‘The decision made by the Secretary of State on23/10/2012 is confirmed.’
‘… The submission should include information as to the complete adjudication history, and in particular information as to whether the decision of23 October 2012 was the first decision as to whether the Claimant had limited capability for work in accordance with the work capability assessment , and if not what previous decisions were made, and on what evidence. Copies of the evidence on which any previous decision was made, and in particular a copy of any ESA 85 or similar report prior to that of28 September 2012 , should be attached to the submission if still available.’
‘In relation to the March 2011 decision, the only relevant record the Secretary of State has been able to find is the Decision Notice dated11 March 2011 . In relation to the May/June 2012 decision, the Secretary of State has been unable to locate a copy of the Decision Notice or other relevant papers. Computer records show that an award was made to (the appellant) on 2.6.12 placing her in the Work Related Activity Group as a result of her successful appeal – however, no other details are noted.’
‘… a tribunal ought to have adjourned a hearing for an earlier medical report to be produced by the Secretary of State where it was being argued that the earlier report would show that a more recent report was incomplete and insufficient.’
‘Where a claimant is arguing that their condition remains materially unchanged from the date of the award in their favour, the prior history of the claim and the previous awards in favour of the claim may be relevant documents in considering any supersession decision and any new HCP report which is relied on as the basis for that decision. It will be for the Tribunal itself to consider and assess the relevance of such material on a case by case basis.’
‘Thus, whilst supersession may proceed on a change of circumstances generally, in ESA cases, once an ESA decision has been taken, there is no need to demonstrate a change of circumstances to supersede that decision: the receipt of medical evidence alone is sufficient to permit supersession.’
‘Conversion entails a determination of whether there is an entitlement to employment and support allowance on the basis that it has been determined that the claimant has limited capability for work or is to be treated so under and in terms of theWelfare Reform Act 2007 and the regulations made thereunder relating to ESA; Existing Awards Regulations[1], reg 7. If on determination a person in respect to whom a conversion decision is determined not to qualify for ESA the existing award of benefit terminates; Existing Awards Regulations, reg 15(2).’
‘The process of assessment in a CWA [capability for work assessment] or a PCA may entail the ascertainment and recording of facts as to an individual’s physical abilities and that may be relevant in an assessment of credibility at a later date. However, the circumstances in which earlier reports will amount to material evidence are, it is submitted, vanishingly thin. PCAs will have been conducted, and observations made, against different criteria. The statutory tests for ESA will not have been addressed; nor would they have been in the mind of the author(s) of the report(s). The report(s) (if any) are likely to be aged. They would fall to be considered against more contemporaneous CWAs in an assessment which does not entail demonstrating a change of circumstances. They would fall to be considered against the Tribunal’s own contemporaneous observations of the claimant. Evidentially, they are likely to carry very little or no weight.’
‘… a pragmatic and proportionate settlement of the obligation of the Secretary of State to provide earlier CWAs and PCAs in any appeal, whilst at the same time recognising the ability of the claimant, or the Tribunal, to call for the same if the circumstances demonstrate likely value in so doing.’
‘Before the First-tier Tribunal the grounds of appeal did not rely on a comparison against her condition at the date of an earlier award. The appellant also accepts that the absence of prior reports was not raised in the oral hearing before the First-tier Tribunal. The Tribunal found the appellant not to be credible or reliable; and instead placed reliance on recent medical reports produced by the claimant when refusing the appeal. Failure to produce earlier reports not, of itself being an error of law and no reliance having been placed by the appellant on earlier reports, the First-tier Tribunal was entitled to proceed as it did.’
