Probably a quickie for the DLA specialist on the forum

I have a cl that suffers from chronic pain syndrome and presently gets DLA MC/LM. By taking a large amount of analgesics (i.e. overdosing sometime when she is out by herself) she can walk at normal speed (with several stops every 50 metes or so) and manage most aspects of her life. Without the analgesics she would otherwise be bed/house bound most of the time.

I am helping her filling in her DLA renewal form and based on what I was told I think she should get High rate for both components were she not taking so much pain killers throughout the day and even when going to sleep.

Are there any guideline/commissioner's decisions on the effect of medication in relation to their care or mobility needs?

What I am struggling with is whether to describe her care needs/mobility ability on the form based on her condition after taking the overdose of analgesics (which enables her to manage life) or if she was not taking it at all, or if she just took the recommended amount which would still not provide her with enough pain relief to manage?
As I wrote this I could see that the likely answer is the third option, i.e. ability after taking the recommended amount of analgesics.
Nonetheless, any further input/discussion on this would be useful.

On the mobility issue - If the only way that the client can walk any appreciable distance is to take a dangerous overdose of medication to overcome the severe discomfort/pain, then it seems obvious that they are virtually unable to walk..........

..........however, as this appears to be a undefined diagnosis case, you may need to look at CDLA/2879/2004 (in briefcase) which was a Tribunal of Commissioners who said:-

"The Tribunal of Commissioners hold that pain, dizziness, or other symptoms, are not a feature of the claimant's 'physical condition as a whole' unless they have a physical cause. In consequence, difficulty in walking which results from pain, dizziness or other symptoms affecting physical functions which are found to have an entirely mental or psychological cause cannot qualify a claimant for the higher rate of the mobility component of DLA.

However, the Tribunal of Commissioners do conclude that in cases where a claimant's inability or virtual inability to walk is caused by both physical and mental factors, a claimant is entitled to the higher rate of the mobility component if the physical disorder is a material cause - i.e. if its contribution to the inability or virtual inability to walk is more than minimal".

Hi Mouster

This does not really answer your query but is your client suffering from RSD/CRPS? (Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome)

If she is then it is very well worth either you or your client contacting RSD UK before completing the form.

The people there are very experienced in DLA for people with this illness and can give invaluable advice on complting the form to achieve maximum benefit.

Helpline no. is 0845 22 66 008.

Thanks for the pointers so far ..
The cl has RSI/Chronic Pain Syndrome/RSD/CRPS (I understand RSI is a physical condition).

On reading various DLA guides, it does not say anything about medication other than refusal to take medication. My difficulty is in striking a balance, because when the cl takes pain killers then the debilitating effect of the condition is masked by the pain killers and the disability is reduced significantly. But the pain relief that the analgesic provide is only temporary and cl told me that when she is out and the effect of the pain killer finishes and the pain comes back she has to take more (an overdose) in order to carry on be stuffed in the street.

What I like to see is a decision similar to the one that said " any walking achieved after the onset of severe discomfort should be disregarded" … so is there anything similar that says any activities/walking achieved under the influence of painkillers/analgesic should be disregarded?

You may not find a decision quite as clear cut as that - the point is that your client suffers from severe discomfort and pain - severe to the extent that taking the recommended dose of painkilling medication does not work - the fact that she takes a dangerously high dosage does not alter the fact that pain is disabling her -

The only comparison I can think of off-hand is the hyperthetical cooking test - there is a Comm Dec somewhere which effectively says that a DM/Tribunal should look at whether the disability precludes a claimant from cooking a main meal for themselves - if there is evidence that it does, they should not then look for ways of cooking using special aids - slotted spoons etc - liken the special aids to the excessive medication......

Does that all make sense ......seems logical to me anyway, but I'm only a WRA - not quite sure how you'd put it in a submission though...

Thanks Mike, I guess you are referring to CDLA 1714 2005 reg. cooking test case. Thanks for highlighting the parallel as I'd failed to see that even though I read that case…. Two heads better than one
Cheers M

Unfortunately CDLA/1714/2005 is not authority for the proposition that a tribunal should not look at whether aids can be used in the situation that Mike describes. At para' 8 it says that "the focus of the tribunal's inquiry must be on the effects of any disability on the claimant'sability to cook a main meal rather than on ways in which those effects can be overcome". So far so good, if only it stopped there, but, however, at para’ 9: -

“That is not to say that aids to cooking are wholly irrelevant. Lord Hoffman accepted that the notional meal contemplated by the cooking test is a reasonable main meal for one person, of the kind described by Mrs Commissioner Heggs in the leading case R(DLA) 2/95. The activities which need to be considered when applying the cooking test are those which are normally required to cook such a meal, and in my judgment, in order to calibrate the severity of a claimant’s disability, it is necessary to consider how those activities are normally carried out. Cooking is normally performed using kitchen implements, and a person without disabilities will sensibly use implements such as a slotted spoon in order to avoid dangers such as burning or scalding. A person with a disability can reasonably be expected to do the same, and I therefore respectfully agree with Mr Commissioner Rowland in CDLA/5686/1999 that if a claimant cannot lift a pan of hot water safely, account can be taken of any ability which the claimant may have to use a slotted spoon to remove vegetables from the pan without the risk of scalding”.

If there is another CD which is authority for the proposition then may be someone could supply the reference. I'm sure that it would make all of us weary welfs's day.

Regards
Paul

Fri 03-Feb-06 08:10 AM by ken

You might find R(DLA) 10/02 useful. It says that unreasonably refusing potentially beneficial treatment might mean that care needs are not reasonably required.

But it would be hard to argue that declining to take a substantial overdose of analgesics amounts to unreasonable refusal; therefore her needs should be assessed without the effects of such a dose; and her ability to cope on the occasions when she does choose to take a large dose does not mean that her needs without such a dose are no longer reasonably required.