[2006] UKSSCSC CI_421_2006 (28 June 2006)
CI/421/2006
DECISION OF THE SOCIAL SECURITY COMMISSIONER
"I wish to appeal against your decision. My hands were not examined due to them saying the facilities were not good enough but they are good enough for other people to be examined. As I have suffered from the early eighties I offered to stand outside to show I had white finger but [the Chairman] said he did not think this worked. But this is a main factor in my white finger …………"
"If they look at my pit reports which they have chosen to use for another matter it tells them I have white finger. It was a very cold day when I went to this tribunal. [The chairman] asked me about the whitening in my fingers. I told him if I stood outside for a couple of minutes he would see the whitening in all my phalanges in all my fingers. He replied I don't think cold is a factor in white finger. …………….So all I want is a fair hearing with a fair board. Facilities to have my hands tested."
"Medical Advisers (MAs) are reminded that the basic cold water provocation test (CWPT) is of limited value, as are the more sophisticated cold provocation tests.
The use of the test should be avoided in cases where there is a clear, consistent history, and clinical findings on which to form the opinion that PD A11 is or is not diagnosed.
The CWPT can be of benefit to an individual claimant who is unable to articulate his/her history of symptoms in that a positive result could assist a claimant whose history is inconsistent by demonstrating that they do suffer from blanching.
However a negative result should not be given any significance, and the opinion as to whether PD A11 is diagnosed or not should be made on the basis of the history and clinical findings."
"As medical understanding of the causes and effects of prescribed diseases is constantly changing, it is difficult to keep the Notes on the Diagnosis of Prescribed Diseases up to date. Thus there are no plans to revise the Notes in the foreseeable future.
Medical Services' Medical Advisers should seek advice from Corporate Medical Group on a case by case basis to ensure that the advice they give is not only up to date medically, but also in accordance with current legislation and case law."
Whether the advice in the amendment referred to in para. 15 above is one of the aspects of the Notes now thought to be out of date, I do not know.
"In the course of investigation for any of the above differential diagnoses, tests may have been carried out and those results made available to the PDA11 Decision Maker. Many tests have been developed in attempts to aid the diagnosis of HAVS and some are used in civil claims. The tests are not truly 'objective' as they rely on the patient's co-operation with the testing procedures and the responses can be learned. The test results have many false positive and false negative results.
As there is no Gold Standard test to diagnose any aspect of HAVS, a battery of tests are used and include the following:
- Vibro tactile threshold testing.
- Thermal aesthesiometry.
- Purdue pegboard tests.
- Cold Water Provocation tests.
- Finger Systolic Blood pressure testing.
- Finger skin temperature testing and
- Jamar grip strength dynamometer tesing.
At best they are diagnostic tools, to be considered along with the history and results of formal and informal observations when making the diagnosis. Tests that take a considerable length of time and require a controlled environment are not considered appropriate for use in IIDB. While the tests may help confirm the diagnosis of HAVS, they are-at this stage of their development- of no assistance in the assessment of disablement in PDA11."
(signed on the original) Charles Turnbull
Commissioner
28 June 2006