Received my PA4 assessment report — need advice

Hello. I've received my PA4 assessment report, and need advice. It recommends 8 points for daily living, and 0 for mobility. I believe this will give me Standard Daily Living for PIP, if the decision maker rubber-stamps it. However, I think I should have Enhanced Daily Living, and perhaps also Standard Mobility. So I need advice on how to proceed.

This is a long post. Skip to the bottom for my main questions if you don't want to read it all… Thanks.

Timeline:

• 02/04/2025 — Posted on this forum to ask for advice.
• 07/04/2025 — Called to begin PIP claim.
• 29/04/2025 — Submitted PIP2 form online, with 12 documents as evidence.
• 30/04/2025 — Text received from Ingeus HAAS saying they are managing my assessment.
• 23/07/2025 — Text received from Ingeus HAAS saying a telephone assessment has been booked.
• 06/08/2025 — Telephone assessment.
• 08/08/2025 — Text received from DWP saying they got my written report.
• 12/08/2025 — Called to request my PA4 assessment report.
• 14/08/2025 — Received my PA4 assessment report in the post.

The PA4 assessment report:

The first part of the form, that details my conditions is largely accurate. Although, it has poor English, there are some minor inaccuracies (nothing too major), and she wrote that my medication has no side effects even though I explicitly listed side effects on the PIP2 form.

The social and occupational history section, all seems accurate.

The functional history section seems somewhat accurate. Again, there are inaccuracies. She wrote that I don't feel anxious once I am out, when I absolutely do. She wrote that there have been no abandoned journeys, which is completely false and contradicts what I wrote on the PIP2 form. Also, she combined my social phobia and depression into a general "mental health" condition.

The observations section is all very positive-sounding, saying I was polite and had no issues, no signs of distress, wasn't anxious at all, wasn't tense, coped well. That's all just made up — there's no way for her to know what I'm feeling, especially over a telephone call.

A weird thing I noticed is that throughout basically the entire report she keeps saying I have no current input on my conditions, marking me down for it. But then when it comes to saying when I should be reviewed, she suddenly says I am getting input and therefore should be reviewed sooner as my condition may improve.

Anyway, it's the descriptors and points section where I mainly have an issue, especially four of them in particular.

Managing therapy, communicating verbally, reading, making budgeting decisions, and moving around, are all at 0 points, and I'm completely in agreement with that, that's fine.

Preparing food, washing and bathing, dressing and undressing, I feel like maybe were low-balled a bit at 2 points, but I'm okay with it. It just comes down to how it's interpreted, and I wasn't really sure what would count. I don't feel like these are worth kicking up a fuss over. She did write some questionable things in her justification, like that I have a mobile phone (what does that have to do with anything!?), and that all my conditions are "discounted as HOC showing no current specialist input and no planned investigations".

But I take major issue with Taking Nutrition being at 0 points (I expected 8), Managing Toilet Needs being at 0 points (I expected 8), Engaging With Others Face-To-Face being at 2 points (I expected 8, or at least 2 or 4), and Planning and Following Journeys being at 0 points (I expected 10, or at least 4).

Taking Nutrition

I have a condition called achalasia, where my swallowing muscles don't function correctly, and food can build up in the esophagus instead of moving down to the stomach. This causes me a variety of issues such as difficulty breathing while eating, painful throat tightness, regurgitation, coughing/choking. This is a lifelong, progressive condition with no cure, although there may be surgical interventions that may or may not provide temporary relief.

I believed I should score 8 points, due to always taking 2-3 hours to get through a meal (so not a "reasonable time"), and for sometimes being unable to complete the meal at all and having to give up. Or at least 4 points, for using aids (cola to clear the blockage and a fan to help with breathlessness). As evidence, I submitted a follow-up report from a hospital doctor, where my diagnosis is confirmed, tests I've had are listed (two endoscopies and a manometry), and symptoms are listed. I also submitted extracts from my GP history, showing that appointments and discussion of the condition has been going on for years. I also submitted proof of medication history.

She recommended 0 points! I can't understand how 0 points could be recommended, when I am always struggling to eat, and am literally in fear of my life due to the breathing issue, frequently feeling like I need to call an ambulance. I did explain this to her over the phone, and wrote it on my PIP2 form.

She wrote in her justification that "HOC shows no diagnosis of eating disorder or cognitive impairment, MSE was unremarkable, suggests he should be able to reliably take nutrition". What? Sure, I have no "eating disorder" (assuming that means something like anorexia) or cognitive impairment… Instead, I have achalasia. I provided evidence of this.

She wrote in her justification that "achalasia and related symptoms discounted as FH shows no specialist input for diet and HOC showing discontinued medications with no changes or reviews to medications". What? Actually, the evidence does show diet suggestions, but I don't know why that would even be necessary anyway. Certain foods may be worse for my condition, but I have the condition every time I eat regardless of what I'm eating. Medications were discontinued as the condition was originally misdiagnosed and so the wrong medications were given — I explained this to her over the phone. How can the entire condition just be "discounted" like that? I gave evidence of it. A report written by the hospital doctor.

She also wrote "aids discounted as HOC showing no current specialist input and no planned investigations". What? How is a report from a hospital doctor not "specialist input"? I'm an outpatient with the hospital. I probably always will be as it's a lifelong condition. The investigations were already done, I had tests and the condition was diagnosed, why do I need more planned investigations?

