PIP Mandatory Reconsideration

joined_flame001

Hello,

I am 20 years old and have been struggling with my mental health and other disabilities such as, ADHD, anxiety, agoraphobia and awaiting an autism test since 2023. 

I was on DLA standard daily living in 2018, while in high school to college I had less and less help with my problems and got a lot worse where I went from playing different sports everyday for different teams to not playing organsied sport or attending education regularly for the next 7 years. 

Around 2022 I got 0 points for both daily living and mobility due to an unhelpful assessor and me and my mum were not informed about the procedure and how it was about the majority of days. We appealed and went all the way to an online tribunal and was awarded 8 points daily living and 10 points mobility pip, at the time I believed this was fair as I was just about doing 2 days at college a week.

 Since late 2022 my disabilities have affected much more as the older I get the less important I become and I mask too much sometimes when I’m afraid of not getting help. I now haven’t been able to leave the house without my mother for the last 2 years as I overwhelm myself with my own thoughts causing physical pain on my stomach which makes me lash out and lose control of myself and I have put myself and others in danger because of this, I have had encounters in the past with bus drivers or taxi drivers not letting me leave making me feel trapped and I can be in unsafe scenarios and haven’t been in either on my own since 2021 and even when I’m with my mother in a taxi or bus I still feel the sickness and trapped. 

In my review decision letter today I was awarded 11 points daily living and 10 points mobility, I believe both to be incorrect as I was awarded 2 points for being able engage with other people with prompting, I will not engage with anyone by myself ever.i will only engage with people while I’m with my mother because my mum knows 100% of my problems and I feel I can breathe and not have to worry about leaving abruptly or lashing out when my mum can explain what I can’t.

The 10 points I got for mobility were for “cannot  undertake any journey because it would cause overwhelming psychological distress to the claimant”. While I can slightly understand this descriptor being applied because most if not all journeys do cause me distress,  the majority of time it would be “overwhelming psychological distress” is the times I was out by myself and have put myself in danger by running across roads straight home because of how trapped I felt or getting lost because I have been in unfamiliar areas and my mum having to find me.

I believe the descriptor “Cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid.” Applies to me as I can go out when my mother is available to be with me and she is much more than emotional support as she is there for navigational support as I get overwhelmed when I get lost and reassurance when I’m feeling trapped in traffic or social situations. She also waited outside for me to finish when I was in college so I know I can get home quickly if I’m sick.

If anyone can help me understand the threshold between the 1.e and 1.f as the availability is the only difference for me as my mother has her own physical disabilities and as of recent cannot always attend outside of the home activities with due to her being injured and an inadequate vehicle.

sorry if this doesn’t make much sense please ask questions if you have them as 99% of the time I’ll will forget thing and I will write in a way that only I understand and sometimes I don’t know what I’m trying to say. Any knowledge or advice would be greatly appreciated.

Spoonie_Turtle

The starting point for answers is here https://www.gov.uk/government/publications/personal-independence-payment-assessment-guide-for-assessment-providers/pip-assessment-guide-part-2-the-assessment-criteria

The bits in bold I've highlighted for emphasis

From the Mobility section:

"A claimant who satisfies 1E cannot also satisfy 1F. If they cannot undertake a single journey on the majority of days due to overwhelming psychological distress, then 1E will be the applicable descriptor, even if there are occasions when they could follow a familiar route, if accompanied.

Descriptor F (12 points): Cannot follow the route of a familiar journey without another person, an assistance dog or an orientation aid.

‘Follow the route’ means make one’s way along a route to a destination. This involves more than just navigation of the route. Safety should be considered in respect of risks that relate to making ones’ way along a route (for example, tendency to wander into the road, inability to safely cross a road or risk of self-harm due to overwhelming psychological distress caused). For example, a claimant with a severe visual or profound hearing impairment may be at a substantial risk from traffic when crossing a road.

The familiar route does not need to be planned – it is familiar. Any significant diversions from that route are therefore irrelevant – it is no longer the familiar route. However, making one’s way around road works, or a change of train platform (i.e. minor diversions) are part of being able to follow the route of a journey.

The descriptor refers to “a familiar journey” rather than “any familiar journey”. Accordingly, claimants can satisfy the descriptor by showing that they typically need to be accompanied by another person or an assistance dog or to use an orientation aid on the majority of days when undertaking familiar journeys (it’s not necessary to show that they need such support for every possible familiar journey on most days).

