Seeking advice on structuring MR letter

SecretAgentFishguts

Hey all - please forgive the username, privacy and that.

I’m looking for some advice on structuring my MR letter, I was hoping someone could help.

I applied for PIP on the grounds of the following:

1) Generalised joint/muscular pain
2) Multiple MH issues - originally diagnosed as anxiety/depression, further investigation led to discussions on OCD and later still ADHD (diagnoses as of this last month!) 

After a bit of a battle that involves Capita LOSING MY REPORT for my original video call assessment and rescheduling it for a telephone assessment a month later and not informing anyone (me or DWP) that it had been lost until I contracted them myself, I finally have received my report and decision and, in a turn of events that shouldn’t really have surprised me, I was awarded a grand total of 4 points.

The reasoning behind awarding me 0 points on each question were one or more of the following:

1) I own and can drive a manual car
2) I work 32 hours a week
3) I don’t have a prescription for pain medication/take regular high amounts of pain medication
4) I didn’t have official diagnoses other than the anxiety/depression 

In each question, it appears than pulling this gotcha to award me 0 points if possible was the goal. If there were any issues with dexterity/mobility, they called on 1, any issues with motivation they called on 2, any issues with pain they called on 3, and any mention of OCD/ADHD they called on 4. However, I have entirely valid reasons as to why these issues do not constitute reasons to award 0 points.

1) I am physically able to drive, yes, but I made it clear in the assessment (and this is noted in the report) that at most I can drive on my own is a ten minute drive to my mothers house, following a specific, quieter, less direct route. This is due to severe anxiety around driving, meaning I cannot drive a route I do not know without someone else in the car. Panic attacks aren’t fun on the road. Also, whereas I can physically drive, it does cause me pain, so I can’t drive for extended periods. Plus, the activity involved in driving, although difficult, isn’t the type of activity that causes me my main issues (namely, repetitive motions especially in my wrists causing severe pain and swelling, and pain and fatigue from supporting my own body weight).

2) I work 32 hours a week, because if I didn’t I wouldn’t be able to pay my bills. This does not, however, mean that I find my work easy. In the two years since I’ve worked my home based contact centre role, I’ve had 2 occupational health reviews (the first of which resulted in a reasonable adjustment of adapted shift patterns, the second is ongoing and delayed due to my sick period), multiple instances of sick, one lasting six weeks and one that I’m currently on that is likely to last considerably longer, I’ve nearly had a disciplinary review due to poor performance and realistically I am only able to work the hours I do because the company is (mostly) incredibly supportive of my disabilities and because I have had to due to necessity. 

3) I don’t have a prescription for pain medication because I had tried many, and nothing has helped with the pain. This has lead to me forgoing pain medication as I am quite frankly scared of what taking high doses of pain medication will do to my body long term especially if they don’t work. I am also incredibly reluctant to take an opiate painkiller, as I am predisposed to addiction and I do not need to add an opiate addiction to my life.

4) This is the fun one - although I was in discussions with GPs and MH nurses for years regarding my OCD symptoms, it looks like this was never recorded on my medical history, and was always listed as Anxiety/Depression. At one point, a MH nurse I was receiving help from (she was honestly) advised me that there would be limited use in going for a psychiatric assessment to log OCD as an issue because the treatment I would be offered she could offer me anyway, and I wouldn’t have to wait the huge waiting period for a psych evaluation. Probably not the best move looking back but it made sense at the time, as I downplayed my own issues and didn’t see myself as qualifying for support for it anyway.

I have recently however had an ADHD assessment, after which I was diagnosed with:

Adult ADHD
Mixed anxiety and depressive disorder
Traits of PTSD

After being on SSRIs for ~12 years and eventually realising they were doing more harm than good, I’ve now been put on ADHD medication, which I’m in my second week of. The fun bit is that due to waiting times, the ADHD assessment and the SECOND Capita assessment landed on the same day, with the PIP assessment first. This also happened to be my dads birthday, who died last year due to alcoholism (hence the opiate fear) so safe to say I wasn’t in the best of moods on the day. This would obviously mean that the PIP assessor didn’t have access to this medical information as I wasn’t able to mail a copy off until a week later when I was able to pick up the letter with the diagnoses. This would have arrived this last Tuesday, and I received the big old ‘Nah Fam’ from DWP today (Saturday) so the timeline would mean that they wouldn’t have received this before making the decision. 