Managing Toilet Needs

I have IBS, and going to the toilet is always a difficult endeavour for me. I actually more recently suspect there might be more to this, and that it might actually be a motility disorder like my achalasia (the internet suggests a link).

I believed I should score 8 points, due to spending 4 hours (on average) to go to the toilet (so not a "reasonable time"). As evidence, I submitted extracts from my GP history, showing that appointments and discussion of the condition has been going on for years. To be fair, evidence for this one isn't as strong, but I did provide my written testimony for how this condition affects me.

She recommended 0 points, with the justification "the evidence in the FH showing he is able to get on and of the toilet and manage hygiene needs, suggests he should be able to reliably manage toilet needs independently". What? Yes, I can get on and off the toilet… but that doesn't mean I don't have a problem? My problem is unrelated to that. How is spending 4 hours on the toilet considered acceptable? I thought the rules say that it needs to be doable within a reasonable timeframe?

Engaging With Others Face-To-Face

I have social anxiety, and it has massively impacted my life. It's caused me to miss so many opportunities. It's been a huge life issue for me, going back over a decade. I have mountains of evidence for this. I submitted discharge reports from multiple CBT courses I've had, several things showing a clear diagnosis, extracts from my GP history showing ongoing discussion going back over a decade, and also proof of a long history of medication.

I believed I should score 8 points, for being "unable to do it without overwhelming distress". Or at least 4 points for "needs support".

She only recommended 2 points, for "needs prompting". I'm not sure where this even came from. Prompting isn't going to help my issue. Someone telling me "hey maybe you should go engage with someone" isn't going to magically make my phobia go away.

In her justification, she wrote "no current input for mental health despite longstanding problems". Well yes, of course? You get input when you have a new problem. There's no current input because it's longstanding. I already had the input years ago!

She also wrote "no current prescribed medications". Why should that matter? I have no current medications, because I already tried them all and they didn't help. I told her this over the phone. I provided evidence showing a long history of taking different medications over a number of years.

Planning and Following Journeys

As above, I have social anxiety, and it's massively impacted my life. I don't have any physical mobility issues, but my social anxiety does keep me trapped at home most of the time. I basically never home unless it's for an appointment, and so go out maybe once every few months. It's been like this for a decade. I'm extremely socially isolated. The evidence for this was the same as for my social anxiety. I also have a sleep disorder which impacts my abilities to follow journeys (can't go out if I'm asleep…) and provided evidence for this as well.

I believed I should score 10 points, for either being "unable to do it without overwhelming distress" or for "needs aids/support". Or at least 4 points for "needs prompting".

She recommended 0 points! I can't understand how such a major life issue just gets 0 points.

In her justification, she wrote "the evidence in the HOC showing no current input for mental health". Again with the "no current input". It shouldn't even matter whether I'm getting current input or not, that's irrelevant to how my condition affects me. I already had the input. I provided loads of evidence. What even counts as "current" input? It takes months just to get a GP appointment, which is then extremely rushed over just a few minutes, so I don't get to make progress on all of my conditions. It takes 6-12 months on a waiting list for CBT therapy.

She also wrote "no medications for mental health as discontinued with no recent changes or reviews". So what, can you not have a condition unless you're actively taking medication for it? Not every condition has a medication that fixes it, and even if it does it doesn't work for everyone, or can have negative side effects. I provided history showing I've tried loads of different medications. They were discontinued as they didn't work. I explained this to her over the phone.

She also wrote "no history of abandoned trips" which is completely false. She didn't ask me about this at all over the phone. But I did explicitly write on my PIP2 form that I have abandoned trips due to my social anxiety. And then of course there's all the trips that I didn't try in the first place because of it, which is technically abandoning journeys too.

So what do I do now?

I haven't had the decision maker's report yet. From what I've read, I know it's most likely they'll rubber-stamp the assessment report, and that I'll be awarded PIP with Standard Daily Living. I know that's not guaranteed, but for now that's the assumption I'm going with.

I don't know if I should just be happy with the Standard Daily Living, and quietly accept that. I do think I'm entitled to more, based on my understanding of the descriptors. I think I should be getting Enhanced Daily Living, and I think Standard Mobility is also possible, depending on interpretation.

I don't know whether to rock the boat or not. Should I just be happy with what I've got, or should I push for more? I really don't think I could do a Tribunal… so for me, it'd only go up to Mandatory Reconsideration, or perhaps just submitting a new claim and hoping that one goes better.

I also don't know if it could negatively affect future reviews if I just stay quiet. Could it? I'm assuming that when they do reviews, they look back at the previous reports? So if I don't correct them, they'll look back at these reports and decide I have no issues in the areas I highlighted (like taking nutrition)?

I've read that I can write to the decision maker with my concerns, pointing out the discrepancies and contradictions in the assessment report, and maybe they'll take them into consideration. I don't know if that's a good idea or not. It's already been 10 days since the DWP got my assessment report. Maybe it's too late now?

I'm also afraid that if I do write in to them, it might actually make my case worse. Could it? Like, maybe they'll think "oh if this person can be so bold and proactive as to request his assessment report and then write to us about it, they must not have actually have it so bad after all" and maybe they'd mark me down because of it?

What's the best course of action now? Do nothing, accept what I got? Write in ASAP to the decision maker to correct the PA4? Wait for the decision, then do a mandatory reconsideration?

What should I do? I'd appreciate any advice. Thanks.