This descriptor is most likely to apply to claimants with cognitive, sensory or developmental impairments, or a mental health condition that results in overwhelming psychological distress, who cannot, due to their impairment, work out where to go, follow directions, follow a journey safely or deal with unexpected changes in their journey, even when the journey is familiar. A claimant who suffers overwhelming psychological distress whilst on the familiar journey and who needs to be accompanied to overcome the overwhelming psychological distress may satisfy descriptor 1F."

The basic difference between 1e and 1f is whether, hypothetically if you had support available every day, you would mentally be able to go out with that support most days.  If yes, 1f applies.  If even with that support available you would not be able to on the majority of days because it would cause overwhelming distress, then 1e would apply.

peteuk

A quick comment as i am at work…

The threshold for overwhelming psychological distress (OPD) is very high, It was explained to me as you cant get through the door, it’s like someone had bricked it up.  There is physical symptoms that stops you from going out,  not just anxiety but physical symptoms eg nausea/vomiting,

joined_flame001

Thank you Spoonie_turtle and peteuk for your comments. I have read online through many different forums and have seen similar to what spoonie_turtle has highlighted. Your basic definition has helped understand me the descriptors.

 Descriptor 1f makes more sense to me however I’ve been awarded 1e. I feel my poor communication and the anxiety I feel during the call causes me to forget and go into detail about the wrong things. However I have tried to explain to the dwp that my mums health is extremely important to me and will not force her to do things that cause her pain just because I am struggling for example I am eager to play competitive sport again as I haven’t since I was a child, I currently cannot get to anywhere as my mother has had a broken leg and knee issues and her car is an old manual which causes her extreme discomfort however she can just about drive it ( i believe it is unsafe for her to drive and I’m terrified about an accident where she gets hurt, she has issues with her own pip) due to this I haven’t left the house in over 3 months other than taking my dog for a walk sparsely and it’s been 2 years and a half years since I have gone out most days because of my mothers deteriorating condition.

to summarise my thoughts, I believe I’m being awarded the 1e mobility because of the reliability and availability of my mother has decreased because of her own medical conditions rather than her being totally unable to assist me, if this is the case how can I make it clearer during a mandatory reconsideration that my mother and her condition is crucial to my case.

joined_flame001

peteuk said:

A quick comment as i am at work…

The threshold for overwhelming psychological distress (OPD) is very high, It was explained to me as you cant get through the door, it’s like someone had bricked it up.  There is physical symptoms that stops you from going out,  not just anxiety but physical symptoms eg nausea/vomiting,

This makes sense as I have had a multitude of physical symptoms since a kid including vomiting, however the line seems blurred in my case as the overwhelming psychological distress only will occur if I’m going out on my own or when my mother is in a worsened condition and she may not be able to accompany 100% of the time if at all. 

for example I would go to college for one hour and my mother would be able to wait until I finished, the journey on the way was easy because I knew she would be there when I left. However somedays she could only drop me off and not wait for me because she was in pain or unwell, these days the journey was difficult because I would feel stuck there therefore the majority of days I couldn’t go out because assistance isn’t available.

Would this discrepancy be due to me and my mother mainly focusing on the severity of my symptoms during the distress, rather than the opportunities I have missed out on due to mine and her condition affecting each other?

Muttleythefrog

Bit of a fogged brain..... but let me see.
Yes this one has come up many a time... and it is one of the rare potential challenges that can carry risk.
Importantly the DWP guidance is that 1e and 1f cannot both apply for the majority of the time... it's one or the other (or neither). 

We have seen arguments for 1F forcing claimant to effectively rule out 1E go wrong. On the face of it I always see 1E as a more severe disablement or at least life quality restricting one but less easily fixed than 1F which may require some money (a carer for example) to do so.

Normally challenging decisions is low risk.

Let me read exactly your descriptions and give you opinion... Spoonie has already linked the key guidance and you've clearly done background reading already.

I think you might have a point in saying they could be looking too keenly at your ability to get out (read my language to refer to familiar journey) based on mother availability (again an issue we may have seen before). What you might have to introduce is the theoretical support that is always available... take them through the mechanics of what happens (risks, behaviours, actions, thoughts) when you do have that support and what happens if not.. and give quite a hard idea of how often you can get out with the theoretical support and without which in your case seems pretty heavily loaded to the support being crucial. I suppose you could point to the gradual erosion of your 'carer' availability has directly corresponded with your inability to do a familiar journey showing how critical such support is... perhaps describing how psychological distress preventing going out is strongly linked to the lack of carer availability.  I do think it possible 1f may successfully be argued to apply but yes some risks... you can even see it arising in the arguments I'm presenting to you to make.

