Tribunal of Commissioners 25 November 2005
Case Nos CDLA/2879/2004 and CDLA/2899/2004
106.In the light of the wording “his physical condition as a whole is such that…” in regulation 12(1)(a), an alternative approach would be to ask whether, if the claimant was suffering from only the physical condition and any psychological consequences of it, he would still be virtually unable to walk. A further alternative would be to ask, adopting a broad-brush approach, whether the claimant’s virtual inability to walk is predominantly the result of his physical or his mental condition, and to award higher rate mobility only if it was predominantly the result of his physical condition.
107.However, like the “but for” test, these further possibilities would involve attempting to undertake an analysis of the relative causative potency of physical and mental conditions which might well be interacting with each other. In many cases, evidence relevant to this analysis would not be available. Often, the claimant’s condition will not have been investigated in the necessary detail. In a significant number of cases, such evidence would simply be impossible to obtain, given the current state of medical knowledge.
108.On this aspect of the appeals, before us there was evidence from Dr Pamela Ford of the Department for Work and Pensions Corporate Medical Group, which we found of considerable assistance. She said:
“3.The fact that a symptom such as dizziness cannot be directly linked to a physical diagnosis or disorder does not mean that the symptom is not physical, or that it is therefore, almost by definition, a symptom of a mental disorder. In addition it does not mean that the symptom is necessarily imaginary or fictitious. Many commonly described symptoms do indicate the presence of a physical disorder. But it is also true that some people with mental health disorders may describe bodily or somatic symptoms that mirror those of purely physical conditions.
Physical and psychological symptoms may co-exist in those with clearly
diagnosed mental health disorders. The fact that the physical symptom lacks a firm diagnosis does not mean that it is necessarily a symptom of the mental disorder. For example a complaint of back pain in a person with schizophrenia is most likely to be due to a physical condition of the lower back rather than a symptom of the schizophrenia. A less well defined symptom like dizziness may still be due to a physical cause rather than the schizophrenia, but could be a manifestation of the mental health condition.
5.People with clearly defined physical problems e.g. lumbar disc prolapse, often suffer from psychological symptoms such as low mood and anxiety. The symptom of low mood may be attributed to the pain arising from the physical disorder or may arise from a separate mental health condition. Even if the latter were not formally diagnosed, it does not mean that it is not a genuine psychological symptom.
6.Assessing medically unexplained symptoms in respect of making a clinical diagnosis is often problematic for the clinician. Both physical and psychological causes have to be considered and some symptoms may be attributed to one aetiology and some to the other. Even if the symptoms and resultant functional restrictions seem out of proportion to the proposed disorder it does not necessarily mean that the cause is always psychological and never physical.