“He has an inherited neurological problem with progressive spastic paraparesis. He is under follow up by neurologists and takes prescribed medication. He has no interventions planned but awaits gait analysis. He walks with two walking sticks. He can climb stairs at home using a hand rail, can sit to travel as a passenger and stands to shower leaning on the shower cubicle walls. On observation, he walked 20 metres with his walking sticks, sat for 15 minutes, stood for 2 minutes supported by his sticks at examination showed reduced right and left lower limb power and increased tone, with brisk reflexes and calf muscle wasting. The evidence is of restriction of walking for prolonged distances reliably and repeatedly, but significant disability of climbing stairs, standing and sitting is unlikely. He has no upper limb problems” (my emphasis). In other words, the doctor appears to have made her recommendation to the Secretary of State on the basis that the claimant could repeatedly walk for more than 50 but less than 200 metres, rather than because she considered he could propel (or repeatedly propel) a manual wheelchair for that distance. 9 There was some evidence that suggested that the doctor may have underassessed the claimant. On27 February 2015 —almost 17 months earlier in the course of a progressive disease—a Consultant in Neuro-Rehab examined the claimant and recorded: “In his upper limbs, he has normal tone, power and coordination. He is weak in his lower limbs especially in hip extension (grade 2 bilaterally, knee flexion grade 3 bilaterally, ankle dorsiflexion and EHL grade 3 bilaterally) he has grade 2 spasticity in both lower limbs (on the Modified Ashworth Scale). He is able to appreciate sensations in his lower limbs but there is a sensory level at D5 on the left and D7 on the right. Vibration sense was impaired at his feet but position sense seems to be fairly intact.” 10 Muscle weakness is assessed on a six-grade scale where Grade 5 denotes normal strength and Grade 0 denotes no muscle movement. Grade 2 denotes an ability to move the joint if gravity is eliminated (i.e., if the limb is supported) and Grade 3 denotes an ability to move the joint against gravity but not against added resistance. “EHL” is an abbreviation for “extensor hallucis longus” which is the muscle that extends the big toe and assists in inverting the foot and dorsiflecting the ankle. The reduction of power in the claimant’s legs that the Consultant found on examination was therefore more than “slight”.
"[The claimant] presents with no contractures at hip or knee level. There is limited hip motion bilaterally; popliteal angles are increased to (R) 90° and (L) 80°. There is equinus of (R) 15° and (L) 10°; weight-bearing foot posture as cavus bilaterally. There is a measured leg length discrepancy, (L) 1cm shorter. There is severe (R) gastrocnemius spasticity, moderate (L) and bilateral hamstring spasticity and mild in the (R) adductors and (L) tibialis posterior. Lower limb strength is reduced throughout with a particular weakness noted in the foot/ankle musculature (L>R) and (R) extensors and adductors."