The pain issues are difficult to verify too, as for years I have kinda been palmed off about them, even though I was having X-rays and bloods done for them before my anxiety manifested originally (~13 years ago). I’m finally seeing a rheumatologist and so far we still don’t know what the issue is even after an MRI. The rheumatologist has provided a letter to the effect of ‘yes, there’s something wrong, no we don’t know what it is yet, give pip plz’. I initially gave the information in the letter over the phone and was advised I didn’t need to send a copy, until I called to provide the information about the ADHD diagnoses and was told actually, yes, plz send. So this letter also didn’t arrive until after the decision would have been made. Although both these letters would have been noted on my file (I was explicitly told they were) it doesn’t appear either were taken into account in any way judging by the wording of the response. 

Anyway, sorry for the life story - my main questions really are:

1) Would providing the above information relating to my ‘disqualifications’ be beneficial in any way? The information I’ve seen about the MR letter I need to write seems to boil down to ‘look at the criteria, explain why the decision made is incorrect, explain why you believe you should have been given a different answer’ which seems pretty straightforward but I am concerned that this information will just be disregarded again like it was in the original assessment. 

2) If I go for an MR now, and insist they look at the supporting evidence I sent after the assessment, would the fact that they now have this information realistically change anything?

3) I mixed up/forgot to include some of the above information in the assessment, as I was in a pit of grief, on four hours sleep, and angry and miserable that I had to go through the assessment process again (but I was ‘articulate’ apparently) - if I include this extra information will this be held against me due to the fact that it would differ to what is written in the assessment?

4) Should I request any further information from medical professionals to support the above? If so, what should I look for? My GP isn’t going to be able to confirm that I barely ever drive, for example, so I don’t know what extra information I can realistically give here.

Thanks for reading all this - sorry it’s so long. It’s just become very apparent that I probably did the assessment ‘wrong’ and I want to make sure I get the MR right as much as I can.

poppy123456

HI,

PIP isn't awarded based on any diagnosis, it's how those conditions affect your ability to carry out daily activity based on the PIP descriptors.

Medical evidence is only helpful if it states exactly how your conditions affect you and most doesn't state this.

What you need to do is put the decision letter down and the assessment report (if you have it) and forget about both of them.

Go through each activitiy to see where you think you should have scored those points and your reasons why. Then add a couple of real world examples of what happened the last time you attempted that acitivity for each descriptor that applies to you. The only person that knows really how your conditions affect you is yourself. The best evidence you can send is your anecdotal evidence.

People do work and claim PIP but if the work you do contradicts the reasons you're claiming PIP then yes it can go against you.

MR success rate is currently about 50% and can as long as 3 months for the decision to be made. No one here can tell you whether the MR will be successful because no one knows exactly how your conditions affect you. If the MR decision doesn't change then it will be time to get some expert advice as well as representation.

woodbine

Please don't whatever you do concentrate on what your illnesses/conditions are for your MR but where you think you should have scored points and didn't, giving where possible real life examples of when you tried to carry out a descriptor and couldn't and why you couldn't. Working should not go against you when claiming PIP, but if some of your problems are caused by pain not taking pain killers will I'm afraid go against you.

chiarieds

Hi @SecretAgentFishguts -  & welcome to the community. I totally agree that PIP isn't about any diagnoses, but rather how they impact on certain activities of daily living &/mobility, & I hope you take the considered advice above onboard. Certainly put your decision letter, & any assessment report behind you, & concentrate on where you should have got points, & detail why.

However, & I could very well be wrong, as I deal with chronic pain, I did explain in my initial claim form the different types of pain meds I'd tried, but which hadn't worked, & why, e.g. I tried low levels of anti-depressants, which lowered my already low blood pressure, so couldn't tolerate them; tramadol made me hallucinate, other pain meds either made me feel ill, or were ineffective, etc. So, perhaps such issues are worth mentioning 'just in case.'

SecretAgentFishguts

Hi @poppy123456 / @woodbine - thanks for your responses. This is where I’m a little bit lost at the moment, however - I don’t feel as though I’ll have any issues articulating what points I believe I should get, or providing real life examples. However, it’s difficult for me to ignore the fact that in the report I did have multiple times my points were marked down purely due to things outside of the information I had given. For example, in the ‘preparing food section’ I stated that I cannot cook for myself more often than not, partially due to pain from standing/swollen wrists and partially due to lack of motivation, to the point where more weeks than not the only home cooked meal I eat is a Sunday roast prepared by my mother.

However, in the decision section I was marked as having no issues with motivation because I work, and no pain issues because I can drive. In my eyes these things are entirely unrelated to my ability to prepare meals, but I was still awarded 0 points. 

There’s also frequent references to ‘Medical History doesn’t support this’ as a reason to award 0, entirely disregarding everything I’ve said. 

