Case Studies » Domiciliary Care Allowance » Domiciliary Care Allowance - Case from 2016 Annual Report (ref. 2016/03)

2016/03 Domiciliary Care Allowance

Oral hearing Question at issue: Whether eligibility criteria continue to be met (review)

Background: The appellant had been in receipt of Domiciliary Care Allowance in respect of her daughter, aged 14 years, who has a diagnosis of epilepsy and recurrent seizures with a background history of brain tumour. In the context of a review, the claim had been referred to a Medical Assessor of the Department of Social Protection and he had opined that the child was no longer eligible on medical grounds. Accordingly, the appellant was given an opportunity to forward additional information before a final decision was made. No further evidence was submitted, however, and the claim was disallowed. In an appeal against that decision, the appellant stated that her daughter suffers from severe headaches, requires constant attention, and that she had been called to school on many occasions as staff members were anxious to ensure that she would not have a seizure.

In the medical report completed by her G.P., it was stated that the child had been seizure free for the last two years; that she complains of frequent headache and remains under the care of Neurology. The degree to which her diagnosis affects her in the area of consciousness/seizures was assessed as severe. A letter was submitted from the children’s hospital which she attends, indicating a need for educational support to maximise learning potential and stating that from a disease point of view, she remains remarkably well and has no demonstrable neurological deficits or toxicities as a result of the treatment.

Oral hearing: The appellant and her husband attended. They said that they understood the qualifying criteria and asserted that they continued to be met. They reported that their daughter must take medication at the same time every day to ensure that she does not have a seizure and that they have to oversee this. The appellant made reference to the shunt which had been fitted in infancy, in line with her daughter’s initial diagnosis of primitive neuroectodermal tumour, predominantly right cerebral hemisphere with associated Hydrocephalus. She said that a second shunt had been fitted in the previous year. She went on to say that the brain tumour is still there and that it causes her daughter to have headaches. She reported that a teacher brought her home from school one day last week, and called to the house to advise that she had been feeling unwell, had been unable to walk, and that it had been feared that she might have a seizure.

The appellant reported that the child’s siblings are doing well at school but that she is not. She said that it has been suggested that she needs special educational supports and that it may be more appropriate for her to attend another school, where her needs might be met more effectively. She said that the headaches that the child experiences are quite severe and that she is experiencing difficulty in a number of areas. She reported that she had attended for a scheduled appointment and MRI scan last month but that her own specialist had been away and she would have to return for a consultation.

The Appeals Officer reviewed the medical evidence on file, referring to the G.P. statement that the child had been seizure free for the last two years. The appellant asserted that this did not reflect the nature of her current difficulties. She referred again to reports from school and the concerns expressed and the Appeals Officer suggested that she might like to submit evidence in that regard.

Further evidence: Following the hearing, a letter from the child’s teacher was submitted, stating that she is in a class with 9 pupils with a full-time Special Needs Assistant (SNA) and that, although she is assigned to help the entire class, the SNA spends almost all of her time helping the appellant’s daughter. It was stated that, despite a lot of extra resource classes and assistance, the child cannot read, write or count, and cannot identify basic terms. An outline was provided of the additional difficulties which her medical condition presents, including severe headaches and seizure episodes where she needs to be taken home. The child was described as being socially unaware and engaging in age inappropriate behaviour, unaware of the consequences of her actions. It was stated that an application had been made to the local HSE Disability Services team with a view to arranging further assessment for the child and the allocation of a place in a special school.

Consideration: The Appeals Officer noted that the question at issue was whether the appellant’s daughter continued to meet the definition of ‘qualified child’ for purposes of Domiciliary Care Allowance with effect from the date from which the claim had been disallowed. She noted that while some of the medical evidence appeared to indicate an improvement in the child’s condition, the additional evidence provided in the context of the appeal had been compelling. Taking note of the evidence adduced at oral hearing and having had particular regard to the additional evidence submitted subsequently, she concluded that the qualifying condition continued to be met.

Outcome: Appeal succeeds.