abbreviations used' section but are used a lot

OverlyAnxious

As already said, they use a driving licence as a standard refusal tool. It's nothing personal.

OPD is Overwhelming Psychological Distress. (Essentially such severe anxiety that you are physically unable to complete the task).

MOD is Majority Of Days. (This is what PIP is about, they aren't interesting in anything that you can do reliably on more than half of days).

VB means Variable. (Not happening frequently enough or severely enough to be considered for PIP).

tifo

https://forum.scope.org.uk/discussion/comment/1014245#Comment_1014245

Thanks

"As already said, they use a driving licence as a standard refusal tool. It's nothing personal".

Yes, i'm finding out. I'll have to see the previous report (2021) if this was the case but I recall the decision mentioned driving license hence blah blah.

In regards to OPD, i made it clear in the assessment that I can't mix with people due to anxiety and OCD, i do not want to see people or speak with them or shake hands with them and that i actually hide or walk away so that i don't have to meet people i know. The report said because my partner accompanies me to hospital visits i should be ok mixing with people. That's a big assumption and unrelated to the activity!

tifo

From the report I can now see that the decision has quoted some word for word statements and I can believe this as it seems there was not much of a decision made by the case manager, he's just quoted from the report. It was all so quick, assessment report sent to DWP an hour after and decision sent out to me the next day.

OverlyAnxious

The decision makers generally do go with the assessors recommendations.

tifo

https://forum.scope.org.uk/discussion/comment/1014266#Comment_1014266

Yeah i know they do. The DWP case manager is meant to review all documents, inc the report, and come to their own decision but they rarely do.

But in my decision the statements are word for word from the assessment report, no effort to write their own.

Dianaf

Just wanted to say after reading this. What about all the millions of pip claiments who have mobility cars and a licence that receive full pip. The reason they get the car is because they receive full pip but at the same time they are not allowed to be able to drive or hold a licence?