1.If possible, please obtain professional help when completing the form. It may help you to be awarded ESA without having to appeal.
Help is available from Shropshire Citizens Advice Bureau. Tel: 0845 99 11 00 or from A4U: 01743 251520
2. Also, You must be able to do a task: regularly, reliably and safely! If not, you are considered unable to carry out the activity.
3.Remember that you are being asked about the work environment.
4. A handy tip from Pat Hirst, one of our committee members is to enlarge the page to A3 size if your writing is not steady or if you have a lot to write.
For general information about the Employment and support Allowance see the Citizens Advice fact sheet below.
Citizens Advice Adviceguide ESA
Hints for Completing the ESA 50 Form.
Activity 1-Moving around and using steps
Avoid the words ‘severe discomfort’ and use ‘significant discomfort’ instead.
For ME which is a fluctuating condition, if you cannot do the activity repeatedly, use ‘exhaustion’ to show you cannot do it again.
Think of the working environment, using steps, walking uphill or downhill.
Remember! If this activity causes you severe discomfort, pain, breathlessness or extreme fatigue or if you could do it once but not repeatedly as your ability varies then you may count as not being able to do it.
If you have chosen ‘It varies’ then you need to explain how much it varies. Any award of points should be based on how you are for the majority of the time. If you have a medical then the health professional should investigate this variability with you and if they fail to refer to it in their report this would be part of your grounds of appeal.
Bear in mind that if you can easily manage around the house and garden you are unlikely to be limited to mobility of less than 200 metres; if you can mobilise around a shopping centre/supermarket you are unlikely to be limited to mobility of less than 800 metres although consideration must be given to the speed of walking, stops and pauses etc.
If you are only able to move around within your home you are unlikely to manage 200m
If this isn’t true in your case then say so in the box – for example, do you always lean on a shopping trolley when walking around the supermarket and stop frequently? Or do you get shop assistants to help you with your shopping or does your partner or carer do the shopping whilst you sit on a chair and wait?
Sample answer
I suffer with ME. The condition makes it is extremely painful to walk even a few yards. I have had to move my bedroom to a downstairs room, as I can no longer climb more than one or two steps without experiencing extreme pain. I can just about make it from one room to the next using either a walking stick or furniture for support before having to sit down to recover from the pain. I seldom go shopping and when I do I use a motability scooter or my wife pushes me in a wheelchair. I could not wheel myself in a chair because of the pain it would cause my hands and shoulders.
Activity 2- Standing and sitting
Doesn’t relate to an upright chair with no arms
Expects employer to provide suitable chairs
Remember! If this activity causes you severe discomfort, pain, breathlessness or extreme fatigue or if you could do it once but not repeatedly or if your ability varies then you may count as not being able to do it.
Sample answer
My ME has caused loss of strength in my legs to the degree that I am now mainly restricted to my wheelchair. I also suffer with weakness in my arms that prevents me from supporting my weight. Therefore, I require physical help to move from my wheelchair to bed, into the car or getting on and off the toilet. When I am not in my wheelchair I still need help to rise from sitting.
Activity 3-Reaching
Intended to assess your capability to raise your upper limbs above waist height and also identifies those who have very restricted shoulder movement. Remember to state whether you have problems with one arm or both.
Remember! If this activity causes you severe discomfort, pain, breathlessness or extreme fatigue or if you could do it once but not repeatedly or if your ability varies then you may count as not being able to do it.
Use the space
think about problems you may have with the following:
Dressing and undressing (including reaching for clothes on shelves/in wardrobes)
Putting on a hat
Hair washing and brushing
Shaving.
Household activities such as reaching up to shelves; putting shopping away at home; household chores such as dusting; hanging laundry on a washing line.
Leisure activities such as aerobics, golf, painting and decorating.
Sample answer
I suffer with ME, which makes my neck and shoulders sore and stiff, coupled with weakness in my arms. As a result, any activity that involves moving the affected joints e.g. dressing, washing up or reaching into cupboards, causes pain. The numbness in my arms makes these movements clumsy and I tend to knock things over easily. My husband helps me get dressed each morning particularly with tops and coats and I now have a friend who comes to clean for me as I cannot vacuum, put away dishes or do laundry. I now have my hair cut short so that it is less painful to look after. Even so, on most days I can’t reach up to wash or dry it with either hand. Usually I have to get have to get my husband to do it. Even a simple task like cleaning my teeth is extremely painful due to the discomfort I experience.
