SELF INFLICTED INJURY.

Hello,

1st post so bare with me!

I have a client who applied for DLA. His case went to tribunal and they postponed on the basis that they wanted medical evidence for the last 5 years!

The report has come back, and clearly suggests that from a medical point of view, my client has no/limited physical problems due to the conditions stated in his form (problems with right knee/back and joints etc.)
However, there is evidence to suggest that the tube grip he wears around the knee (for support which the client believes he needs) is causing him to have reduced movement in his knee and in turn is causing muscle wastage in his right leg.

All the doctors have stated that if the grip was removed his knee and leg would, in time, return to normal.
One doctor has mentioned Waddells criteria…

I would say from the client’s behaviour (and his decision that he would now like his leg amputated) that there is mental health element to the condition and I will be incorporating this into my submission. However, I would like some advice on whether other people feel I can use the physical problems he has, even though they are 100% self-inflicted. Clearly there are now physical problems, however these would stop if the client did as advised in his medical reports…

Any advice/case law you have would be much appreciated. I have found two cases regarding Waddells criteria.

Thanks.

Daisy

It does as you say seem likely that he has a mental health problem, including body dysmorphia (the feeling that the body is seriously “wrong” in some way - seeking and amputation is grossly abnormal). I have seen reports of cases where people had always felt that some part of the body did not belong to them and they could only feel right it it was amputated.

Waddell’s sign is usually found in the form of inappropriate (impossible) sensations of pain or loss of sensation which cannot be related to any known physical cause and are not consistent with the primary complaint, often back pain. If it is linked to demonstrable psychological problems then I do not see why and resulting genuine physical disability cannot be taken into account.

Your case is very similar to those of people who wear inappropriate body belts and neck collars that have not been presercibed for them, which are also likely to lead to muscle wastage and increaed rather than lessened pain, or to people who refuse to do any exercise at all because they claim it hurts, when a primary reason for the pain is loss of muscle tone. These are also self inflicted.

I have recently helped with an appeal for a cl. with body dysmorphia. This person’s percieved physical ‘abnormalities’ had no physical effect on his ability to walk, self care and so on but the overwhelming feeling that people were staring at him because he looked somehow different had a marked effect on his ability to go outside alone and his general mood and motivation to care for himself. Perhaps the MH aspect may be more helpful than the physical.

Hi,

Thanks for the replies. I had been considering looking for cases where clients request amputation due to body dismorphia etc as it does appear that my cl may fall into this category.
Its definitely an interesting case!