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The UKFibromyalgia Forums • View topic - Fibromyalgia and PIP Question 13 Journeys



Fibromyalgia and PIP Question 13 Journeys

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Fibromyalgia and PIP Question 13 Journeys

Postby philhj » Sat Nov 18, 2017 6:31 pm

Hi all. Thanks for reading. I helped Mrs philhj with her PIP application and she got a 5 year award of 10 points for 20 to 50 metres walking - double hip replacements so she has never recovered ability to walk distance as the FM pain knock on is too great. We will challenge this as I did a diary for her and she only walked 20 or more metres on 4 days out of 28, basically only when she goes to medical appointments she prefers to walk further on those occasions and suffer the knock on pain from the extra muscle work, rather than do the car journey and a wheelchair journey and end up with muscle spasms from stiffness. Also on those occasions we recorded and pointed out the pattern of days of increased muscle pain from a single extended walk. However as she is capable of walking in the 20-50 metre range, and chooses not to because of the knock on impact on subsequent days, its not guaranteed that this argument will prevail. In denying points the assessment report specifically used the argument that she walked to and from the waiting area to assessment room which is 20 metres without becoming unsteady. I will also put forward the arguments that a) if she did walk in the 20-50 range then she would not be able to do so reliably because of the knock on impacts on subsequent occasions/days and b) she only walks atall in her active period in the morning between 9am and 1pm, and then returns to bed for the rest of the day. As she is not able to get up and walk for the majority of the day she cannot be said to walk reliably. But all these arguments might not be accepted so I also want to address the journeys question as another route to getting those 2 additional points.

Mrs Philhj has not been on any journeys other than to medical appointments driven by me, for the last 2 years and only on very rare occasions (a handful of times a year) in the 3 years before that. Those journeys were also driven by me and she would not allow anyone else to drive her because of knock on neck strain / stress flares etc. She would love to go to the shops to choose things, or to the garden centre to get some plants for her beloved garden, but is unable to do so because the journey is intolerable even if I take her. This is the place it gets tricky, because the PIP criteria want to separate the issues of is this due to pain (in which case it doesnt qualify for the mental health questions such as Q13) or is it due to "psychological reasons" and the psychological aspect divides into cognition issues and distress issues. In the application I focussed on the overwhelming distress argument, that the "levels of pain, fatigue, social anxiety, cognitive impairment from 'brain fog' memory problems and communication anxiety, combine to cause her overwhelming psychological distress which prevents her from going out for journeys". Giving all those terms their normal meaning that accurately outlines why she wont go on a journey, its a composite reason from a variety of sources, building into both cognitive imparment and psychological distress. You know what we are talking about here. Mrs P has had fibro diagnosis for 10 years now starting at age 47 and had to stop working 5 years ago. I elaborated the nature of the impacts preventing her taking journeys from a dozen angles, and majored on the simple fact that she now DOES NOT go out on journeys except by medical necessity, and that this is not a matter of preference as she would want to if she was not ill. (This is a very restricted woman now, who does not leave home any more, even to visit neighbours.)

Their argument in denying points is that: "mental state examination showed adequate memory, concentration and cognition. At the assessment you were observed to convey and understand information, you responded appropriately and without prompting. You engaged well with the assessor with adequate eye contact and rapport, you did not appear withdrawn or anxious." The assessment report also states "as she is not being treated for a mental health condition, and does not receive any specialist input for her mental health, and as the MSE showed she was not withdrawn, anxious, tense, sweating or trembling...... she can manage this activity". Well I'm sure I dont need to explain to you why this is irrelevant.

At appeal the fact of her not taking journeys may be enough, but the specific point I am going to put forward for the mandatory review (and any subsequent appeal since MR is likely to fail of course) is as follows:
"DWP stated in their answer to the select committee on which mental health issues might qualify for enhanced mobility. "A person who has chronic fatigue syndrome (CFS) and experiences symptoms including significant fatigue following physical exertion, muscular and joint pain and balance problems, together with psychological difficulties which manifest as depression and panic attacks, could qualify for the enhanced rate under mobility activity 2, or by scoring points on a combination of mobility activity 1 (4 points under descriptor b, for requiring prompting to avoid psychological distress when undertaking any journey) and mobility activity 2 (8 points under descriptor c, for being able to stand and then move unaided more than 20m but no more than 50m). As explained above, Chronic Fatigue Symptom (CFS), also known as myalgic encephalomyelitis (ME), has complex causes which are still not well understood, but which may involve both physical and psychological factors."

Fibromayalgia and CFS are closely related conditions which both have physical and psychological impacts, and the psychological difficulties are part of the condition being monitored and treated and so may not require specific treatment or specialist input. The fact that Mrs philhj avoids situations that would cause her overwhelming psychological distress and so has not needed to pursue separate treatment for it, does not mean that those situations would not cause distress.


Any and all comments on this would be welcome.
I am trying to get this argument sharp because the same argument applies to whether or not she has difficulties with cooking, communicating, understanding reading, engaging socially, and making budgeting decisions. She got zero points for all of those, whereas I know I have to assist her with all of those areas, and most of them she just avoids as they are too much for her.
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Re: Fibromyalgia and PIP Question 13 Journeys

Postby philhj » Tue Nov 21, 2017 8:15 pm

philhj
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Re: Fibromyalgia and PIP Question 13 Journeys

Postby philhj » Fri Nov 24, 2017 10:16 pm

philhj
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Re: Fibromyalgia and PIP Question 13 Journeys

Postby philhj » Tue Nov 28, 2017 11:53 pm

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Re: Fibromyalgia and PIP Question 13 Journeys

Postby philhj » Fri Feb 09, 2018 2:08 am

MR no change of course. Put appeal application in mid January, have the bundle, now putting together the appeal submission.

One thing I have found that is very useful is having a sympathetic supporting letter from Mrs P's daughter which is written in detail activity by activity. It gives me an independent document (outside of my own written material) that I can reference in every activity to point out how DWPs dismissal of Mrs P's activity restrictions are contradicted by the facts of how she is affected. You (DWP) say she can communicate fine and her mental state examination is normal, but Mrs P's own daughter says that on the majority of days that she visits Mrs P is unable to engage in more than a few minutes of the simplest conversation even with someone she knows really well etc etc.

I am finding it a lot easier to do the tribunal submission than the original PIP application. With the DWP application you know they are going to avoid every piece of information, so its kind of frustrating trying to build the case. With the tribunal its so much easier because you know they will follow the rules of the system. Hence its easier to say, DWP found that Mrs P can walk 20-50 metres because she walked 20 metres into the assessment room. However the DM has not addressed the 28 day diary submitted in the application which shows she only walked 20 metres on 4 days out of 28, therefore she CANNOT walk 20 metres reliably.

Tribunal says: No more avoiding the application detail Mr DWP :nono:
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