Activity 4-Picking up and moving things
Remember! If this activity causes you severe discomfort, pain, breathlessness or extreme fatigue or if you could do it once but not repeatedly or if your ability varies then you may count as not being able to do it. If it hurts, say that doing the activity will cause you pain or brain fog or muscle fatigue
Use this space
Include any problems you have with the following activities,
Shopping (lifting goods out of shopping trolley or from the supermarket shelves).
Cooking (lifting and carrying saucepans, crockery)
Dealing with laundry/carrying the laundry
Lifting a pillow
Making tea and coffee
Removing a pizza from the oven/ carrying a pizza box
Sample answer
The muscle weakness and fatigue in my arms and hands caused by my ME is so bad that I can no longer pick certain things up e.g. cup of tea as my hands and arms are so unresponsive. I can usually lift a relatively light item like a box of tissues but often I drop it because I cannot control my grip.
Activity 5-Manual Dexterity (using your hands)
Remember! If this activity causes you severe discomfort, pain, breathlessness or extreme fatigue or if you could do it once but not repeatedly or if your ability varies then you may count as not being able to do it.
Use the box. You may have difficulties because of limited movement or feeling in your hands or wrists, because of co-ordination problems or because of pain or tremors, for example.
Think about how you cope with the following:
Filling in forms (e.g. ESA50, national lottery ticket)
Use of phones, mobile phones, setting house alarms, light switches
Paying for things with either cards or cash
Coping with buttons, zips, and hooks on clothing
Cooking (opening jars and bottles; washing and peeling vegetables).
Leisure activities such as reading books and newspapers; doing crosswords; knitting; manipulating the petrol cap to refuel a car, using keys to open locks etc.
Sample answer
I cannot complete tasks that require fine movements e.g. holding a pen or pencil. In the morning I can usually do more, for example I can butter my toast or turn on the taps to have a wash. However by lunchtime these tasks have become too painful.
My brain fog is so bad in the afternoons that I can't do anything and have to lie down in a dark room to rest.
By the evening, even after taking painkillers I struggle to turn the pages of my book or hold a toothbrush to clean my teeth.
I no longer attempt to peel or chop vegetables because I have cut myself several times and my wife always does the driving and fills the car with petrol because I can no longer manage due to pain in my hands. I cannot handle coins of any sort and have great difficulty putting the correct pin number in when paying for things, to the extent that my wife now does all the shopping.
Activity 6- communicating with people - how you can communicate with others
Use this space
Give information about any problems you have with the following activities:
The ability to socialise with family and friends
The ability to ask for items e.g. order drinks at a bar or ask for items in a shop where self –service is not available – do you use speech or do you write a list and hand it over.
Ability to use public transport/ taxis.
Ability to use a telephone. Can you make yourself understood during a long phone call?
Ability to use text/e-mail.
Ability to deal with correspondence – if you complete the ESA 50 it may give information about your ability to deal with written communication.
Sample answer
One of the difficulties that I have as a result of suffering from ME is that I struggle to make myself understood verbally. I have trouble controlling both the volume and speed of my speech, which results in me speaking very slowly and quietly. Often I involuntarily say the wrong word and people have difficulty understanding. Family and friends have become very patient and spend a lot of time ensuring they have understood me correctly. However, when in circumstances that require me to talk to other people e.g. shops, the Jobcentre etc it is very difficult to get across what I am trying to say. On many occasions people have become impatient which makes it even more difficult to control my speech. I no longer use the phone for all the above reasons and have family members that act on my behalf in circumstances where telephone contact is necessary.
I also struggle to write and would have great difficulty using a keyboard because of the pain in my hands. Even if I manage to write, other people would have great difficulty reading my handwriting. I do not use a computer but it would be a very slow and laborious task for me to type any kind of message because of the difficulty of striking the correct key due to my pain. My brain fog makes it hard for me to think logically and I often say what I don't mean or use the wrong words.
