PIP and relapsing-remitting fibromyalgia

Spoonie_Turtle

I would also caution against necessarily using the phrase 'good day' - for most of us our 'good' days are actually just 'less hard' days, or 'lower symptom' days.  Our version of 'good' (or even 'better' as in, better/worse) is generally nothing like what a healthy person thinks of as a good day, and subconsciously they could be thinking 'well if they have good days then it can't be that bad'.  Whereas 'lower symptom day' is more accurate without the subconscious connotations. 

From what you've said, don't think that fluctuations preclude you from qualifying for PIP, but with such a widely fluctuating condition I think you will have to be very careful and specific about what you write.
Further to the excellent links Alice_Holt has provided, this page sets out exactly how PIP assesses fluctuating conditions https://pipinfo.net/issues/fluctuating-conditions

samk777

I used the guides on the Benefits and Work website when I had to do a mandatory reconsideration as I was awarded PIP but the points and rate were lower than they should have been. Their guides gave really clear info on how to answer the questions.  I had to pay a subscription - maybe £25 but it was money very well spent.
It's such a minefield. Very best of luck and if you don't get an award initially please do get it reconsidered - it's commonplace for people to be awarded more on reconsideration or appeal. 

peteuk

poppy12345 said:

peteuk said:

You have said your diagnosis was earlier this year, to apply for PIP you should have a condition for 3 months prior to application and it is likely to remain for at least 9 months (which it will)

Having been diagnosed with fibro myself 10 years ago it took 3 or 4 years for me to get that diagnosis. It's not an easy condition to diagnose and many various different tests are needed first to rule out other conditions because it does mimic other conditions. For this reason i would think that the OP had symptoms for quite sometime.

Although PIP isn't about a diagnosis anyway, which i'm sure you're already aware of.

Hence the reason why I have used condition rather than diagnosis, however in reality you don't have a condition until you have a diagnosis.  What you do have is a bunch of symptoms.    Eligibility notes clearly state 

• you have a long-term physical or mental health condition or disability

So yes the outcome of a PIP assessment is not based on the condition/diagnosis, as you know you can have two claimants with the same diagnosis but with different effect on health and ability.  But you need the condition/diagnosis in the first place. 

I am aware that fibro is difficult to diagnose, and is diagnosed by the absence of other diseases.  I am equally aware that many health care professionals know very little about the symptoms including those who undertake the PIP assessments.   

Spoonie_Turtle

peteuk said:

poppy12345 said:

peteuk said:

You have said your diagnosis was earlier this year, to apply for PIP you should have a condition for 3 months prior to application and it is likely to remain for at least 9 months (which it will)

Having been diagnosed with fibro myself 10 years ago it took 3 or 4 years for me to get that diagnosis. It's not an easy condition to diagnose and many various different tests are needed first to rule out other conditions because it does mimic other conditions. For this reason i would think that the OP had symptoms for quite sometime.

Although PIP isn't about a diagnosis anyway, which i'm sure you're already aware of.

Hence the reason why I have used condition rather than diagnosis, however in reality you don't have a condition until you have a diagnosis.  What you do have is a bunch of symptoms.    Eligibility notes clearly state 

• you have a long-term physical or mental health condition or disability

No, this is so wrong.  If you have a condition then you have had it from onset, no matter whether doctors have identified what it is or how long it takes them to do so.

You can't diagnose a condition without it first existing to be able to be diagnosed … !
The label (diagnosis) just identifies what's going on, sorts out what cluster of symptoms belong to a single condition and whether there are other conditions alongside it explaining other clusters of symptoms.

Re: the eligibility criteria, regardless of diagnosis, if it's disabling then it's a disability.

Alice_Holt

peteuk said:

poppy12345 said:

peteuk said:

You have said your diagnosis was earlier this year, to apply for PIP you should have a condition for 3 months prior to application and it is likely to remain for at least 9 months (which it will)

Having been diagnosed with fibro myself 10 years ago it took 3 or 4 years for me to get that diagnosis. It's not an easy condition to diagnose and many various different tests are needed first to rule out other conditions because it does mimic other conditions. For this reason i would think that the OP had symptoms for quite sometime.

Although PIP isn't about a diagnosis anyway, which i'm sure you're already aware of.

Hence the reason why I have used condition rather than diagnosis, however in reality you don't have a condition until you have a diagnosis.  

       This is not correct.

       Thankfully tribunal panels use the correct criteria when considering appeals. Which is why some 70% of appeals succeed. 
      The assessment process can be badly flawed, one element being that the private companies assessors are unaware of legislation and case law, and over reliant on their interpretation of company manuals.

ayupmeduck

marcia_ said:

 Your condition does not have to be present constantly to qualify.I have epilepsy, I'm not having seizures all the time. I might have 4 over 2 days then none for a month and I qualified. 

Epilepsy is one condition where majority of days isn't considered, fibromyalgia is a tricky one along with long covid, it would require a full consultation and I think majority of days (good/bad days) count.

poppy12345

ayupmeduck said:

marcia_ said:

 Your condition does not have to be present constantly to qualify.I have epilepsy, I'm not having seizures all the time. I might have 4 over 2 days then none for a month and I qualified. 

 fibromyalgia is a tricky one along with long covid, it would require a full consultation

For what exactly? Or do you mean an actual assessment? rather than paper based?

