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Thread: About to begin a mandatory reconsideration for ESA and need guidance

  1. #1
    New Member
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    Jan 2014
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    About to begin a mandatory reconsideration for ESA and need guidance

    Hi all.

    You may have seen the details of my esa assessment by atos in a previous post but as a recap, I have Trigeminal Neuralgia type 2 or atypical which means pain in my face all day.

    I have been turned down at my medical after waiting 11 months to be see .

    I'm now waiting to begin my mandatory reconsideration. What do I need to supply?

    The atos medical people had some of my consultant's appointment notes which stated:
    Details of my presenting complaint- says "extensive facial pain across cheek and forehead which is disabling and makes her have to lay down for a good three hours. She has nausea and associated photophobia and photophobia. This has been happening frequently since December 2012"

    It's states pain began in 2009 after trauma to the face but is chronic and will deteriorate over time. It also states my pain scale as between 7-10, happens 4 times a day but mild pain constantly.

    It states the factors affecting my pain as: light touch, warmth, fatigue and stress
    Associated factors: some altered sensation which is variable.
    Nasal stuffiness at all times
    Intermittent ear pain on left side, left sides tinnitus persists and variable dizziness
    No history of headaches but I believe new attacks of pain are migrainous also.

    Impact of pain:
    Fatigue related to facial pain
    Concentration impairment by facial pain and medication
    Sleep severely affect by facial pain which affects her functioning
    Mood; evidence of both anxiety and depression as noted by Hospital anxiety and depression scale
    PCS shows moderate levels of unhelpful thoughts about pain

    It details the medications have been prescribed and doses and states my diagnoses of migraine, trigeminal neuropathic pain secondary to trauma/ trigeminal neuralgia and associated anxiety and depression.



    Can I use this same consultant report to appeal and state that I should be under extreme circumstances?
    Should I ask for GP to supply support letter or medical notes detailing my inability to eat solids during pain days and monthly fainting due to pain or meds and then I supply a letter stating the ground I believe I should fulfil the esa points?

    Any information would be a great help.

  2. #2
    Senior Member
    Join Date
    Apr 2012
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    801
    Can you get some advice form CAB or a similar professional welfare advsior in your local council to help you with this. Because as you've already said your condition isn't one which easily fits into their tick boxes.

    Because you menioned your inability to eat solids on some days I looked this up in the ESa Assessors ahdnbook but other than the support Group descriptor which includes being unable to take solids or drinks and seems to relate to being fed by a nasal or gastro tube, I couldn't find any other descripter which fits this symptom as you describe it. And not convinced it helps with the special circumstances either, just from thinking some people on weight loss diets only eat liquid preparations for weeks with no ill effects.

    Hopefully someone with a bit more knowledge on the descriptors can advise better. It might help some one else to advise if you can say which descriptor you were awarded 6 points for, and something can be built from that on different descriptors using the same reasoning. ?.

  3. #3
    Senior Member
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    Dec 2013
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    I endorse seriouslyfedup's suggestion to get help if possible. In any case that doesn't fit neatly into the criteria, this becomes more important.

    I've made some general points about reconsideration in your previous thread - the remainder of this post continues from my points there.


    The "silo" nature of the ESA activities and descriptors is problematic in cases such as yours, where the activities in the test neither capture your problems well nor are a good proxy for your most significant problems.

    Two big problem areas with ESA are pain and fatigue, which are only considered within the specific activities when it is their global effect that can be utterly disabling. My health problems have a substantial neurogenic pain component, albeit not trigeminal neuralgia. Unfortunately, both pain and fatigue are difficult to measure objectively, as well as being fertile ground for the fakers.


    The medical evidence will not be conclusive over points such as the frequency, severity and effect of your attacks, though it helps that the hospital has seen fit to put them into writing. The problem is that, in many cases, those sort of notes are based solely or entirely on your report of your symptoms and their effects, not any sort of objective assessment or measurement by the hospital. The task is to persuade the decision maker that it is more likely than not you cannot manage the descriptors that, added up, score you 15 points.

    I suggest you read section 3.1.9 of the Work Capability Assessment handbook (pages 66 and 67 of the PDF), which is the guidance given to assessors on variable and fluctuating conditions.


    One issue you may have to address with the notes you have supplied are the phrases "evidence of both anxiety and depression" and "moderate levels of unhelpful thoughts about pain". These are entirely understandable in the context of your pain, but they open up the possibility that some of your functional impairment is non-physical in origin. The ESA Work Capability Assessment only looks at problems of physical origin on the physical descriptors - see section 3.2.1 of the aforementioned Work Capability Assessment handbook.

    Once you have your assessment report, you can see why the conclusions have been reached and work out how to argue for more points.


    I'm not justifying the test applied - I'm just pointing out why you might be having problems with it. I believe the Work Capability Assessment is based on some misconceptions about disability, including that disability falls into neat silos, that functional impairment can be always measured on a clear objective scale and that functional impairments have a solely physical or solely mental origin.

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