Mandatory Reconsideration advice please



Hello
Some background: My wife suffers from Chronic Fatigue and anxiety - applied for DLA in 2005 got refused then was awarded lower rate for both care and mobility at tribunal that same year. In 2016 she was moved over to PIP - lost the daily living element (she was too unwell at the time to appeal) but kept the mobility element (standard rate)
She was due for renewal and had a telephone assessment in November, this lasted 20 minutes. Received the decision letter saying she had lost her award.
Her points previously (2016) were:
Preparing food -2 points
Mixing with other people (due to anxiety) -2 points
Planning & following a journey (due to anxiety) - 4 points
Moving around - 4 points
Points now (2020)
Preparing food -2 points
Washing and bathing -2 points
Moving around - 4 points
The DM is stating that as she has no dietician or specialist input (and can read!) this means she can manage all of the daily living activities, apart from preparing food and washing & bathing, which they’ve given points for despite not having any specialist input for these either! Incidentally the washing/bathing are ‘new’ points she’s been awarded so they’ve acknowledged and accepted she’s worse than last time with that!
They also said “You said you have difficulties planning/following journeys. At your telephone consultation you said you go out once or twice a week. I have therefore decided you can plan/follow the route unaided”. My wife clearly stated to the assessor that she could only go out once or twice a week maximum and only on a good week if her fatigue allowed, some weeks not at all, and if she was able to go out it was never alone (always with me) because of her anxiety - so certainly not unaided, but they have removed all previous points awarded due to her anxiety.
Have phoned the DWP to ask for a Mandatory Reconsideration which we will be following up with a letter. Also requested the accessors report but have received a further 2 copies of the decision letter instead! Have requested the accessors report again, but the MR letter has to be back by 16th January so we don’t have much time now.
We have read up about the MR and it’s recommended to send medical evidence, but the problem is she doesn’t have any current specialist input - so can only repeat what she put on the renewal form - so presumably if they ignored this before they will again?
Also the real life examples are difficult as she has learnt to ‘pace’ herself with the CFS and to avoid situations which cause her anxiety/distress. She was due to have a minor procedure done but because of Covid the hospital are saying that she can’t have anyone with her so she has had to turn the appointment down as her anxiety would be too overwhelming if she was alone - so would this be a suitable example? How recent do examples need to be?
Finally is it worth me putting a letter in with the MR explaining my wife’s difficulties or is this pointless?
If anyone has any advice it would be much appreciated, thank you
Replies
For real life examples, explain pacing and WHY, explain how she copes, and what would happen IF she tried xyz or pushed too far. Same with the journeys, just tell them why their reasoning/assumptions/justifications are wrong.
My assessor's report arrived way after the decision letter but it turned out the justification in the decision letter was almost verbatim from the report. Justification for being fine included because I hold a driving licence (even though I've been too unwell to drive for ~5years, and I told them that), that I went to mainstream school - !!! yes really -, that I answered all the questions (only because I was laying in bed with my eyes closed with the phone on speaker, and it took me time to find my words and I had literally only got out of bed to go to the toilet that day, had a nap before the call and slept after the call), and that I had no specialist input (because neither the GP nor the Chronic Fatigue Service could do anything else to help; and by the time I saw the service I'd already had to buy my own wheelchair and they gave zero help for mobility - all of which I put in my form and told the assessor).
It is worth persevering. I was fortunate that the DM who looked at my MR actually did her job and made a much better decision. She phoned me up to clarify some things, and while I didn't agree with all her descriptor choices it was enough for an appropriate award. Even if you do the work for an MR and it remains the same, you'll have laid a good foundation for an appeal.
Do include a letter, focusing on the activities assessed and particularly the ones you disagree with the descriptors.
Overall for an MR, focus on the avtivities/descriptors where you think she should score points (or score more points), not so much ones where she has difficulty but not enough to score any (extra) points.
I'm assuming you understand how PIP is assessed but in case not, helpful links:
https://www.citizensadvice.org.uk/benefits/sick-or-disabled-people-and-carers/pip/appeals/how-decisions-are-made/
RELIABLY is probably the most important concept, especially for illnesses that aren't straightforward physical impairments
https://www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-2-the-assessment-criteria#reliability-1
The reason we phoned first to request the MR was because the decision letter was dated the 16th December but we didn’t receive it until Christmas Eve - the DWP were then closed until the 29th and we were concerned that we would run out of time. Due to her cognitive dysfunction caused by the CFS it takes a long time to get letters/forms completed and it exhausts her.
(It took me many months to draft my answers for the PIP form, then another 3 months to do the final thing back when they were giving that long because of the pandemic, but that was another justification they used: that I filled in the form myself. I had to get a friend's help to do the MR because I only had a couple of weeks, which probably helped my case!)
Actually the points your wife was awarded were exactly the same as my initial outcome! I wonder if there's a standard "ME/CFS with no specialist input = these are the likely points" guideline! (If it weren't so distressing it would be laughable.)
Just to reinforce Spoonie_Turtle's point about reliability.
This will be very important in your PIP appeal. It includes doing tasks safely, to a acceptable standard, in a reasonable time scale (no more than twice as long as a person without that illness / disability), and repeatedly.
So, as an example - let us take the dressing activity (for which the assessor scored your wife no points) - does your wife take a long time to dress [on the majority of days] ?
If so then she needs to fully explain this in her appeal.
Re the Social engagement PIP activity. Have a look at the assessors report (when you get it). Assessor's often use the wrong test. It is not if someone can engage (fleetingly) with a shop assistant, the assessor, a close family member. The test is whether they can initiate, maintain, and sustain meaningful social engagement. Does your wife's condition prevent her from achieving this [on the majority of days], as she would wish to do?
The case law around this is stated in [2017] UKUT 154 (AAC) CPIP/3622/2016
https://www.gov.uk/administrative-appeals-tribunal-decisions/pm-v-secretary-of-state-for-work-and-pensions-pip-2017-ukut-154-aac
"Regulation 4(2A) of the main PIP regulations provides -
Regulation 4(4) of the main PIP regulations provides -