Activity 7- This activity is about being able to understand communications from other people, either spoken or written.
Use this space
Think about any problems you have with the following activities, as these are ones you are likely to be asked about if you have a medical
Consider any restrictions reported in the typical day with communication such as difficulty socialising, shopping and engaging in hobbies.
Note the use of any accessory aids such as headphones or loop system amplification for TV, radio, or video; amplification for telephone handset; loud front door bells or door lights.
Consider your visual abilities, such as reading a newspaper, e-mails, use of the internet, watching TV etc.
Consider day to day tasks where contact with other people is likely such as in the supermarket, using public transport etc.
If you have tinnitus or Meniere’s disease, describe any effects on your ability to hear and also any treatment you have received which may show the seriousness of your condition, such as: referral to a specialist; use of hearing aids, prescription of vasodilators, anti-depressants or sedatives. If your ME affects your concentration or your mood also consider completing the mental function section of this questionnaire.
Sample answer
I am very sensitive to noise. It is incredibly overwhelming and disorientating to have to cope with even average sounds. When it is very bad I have to go and lie down in a quiet room.I can't cope with having a loud ringing phone in the house. I find it difficult to cope with crowds of people and the noise in a supermarket.
I am also very sensitive to light. Because of my visual problems I also have great difficulty in reading ordinary type or handwriting. When I am overwhelmed with light I have to wear dark glasses or lie down in a room with the curtains closed.
I struggle to use a computer for more than ***minutes. I feel disorientated and my brain can't cope with using the computer for very long.
My brain fog makes it difficult to understand what people are saying to me.
Activity 8-Getting around safely if you have sensory impairments
Use this space
Think about about any problems you have with the following activities
Driving – both from the visual acuity and visual field point of view
Ability to get around indoors
History of falls or accidents
Ability to use public transport- get on and off buses unassisted and read the bus name and number
Mobilising independently outdoors
Going to a supermarket
Reading newspapers or magazines
Maintaining safety in the kitchen, ability to cook meals
Getting in and out of a bath
Caring for children
Sample answer
It is not safe for me to cross roads unaccompanied because I cannot be sure that I have seen oncoming traffic. I trip often because the dark streaks in my vision prevent me from seeing some obstacles e.g. kerbs, bollards etc and I recently walked into a small child because my sight of him was blocked. This was most upsetting and resulted in my refusal to go outside of my home without someone to guide me.
Fatigue can make me feel unsteady and I find that I start needing to hold on to the furniture and bumping into things. I can't calculate distances.
Activity 9- Controlling your bowels and bladder and using a collecting device.
N.B. Loss of dignity may be so severe that it is unreasonable to expect you to work.
Sample answer
Since I started suffering from ME I have had a recurring loss of control over my bowels. I get very little warning that I need to “go”, often only seconds and if I am unable to reach a toilet I will completely lose control. This is intensely embarrassing. I can sometimes go weeks without any trouble at all but I cannot predict when I am likely to get an uncontrollable urge. It happens on average at least once a month. It happened twice at work, where I soiled myself and had to go home, before I became so ill that I was unable to continue working. This issue coupled with the pain and fatigue of my condition has seriously reduced my quality of life. I no longer go out socially for fear of an episode and if I go shopping I make sure I only go to places where I know where all the toilets are.
If you have problems, do you carry spare clothes around in case of emergencies?
Do you have medication for this and does it work well?
What problems do you have if you want to go out or visit relatives?
Activity 10- Staying conscious when awake.
Mention unpredictability and the time needed to recover afterwards.
It isn’t just fits or blackouts that are covered by this activity, but any episodes of lost or altered consciousness that significantly affect your awareness or concentration. This could include: generalised, partial or absence seizures, cardiac arrhythmia, hypoglycaemia.
The Handbook claims that giddiness, dizziness and vertigo are not covered by this activity.
However, there is case law in relation to the personal capability assessment for incapacity benefit which suggests that vertigo may cause lost or altered consciousness.
This activity relates to fits that happen when you are awake: any fits or other episodes that occur whilst you are asleep are not taken into account.
