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Tribunal of Commissioners                                                                                                    25 November 2005

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

157.The notes also included a transcript of a letter dated 8 May 2003 to her GP from Mr Dekker, a consultant ENT surgeon. That letter included the following:

“… [T]his lady has a problem of intractable chronic vertigo which is felt to be due to an uncompensated peripheral vestibular disturbance.  She was extensively investigated in 1996/7.  She saw a neurologist, ENT surgeons, and cardiologists.  She had had an MRI scan, echocardiogram, and caloric tests.  She saw Professor Luxon at Queens National Hospital for nervous diseases….  She underwent vestibular rehabilitation therapy at Sandwell and City Hospital.  She eventually declined further treatment as vestibular rehabilitation therapy was not helping and she did not wish to have any further investigations.  It is likely that she has an uncompensated peripheral vestibular disorder with psychogenic overlay.  The history is not classical of benign positional paroxysmal vertigo.  Unfortunately she will not allow me to do a Dix Hallpike test as she feels this may exacerbate her vertigo.  In fact she claims to have been dizzy for three years following her previous caloric test.  I feel this lady’s interest would be best served by having a further vestibular assessment and posturography at the Leicester Balance Centre and I will be referring her.”

158.There was also a letter dated 13 October 2003 from Mr Dekker to the Department, in which he stated that when he saw the claimant in 1996 he felt that the claimant had “a longstanding uncompensated peripheral vestibular dysfunction” and that Professor Luxon had “confirmed this and felt that she should have vestibular rehabilitation.  She however wanted to perform further investigations before making any decisions.”  The letter went on to state that the claimant refused to have further investigations “and therefore it was not possible to confirm a diagnosis or indeed institute treatment.”  Mr Dekker then went on to state that he did not see the claimant for 6 years, until April 2003, when he referred her for further full vestibular assessment and thereafter vestibular rehabilitation therapy, but that he had heard nothing since.  The letter concluded by saying that “we are unable to make a diagnosis as [the claimant] refuses to undergo any further investigation and indeed treatment. Under the circumstances I expect the prognosis for this lady’s recovery is extremely poor.”

159.There was a report dated 12 November 2003 from the claimant’s GP which described the diagnosis of the claimant’s disabling condition as “uncompensated peripheral vestibular disturbance.”  In a letter dated 15 January 2004 the GP said that the claimant had seen a number of specialists and that “no-one has been able to get to the bottom of her problems.”

160.In paragraph 5 of its statement of reasons the tribunal, having stated that the medical evidence before it consisted of the report from the claimant’s GP, the letter from the claimant’s GP dated 15 January 2004, the letter from Mr Dekker dated 13 October 2003 and the medical notes, continued:

“Dr Mitchell [the GP] last saw [the claimant] on 24 April 2003 and his report is dated 12 November 2003.  He stated that she had suffered from severe giddiness for 5 years and that the diagnosis of the condition was “uncompensated peripheral vestibular disturbance”, although at p.8 he stated that “it is likely that she has uncompensated peripheral vestibular disorder with psychogenic overlay.”  GP notes indicate that despite intensive investigations specialists had not been able to find an organic cause for her dizziness [and the tribunal then gave references to the letter dated 7 February 2002 from Dr Lopes and the letter dated 8 May 2003 from Mr Dekker]”.

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