‘50. The implications of the introduction of the Great Britain equivalent of regulation 6(2)(g) of the Social Security (Decisions and Appeals) Regulations (Northern Ireland) 1999 and, more particularly, the effect of the introduction of that provision on the requirement to consider previous adjudication history, have been considered by the Social Security Commissioners in Great Britain in a number of well-analysed and thorough decisions. From those decisions we derive and accept the following principles: (i) there was a clear purpose to the introduction of regulation 6(2)(g) of the Social Security (Decisions and Appeals) Regulations (Northern Ireland) 1999, which was to provide that the obtaining of a medical report or medical evidence following an examination is in itself a ground for supersession; (ii) accordingly, there is no requirement to identify a regulation 6(2)(a)(i) change of circumstances in order to supersede an IB decision; (iii) there is a difference between the evidential requirement to determine the ground for supersession and the evidential requirement to establish whether an individual is incapable of work in connection with the all work test or personal capability assessment; (iv) it is no longer[2] necessary as a matter of law for an appeal tribunal to have before it and to consider the evidence of the claimant’s previous assessments in connection with the all work test or personal capability assessment; (v) an appeal tribunal is entitled to call for whatever evidence it considers to be relevant to the proper determination of the issues arising in an appeal; (vi) the requirement for an appeal tribunal to consider the evidence associated with previous favourable assessments in connection with the all work test or personal capability assessment depends entirely on the relevance of the earlier assessments to the determination of the claimant’s incapacity for work at the date of the supersession decision; (vii) an appeal tribunal will be required to consider the evidence associated with previous favourable assessments where an appellant asserts that there has been no change in his medical condition or disablement and that the evidence associated with previous assessments is relevant to that continuing medical condition or disablement. In such circumstances the last previous assessment is likely to be of more relevance than earlier ones and the relevance of any particular assessment is likely to diminish with the passage of time; (viii) details of the basis of the claimant’s previous assessments in connection with the all work test or personal capability assessment may be relevant evidence of the claimant’s overall capacity, particularly where the claimant has a variable condition. Variability may increase the relevance of older assessments carried out before the last previous assessment; (ix) details of the basis of the claimant’s previous assessments in connection with the all work test or personal capability assessment may be of no relevance in a case, for example, where there is evidence that the claimant’s condition has changed in a way that renders the details of the earlier assessment irrelevant; (x) where the evidence associated with a previous favourable assessment in connection with the all work test or personal capability assessment is no longer available, it does not follow that the award of entitlement to benefit or credits, based on that favourable assessment, should automatically continue, simply because a comparison cannot be made. The appeal tribunal must reach a decision based on whatever evidence is available to it; (xi) the value of the evidence associated with a previous favourable assessment in connection with the all work test or personal capability assessment may be minimal. This may be the case where an appeal tribunal has replaced a decision of the Department with its own decision, and there are no relevant findings in fact or reasons for the appeal tribunal’s decision because the success of the appeal obviated the requirement to call for these; (xii) an appeal tribunal may call for evidence associated with a previous unfavourable assessment in connection with the all work test or personal capability assessment. It follows that where evidence of previous assessments is of relevance in cases, for example, where the claimant’s condition is variable, the evidence may assist in determining the claimant’s overall capacity.’
‘… whether there is a breach of natural justice and the appellant’s right to a fair hearing enshrined inarticle 6(1) of the European Convention on Human Rights (“the Convention”) when a previous ESA85 medical report was not put before the First-tier Tribunal considering an appeal from a Secretary of State’s decision that arises from a subsequent ESA85 medical report concerning the same claimant. In addition, may such a breach arise even if the appellant had the previous ESA85 medical report but did not put it before the First-tier Tribunal?’
‘The role of the Secretary of State’s decision makers in this assessment process, both at the initial decision making stage and on appeal, is therefore not one where the decision maker is adverse to the claimant/appellant, but is rather one where he or she is assisting, as far as the decision maker can, in deciding the correct level of benefit for the claimant or appellant. And, crucially for present purposes, that will include providing information which the Secretary of State holds.’
‘The decision maker must provide with the response …. copies of all documents relevant to the case in the decision maker’s possession, unless a practice direction or direction states otherwise.’
‘Accordingly, the breach of that duty by the Secretary of State’s decision-maker means that the decision arrived at by the First-tier Tribunal was erroneous in point of law.’