Muttleythefrog

peteuk said:

poppy12345 said:

peteuk said:

You have said your diagnosis was earlier this year, to apply for PIP you should have a condition for 3 months prior to application and it is likely to remain for at least 9 months (which it will)

Having been diagnosed with fibro myself 10 years ago it took 3 or 4 years for me to get that diagnosis. It's not an easy condition to diagnose and many various different tests are needed first to rule out other conditions because it does mimic other conditions. For this reason i would think that the OP had symptoms for quite sometime.

Although PIP isn't about a diagnosis anyway, which i'm sure you're already aware of.

Hence the reason why I have used condition rather than diagnosis, however in reality you don't have a condition until you have a diagnosis.  What you do have is a bunch of symptoms.    Eligibility notes clearly state 

• you have a long-term physical or mental health condition or disability

So yes the outcome of a PIP assessment is not based on the condition/diagnosis, as you know you can have two claimants with the same diagnosis but with different effect on health and ability.  But you need the condition/diagnosis in the first place. 

I am aware that fibro is difficult to diagnose, and is diagnosed by the absence of other diseases.  I am equally aware that many health care professionals know very little about the symptoms including those who undertake the PIP assessments.   

As above... not sure if you're talking from the POV of an assessor, the PIP claims process or personal opinion... or have not used words as you intended.. or if I'm misinterpreting. But obviously someone has a condition when they have a condition (rather like someone has committed a crime when they commit a crime)... a diagnosis is an up in the air thing that relies on someone else affording time, investigation and interest to give it a label (rather like someone is found legally guilty of a crime) which may or may not be correct or accurate. You can't postpone the pain of a broken leg until a doctor says 'you have a broken leg'. Clearly to get PIP a diagnosis is not required although it's probably inherently easier to persuade anyone of disablements and symptoms if there is some diagnosis which is consistent. Needless to say as someone who pushed and pushed and pushed for diagnoses (often in the literal face of psychiatric professionals asking why I felt the need for such - I honestly replied that it was for benefits) until I felt they reasonably accurately captured a meaningful array of them. HCP reports have commonly attributed disablements to wrong diagnosis or a one minor in relevance. 

Frankly for fibro type conditions I think someone who ends up with a diagnosis in the UK has likely not just suffered for significant time but probably deserves a medal for endlessly surviving banging their head against an organisation that has virtually no seeming interest in going beyond standard tests and diagnosis before offering little other than a 'let me know how you get on'. My own wife just gets told to lose weight and gets pushed back out the door... we have had to accept she will only get a diagnosis in private setting or abroad. So if there is a mentality among HCPs and those who direct their training and parameters of performance in conducting assessments that there should be a diagnosis for any serious issues people have then god help us... or rather as Alice implies tribunal help us.

I'm mindful in light of Alice's post to quote directly what an HCP said to me in an assessment when I challenged them on their interpretation of Mobility 2 and I wanted to remind them of, then recent, case law - she said and I directly quote "Mr x I am not here to apply the law". And I do wonder if that is also the approach your training led to.

Alice_Holt

ayupmeduck said:

marcia_ said:

 Your condition does not have to be present constantly to qualify.I have epilepsy, I'm not having seizures all the time. I might have 4 over 2 days then none for a month and I qualified. 

Epilepsy is one condition where majority of days isn't considered...

      Indeed.

       The assessor should take into account harm, and the severity and consequences of the risk of harm. The requirement for majority of days can be modified for conditions like epilepsy, as it's overwritten by the PIP 'safely' aspect:

https://cpag.org.uk/welfare-rights/resources/article/‘safely’-personal-independence-payment      

"‘an assessment under the PIP Regulations that an activity cannot be carried out safely does not require that the occurrence of harm is “more likely than not”. A tribunal must consider whether there is a real possibility that cannot be ignored of harm occurring, having regard to the nature and gravity of the feared harm in the particular case. Both the likelihood of the harm occurring and the severity of the consequences are relevant. The same approach applies to the assessment of a need for supervision.’"     

For some time after the UT ruling, my colleagues & I, were seeing assessments not adhering to this case law. The result being that an appeal to the Tribunal Service was necessary to reverse the flawed decosion. The sheer stupidity of a ATOS / Capita assessor asserting that "We are not here to apply the law" (per Mutley above) causes more taxpayer costs and considerable stress for our Cit A clients. However as those costs are not borne by the DWP, the private assessment companies or its employees...  

peteuk

@Muttleythefrog and @Alice_Holt. 
I dont doubt that someone with fibro hasn’t suffered for many years, so I ask the question why havent they claimed PIP with their symptoms.  

For a PIP assessment the claimant needs to provide evidence, specialist referral, diagnosis, medication ect.  of the condition they are claiming for, what I am saying is if your condition is Fibro youve been diagnosed with it.  If you claim PIP saying youve got Fibro then the question will be where is the evidence.  

Put another way, if someone has seizures, seizures is not the condition it’s a symptom of a condition.  Go to a doctor and he will treat you for the symptoms and refer for diagnosis.  Provided with medication to reduce/stop the seizures whilst the referral goes through.  The condition comes with diagnosis.   Eg epilepsy or tumour.  In some cases such as if there is evidence of a head injury prior to the seizure then it’s likely to be a one off depending on the severity of the head injury.  Hence why the seizure is a symptom not a condition. 

In the end it’s semantics really.  In my experience you don't get far with a PIP assessment without evidence of a condition/diagnosis.