Use this space
It’s a good idea to give information about any problems you have with the following activities, as these are ones you are likely to be asked about if you have a medical, according to the WCA Handbook:
· Driving – Atos staff are told the DVLA will refuse to issue a licence to anyone who has had a daytime fit in the past year.
· Potentially hazardous domestic activities such as cooking.
· Recreational activities e.g. swimming.
(Thanks to the Leger (Doncaster) ME website for the following answers in this section.)
The ESA handbook(4) issued to Medical Services gives the following guidance:
…."Altered consciousness" implies that, although the person is not fully unconscious, there is a definite clouding of mental faculties resulting in loss of control of thoughts and actions…”
Firstly, most people with ME/CFS need to sleep sometimes when they would normally be awake. If you keep awake and don’t sleep, your concentration will be impaired because you will nap or day dream.
Secondly, there is brain fog which can impair thinking or reactions.
Most of the people I see suffer something like this on a daily basis—which would imply ticking the first box —weekly.
However, and quite rightly, a number of members have pointed out that by doing this it implies that they may be unfit to drive. The advice I give to members is to discuss with their doctor and then inform DVLC about ME/CFS. Everyone I’ve dealt with to date gets a letter back saying that there is no restriction on their driving. If you have ME/CFS, you are aware that you are tired or having brain fog—and so can choose not to drive to make yourself safe. The choice is akin to driving under the influence or drink or drugs.
Sample answers
At the recently held ESA 50 masterclass and after discussion with Sally from Clouds,our model answer is to tick the weekly box, and include the following in the narrative box:
1. I do not suffer from fits or blackouts, but I have two problems where episodes of altered consciousness on a daily basis which I think may apply.
Firstly, I suffer on a daily basis due to 'brain fog'. This is a temporary inability to make decisions and react to input from the world outside. This is a disorienting disabling cognitive impairment which can happen from a few seconds to several minutes or hours. Among the problems is inability to recognise people and lack of short-term recall. I go on to automatic pilot, and behave like a robot.
Secondly, on a daily basis I have sleep problems in that I have the need to sleep during the day. If I don't allow myself to sleep, I just will drop off to sleep without warning. I could not go out, even if I wanted to. When this happens I need to go to bed, and there is no choice in the matter, and it cannot be put off. I can't walk or move around inside or outside safely until I have slept.
2. With ME I have occasions when I don’t know what has been said to me. I have an absence for a few seconds then I realise I have completely ‘switched off’. This becomes worse the more exhausted I become.
3. When ME symptoms worsen, brought on by increased mental, physical or emotional activity I have very disturbed nights. I wake dreaming 3-4 times a night. I can be restless which increases daytime pain, or lie awake for up to 4 hours. All of these cause sleepiness in the day. I have to return to bed during the morning for up to 2 hours or have a sleep at lunchtime.
Activity 11 -Mental, cognitive and intellectual functions.
Learning how to do tasks (can be impaired by medication)
Sample answers
Brain problems
1 Because of my brain problems which have affected my ability to process sound, my concentration and my short-term memory, I have problems with moderately complex tasks.
I also have problems both with understanding and remembering instructions.
I don’t follow sequences of directions well and need them broken down into very small steps or I will miss parts of the explanation and then do it wrong. Even after learning things like using a washing machine if I try to do it again the next day without anyone there to help I will do things like forget to put the soap in or put it in the conditioner slot.
My condition affects me like this all the time.
Activity 12- Awareness of hazard or danger
N.B ‘need’ for supervision, not ‘receiving’
Sample answers
Depression
1 I have problems because of severe depression and because I self medicate with alcohol.
2 As a result of the effects of prescription drugs and alcohol, I am frequently confused, have poor concentration and do not realise when I am putting myself in danger.
3 I have fallen down stairs and cracked a rib, nearly been hit by cars, taken accidental overdoses of prescription medication leading to hospitalisation and burnt myself with hot drinks and hot pans. I frequently leave the iron, cooker or electric fire on and fall asleep with cigarettes burning. It’s really only by luck that the house hasn’t burnt down.
