[2005] UKSSCSC CI_1160_2004 (03 March 2005)
CI/1160/2004
DECISION OF THE SOCIAL SECURITY COMMISSIONER
(1) in the statement of the tribunal's reasons for its decision it is said only that the claimant's consultant measured the FEV1 at 1.38 but does not take into consideration that the claimant's predicted FEV1 is 2.77 litres and that, therefore, the consultant had measured a drop of more than 1 litre,
(2) the tribunal had not attached any significance to the fact that the claimant's pre-broncho dilator test showed a drop of over 1 litre as confirmed by his consultant,
(3) the Tribunal did not fully consider and attach significant importance to Dr. A's report,
(4) the tribunal did not fully consider the submissions of the claimant's solicitors, merely summarising the submissions at paragraph 8 of the statement of reasons but not explaining why the arguments submitted had been rejected,
(5) the tribunal's decision is mainly based on the FEV1 test taken at the hearing but the equipment used was clearly defective, the claimant having to attempt to give 4 tests with the result that the readings should not have been used to arrive at a decision.
"Short, rather obese man. Short of breath on moderate exertion within the Tribunal area. No clubbing. Chest poor expansion. Crackles over both lower lobes which clear on coughing. Occasional wheeze.
RFTs 9 tests performed FVC 3.331 (Pred 3.69) FEV1 1.95 (Pred 2.77) P flow 336 (Pred 503). Drop in FEV O.82L."
" 1. This appeal relates to [the claimant's] claim for Industrial Injuries Disablement Benefit. [The claimant] had been employed as a miner. He claimed his benefit for PD12 on 09 10 02. Prescribed Disease No. D12 is defined as chronic bronchitis and/or emphysema when there is accompanying evidence of a forced expiratory volume in one second (as defined) ("FEV1") of at least 1 litre below the mean predicted value (statutorily defined) or less than 1 litre.
2. On 21 01 03 [the claimant] was examined by a medical adviser who carried out a test to determine [the claimant's] FEV1. The drop in FEV1 was recorded as 0.67 litre. On the evidence of this test the adviser gave the opinion that [the claimant] was not suffering from PDD12. The decision maker then determined that [the claimant] was not suffering from PDD12. [The claimant's] application for disablement benefit was refused.
3. [The claimant] appealed against this decision. The appeal was originally listed for hearing on 10 10 03 but was adjourned at [the claimant's] request. [The claimant] was asked to produce the full MAP report that had been prepared in connection with his claim against British Coal.
4. [The claimant] attended the hearing of his appeal accompanied by his wife. The medical member of the tribunal hearing the appeal had specialist expertise in respiratory disease.
5. On 17 November the tribunal had considerable medical evidence before it. This included a previous vitalograph test dated 07 04 98 which found a drop in FEV1 of 0.47 litre. The MAP report indicated that a vitalograph test had been administered on the date of the examination (about 26 06 00). This disclosed a pre-inhaler FEV1 drop of 0.97 litre. The report does not however disclose the basis of the prediction.
6. [The claimant] produced a report from Dr. A [The consultant] examined [the claimant] on 03 11 03. In Dr. A's opinion [the claimant] has chronic bronchitis and COPD. In Dr. A's view the detailed lung function test of the MAP examination show that [the claimant] would pass the eligibility test if his pre-bronchial-dilator results were taken. Dr. A makes criticisms of the eligibility criteria for PDD12. Dr. A measured the claimant's FEV1 at 1.38.
7. At the hearing on 17 November [the claimant] told the tribunal that his condition was worsening over time and that he was slightly worse than he had been in January 2003. [The claimant's] lung function was tested. [The claimant's] measured FEV1 was 1.95L compared to a predicted FEV1 of 2.77L – a drop of 0.82L. [The claimant] had used inhalers on the morning of the hearing – at 9 am. [The claimant] was examined at 3.45 PM.
8. [The claimant's] solicitors prepared a submission arguing that [the claimant's] FEV1 reading would fall to the requisite level if he stopped taking his inhalers and also painkillers. It was suggested that [the claimant's] painkillers assisted his lung function as they thinned his blood – although [the consultant] makes no such connection.
The tribunal was not satisfied that the balance of the evidence supported the view that [the claimant] fulfilled the statutory criteria for a diagnosis of PDD12. Whilst satisfied that recent use of inhalers will improve lung function, we would need to be satisfied that the evidence supported the view that as at the date of hearing [the claimant's] measured FEV1 would be at least 1 litre less than the predicted value [using the statutory basis for prediction]. It is not clear what prediction criteria were used for the MAP test [where Mr B's drop pre-inhaler is in any event less than 1 litres] or by Dr. A. Having considered very carefully all of the available evidence we were not persuaded that [the claimant] had made out his case that as at January 2003 he satisfied the statutory criteria for a diagnosis of PDD12. We therefore confirm the decision of the Secretary of State.".
" (ii) A forced expiratory volume in one second of at least 1 litre below the mean value predicted in accordance with 'Lung Function: Assessment and Application in Medicine' by J. E. Cotes, 4th Edition (1979) … for a person of the claimant's age, height and sex, measured from the position of maximum inspiration with the claimant making maximum effort.".
With effect from 9 April 1997 paragraph D12 was amended by regulation 6(5) of the Social Security (Industrial Injuries) (Prescribed Diseases) (Miscellaneous Amendments) Regulations 1997 by the deletion of the reference to evidence of dust retention demonstrated by a chest radiograph. With effect from 10 July 2000 para D12 was amended by a new specification of the spirometric evidence. The new specification of the prescribed disease dropped the reference to Cotes and, insofar as relevant to this appeal, reads –
"D12. Except in the circumstances specified in regulation 2(d) –
(a) chronic bronchitis; or
(b) emphysema; or
(c) both,
where there is accompanying evidence of a forced expiratory volume in one second (measured from the position of maximum inspiration with the claimant making maximum effort) which is –
(i) at least 1 litre below the appropriate mean value predicted obtained from the following prediction formulae which give the mean values predicted in litres –
For a man, where the measurement is made without back-extrapolation, (3.62 x Height in metres) – (0.031 x Age in years) – 1.41; or, where the measurement is made with back-extrapolation, (3.71 x Height in metres) – (0.032 x Age in years) – 1.44;
For a woman, ……….; or
(ii) less than 1 litre.".
Regulation 7(1) of the same Amending Regulations provided that the new specification of the prescribed disease would not apply to claims made within the three months following 10 July 2000 if the onset of the disease was prior to that date.
(i) had the tribunal adequately explained how it allowed for the effect of broncho-dilators on the spirometry and
(ii) did Dr. A's criticisms of the PDD12 prescription establish that the prescription is irrational?
(Signed) R J C Angus
Commissioner
(Date) 3 March 2005