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You are here: BAILII >> Databases >> England and Wales High Court (Administrative Court) Decisions >> Laws, R (on the application of) v The Police Medical Appeal Board [2009] EWHC 3135 (Admin) (12 November 2009) URL: http://www.bailii.org/ew/cases/EWHC/Admin/2009/3135.html Cite as: [2009] EWHC 3135 (Admin) |
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QUEEN'S BENCH DIVISION
THE ADMINISTRATIVE COURT
Strand London WC2A 2LL |
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B e f o r e :
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THE QUEEN ON THE APPLICATION OF LAWS | Claimant | |
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THE POLICE MEDICAL APPEAL BOARD | Defendant |
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MR S WALSH (instructed by THE METROPOLITAN POLICE AUTHORITY) appeared on behalf of the Defendant
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Crown Copyright ©
The facts
"Her clinical condition is certainly quite severe, and the clinical signs and symptoms are indeed somewhat disproportionate in relation to the injury that she sustained. This is, however, not that unusual, and one sometimes sees very severe symptoms after quite minor incidents, such as a small whiplash injury. Some of her symptoms, however, probably amount to fair degree of emotional overlay, but it is incredibly difficult to separate this out from the underlying neuro-muscular skeletal problems."
He continued:
"In trying to answer your question simply, I think one can attribute her problems to the incident on 11 October as she did not suffer from any problems up until that time. There clearly was a cause and effect, and the fact that there are now so many diverse and odd symptoms does not necessarily mean these are imagined."
"No enquiry seems to have been made into it, other than the observation that it is difficult to separate the physical from the psychological state. It seems to the Chair that the psychological disability arising from a physical injury is no less relevant in terms of the level of disability and cannot be dismissed".
"It is agreed that there was a neck injury arising from an incident in the performance of her duty by PC Belinda Eaton in October 1997. Although it appeared no more than a wrenched shoulder at the time, and a minor thumb injury, she subsequently developed left shoulder, upper back, and left arm pain. This gradually deteriorated, becoming more extensive, to include her neck and right arm. She also developed severe headaches and by February 1998 her symptoms included low back pain with left leg sciatica pain. Her own doctor observed signs of reduced prick sensation and power in her left leg ... Two referrals to the police convalescence establishment failed to produce benefit and a pain clinic referral produced no tangible benefit. An attempt at a recuperative return to work on light work had proved a failure, although there is little evidence in the police medical record that much notice was taken of the significance of this, other than a reference to her unwillingness to return to work ... She continued to report disabling symptoms after this failed trial of sedentary work, and with no sign of improvement in her presumed neuropathic pain, the decision was taken to medically retire her. She had apparently been unable to perform at two levels of sedentary work, namely at a display terminal and a telephone enquiry point. This information was provided by her and not challenged by Dr Reynolds. If she was unable to cope at this level, it is difficult to see what other work she might have been able to do, whether at a skilled or unskilled job. Thus, at that time, she had, on the balance of probabilities, to be considered virtually unemployable. That situation is not altered by her psychiatric state at the time. If she was psychiatrically or psychologically unable to cope with the consequences of her injury, she must still have been considered disabled. There is no evidence that these issues were considered in depth at the time by the Authority, and now none convincing that her inability to cope, owed anything to her life event difficulties at that time. I therefore feel that the appropriate disability banding should be Very Severe Disability, and that the level of disability due to continuing neuropathic pain should be considered in excess of 85 per cent. Her appeal, therefore, is successful."
"She reported that this was early in her career with the Metropolitan Police Service. At that time she had been advised that if the clinical disablement had remained unchanged there was no need for her to alter the degree of disablement. Since that time, however, there has been a significant change in the overall review process of all ill-health retirements and degree of disablement assessments. In the review process, a much more robust approach is taken, and in each and every case a job comparison study is undertaken".
"Over the last 9 years she has continued to suffer similar symptoms. Her back has been progressively worse, particularly in the low back ... I note there is a past history of fibromyalgia and colitis related to Diclofenac ... This lady is clearly in considerable pain in relation to her cervical and lumbar spine. I understand imaging has shown evidence of a lumbosacral prolapsed intravertable disc, although I do not have any access to the investigations that have been undertaken. Examination confirms that she is in a lot of pain, but there are no signs to suggest nerve root or spinal cord compression. In the absence of signs, it is difficult to be certain about the extent of cervical or lumbar spine disc or degenerative changes. It is more likely that the majority of her pain at present has a soft tissue basis, but I would certainly recommend that investigation, including imaging of the cervical and lumbosacral spine, and EMG studies should be undertaken.
You have asked me specifically to comment on the degree of disablement. I am afraid that this is a very difficult issue on which to be definite. It is clear that her functional capacity is limited by pain at present. This pain seems to originate both from cervical and lumbar spine degenerative changes, and from soft tissue disease. It seems to be the pain that is limiting her ability to work at present, and it is clear that this pain is causing very considerable disability for ex-Constable Laws."