5 My flatmate keeps an eye on me most of the time.
6 I have accidents or near misses on most days.
Neurological conditions
1 Because of my ME, I lack awareness that some situations could be dangerous and have very poor concentration.
2. It’s not safe for me to cross roads alone as I often don’t think to look for traffic. I don’t remember whether I have taken my medication and so would sometimes fail to take it and sometimes take it several times if I wasn’t supervised. It is not safe for me to cook, use knives or make hot drinks unsupervised any more because I forget that I have a sharp knife or hot kettle in my hand. My partner always runs the bath for me because I have forgotten to turn it off and also made it much too hot and then attempted to get in. I cannot choose appropriate clothes to wear for the weather and would go out without a coat even on freezing, wet days.
3. My partner never leaves me on my own for more than a few minutes at most because it would not be safe to do so.
4. I have better and worse days, but no days on which I could be left unsupervised.
Activity 13- Initiating actions
‘Use this space’
1 What condition or medication causes you problems with starting or completing tasks?
2 Do you have problems with starting tasks or with finishing them once you have started or both?
3 Do you need someone to prompt or encourage you to start or complete tasks?
4 Can you give examples of the problems you have and how someone can help?
5 How much of the time do you have these problems?
Depression
1 Because of my severe depression
2 I have problems motivating myself to start doing things and frequently give up after starting through apathy and fatigue.
3 If my partner is at home he encourages me to do things. He has to keep on reminding and hassling me until I do things.
4 For example, if he is not around I don’t bother to get out of bed until lunchtime and then I can’t get myself to have a proper wash. Often I won’t bother to get dressed at all because I can’t see the point. But if he’s there he reminds and encourages me over and over again until I do get washed and dressed. I would never bother buying proper food or cooking a meal unless he was with me and kept encouraging me.
5 I have worse days when nothing even he says makes any difference, but for the rest of the time I can do things with enough prompting and encouragement.
ME
1 Because of my ME I get very ‘foggy’ and confused so that I forget to do things and can’t concentrate when I do attempt to do things. I very often start things and then don’t finish them because of poor concentration.
2 I need prompting or reminding in person, by phone and by using notes and alarms.
3 I have a pill dispenser with a timer which my wife fills and sets for me every morning. My wife also writes on a pad on the fridge anything I need to remember for that day, such as bringing the wheelie bin in or being home for a delivery. We have an arrangement that my wife will ring me from work several times a day to remind me to do things like let the dog into the garden. My wife comes home to find piles of clothes where I have started to sort some washing and then forgotten about it. I often leave washing out in the rain because I forget it is there. I frequently find that it is the middle of the afternoon before I remember to eat, dress or bathe. I can no longer drive a car because my concentration is much too poor for me to be able to do so. If I was left by myself I would not be able to cope.
4. Some days I just can't think because of my brain fog. I try to make decisions when the brain fog lifts as I'm more likely to make sensible decisions.
5 I am like this on the majority of days although I have some better days and I have days when I am so bad I can’t even get out of bed except to go to the toilet.
Activity 14- Coping with change
‘Use this space’
1 What condition or medication causes you problems with this task?
2 Does your condition cause problems coping with expected changes, unexpected changes or both?
3 When change happens, are everyday activities made impossible for you, much more difficult or can you still manage?
4 Can you give examples of changes and the effects they have on your ability to carry on with your day?
5 How much of the time are you affected in this way?
I have organised my life around my ME. I have to pace myself to ensure that I keep within my energy levels. If I have to go out, I worry that I might have to sleep and there will be nowhere for me to rest. I feel anxious when things change as I never know if I'll be able to cope.
Activity 15- Getting about
Also consider – exceptional circumstances and activity 16
Exceptional circumstances
If you can’t get to specified places without being accompanied or at all, would there be a danger to your health if you were found not to have limited capability for work? You would have to claim JSA, go to the Jobcentre Plus offices to sign on, draw up and stick to a jobseekers agreement and possibly attend interviews, training programmes and possibly take a paid job. Would you be able to do all these things? If not, would your JSA be stopped? Would there be a danger to your health if you had no income? Could you buy food, pay for electricity, water and other services or would you have to try to survive without.
