Mandatory Reconsideration

I have been denied PIP yet again based on my telephone assessment but thankfully I have found this website which has helped my hugely in preparing my mandatory reconsideration. i feel as though i have written in as much detail as possible and would gratefully appreciate if anyone has advice.

Dear Sir/Ms,

MANDATORY RECONSIDERATION NOTICE

I request that you reconsider your decision dated 14/12/2023

I consider that I provided enough evidence for a decision to be made that I am entitled to PIP at the enhanced rate for daily living and standard rate for mobility.

I do not consider that the decision maker took full account of the severity of my conditions or of the way that it affects my everyday activities.

I wish to add the following evidence: edited PA4 form



Daily Living Component

1.Preparing food
In my assessment it states I have difficulties consistent with fatigue. That I use my slow cooker 3 times a week, when actually I told my assessor that I can only use my slow cooker for a maximum of 3 times a week. I barely use it now that I order ready meals online as it is less fatiguing. Descriptor given: need an aid or appliance to be able to prepare or cook a simple meal – 2 points

My MS fatigue makes me much slower when preparing food. Also, because of my MS cognitive problems causes me to struggle with processing recipes it makes this task is very time-consuming and exhausting. I also struggle with my memory since being diagnosed with MS and I must repeatedly check that I have that correct ingredients, the correct measurement and how to prep each ingredient. I always need to rest after doing this task for 20-30 minutes to regain some energy because I am so drained. I use aids to decrease how long it takes me however, it still takes me an unreasonable amount of time. To prepare ingredients, to put into my slow cooker, it takes at least 45 minutes. To cook a fry-up would take me at least an hour. To even boil frozen vegetables, pasta or rice takes me 25-55 minutes because I need to rest more in the evening so I cook on a smaller hob. I need somebody to help me with this task as it is so time-consuming, and fatiguing. My abilities never vary from day to day.

Given that I cannot complete this task to an acceptable standard or within a reasonable amount of time the correct descriptor should be: 1e. needs supervision or assistance to either prepare or cook a simple meal – 4 points.

2.Eating and drinking
In my assessment it states I can eat 1-2 meals a day and have no dietary input(I don’t understand what that means) but there was no mention of the fact that I lack motivation and need to use aids to be able to eat and drink safely. Descriptor given: 2a. can eat and drink unaided - 0 points.

I have difficulties with this task because of my multiple sclerosis and depression.
Since I have had multiple sclerosis, I have always had difficulty swallowing liquid and food. I can only drink water through a straw otherwise I will choke or spill it down me. I always spill food down me and do not have the energy to change my outfit. I often forget how to swallow when eating and must wash food down with water. After eating I must rest for at least 30 minutes because I find the task of eating exhausting. Plus because of steroid treatment in the past I must rest to avoid indigestion. Preparing and eating food makes me feel so fatigued and is such a waste of energy because I have housework that needs to be done and is more important to me. I must drink through a straw and wear clothing protectors. I need somebody to prepare food for me and motivate/ encourage me to eat so I don’t waste energy. Lunch is always the most exhausting meal that’s why I never eat lunch unless I’m at my aunts and she makes me lunch. I must make my breakfast the night before otherwise it’s too cold for me eat, so if I’m too fatigued at night then I will not have breakfast.

Because of my depression I take medication that causes me to have dry mouth which puts me off eating as I am unable to swallow food. I don’t have the motivation to eat 3 meals a day, so I tend to drink protein/ meal replacement shakes to fill me up. On most day I’ll buy chocolate and crisps to binge and over consume on to give me comfort and to try and feel better. I would prefer not to eat at all because I’m too lethargic, fatigued and unmotivated to eat and if I don’t feel hungry, I won’t eat a meal or drink a shake. I must leave treats at my aunties because she’ll tell me if I’m over consuming. Because I’m bored in the evenings/ nights that’s when I will over consume on junk food, and once I start, I cannot stop eating.

Because I don’t eat much, my eyes are bigger than my belly and I end up overconsuming at meal times which makes me so much more fatigued.

Sometimes I will have breakfast but most days I don’t. I never have lunch.

Given that my depression and fatigue prevent me from eating and drinking safely or as often as reasonably required the Correct descriptor should be: 2d.needs prompting to be able to eat and drink - 4 points


3.Managing treatments
In my assessment it states that my therapy is helpful, there has been no changes to my medication, I’ve had no contact from crisis team and I’m not prescribed analgesia for pain. Descriptor given: 3a(ii) I can either manage medication / therapy or monitor my health condition unaided, or I do not need to – 0 points
I don’t understand why I need to be prescribed analgesia for pain when I have never claimed to suffer from pain.

