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Tribunal of Commissioners                                                                                                    25 November 2005

Case Nos CDLA/2879/2004 and CDLA/2899/2004

the GP report provides little extra detail.  However it seems to be the case that the claimant has been investigated and treated for back pain at some time in the past.  I accept the available clinical findings provided by the EMP.  Ideally a fuller examination of the back recording neurological findings plus observations of him standing, walking, rising etc. would have been helpful.  The claimant did not however choose to cooperate fully with the examination.  The physical findings as recorded in this case are persuasive but not conclusive.

38.It seems likely that this claimant has a diagnosis of mechanical back pain.  This is a condition in which the person describes pain in the lower back.  Investigations such as X rays, scans or blood tests reveal no abnormality.  Physical examination shows a full range of spinal movement in all directions without any muscle spasm or wasting.  There is no impairment of the lower limbs i.e. no wasting, joint abnormalities or neurological deficit.  From the medical point of view it would be accepted that the condition does have a physical cause.  However on the basis of the normal clinical findings it is reasonable to expect the person to have good mobility.  This would seem to be the situation in this claimant, and I think that the tribunal reaches the correct conclusion in not awarding higher rate mobility component.  Some people with this diagnosis may have psychological or social factors as discussed above that do influence their need for help to a much greater extent.  This does not negate the argument that there is an underlying physical disorder that could lead to physical disablement.”

145.Of relevance here is also the following later evidence from Dr Ford specifically in response to a direction made by the Chief Commissioner inviting medical evidence on the question “as to whether it is possible, and if so how likely, that there is a physical (as opposed to mental or psychological) cause for a claimant’s apparently physical symptoms in a case where, despite investigation by doctors, no such physical cause has been identified - recent Commissioners’ decisions suggest that this may be most likely to occur in cases of lower back pain, generalised muscle weakness and fatigue, and dizziness”:

“1.Low back pain is conventionally regarded as a physical symptom.  Although the pathology of the condition is not well understood, most medical authorities would agree that the pain does arise from anatomical structures in the back such as muscles, ligaments, joints or parts of the spine.

2.If demonstrable by physical examination generalised muscle weakness is likely to be regarded as a physical symptom.  Descriptions of weakness and/or fatigue could be either physical or mental symptoms.  For example such symptoms occur in many types of cancers and blood disorders such as anaemia, where the ability of the blood to carry oxygen is reduced.  Their presence in a condition such as chronic fatigue syndrome, where the pathophysiology of the condition is poorly understood and no special tests or investigations exist to confirm the diagnosis, may also be accepted as a manifestation of a physical symptom.

3.Most medical authorities would agree that dizziness may be a physical symptom, even though its exact pathological cause is unclear in many medical conditions in which it occurs.

4.In conclusion, if a person presents with physical symptoms, but no diagnosis has been made, or no clear physical cause has been identified, the cause could be physical,

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