Hello all,
Any help or experience would be gladly received. My daughter as she has now turned 16 and she has just been through her first PIP assessment, she previously got DLA for middle rate care allowance and enhanced mobility, PIP have now decided that she is entitled to the basic living allowance and 0 points for mobility. We have now sent the below reconsideration along with medical records from consultants ect ect.. I have also phoned the DWP this morning saying that we are basing Rachel as walking aided / unaided no more than 200 meters with someone actually having to walk by her side. I have requested if they consider having to walk with someone to hold on to as aided. Does aided mean just with the use of her splint as Rachel would then fall into the category of no more than 20 meters without someone ??
Will the below be enough in peoples experience. This has put Rachel under significant stress as she has only just received her learner driving license after 7 months of waiting to be deemed medically ok. Rachel would also need a special adapted car which now due to not having been awarded mobility she cannot get so the chance of any bit of independence has been taken away from her.
On the 25th August 2015, Rachel suffered a large
deep right sided intracranial bleed from an Arteriovenous Malformation with
extension into the right lateral ventricle, also triggering a stroke and
causing significant damage to Rachel`s brain.
On the 27th August her neurosurgeon advised that Rachel would need immediate surgery to remove the bleed
and AVM due to the swelling increasing and the risk loss of life to Rachel. The
surgery was essential to save her life but also Rachel`s brain was to suffer
more damage due to this necessary procedure. The surgery was successful and
Rachel was awoken from her induced coma to which when she came around had
resulted in her left side being completely paralyzed.
Rachel spent four months from the 25th August to
the 17th December as an inpatient receiving intense
physical rehabilitation. Two months into her hospital stay Rachel received some
movement back into her left leg but still to this day Rachel has no function of
the left foot from the ankle to the toes and has to have this manipulate into
her leg splint in order to protect the ankle. Rachel also regained a little
movement in her upper body limb but still has a dropped shoulder and no
movement from the elbow to the fingers. Neurologist advised before
Rachel being discharged from Alder Hey that she would not regain anymore
movement than what had already been achieved due to the brain sustaining damage
from the bleed and then further damage due to the necessary surgery and this is
how Rachel still remains today.
DLA was applied for and Rachel was granted full mobility and
the middle rate care allowance that was to be reviewed after two years. In 2017
DLA was reapplied for and she was awarded an indefinite award due to her
limited ability and functions that she could perform.
Rachel turned 16 on the 17th November 2019 and
was then invited to apply for PIP to which the forms were completed and
returned and a face to face assessment was carried out in January 2020 in her
own home.
On April 09th 2020 has received the PIP decision
and she was awarded 8 points for living allowance and 0 points for mobility.
We are now completing the Mandatory Reconsideration as the
decision of the above seems to have discrepancies or missing information that
may not have been considered when assessing this award.
Please see below the list of what has been awarded and the
comments Rachel has advised in her initial claim, along with the guidance for
points as per the PIP assessment guide on the Gov.UK website
PREPARING FOOD, awarded 2 points.
It was clearly advised that Rachel cannot prepare or cook
even a basic meal. Due to having no function in her left hand from the elbow
down and very limited function to her left shoulder she is unable to open food
packaging, prepare (cut or chop) or even cook. Also due to balance issues due
to the left sided hemiplegia then balance when lifting hot objects can cause
serious risk of her falling or dropping items resulting in scolding/burning to
her body. The decision only states that “It
was noted that you have difficulties preparing food” there was no mention
of Rachel also being unable to cook.
Descriptor F (8 points):
Cannot prepare and cook food
This descriptor refers to the person’s functional ability in relation to
any impairment and their cooking skills should not be taken in to consideration
for this descriptor. If a claimant cannot cook because they have never learned but
their functional ability indicates they could undertake tasks involved in
preparing and cooking food then this descriptor would not apply.
MANAGING YOUR TREATMENTS, awarded 0 points.
Rachel has a one hour physio routine assigned to her by her
physiotherapist that requires help from another person to complete on a daily
basis to ensure the muscles are being strengthened and to avoid spasticity in
her limbs, this routine includes upper limb, lower limb and core muscle to help
her complete left side. The assessor at the face to face assessment was offered
to be shown the full printed out physio exercise routine assigned to Rachel but
declined saying it wouldn`t be necessary.