Owing to my MS-related fatigue, which can slow memory processing and recall, I need to use aids to help assist me when taking my medication . If I didn’t use a pill organiser, then I would forget to take my pills or take double because I might believe I haven’t taken them. I have had to label my morning pills because I accidently took my night pills. Given my fatigue, I often forget to take my sleeping tablets and I can’t sleep. If I don’t get a good night’s sleep I am more fatigued for at least a week or longer. I have a reminder on my phone for 7pm every night to remind me otherwise I’d forget. I often believe I have already taken my pills and don’t realise that I haven’t until I can’t fall asleep meaning I don’t fall asleep until early hours of the morning, which is very late for me. I have an app that remind me to take my MS injection and also keeps a record of my injection site and side effects. If the NHS didn’t text me to remind me of appointments that I had forgotten about then I would miss these appointments. Also, I cannot wake up before 7am or rush to get ready otherwise it would adversely impact my fatigue so therefore I cannot attend a local appointment before 10am.

My depression and childhood abuse has driven me to overdose so many times I’ve lost count. I started with a bi-monthly prescription but because of my overdoses my Dr now only prescribes me medication weekly, I still have thoughts of suicide, especially when I forget to take my sleeping pills because I’m thinking about the fact that there no benefit for me to be alive and just exist. I realised after taking my last overdose and putting myself in a coma that I was wasting my time crying for help because the NHS cannot provide me counselling.

Since I've been going to counselling it has helped me learn to value myself and recognise my needs, emotionally and physically, and has helped me better face my limitations, especially regarding fatigue. It has helped me learn how to listen to my body and pace myself better in order to conserve more energy. I've had the opportunity to reflect on and acknowledge the abuse I suffered as a child/teenager. Counselling has allowed me time to process difficult emotions relating to my mum’s death. Due to the nature of the trauma, I have experienced, my sessions have frequently been extended to accommodate from my ongoing psychological needs. It has encouraged me to better manage my fatigue but is unable to help with the improve any of my MS related difficulties, namely adverse fatigue. I am continuing to work on my high anxiety levels when facing new situations and to gain new relationships.

Given that I cannot carry out this task safely or without aids or appliances because of my MS-relating cognition and memory problems and depression the correct descriptor should be: 3b(i) needs to use an aid or appliance to be able to manage medication (ii) supervision, prompting or assistance to be able to monitor a health condition – 1 point

6.Dressing and undressing
In my assessment it states that I dress daily, but I have been awarded points for needing an aid for washing and bathing due to my MS-related balance problems. Descriptor given: 6a. can dress and undress unaided – 0 points

Ever since I have been diagnosed with multiple sclerosis my balance has been adversely affected. I cannot dress/ undress my lower body safely whilst standing because I will fall and injure myself. I must sit down to complete this task safely even when I am wearing loose clothing. I cannot safely put on shoes or slide on slippers unless I am seated. It has been suggested I use crutches to dress/undress however I think crutches would not help with my balance and would cause me to become more fatigued. I always need to rest after getting dressed/undressed because I find completing this task exhausting. My difficulties for this task never change and I struggle every day.

Given that I cannot carry out this task safely or to an acceptable standard the correct descriptor should be: 6b. needs to use an aid or appliance to be able to dress or undress – 2 points

9.Mixing with other people
In my assessment it states that I engaged with my assessor but there was no other information regarding this activity. Throughout my telephone assessment I was extremely anxious, fatigued and kept clutching my crystals to help calm my nerves. I was also pressured into answering what I would do if somebody would ask me for the time and because I panicked when the question was asked I said what I thought she wanted to hear. Descriptor given: 9a. I can engage with other people unaided – 0 points

My anxiety causes me to fear going out because I don’t trust the public. I must mentally prepare myself to leave my home and I wear earphones every time I have to go out and avoid eye contact with people, so they don’t talk to me. If I can see somebody is trying to get my attention then I will pretend to be on my phone and turn my back to them. I am now so petrified of somebody asking me for the time that I am now doing all my shopping online.

My depression means I lack motivation to leave the comfort of my own home making me very isolated and lonely, but at least I am safe. I spend most of my days at home not engaging with anyone other than my immediate family.

