Tribunal of Commissioners 25 November 2005
Case Nos CDLA/2879/2004 and CDLA/2899/2004
20.Treatment known as vestibular rehabilitation may be recommended for people with persistent symptoms of vestibular disorder. This consists of exercises involving a coordinated set of eye, head and body movements that the person is taught to carry out 3-4 times a day. The purpose is to retrain the brain to compensate for the impaired vestibular function….
21.People with long standing vestibular disorders may become anxious and depressed, especially if simple treatment with medication does not relieve symptoms. They may become afraid that attacks of vertigo will render them incapacitated in public or in the street. They may become fearful of walking out of doors on their own. Low mood, anxiety and panic attacks in their turn may cause feelings of dizziness. Associated anxiety/depression in those with vestibular disorders may need treatment in their own right. As described above the resultant degree of functional restriction may arise from a complex interaction of biological, psychological and social factors.
22.The commonest type of vestibular disorder seen in general practice is acute labyrinthitis/vestibular neuronitis. The person presents with short lived episodes of vertigo, frequently accompanied by nausea and vomiting…. The condition resolves itself quickly over a few days or weeks and is relieved by specific medications. It is postulated that recovery occurs because the brain compensates for, or learns to adapt to, the abnormal signals that it receives from the inflamed vestibular organ/nerve….
23.You enquire what is “uncompensated peripheral vestibular disorder”. In [the claimant’s] case it is clear that she has consulted a number of specialists and had several relevant investigations. The description “peripheral vestibular disorder” indicates that the problem affects the balance organs or nerve in the inner ear. Central problems affecting the brain such as a tumour or stroke have been ruled out. The term “uncompensated” indicates that spontaneous recovery or resolution has not occurred. The terminology used also indicates that a specific condition like Menière’s disease has not been identified. To say that “no treatable cause found” may mean that no specific diagnosis has been made, or it may mean that no treatment has been successful or that little or no recovery has taken place. It does not necessarily mean that symptoms are psychological or imaginary, or that there is no recognised disease, or that there is no organic cause for the disabling condition. The term “psychogenic overlay” may indicate that the claimant has developed psychological symptoms such as anxiety in response to her persistent disabling symptoms, and that this is contributing to the degree of disability observed. It does not necessarily imply that there is a conscious intention to mislead or malinger.
30.In conclusion I think that [the claimant] should be considered as having an underlying physical cause for her symptoms of vertigo and dizziness. I appreciate the diagnosis of uncompensated peripheral vestibular disorder is to some extent a diagnosis of exclusion, and also a description of a conglomeration of persistent symptoms, most of which might be considered to be subjective. Nonetheless it would be recognised as a medical condition by most medical authorities and considered to have some disabling effects of a physical nature. It would also be accepted that psychological and other factors may contribute to the overall level of disability observed in some individuals, as is the situation in many more well defined physical and mental disorders.”
163.In our judgment the tribunal’s decision was erroneous in law in the following respects.