Given you've gotten 11 points for DL I actually suspect you might find it easier as many with mental health problems like this do to get 12 or above on DL rather than above 10 on mobility. Of course both is possible and there are relevant posters on the board. But given strong hint you think you may have been underscored on at least one DL activity... well... you've already seen your points notched up since previously assessed. A MR may be worthwhile... it's just that unusual risk that seems to be carried on Mobility 1e/f that niggles me given the peculiarity of argument needed for what seems a less disabling situation... you're essentially arguing 1E does not apply the majority of the time so if they do not accept 1F applies they may conclude neither do... a small risk that has to be stated. My advice would be, given you seem pretty switched on, to proceed with MR and appeal if necessary to try to get Mob 1F and at least one of the DL activities (you already cite one is underscored) with a raised score.

Note: 1F would lead to possibility of motability scheme. 1E automatically qualifies you for a blue badge on application.

Good luck with what you decide to do and obviously don't expect as such a changed decision at MR... more likely at an independent appeal after that.. but you never know!

joined_flame001

Muttleythefrog said:

Bit of a fogged brain..... but let me see.
Yes this one has come up many a time... and it is one of the rare potential challenges that can carry risk.
Importantly the DWP guidance is that 1e and 1f cannot both apply for the majority of the time... it's one or the other (or neither). 

We have seen arguments for 1F forcing claimant to effectively rule out 1E go wrong. On the face of it I always see 1E as a more severe disablement or at least life quality restricting one but less easily fixed than 1F which may require some money (a carer for example) to do so.

Normally challenging decisions is low risk.

Let me read exactly your descriptions and give you opinion... Spoonie has already linked the key guidance and you've clearly done background reading already.

I think you might have a point in saying they could be looking too keenly at your ability to get out (read my language to refer to familiar journey) based on mother availability (again an issue we may have seen before). What you might have to introduce is the theoretical support that is always available... take them through the mechanics of what happens (risks, behaviours, actions, thoughts) when you do have that support and what happens if not.. and give quite a hard idea of how often you can get out with the theoretical support and without which in your case seems pretty heavily loaded to the support being crucial. I suppose you could point to the gradual erosion of your 'carer' availability has directly corresponded with your inability to do a familiar journey showing how critical such support is... perhaps describing how psychological distress preventing going out is strongly linked to the lack of carer availability.  I do think it possible 1f may successfully be argued to apply but yes some risks... you can even see it arising in the arguments I'm presenting to you to make.

Given you've gotten 11 points for DL I actually suspect you might find it easier as many with mental health problems like this do to get 12 or above on DL rather than above 10 on mobility. Of course both is possible and there are relevant posters on the board. But given strong hint you think you may have been underscored on at least one DL activity... well... you've already seen your points notched up since previously assessed. A MR may be worthwhile... it's just that unusual risk that seems to be carried on Mobility 1e/f that niggles me given the peculiarity of argument needed for what seems a less disabling situation... you're essentially arguing 1E does not apply the majority of the time so if they do not accept 1F applies they may conclude neither do... a small risk that has to be stated. My advice would be, given you seem pretty switched on, to proceed with MR and appeal if necessary to try to get Mob 1F and at least one of the DL activities (you already cite one is underscored) with a raised score.

Note: 1F would lead to possibility of motability scheme. 1E automatically qualifies you for a blue badge on application.

Good luck with what you decide to do and obviously don't expect as such a changed decision at MR... more likely at an independent appeal after that.. but you never know!

Thank you so much Muttleythefrog for your detailed and lengthy comment it really does help me understand my situation more.  Sorry if I give too much or too little information about somethings I’m not always sure what’s best. It is essential for me to get the right decision as I believe I can really turn things around for me if my mother has the right vehicle, I cannot entirely blame the DWP for awarding 10 points as we have focused mainly on how intense my physical symptoms are when trying to leave the house alone rather than how much they are negated when my mother is fully available. As you have said though it does come with a risk which is why I think we have been hesitant in the past because when we haven’t focused entirely on my physical and psychological symptoms I have been awarded 0 points for mobility just for saying I could go out some days with my mum.

joined_flame001

Muttleythefrog said:

Bit of a fogged brain..... but let me see.
Yes this one has come up many a time... and it is one of the rare potential challenges that can carry risk.
Importantly the DWP guidance is that 1e and 1f cannot both apply for the majority of the time... it's one or the other (or neither). 