Because I suffer from MS-related fatigue and lack of balance I have absolutely no choice but to travel on public transport to attend appointments, go shopping or visit family. Even though I do not qualify for the moving around component I am not capable of walking miles to get to places. I must sit down on a bus so I can only travel between 10am-2.30pm as that’s when the buses are less busy and I am too afraid to ask somebody for a seat.

My hyperhidrosis makes me feel so embarrassed, ashamed and disgusted at myself. People have approached me in the past to ask if I am okay because I’m sweating profusely and thought of it happening again terrifies me. As I am limited on the number of tablets I can take I am therefore limited on how often I can leave my home. I immensely struggle with this problem throughout spring, summer and autumn since the weather is warmer.


Given that I cannot complete this task reliably on most days the Correct descriptor: 9b. needs prompting to be able to engage with other people – 2 points

Mobility component

1.Planning and following a journey
In my assessment it states that I can use public transport and I have no cognitive impairment with adequate concentration with memory. Just because I can plan and follow a route to a familiar location that doesn’t mean I do not have severe and extreme difficulties because of my MS, depression and anxiety. I have lived on Basingstoke all my life and so I am very familiar with the journeys that I undertake but I don’t go to some areas of Basingstoke because I am too fearful of becoming lost. Also, there was no mention of the fact that during my assessment I did state that if I was lost I would fear a stranger talking to me. Descriptor given: 1a. can plan and follow a route of a journey unaided – 0 points

Owing to my multiple sclerosis causing me cognitive issues, I am incapacitated to take in a lot of information at once and I'm unable to memorise directions. As previously stated my MS fatigue can cause me problems with memory and focus. If I am lost I wouldn’t be able to look up directions because all the noise around me would inhibit me from concentrating. My cognitive problems only add to my extreme anxiety making it impossible for me to make sense of how to get somewhere or what transport to take. My dad takes me to all my specialist appointments at Southampton hospital as I am incapable of making my own way there. I cannot travel to an appointment in Basingstoke before 10am or after 4pm because it would have a detriment effect on my fatigue.

Because of my overwhelming anxiety the sheer thought of going somewhere unfamiliar terrifies me to the point of I am incapable of even leaving my home. I believe that if I was lost that I’d be a vulnerable target to be attacked and robbed for my phone and money which would leave me completely stranded and unable to contact someone for help. I cannot understand unfamiliar directions because I don’t recognise the road names, this increases my anxiety and fear of becoming lost. I am so immobilised by fear of getting off on the wrong stop that I will not ever use public transport to an unfamiliar location. If I was to become lost I would be in such an overwhelming state of panic that I would not check for cars before crossing a road. I will cancel any appointment or meet up with family if the familiar roads are closed and the bus must go a different route. I would feel too powerless, worried and fearful that I could possibly get lost and I will be inept of getting home safely.
When I receive an appointment, that I must go to, but is in an unfamiliar location I become so overwhelming distressed, I self-harm and I must call my aunt to calm me down. Also, my aunt encourages me not to cancel my appointment and reassures me that I will not be travelling alone. I had to attend an appointment in Reading so my cousin came with me, even though I was familiar with the train journey we had to pay for a taxi from the station because I was too panicked and afraid to use public transport, especially as there was no bus station. If the buses are too busy and I am unable to safely stand on a bus and too afraid to ask for a seat.

Since having depression, I have always known that I need counselling. As I couldn’t get it on the NHS I had no choice but to look up online for possible places to go. I was unable to enquire, for years, because potential counselling offices were in unfamiliar locations and I was too apprehensive because of the absolute turmoil I get in. I tend to punch myself and think about suicide because I'm so pathetic and can’t do what should be a simple task.

I have recently needed to be able to use a local foodbank but because my local foodbank is an unfamiliar place I cannot go. I am struggling to pay for food but I can manage at the moment. If I have to use the foodbank then I’ll have to arrange for my auntie to come with me.

My doctor recognises the problems I have planning and following a journey, hence why she wrote a letter requesting I have a telephone assessment.

My abilities never vary from day to day, I'm always so overpowered by my emotions and counselling hasn’t helped me with this problem.

Given that I cannot complete this task safely, repeatedly or to an acceptable standard without the help from another person the correct descriptor should be: 1e. cannot follow the route of an unfamiliar journey without another person, assistance dog or orientation aid – 10 points