The decision states “You
have daily help to straighten your left hand so you can perform your
physiotherapy exercises. However, your right upper limb power and grip is
normal and were observed to grip your left arm with your right hand, suggesting
you can manage your own therapy
unaided”
The physio routine is a full body workout assigned to help
her to try and strengthen / preserve the muscle in her complete left side and
not just the left hand.
Also in the decision it states “You were able to raise and bend your left arm within normal range.
However, your physical examination did show you have a weak grip in your left
hand”.
Rachel has been under a neurosurgeon and a number of
physiotherapist at Alder Hey and also in Warrington and the details were
provided on the original PIP application, and not one of them has advised that
she has normal range in her left limb and when it is raised towards her head
the left limb will show sever signs of clonus which is muscle spasm involving
repeated, often rhythmic contractions and that the left hand will never return
any movement and only have limited feeling.
There was no mention of the regular botoulinum toxin she
receives to her upper left limb in order to preserve the joints in her left
hand and to prevent what is known as clawed hand where the fingers seize into
the palm. This was also advised to the assessor in the face 2 face assessment.
Descriptor E (6 points): Needs
supervision, prompting or assistance to be able to manage therapy that takes
more than 7 but no more than 14 hours a weekFor example: a claimant who
requires assistance to perform exercises which have been recommended by a
physiotherapist for the purpose of improving a health condition for 1.5 hours
every day.
DRESSING AND UNDRESSING, awarded 2 points
Rachel was awarded 2 points, it was clearly stated that
Rachel needs full assistance in helping her dress both lower and upper body as
she cannot complete bra straps and also any tops with buttons or zips, lower
limbs she cannot put on leg splint and needs someone to put on her shoes.
Rachel has daily help getting dressed for both upper and lower body. Again all
this was advised on both the forms submitted and also to the assessor.
Descriptor E (4 points): Needs
assistance to be able to dress or undress their upper bodyApplies to claimants
who cannot dress or undress their upper body, even with the use of aids or
appliances and require the physical assistance of another person.
MOBILITY
Rachel has been awarded 0 points for mobility and the
decision completely contradicts itself. It was advised on both the forms and to
the assessor that Rachel could only stand and walk 50m but no more than 200m.
Rachel cannot walk any further due to spasticity in the left leg when she
becomes tired causing the left leg to clonus and she becomes high risk of
falling. The assessor asked Rachel how long she could walk around a supermarket
to which the response was she couldn`t as busy places if she was to take the
slightest knock would cause her to fall and she is unable to stand herself back
up without assistance and could cause serious injury to herself that could
leave her with loss of all mobility if she was to suffer an injury on the right
side, the assessor then asked her to imagine if it was late night shopping and
no one was around. This would also not be possible as after 18:00 in the
evening Rachel is physically exhausted and fatigued and does not leave the
house, the 10 – 15 minutes as advised in the assessors report and the decision
is completely inaccurate. The decision also states that Rachel cannot go out safely
on her own due to lots of people this is in fact down to the above point of
that it would cause her significant harm or injuries if she was to be knocked
off balance and also cause her too much psychological distress. Rachel has also
advised on both forms submitted and to the assessor that in busy places (most
shops on a daily basis) she uses her wheelchair and
does not walk. Rachel also requires the aid of another
person to push the wheelchair as she cannot manoeuvre it herself as she has no
use of the left upper limb.
The decision states “You
reported that you are able to workout timetables and only have someone with you
when going out due to worrying about being around lots of people.”
Rachel cannot safely walk outside the house without another
person by her side as she even struggles to be able to walk in a straight line
due to balance issues even on any journey undertaken. Rachel cannot safely
manage any steps without the assistance of grab rails (present throughout the
home) or the help of another person, this is essential in crossing roads and
having to step up and down curbs where there are no grab rails, as stated
Rachel would not be able to stand herself up without assistance and if she was
to fall when stepping off a curb into the road this could be extremely serious.
Rachel has taken a number of falls within the house and suffered bruising to
her body, this was also advised to the assessor and that it happens
approximately once a month due to balance issues especially when she becomes tired.
Descriptor F (12 points): Cannot
follow the route of a familiar journey without another person, an assistance
dog or an orientation aid.
