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  1. #1
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    Dec 2013

    Thumbs up PIP success story and some reflections

    An unwilling volunteer

    My most recent fixed-term DLA award ran out in the summer: highest rate care and higher rate mobility for a 5 year period. In total, I'd had 12 years of highest rate care and higher rate mobility, and around 5 years of lowest rate care and higher rate mobility before that.

    I reapplied for DLA, but for unknown reasons, the DWP rejected the renewal claim for DLA, treated it as a defective claim for PIP and issued the PIP2 How your disability affects you questionnaire. This was an error of law, despite it happening in early July after new DLA claims were impossible, as I had a Secretary of State's letter inviting me to renew.

    I faced a difficult decision: request revision of the decision to reject the DLA claim, or claim PIP. it would have been easy for me to request revision - I'm over half way through a law degree, and this is hardly a complex point of law. However, had I got a new DLA award, I could, at best, have got myself as far as the forced conversions to PIP due to start in October 2015. The legal powers for these conversions already exist: there will be 8 weeks between the request to claim PIP and the cancellation of the DLA award for non-return of the PIP claim, giving limited opportunity to obtain evidence. Whilst it would be possible to submit a PIP claim with evidence to follow, it is easier to write your claim with the evidence in front of you.

    As up to date consultant's reports had been prepared especially for the abortive DLA renewal. I chose to use these reports to claim PIP, making me a rather unwilling volunteer.

    Important points to understand

    I worked directly from the PIP Regulations, though cannot recommend this approach to anyone without a formal legal education. There are good PIP guides for the lay person available from various sources.

    It is crucial to understand the PIP points allocation mechanism, as it does not use the simple "best fit" approach from ESA. The PIP system is hard to describe briefly, though it is based around the proportion of days each scoring descriptor applies. A full description is in regulation 7(1) of The Social Security (Personal Independence Payment) Regulations 2013 (SI 2013/377).

    With PIP, you can only be assessed as doing something if you can do it safely, to an acceptable standard, repeatedly (as often as reasonably required) and in a reasonable time period (in no more than twice the maximum time taken by someone without a relevant disability). When put together with the points system's foundation in proportion of days, this serves to exclude occasional superhuman efforts, which might be particularly relevant to walking.

    The PIP2 questionnaire - my approach

    My disabilities do not allow me to write more than a handful of words, and, as each PIP2 is individually bar coded, there's no downloadable PDF version of the form. I created my own document which replicated the questions on the PIP2 and answered them. I joyously printed a load of labels saying "See enclosed document" and stuck them over each answer box on the PIP2 before signing and dating the PIP2.

    My assessor commented that it was far more useful to receive a nicely laid out printed document than a poorly structured handwritten form of dubious legibility.

    For each activity, I used the headings:
    • Issues I face
    • Aids and appliances
    • Particular aspects
      • Safety
      • As often as necessary
      • How well could I manage?
      • The time it would take me

    • The legal test

    Issues I face were brief statements like "My ability to sense temperature is impaired", with an explanation of how that issue impairs my ability to carry out the task if it is not obvious. I placed these under headings relevant to my disability (Sensory, Muscular, Concentration, Fatigue, Pain) to keep things organised.

    Aids and appliances listed all the aids and appliances I have, together with any that might be felt relevant by the assessor. In each case, I explained how well the aid or appliance would help me.

    Particular aspects were brief statements to those four key considerations, such as (under Safety) "My sensory problems create a risk of burns", with an explanation relating that statement to the Issues I face.

    The legal test made directly addressed each potentially relevant descriptor in turn. These comments always made explicit reference to the proportion of time I believed I satisfied that descriptor, with justification for the answer given.

    There are many other valid approaches - I have no idea what the various guides suggest. This approach was the way I felt best able to make all relevant points.

