Manual Dexterity

Kind of thinking aloud but was looking for input… 

Client has swollen disfigured hands and loss of sensation and motor coordination because of this.  He can turn one page of a book, slowly and with difficulty.  However.. two things:

1) the descriptor says pages and if he tries to turn multiple pages, he struggles as his hands begin to lock up

2) when i asked him to close his eyes and try turning pages, he was unable to distinguish one page from the next and grabbed a whole clump - this is becuase of the loss of sensation in his fingers

Do I have arguments for the support group?  Is the descriptor only looking at function in his hands, becuase arguably its his vision that enables him to turn pages at all? 

If anyone has any comments about 1) or 2) or about the descriptor in general, I would be very grateful..

i don’t see what his eyesight can have to do with it.

if he clearly can’t turn “pages” and the descriptor says “pages” then he can clearly demonstrate his inability to turn “pages”.

but of course, the DWP may well argue that the plural “pages” includes the singular “page” so you may well end up at tribunal anyway.

if he ALSO has sight difficulties, that would be another matter.  but my understanding is that someone with sight difficulties would still (absent neurological issues affecting the hand) would still be able to turn “a page” using their sense of feel.

you could also think about the other problems caused by the hand problem and see whether that helps with any other descriptor, such as carrying stuff.  if he can’t turn a page, can he carry anything?

@Claire Hodgson
Thanks for this.  The only reason I mentioned eyesight was because when he can see the pages he is able to distinguish one from the other when trying to turn.  His eyesight helps him to overcome the loss of sensation in his hands/fingers to some extent (he has no problem with sight)..

Reg 19(2) states:
The limited capability for work assessment is an assessment of the extent to which a claimant who has some specific disease or bodily or mental disablement is capable of performing the activities prescribed in Schedule 2 or is incapable by reason of such disease or bodily or mental disablement of performing those activities.

So I guess it doesn’t matter if he needs to use his eyes also to perform the activity (assuming that using both his eyes and hands he can turn the pages). But still not sure if it is a test of manual dexterity, or of his ability to turn pages?  Why the heading ‘Manual Dexterity’ if that is not what is being assessed?  Mmm..

Don’t forget repeatedly. Seems to me he cannot turn pages repeatedly and reliably.

I found the following really useful.  It seems the ‘closed eyes’ approach may work as the test is a functional one and therefore should isolate manual ability in my opinion.  This case law was helpful..

R(IB) 2/03
A case where someone using his hands to help with standing from a seated position was found not to be able to perform the descriptor.  Instead the descriptor tested a different function of the body (see paragraphs 8 and 9).

Paragraph 7 says that the ESA activities deal with different functions of the body.

‘That section consists of a variety of activities that deal with different functions of the body. It is obviously designed to test in a systematic, analytical way the claimant’s various physical disabilities.’

also

‘It is, therefore, to be expected that each of the activities will concentrate on different parts of the anatomy so as to isolate, as far as possible, the claimant’s ability in respect of each.’

GS v SSWP (ESA)
[2010] UKUT 244 (AAC)
CE/0313/2010

Paragraph 11 reiterates R(IB) 2/03.

Paragraph 14

‘The descriptor tests the claimant’s anatomical functions that would be involved in fastening or unfastening buttons. They include pinch grip, co-ordination of finger movements, and flexibility of the finger joints. The reference to small buttons identifies the size and shape of the object to which those functions are applied. The First-tier Tribunal should focus on the claimant’s functional ability to perform the particular aspect of the activity covered by a descriptor. By doing that, it will avoid the myriad questions that otherwise appear to arise on descriptors. Is the ability to use a tap tested with wet or dry hands? What sort of surface is the £1 coin resting on? How smooth or thick are the pages of the book? And so on and so on.’

KH v SS (ESA)
[2014] UKUT 0455 (AAC)
CE/2774/2013

Paragraph 10

‘...what is being tested is the physical ability, so far as manual dexterity is concerned, to use a suitable keyboard or mouse.’

@Terry1951
I think this case also covered your point about repeatedly and reliably to some extent.

‘It is possible that a person may have sufficient control of the hands to be able to move and click the mouse or type letters but insufficient control to do so with any degree of accuracy or with any regularity or for any reasonable time.’

DG v SSWP (ESA)
[2014] UKUT 0100 (AAC)
CE/3466/2012

This also confirms R(IB) 2/03 functional approach at paragraph 39.

Would be interested to hear any thoughts..