‘I do not accept the claimant’s argument that the tribunal were required to take into account previous medical reports in relation to his Incapacity Benefit (IB) claim. Recent case law, for example in ST v Secretary of State for Work and Pensions (ESA)[2012] UKUT 469 (AAC) , suggests that where the claimant was claiming ESA and the papers relating to an earlier WCA were not placed before the tribunal, it may be an error in law. There were some circumstances fairly unique to the particular case in question, but the UT Judge’s general conclusions on what evidence the Secretary of State should present to a tribunal, as given in paragraphs 38 and 39 of that decision, are binding in all cases. However, in the instant case the claimant was being reassessed for ESA from a position of being entitled to National Insurance (NI) credits by way of being found incapable of work under the old Incapacity Benefit (IB) scheme. In order to continue receiving NI credits under that scheme, he needed to be found incapable of work under the Personal Capability Assessment (PCA), either by being found to have a specific medical condition which would have automatically allowed him to pass the PCA or passing a medical assessment. However, the ESA Work Capability Assessment is a completely different assessment, based on different descriptors and with a different scoring system, and, whilst the clinical findings and observations made under the PCA may have ongoing significance to, for instance, a stable condition, its relevance overall is limited. It should also be pointed out that PCA reports are becoming increasingly old as PCAs ceased on a widespread basis in 2011. Thus while PCA reports are still available to decision makers and Health Care Professionals do consider such reports at file work or examination, such reports will only be presented to a First-tier Tribunal if their relevance as evidence is considered significant. As a final point on this issue, I should state that there is an alternative view as to the relevance of IB papers to an ESA claim contained in CE/2796/12, where the Upper Tribunal Judge considers that PCA reports do not assist a tribunal at all and may even impede its reasoning.’
‘On either approach, regulation 6(2)(g) merely authorises a supersession procedure. It does not determine the outcome. It merely recognises that evidence has been produced that may, or may not, show that the operative decision should be replaced. The outcome is determined by the conditions of entitlement for an award.’
‘… However, where, as here, it is plain from what is being said by or on behalf of the claimant that she is no better (and maybe even worse) since she was last awarded ESA or was last subject to a limited capability for work assessment, and where (as here) there has been no relevant supervening event such as a change in the law or a successful medical operation, I cannot see any lawful basis for the Secretary of State or his decision makers denying to the First-tier Tribunal the previous ESA85 medical reports concerning the appellant (or at least the knowledge that such existed, and the ESA decision(s) made subsequent to them, if they are lost and no longer in his possession).’
‘Accordingly, the breach of that duty by the Secretary of State’s decision-maker means that the decision arrived at by the First-tier Tribunal was erroneous in point of law.’
‘… in a limited class of case, where there is an assertion that there has been no change in the claimant’s condition, and where the evidence associated with the previous adjudication history is relevant to that submission or, for example, where the claimant’s medical condition, and the evidence associated with the previous adjudication history assists in the assessment of the claimant’s overall capacity.’
‘However it is to be noted that the Secretary of State in guidance to officials requires in second and subsequent decisions as to whether a claimant has limited capacity for work that are appealed to the First-tier Tribunal, in limited and defined circumstances, to provide to the Tribunal in the response, so far as possible the earlier papers (or explain why that cannot be done). Thus the departmental document Submitting appeals to Her Majesty’s Courts and Tribunals Service provides, inter alia: ‘4255 In second or subsequent PCA/LCW cases where there has been an award and there has been no clear change or the appellant says that their condition has not changed or has worsened since that award, the earlier PCA/LCW papers should be included. If they cannot be produced an explanation should be provided. Where storage contractors have destroyed earlier PCA/LCW papers (they are routinely destroyed after 15 months) include this information as part of the explanation.’
‘It is submitted that if this Tribunal is minded to determine that to comply with rule 24(4)(b), TPR more information ought to be produced by the respondent to inform the claimant and the Tribunal of potential existence of potentially relevant material it is submitted that obligation would be met by a short statement of known decisions and referrals from the new DMACR and MSRS interrogation screens, which failing a print out from those screens.’