‘Use this space’
If you’re struggling to know how to give detailed evidence for this activity, try writing the answers to these 4 questions:
1 What condition or medication causes you problems with this task?
2 What would happen if you tried to go to a familiar or an unfamiliar place on your own?
3 What difference, if any, does having someone with you make?
4 How much of the time are you affected in this way?
Sample answers
1 Because of my ME I cannot go anywhere on my own and just thinking about doing so makes me very anxious indeed.
2 Even if someone accompanies me I can only go as far as the corner shop (approx 200 yards).
3. My doctor visits me at home because I cannot go to the surgery and I have not seen a dentist for 3 years. I do all my shopping online or get friends and family to pick things (e.g. medication) up for me.
4.If I were able to go somewhere I could never be sure that I could get back as my ME might make me exhausted.
5 I am always like this.
Activity 16- Coping with social situations
‘Use this space’
1 What condition or medication causes you problems with this task?
2 Do you become distressed if you have to meet people or have problems relating to them and, if so, does this only apply to new people or also to people you are familiar with?
3 Can you describe in detail the feelings or problems you experience if you have to engage in social contact?
4 How much of the time are you affected in this way?
Sample answers
Depression
1 Because of my depression.
2 I have become very isolated and see people as little as possible.
3 I try to go out only very early in the morning or after it gets dark so that there is less chance of bumping into neighbours and having to say hello. Even having to speak to an assistant in places like the chemist, health food shop or library makes me feel very anxious and I try only to go to supermarkets because you don’t have to speak to people there. If anyone in a shop does try to strike up a conversation with me I avoid going there again. I virtually never go to new places and would not dream of going to any sort of social event. Just setting foot outside my door makes my heart beat very fast and I have to fight back the panic.
If I felt that I had to attend some sort of social occasion, such as a funeral I would be frightened for days and days beforehand. I wouldn’t eat properly for days because I would feel so sick and anxious that people would try to talk to me. I would be very tempted to have a few drinks before going and be very worried that I would drink too much and make a fool of myself. I would probably end up not going, but if I did go I would be terrified and would sweat and shake and mix my words when anyone acknowledged me or spoke to me. Afterwards I would feel ashamed and hate myself.
4 I am always like this and have been for a long time.
ME
1 Because of my ME I have found it increasingly difficult to be in any social situations or to meet new people.
2. I avoid going out as much as possible and if I do have to go out I always have someone with me. I no longer have a social life or see any of my former work colleagues. At home I can no longer have friends round as then I cannot get away if it all gets too much and I start to panic.
3 I am like this for the majority of the time now and it seems to be getting worse.
Activity 17- Behaving appropriately with other people.
A system for completing the ‘Use this space’ box
1 What condition or medication causes you to have uncontrollable episodes?
2 Do you become aggressive or dis inhibited?
3 Can you give examples of your behaviour and what effect it has had on other people who were there at the time?
4 Is it easy to predict when you are likely to have an outburst and can you control it?
5 Roughly how often do these outbursts happen?
What to do when you have completed the form
1. Keep a copy of everything to do with the claim. Copy the form and send it off by recorded delivery. Keep the proof of posting.
2. If you are phoned by the DWP about the claim you can tell them that you have problems taking in information over the phone and ask them to write to you instead. Keep a note of who phoned you, when and why.
3.If you are not awarded ESA and you think you qualify for it, please appeal within one month. You are more likely to be given ESA on appeal if you turn up to the tribunal. 40-50% of those who go to the tribunal in person are awarded ESA. (Think about how you will travel as you must show that what you said in the form corresponds with how you get to the tribunal.) You can take someone with you to the appeal.
Links
Help when going to the medical
http://www.edinburghagainstpoverty.org.uk/node/5Appealing ESA Decisions
http://www.dls.org.uk/advice/Factsheet/welfare_benefits/employment%20support%20allowance/Employment%20Support%20Allowance%20Appeal%20%20Decisions.pdfHelp with how to appeal - remember that you have one month to appeal the decision. You appeal by completing a GL24 form, available from Jobcentre Plus or by download from the Direct Gov website (just put GL24 in the search panel)
You can get a copy of the leaflets about the appeals procedure by telephoning The Tribunal Service Customer Leaflet Hotline on 08700 852611.
If you have hearing difficulties you can telephone Typetalk on 18001 08700 852611. Calls are charged at national rate.
Thu Feb 05, 2015 9:36 pm by 
