Caroline Wood’s successful claim for Sensorineural symptoms of Hand Arm Vibration Syndrome (HAVS) alongside a diagnosis of Constitutional Raynaud’s disease

Caroline Wood, instructed by Richard Sheppard at Oxley Coward Solicitors, represented the successful Claimant at a contested HAVS trial, attended by Mr Cushieri, Consultant vascular surgeon and Professor Bainbridge, Consultant plastic and hand surgeon. The claim was settled in favour of the Claimant at the start of the second day of trial, prior to hearing from the medical experts. The trial took place at Leeds County Court and was heard by Recorder Najib.

The medical experts disagreed as to whether the Claimant had Constitutional Raynaud’s or vibration – induced HAVS. The Claimant had described an onset of vascular symptoms of blanching within 12 – 18 months of exposure to vibration when employed by the First Defendant and had described to Professor Bainbridge, the expert instructed by the Defendants, that the blanching had not progressed, despite continued exposure to vibration for a further 15 years. Professor Bainbridge suggested that onset of HAVS so soon after the exposure to vibration was an exceptionally short period of time. Further, onset after such a short duration of vibration exposure indicated a particular sensitivity to vibration which was inconsistent with the absence of progression of symptoms despite continued exposure to vibration for at least another 15 years. Accordingly the Defendants’ case was that the Claimant had Constitutional Raynaud’s.

In relation to sensorineural symptoms, both experts at the time of their respective medical examinations had found that the Claimant had normal 2 point discrimination. There was also evidence of tingling of the right middle finger given to both experts and the ring finger of the left hand to Mr Cushieri. Mr Cushieri had found loss of sensory perception in relation to cotton wool in the pulp of the middle and ring finger of the left hand and the middle and index finger of the right hand. Other experts may use a monofilament instead of cotton wool to test for sensory perception. Accordingly, Mr Cushieri had graded the Claimant 2SN, defined in the Stockholm Workshop scale as “intermittent or persistent numbness, reduced sensory perception”. Professor Bainbridge had diagnosed the Claimant, if he had HAVS, as 1V, 1SN. Professor Bainbridge also excluded carpal tunnel syndrome, cubital tunnel syndrome and any other peripheral nerve entrapment.

The joint report read as follows, “We agree that the Claimant describes sensory symptoms which Mr Cushieri believes are consistent with the neurosensory manifestations of the hand arm vibration syndrome… Mr Bainbridge notes no reported history of sensorineural symptoms except during a blanching attack…Mr Bainbridge notes normal 2 point discrimination. Mr Cushieri also found normal 2 point discrimination but noted reduced sensory loss in the middle and ring finger of the left hand and the index and middle finger of the right hand. We note that sensory testing can be prone to subjective bias”.

Sensorineural symptoms of numbness and tingling of the fingers associated with a blanching attack is not inconsistent with Constitutional Raynaud’s. Tingling of the fingers while using vibrating tools up to 20 minutes afterwards is a normal physiological reaction to vibrating tool use. Reduced sensory perception and/or tingling outwith exposure to vibrating tools is not accounted for by a diagnosis of constitutional Raynaud’s. Further, a diagnosis of constitutional Raynaud’s does not exclude a diagnosis of HAVS.

The claim against the First Defendant, who employed the Claimant from 1982/83 to 1986/87, settled prior to a preliminary hearing on limitation. The remaining Defendants employed the Claimant as an HGV Technician from 1997 to 2016 and admitted exposure to above the Threshold Level (1m/s²) but denied exposure above the EAV.

Following the Claimant’s evidence, which was to the effect that the blanching of his fingers started before any exposure to vibration, the medical experts had a “joint meeting” at court in which they agreed:-

1. On the basis of the engineering evidence, witness statement and Claimant’s evidence today the vibration exposure at the time of onset of symptoms in 1982 – 1984 is not sufficient to cause HAVS and that therefore on the balance of probabilities he suffered from Constitutional Raynaud’s.
2. We agree that on the basis of the description of the extent of whiteness in 1982 – 1984 reported to Professor Bainbridge and the evidence of the Claimant there does not appear to be progression of vascular symptoms.
3. We both note that there is no clear description of loss of dexterity or numbness outwith a blanching attack. Mr Cushieri, on the basis of tingling* reported to him believes that there is an element of sensorineural HAVS up to early 2SN. Professor Bainbridge did not receive such a report and notes nothing in the Claimant’s evidence today to suggest sensorineural symptoms and grades him at 0SN.

Although the joint report referred only to tingling, the definition of 2SN includes reduced sensory perception and it was implicit in Mr Cushieri’s conclusion that the Claimant was 2SN that he was taking into account his findings at medical examination of reduced sensory perception.

On the morning of Day 2 of the trial, Recorder Najib identified the issues for the court to determine as: –

1.  Whether the Claimant had sensorineural symptoms of HAVS in one or both hands. If no, the Claimant’s claim would fail.
2. If yes, when did those symptoms start? If during employment with D2/D3 claim succeeds.
3. If during employment with D1 was there any progression? If no, claim fails.
4. If successful in relation to one of the above, the Claimant has to establish loss and dam-age, which would include potential issues of apportionment.

The court provided an adjournment to enable the parties to discuss those issues with their relevant experts. During this adjournment the claim settled in favour of the Claimant on the basis of sensorineural symptoms alone, notwithstanding it was agreed that the vascular symptoms were attributable to Constitutional Raynaud’s.

Caroline Wood is an experienced disease practitioner. She has provided representation at numerous noise induced hearing loss trials and limitation hearings, including on appeal, acting on behalf of both Claimants and Defendants. She understands the CLB and LCB guidelines and is able to calculate the NIL. She has a thorough understanding of the medical issues in relation to HAVS claims, particularly benefitting from Mr Cushieri’s expertise at the trial described above. She has a growing practice in asbestos related claims, including low level asbestos exposure prior to 1965.

To instruct Caroline please contact the civil clerks on 0113 213 5252 or email clerkscivil@psqb.co.uk.