‘The main programs that can be accessed by DMs when preparing for an appeal which would provide information on the issue of medical examinations are Decision Making and Appeals Case Recorder (DMACR) and Medical Services Referral System) MSRS. DMACR is a stand alone system and is used solely to record decisions and is not joined up with other DWP computer systems. To comply with data protection principles, DMACR only retains information for the preceding 14 months on a rolling basis (reflective of the period in which a claimant may appeal a decision). If within that period there has been a decision following a medical examination, the decision (but not the medical report) ought to be identifiable and readily accessible on DMACR. On inspection of DMACR, the DM should be able to identify for any claimant a benefit type (e.g. “ESA”), a date of decision and a very short narrative (e.g. WCA-LCW Disallowance Following Med Exam” … The decision itself ought to be capable of being printed off. The report of the medical examination would not. The reporting to the Tribunal, from DMACR, of the existence of a decision would at least give notice as to the possible existence of a medical examination report within the 14 month period of the database, for the parties to request the Tribunal, or the Tribunal itself, to order production of the decision or the medical report, if available and if considered relevant. MSRS is essentially a record of medical referrals. DMs can access a screen that lists medical referrals that have been requested … It can identify when a medical examination was requested. For each entry it further permits access to additional information, including the possibility of the drawdown of a PDF of subsequently obtained medical reports if a PDF of the report was made at the time … However not all medical reports are available in PDF format. Further still, MSRS is also a time limited database. MSRS could, however, be used to identify a summary of medical referrals for the period of the database that would at least identify the possibility of medical reports sought that, if determined to be relevant, a claimant could request and the Tribunal order production of, if available. The ascertainment of whether there are potentially relevant decisions earlier than the rolling 14 month period covered by DMACR or medical reports not available through MSRS requires DMs to either (a) access an earlier version of DMACR; or (b) recall of the claimant’s file(s) from storage.’
‘it would appear that the Department have been capable of sourcing the report and including it in the papers as a matter of course, and it would seem to me that this is a very sensible approach rather than the expense of numerous Tribunal hearings being adjourned for the provision of such evidence.’
‘This was described by Baroness Hale in Kerr –v- Department of Social Development[2004] UKHL 23 , R 1/04(SF), at paragraph [62] as follows: “What emerges from all this is a co-operative process of investigation in which both the claimant and the department play their part. The department is the one which knows what questions it needs to ask and what information it needs to have in order to determine whether the conditions of entitlement have been met. The claimant is the one who generally speaking can and must supply that information. But where the information is available to the department rather than the claimant, then the department must take the necessary steps to enable it to be traced”. The decision in Kerr turned on whether any of the claimant’s siblings were in receipt of a relevant social security benefit at a particular time - information which only the Department for Social Development held – hence the focus of the language used by Baroness Hale in the last sentence. However, in my judgment the principle in Kerr is wider than this, and is to the effect that in the cooperative process of investigating a person’s entitlement to benefit the Department (or Secretary of State for Work and Pension in this case) is obliged to provide to that investigation all relevant information that it or he holds.’
‘… Appeal tribunals should not be overwhelmed with submissions that there has been no change in the appellant’s medical condition and that, accordingly, the evidence associated with previous determinations in connection with the all work test or personal capability assessment should be produced.’
‘… where, as here, it is plain from what is being said by or on behalf of the claimant that she is no better (and maybe even worse) since she was last awarded ESA or was last subject to a limited capability for work assessment, and where (as here) there has been no relevant supervening event such as a change in the law or a successful medical operation.’
‘I enclose a copy of a report I sent to yourselves in 2012 and I can confirm that since that time things haven’t changed very much. She continues to attend with her pain and has developed a recurrent rash on her neck which the dermatologists feel is probably neurodermatitis. I would agree with this absolutely. This is a rash which is really generated by someone persistently scratching and creating an itch-scratch cycle. … She has as you will be aware attended the Pain Clinic over a number of years but they have now discharged her as they feel there is nothing much more they can offer him (sic) in a medical review.’
‘… any lawful basis for the Secretary of State or his decision makers denying to the First-tier Tribunal the previous ESA85 medical reports concerning the appellant (or at least the knowledge that such existed, and the ESA decision(s) made subsequent to them, if they are lost and no longer in his possession).’
‘… the value of the evidence associated with a previous favourable assessment in connection with the all work test or personal capability assessment may be minimal. This may be the case where an appeal tribunal has replaced a decision of the Department with its own decision, and there are no relevant findings in fact or reasons for the appeal tribunal’s decision because the success of the appeal obviated the requirement to call for these.’