Sorry if it seems like I’m repeating myself, but I can’t see how I’m able to provide a statement that wouldn’t be responded to in the same way even if it is more in depth (which it will be - I’m much better at the written word than talking). The through line of the report seems to be that they simply don’t believe what I’m saying due to the external factors. If they refused my first response for this reason, I don’t know how I can frame my MR in a way where they won’t just use the same methodology again?

Plus, if I don’t include any information about my struggles with work, I’m not sure how I would be able to show that my work doesn’t contradict my statements, as none of the questions lend themselves to me explaining this. Same goes for the car etc.

Also considering just asking the doctor if they can provide a painkiller prescription anyway. I’m just confused as to how me saying ‘I have pain issues and painkillers don’t help, so in the interest of my own health I opt not to take them as all they’d be doing is causing me the side effects’ is interpreted as ‘they don’t have pain issues.’ Etc. 

Sorry, I’m rambling - I’m just really confused.

SecretAgentFishguts

Hi @chiarieds! Sorry, I didn’t see your reply - it seems the general consensus (not just here, but online in general) is to focus on the questions and provide examples, as anything extra won’t be taken into consideration anyway - in the case of explaining the issues with pain meds not working, do you think it would be worth slotting this information in amongst the answers (‘difficulty preparing food due to wrist pain, medication doesn’t alleviate this’) rather than added say, and introductory note explaining these things that aren’t really covered by the questions?

SecretAgentFishguts

Hey @Username_removed thanks for the reply - this does clear some things up. I’m fully expecting the MR not to be successful tbh, I just wanted to give myself a fighting chance at getting it sorted ASAP - realistically though, I’m aware that this will likely need to go to appeal regardless. 

I’m more that happy to write a detailed document covering each question just to send back for the MR - regarding your comparison between assertion and evidence, would structuring it like ‘I think I should get x points, this is why, here are examples of this in a real life context’ be okay? Though there’s still a part of me that feels as tho they’re going to use external information to claim it isn’t true. Man, I’m trying so hard not to yell ‘DWP are just accusing me of lying!’ because I know there’s structures in place, but it’s hard not to feel like that’s the case.

Regarding matching my PIP2 - I gotta say I messed up and didn’t copy it before I sent it. I know, I know, silly move. But I wrote it in March, a lot can change in 6 months, will discrepancies between the PIP2 and the MR letter be a big deal? It will be the same general issues, I haven’t had a massive change in my condition, but I can’t check to make sure it’ll be accurate to the PIP2.

SecretAgentFishguts

Regarding your last point about medical evidence too @Username_removed - I did provide medical evidence, medical history, doctors notes, fit notes, information from occ health reviews in work etc. Mainly stuff that I now know isn’t really relevant. Naivety and lack of knowledge on the process led me to believe that is what they wanted, in a probably misguided attempt to show that I had been dealing with medical professionals, believing that this proof of my treatment would lend credence to my written report. Whereas it seems written letters explaining how my condition effects me is more what they wanted - it does seem what they request can be unclear. I feel like I’ve learned more about the PIP process from forums like this over the last 24 hours than I did from all the official documentation. Might be the new meds tho, who knows.

chiarieds

Hi @SecretAgentFishguts - it's difficult to put the assessor's report behind you. They do some unfortunate 'cut & paste' responses that often bear no resemblance to how you are, but ignore them you must. Focusing on the assessor's report or your decision letter does not gain you a PIP award. You really do have to look at & understand the activities/descriptors that are used for PIP, & give detailed examples as to the difficulty you faced. To say you have, 'difficulty preparing food due to wrist pain, etc.' doesn't go there. Why do you have pain, where exactly is it, what exactly happens, what difficulty did you have, how does it hinder you in preparing food, when exactly did it happen, were there any consequences to this? begins to get there. Now I'm not saying that mentioning what meds you've tried, & why they don't help is of no consequence, but your emphasis needs to be on the above. Perhaps a general statement as to why you don't currently take pain meds is worth a mention IMHO without saying this isn't covered by the questions.

SecretAgentFishguts

Ah @chiarieds thank you for that breakdown of questions, that’s a perfect baseline I can go off of - it seems that it’s likely the information that I’ve given so far lacked the depth they needed. It was probably pretty surface level. How it is possible to go into that much depth for every section over a 1 hour phone call is beyond me tbh, and the copy and paste stuff does sting, but this will help me move forward for sure. 

poppy123456

SecretAgentFishguts said:

How it is possible to go into that much depth for every section over a 1 hour phone call is beyond me tbh,

Which is what the forms are meant for.. If they went into all that detail during the assessment then backlogs would be even longer than they already are.