Case Studies » Sickness » 2014/08 - Specified Disability: Congenital Bilateral Hip Dislocation
Specified Disability: Congenital Bilateral Hip Dislocation
Background: The appellant, aged 29 years, had applied for Disability Allowance in 2009. Her G.P. certified her incapacity and referred to multiple operations. He confirmed that the most recent operation at that time had taken place two years previously and that she was awaiting further surgery. The claim was disallowed and she made an appeal. Following an oral hearing in 2011, the Appeals Officer concluded that the appellant continued to have some impairment but not such that it could be regarded as significant and he held that the medical qualifying criteria were not met. The appellant re-applied in 2013 and Disability Allowance was awarded. Her G.P. reported that she had undergone a total hip replacement in 2012, and that she suffered chronic pain and depression.
Appellant’s contentions: The appellant sought to have Disability Allowance awarded with effect from the date of her initial application and she submitted a detailed account of her medical history in support of that request. This referred to her diagnosis, surgery and pain management. In addition, she submitted that her extensive medical issues had led to a diagnosis of Depression for which she had been referred to a Psychiatrist.
Having been awarded Disability Allowance in 2013 and having regard to the appellant’s request to have payment backdated to her initial application in 2009, the question at issue was whether the Appeals Officer’s decision in 2011 was erroneous in the light of new evidence or new facts, as provided for under Section 317. This question was examined by a second Appeals Officer.
The Social Welfare (Consolidation) Act, 2005, Section 317, as amended, provides that:
1. An appeals officer may at any time revise any decision of an appeals officer—
(a) where it appears to him or her that the decision was erroneous in the light of new evidence or new facts which have been brought to his or her notice since the date on which it was given, or
(i) the effect of the decision was to entitle a person to any benefit within the meaning of section 240, and
(ii) it appears to the appeals officer that there has been any relevant change of circumstances which has come to notice since that decision was given.
2. In subsection (1)(b)(ii), the reference to any relevant change of circumstances means any relevant change of circumstances that occurred before, or occurs on or after, the coming into operation of the Social Welfare and Pensions (No. 2) Act 2013.
Comment/Conclusion: In examining the case, the Appeals Officer noted the following:
- The initial application was refused on grounds that the appellant did not meet the medical qualifying condition, a decision which was based on the opinion of the Medical Assessors that her existing restriction was not expected to last for more than one year – implying an acceptance that she was substantially restricted at the time, albeit that the condition was expected to be of short duration.
- Subsequent events made clear that the appellant’s medical condition, and consequent restriction, had been continuous since the period from her first application. In particular, she had provided evidence of ongoing problems following surgery in 2009 and the requirement for a revision of that surgery in 2012.
- Since her initial claim in 2009, the appellant had experienced significant pain management issues which would have substantially restricted her ability to engage in employment.
- The appellant’s medical condition at the time of her second application included Depression, which had not been certified in the original application. However, the medical evidence confirmed that this was something she had been dealing with since at least 2011, although no reference had been made to the fact in the report of the oral hearing in 2011.
- The report of the Consultant Psychiatrist stated that the impact of the appellant’s physical condition had been significant and had reduced her confidence and her ability to work.
The Appeals Officer considered that it was clear that the appellant had been suffering to a significant degree with the effects of Depression prior to her referral to the Consultant Psychiatrist in 2011. He noted that, when considering the issues in the case, it was particularly relevant that this did not appear to have been taken into account in relation to her initial application or in the context of her appeal.
Having examined all of the evidence available, and acknowledging that he had the benefit of hindsight in relation to the long-standing restrictions imposed on the appellant as a result of her medical conditions, the Appeals Officer revised the earlier appeal decision, with reference to the provisions of the Social Welfare (Consolidation) Act, 2005, Section 317 (1) (a). Accordingly, he held that with effect from a specified date in 2009, the appellant could be held to meet the qualifying criteria for receipt of Disability Allowance.
REVISED DECISION: The appeal is allowed.
Decision reason(s): I find that, with effect from [specified date] 2009, the appellant was suffering from a medical condition which was reasonably expected to last for at least one year and as a result of this condition, was substantially restricted in undertaking work which would otherwise be suitable having regard to the her age, experience and qualifications.
Having examined all of the evidence in this case (and with the benefit of hindsight in relation to the long-standing restrictions imposed on the appellant as a result of her medical conditions), I am revising the appeal decision in this case under Section 317 (1) (a), Social Welfare Consolidation Act 2005.