‘Follow the route’
means make one’s way along a route to a destination. This involves more than just
navigation of the route. Safety should be considered in respect of risks that
relate to making ones’ way along a route (for example, tendency to wander into
the road, inability to safely cross a road or risk of self-harm due to
overwhelming psychological distress caused). For example, a claimant with a
severe visual or profound hearing impairment may be at a substantial risk from
traffic when crossing a road.The familiar route does not need to be planned – it is familiar. Any
significant diversions from that route are therefore irrelevant – it is no
longer the familiar route. However, making one’s way around road works, or a
change of train platform (i.e. minor diversions) are part of being able to
follow the route of a journey.The descriptor refers to “a familiar journey”
rather than “any familiar journey”. Accordingly, claimants can
satisfy the descriptor by showing that they typically need to be accompanied by
another person or
an assistance dog or to use an orientation aid on the majority of days when
undertaking familiar journeys (it’s not necessary to show that they
need such support for every possible familiar journey on most days).This
descriptor is most likely to apply to claimants with cognitive, sensory or
developmental impairments, or a mental health condition that results in
overwhelming psychological distress, who cannot, due to their impairment, work
out where to go, follow directions, follow a journey safely or deal with unexpected changes in their
journey, even when the journey is familiar. A claimant who suffers overwhelming
psychological distress whilst on the familiar journey and who needs to be
accompanied to overcome the overwhelming psychological distress may satisfy
descriptor 1F.A claimant who is actively suicidal or who is at substantial
risk of exhibiting violent
behaviour and who needs to be accompanied by another person to prevent them
harming themselves or others when undertaking a journey would meet this
descriptor. In cases such as this, the HP should look for evidence of suicidal
thoughts and/or behaviour. In cases of violent behaviour there must be evidence
that they’re unable to control their behaviour and that being accompanied by
another person, who can intervene if necessary, reduces a substantial risk of
the person committing a violent act.
Descriptor B (4
points): Can stand and then move more than 50 metres but no more than 200
metres, either aided or unaided.
In the written decision it also stated the below points
“I decided you can
plan and follow the route of a journey unaided” and the following sentence
then states “it was noted that you also
have difficulty moving around” to which these two statements contradict one
another.
During the face to face assessment Rachel was in a sitting
position and never stood up or walked for the assessor to be able to make any
kind of assessment.
The decision also reports that Rachel “showed adequate general memory” this was also advised that Rachel
does have memory issues caused by the bleed and the swelling to slightly damage
this part of the brain in the frontal lobe and the example of the audio book in
English Literature was one that was given to help her with this problem.
Rachel since returning to school has also had a funded
personal assistant helping her every day in school from explaining classwork
when she has struggled to remember or understand along with her leaving lessons
10 minutes early to ensure that the corridors are clear and that she can safely
get to her next lesson along with her personal assistant. Rachel`s physio in
Warrington also comes out to the school to assess her needs as some lesson (e.g
Science) she requires a special chair that she can sit on safely without
risking a fall but this also has not been mentioned in the current decision. It
was also advised that Rachel has to be driven to school and dropped off at the
reception by her mother and collected at the end of school by her grandparents
where she stay until her mother is able to finish work and collect her. Rachel
is unable to be left unattended without supervision due to her condition and to
do so could result in serious harm both physically and mentally.
Please can you send a full copy of the assessor report along
with the names and occupations of all the people involved, copies of all
communication channels and any case notes (all versions) relating to this
assessment of Rachel`s claim so that the details can be checked that the
relevant parties where qualified enough to make the below assessment
accurately, especially as Rachel remained seated throughout hew whole face to
face assessment and also that it is not consistent with any of Rachel`s medical
history advised to us by her neurologist team and physiotherapists.
All the above information is required if this
reconsideration decision is not successful and we have to take the issue further
so that we can present clear and precise evidence to show that the decision
made is incorrect and factually inaccurate in comparison with the medical
experts that Rachel has been under since 2015.
Written decision
“You are able to walk
around shops for 10 to 15 minutes as a slow pace without stopping. On the
balance of probability and the assessor understanding and experience of your
condition, it is reasonable to suggest that you would be able to walk over 200 meters.
I decided you can stand and then move 200 meters either aided or unaided. This
is consistent with your medical history, informal observations at your face to
face consultation, the information you provided how your disability affects
you, your mental state and physical examination results.”