    I believe claiming DLA and PIP is about painting a picture, especially for someone like me who has a condition that does not fit into a neat diagnosis. If you explain clearly the problems you have, the effects of your problems and how they relate to the legal tests, it is harder for the decision maker to find against you, especially if your messages remain consistent throughout and your answers are grounded in relevant medical evidence whenever possible.

    I believe it is important to concede points quickly when that is the right thing to do. For example, I explained I can always stand and walk at least one metre. Nothing in the evidence suggested any problem with this and I would likely have had no problem if asked to do this at the face to face assessment.

    Conversely, if there is some fact that appears to contradict your case, explain it. If you can manage something only twice a week, explain why this is the case and the problems you have with that task. That approach is better than leaving apparent inconsistency in your story.

    It is important not to stray into irrelevant matters. There is no point going on about how far I live from the nearest bus stop (unless I am using that distance as a benchmark of my walking ability) or how bad the bus service is, because the availability and quality of public transport are not relevant to the award of the PIP mobility component.

    The face to face assessment

    My assessor, a physiotherapist, had clearly spent a considerable amount of time going through my document and medical evidence, and had some specific questions for me at the beginning of the assessment once the formalities were out of the way.

    Following these specific questions, she asked me to discuss my problems without referring to my document or other notes. This was difficult, as I was tired and many of the problems I face with the various activities are the cumulative effect of several issues. I appreciated that she was attempting to test the credibility of my written answers: had I been unable to discuss the key messages without notes, it would have created doubt over those written answers. As I had been careful to state the extent of my problems without exaggeration, I had nothing to hide.

    She asked me if there was anything I wanted to add to the answers I had given, so I said that my full explanations were in my written submission. It was most helpful to be able to rely on the document at this point.

    My muscles had locked up whilst I had been sitting in my wheelchair, so the assessor said she would be happy to skip the physical examination entirely. Not wanting to turn down the opportunity for her to get "hands on" with my problems, I said I would rather she proceeded but would let her know if it got too much.

    She tested the range of movement in my hands, arms and shoulders, which was severely restricted in some cases with one axis of measurement being recorded at 10% of normal.

    She moved on to my legs and feet, which she tested with me sitting in my chair. She stated that, in her opinion and taking into account her findings that far, it would be unethical to ask me to attempt to stand or walk, which brought the physical examination and the face to face assessment to a close. It had lasted around 90 minutes.

    The result

    As those going through the PIP process will know, there are huge backlogs at present. It took over six weeks from the assessment to the decision:
    • medical on 4 November
    • report received by DWP from ATOS on 6 December
    • decision dated 13 December
    • decision received in the post on 19 December

    I was awarded 23 points for the Daily Living activities, giving me the Daily Living component at the enhanced rate with 11 points to spare.

    I was awarded 12 points for the Mobility activities, giving me the Mobility component at the enhanced rate.

    This is the equivalent of my old highest rate care and higher rate mobility DLA.

    The decision was "on an ongoing basis", with a check on entitlement on or after the tenth anniversary of the claim (July 2023). This is the equivalent of an indefinite DLA award, albeit with an up-front expectation set for an entitlement check.

    The DWP's intention is to make open-ended awards much rarer under PIP. What little I have found on the subject suggests that "ongoing basis" should only be used when there is no more than a slight prospect of a change in condition, and that a long term fixed-length award should be used if there is a greater possibility of change over time.

    I had supplied a report by a consultant neurologist who has been the lead clinician in my care for the past seven years, stating that in his opinion there had been no reversible causes found for my symptoms after exhaustive investigation. After some discussion about how my symptoms fluctuate around a baseline that is either constant or slowly deteriorating, he concluded that there is no realistic prospect of improvement in my condition. I suspect this may be the sort of standard DWP are looking for in order to make an "ongoing basis" PIP award, despite it typically being very hard to obtain such an emphatic prognosis.
    Last edited by Flymo; 13-02-14 at 12:48. Reason: Fixed the bulleted list (hopefully)

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