We have seen arguments for 1F forcing claimant to effectively rule out 1E go wrong. On the face of it I always see 1E as a more severe disablement or at least life quality restricting one but less easily fixed than 1F which may require some money (a carer for example) to do so.


Note: 1F would lead to possibility of motability scheme. 1E automatically qualifies you for a blue badge on application.

I agree with you that it does seem 1e is more of a severe disablement which has always confused me as it awards less points, although never going out would mean less need for a carer or a car maybe. 

I could be very wrong but I believe I’ve effectively been forced into the 1e descriptor because my mother isn’t physically fit all the time therefore on the majority of days because of overwhelming psychological distress linked heavily to my mother’s (my carer)  worsening condition I can not leave the house. 

I’m understanding that I need to make it clear to the DWP that theoretically if my mother was available 100% of the time uninjured I would be able to avoid overwhelming psychological distress almost completely ( I cannot say it would completely because I do not know as the last time she was fully fit I was in primary school and I’m a grown man now).

Spoonie_Turtle

joined_flame001 said:

Muttleythefrog said:

Bit of a fogged brain..... but let me see.
Yes this one has come up many a time... and it is one of the rare potential challenges that can carry risk.
Importantly the DWP guidance is that 1e and 1f cannot both apply for the majority of the time... it's one or the other (or neither). 

We have seen arguments for 1F forcing claimant to effectively rule out 1E go wrong. On the face of it I always see 1E as a more severe disablement or at least life quality restricting one but less easily fixed than 1F which may require some money (a carer for example) to do so.


Note: 1F would lead to possibility of motability scheme. 1E automatically qualifies you for a blue badge on application.

I’m understanding that I need to make it clear to the DWP that theoretically if my mother was available 100% of the time uninjured I would be able to avoid overwhelming psychological distress almost completely ( I cannot say it would completely because I do not know as the last time she was fully fit I was in primary school and I’m a grown man now).

What matters is the majority of days.

You definitely need to make it clear what YOU can do, what help you need and how having support enables you to go out.  Your mother's injury and availability is only relevant to your claim as an explanation for why you haven't been leaving the house like you would be able to if you always had the support.  And you definitely should not mention needing a motability car for her to drive; the only hypotheticals mentioned should be along the lines of 'if I always had support available, … '.

I understand that you want to make your situation clear to them, and in your everyday life your mother's abilities and availability do impact what you're able to do, but all DWP are interested in for your PIP claim is your disability and how it affects you.

joined_flame001

Spoonie_Turtle said:

joined_flame001 said:

Muttleythefrog said:

Bit of a fogged brain..... but let me see.
Yes this one has come up many a time... and it is one of the rare potential challenges that can carry risk.
Importantly the DWP guidance is that 1e and 1f cannot both apply for the majority of the time... it's one or the other (or neither). 

We have seen arguments for 1F forcing claimant to effectively rule out 1E go wrong. On the face of it I always see 1E as a more severe disablement or at least life quality restricting one but less easily fixed than 1F which may require some money (a carer for example) to do so.


Note: 1F would lead to possibility of motability scheme. 1E automatically qualifies you for a blue badge on application.

I’m understanding that I need to make it clear to the DWP that theoretically if my mother was available 100% of the time uninjured I would be able to avoid overwhelming psychological distress almost completely ( I cannot say it would completely because I do not know as the last time she was fully fit I was in primary school and I’m a grown man now).

What matters is the majority of days.

You definitely need to make it clear what YOU can do, what help you need and how having support enables you to go out.  Your mother's injury and availability is only relevant to your claim as an explanation for why you haven't been leaving the house like you would be able to if you always had the support.  And you definitely should not mention needing a motability car for her to drive; the only hypotheticals mentioned should be along the lines of 'if I always had support available, … '.

I understand that you want to make your situation clear to them, and in your everyday life your mother's abilities and availability do impact what you're able to do, but all DWP are interested in for your PIP claim is your disability and how it affects you.

Thank you for replying again Spoonie_turtle I’m understanding more. The part I ’m struggling to discern is the fully available part, because yes if my mother was 100% fit I would be able to go out all the time most likely walking or driving to most places. However that is not what 12 points offers that is why I was mentioning the mobility car as no matter what I don’t know if my mother can be 100% available but I can see why that may be a problem to do so. 

To my brain linking my problems to my mother driving a mobility car which may be a  possibility made more sense than linking it to a theoretical version of my mother that wasn’t injured at all, but assuming I’ve understood correctly I should explain an uninjured healthy mother would help me get out of the house on the majority of days as the only reason I cannot leave the house is because my mother is in such an unhealthy condition.