"11(1)- this regulation applies to a person who ceases or has ceased to be a member of a police force and is permanently disabled as a result of an injury received, without his own default, in the execution of his duty (in Schedule 3 referred to as the "relevant injury").
11(2)- a person to whom this regulation applies shall be entitled to a gratuity, and, in addition, to an injury pension, in both cases calculated in accordance with Schedule 3 ...".
"(1) subject to paragraph 2 [not relevant to this case] a reference in these Regulations to a person being permanently disabled is to be taken as a reference to that person being disabled at the time when the question arises for decision, and to that disablement, being, at that time, likely to be permanent ...
(5) where it is necessary to determine the degree of a person's disablement, it shall be determined by reference to the degree to which his earning capacity has been affected as a result of an injury received without his own default in the execution of his duty as a member of a police force."
A decision as to disablement and its permanence is, thus, a decision to be taken at the time of the decision as to entitlement under regulation 11.
"(1) subject to the provisions of this Part, the question whether a person is entitled to any, and if so what awards under these Regulations, shall be determined in the first instance by the police authority.
(2) subject to paragraph (3) where the police authority are considering whether a person is permanently disabled, they shall refer for decision to a duly qualified medical practitioner selected by them, the following questions: (a) whether the person concerned is disabled; (b) whether the disablement is likely to be permanent, except that in a case where the said questions have been referred for decision to a duly qualified medical practitioner under regulation H1(2) of the 1987 Regulations, a final decision of a medical authority on the said questions under part H of the 1987 Regulations shall be binding for the purposes of these Regulations; and, if they are further considering whether to grant an injury pension, shall so refer the following questions: (c) whether the disablement is the result of an injury received in the execution of duty; and (d) the degree of the person's disablement; and, if they are considering whether to revise an injury pension, shall so refer question (d) above.
...
(6) the decision of the Selected Medical Practitioner on the question or questions referred to him under this regulation shall be expressed in the form of a report and shall, subject to regulations 31 and 32, be final."
"The decision of the Board of Medical Referees shall, if it disagrees with any part of the report of the Selected Medical Practitioner, be expressed in the form of a report of its decision on any of the questions referred to the Selected Medical Practitioner on which it disagrees with the latter's decision, and the decision of the Board of Medical Referees shall, subject to the provisions of regulation 32, be final".
Regulation 32, providing for further reference to medical authority, does not arise in this case.
"Subject to the provisions of this Part, where an injury pension is payable under these Regulations, the police authority shall, at such intervals as may be suitable, consider whether the degree of the pensioner's disablement has altered; and if after such consideration the police authority find that the degree of the pensioner's disablement has substantially altered, the pension shall be revised accordingly".
1.) had the claimant's degree of disablement, as a result of the duty injury, altered since the last review of her injury pension in 2005? By regulation 7(5), this question was to be determined by reference to the degree to which the claimant's earning capacity had been affected as a result of the duty injury.
2.) if so, had it substantially altered?
3.) if so, what revision, if any, should be made to the claimant's injury pension as a result of this substantial alteration?
The Board's decision
"The task for the Board in this case is to assess the current impact upon earnings of the index event of 11/10/1997, and then determine the Degree of Disablement as defined in the regulations".
"The level of reported functioning is inconsistent with the injury. There is evidence of marked illness behaviour with widespread body pain and symptoms unrelated to the incident and not supported by clinical findings. The report from a consultant neurologist (October 2008), and that of the SMP, are consistent with the Board's finding of no organic pathology. The Board note the co-existence of unrelated psycho-physical symptoms in the form of the suggested diagnoses of chronic fatigue syndrome/fibromyalgia/IBS. The presence of these features requires a bio-psycho-social rehabilitation plan be put in place to enable her to return to work."
They continued as follows:
"From questioning the Appellant it is clear that there has been a significant improvement since 1998, and it is manifestly clear that the argument that her condition has not improved is not sustainable ... The Board considers a substantial argument has been put forward for the Appellant's functional capability for work and that she has the appropriate competencies ... Taken in the round, the Board conclude that the Appellant is capable of working 30 hours per week and has the competencies to carry out the roles put forward ... With further intervention on the basis of the bio-psycho-social model of rehabilitation, there is no reason why the Appellant could not in the future be capable of returning to full time work. Nevertheless, the Degree of Disablement as a result of the injury on duty of 11/10/1997 is Band 1, as indicated in the Police Authority's submission".
"Regulation 30 may well raise questions of great difficulty, such as here in relation to causation. Those are not only questions which arise in medical situations, pension situations, and in all kinds of similar tribunals, but of course in the ordinary courts also where a condition such as, for example, asbestosis may have arisen in any number of different ways and during any number of different employments. It is important from the point of view of disputes such as pension entitlement that a decision, once made, should be final if at all possible, and that is what is provided by these regulations".
"From a competency point of view she has a degree and therefore, arguably, she is capable of undertaking the roles put forward by the MPA in terms of the administrative tasks required. Taking her level of functioning in the round, the Board considers she is capable of at least the 30 hours suggested by the SMP".