§ The Countess of Mar
asked Her Majesty's Government:
What are the clinical signs and symptoms used by doctors appointed by the Department of Social Security to assess individuals suffering from the chronic effects of organophosphate exposure for invalidity benefit purposes; and
What are the clinical signs and symptoms used by doctors appointed by the Industrial Injuries Board to assess individuals suffering from the chronic effects of organophosphate exposure for industrial injury benefit purposes.
The assessment of individuals for Invalidity Benefit and Industrial Injuries Benefit purposes is a matter for Mr. Michael Bichard, the Chief Executive of the Benefits Agency, who will write to the noble Lady
Letter from the Chief Executive of the Benefits Agency, to the Countess of Mar, dated 1 November 1993:
As Chief Executive of the Benefits Agency, it is my responsibility to answer questions raised about relevant operational matters. I am therefore replying to your recent Parliamentary Questions asking Her Majesty's Government what are the clinical signs and symptoms used by doctors appointed by (i) the Industrial Injuries Board to assess individuals suffering from the chronic effects of organophosphate exposure for industrial injury benefit purposes and (ii) the Department of Social Security to assess individuals suffering from the chronic effects of organophosphate exposure for invalidity benefit purposes.
The doctors who assess customers for Industrial Injury Disablement Benefit purposes are appointed by the Secretary of State for Social Security and act as independent adjudicating medical authorities.
As regards Prescribed Disease C3, Poisoning by Phosphorous (which also includes acute and chronic poisoning by organophosphates), the Adjudicating Medical Authority is concerned with deciding whether or not the customer has the Prescribed Disease and if so, what is the degree of disablement as a result of this disease.
In chronic poisoning by organophosphorous compounds there may be various symptoms such as, tingling 145WA in the limbs, weakness, loss of balance, gastrointestinal symptoms and paralysis. Clinical signs of paralysis of limbs may also be present. Not all of the symptoms and signs may be present and in some cases, apart from a feeling of weakness and general ill health, there may be few complaints and little to find on examination. None of these symptoms or signs are specific for chronic poisoning by organophosphorous compounds and there are a number of other conditions which can give rise to such symptoms and signs.
The general approach to diagnosis is the same as for all medical conditions. A full history, including occupational history, must be obtained. The person is examined, a differential diagnosis is drawn up and various investigations carried out to arrive at a diagnosis.
The diagnosis of poisonings is difficult and Adjudicating Medical Authorities will have a report from a Consultant Toxicologist, Consultant Occupational Physician, or somebody of like standing to assist them in arriving at a diagnosis.
On the question of invalidity benefit, doctors employed by the Benefits Agency Medical Services (BAMS) provided the Adjudication Officer with a second opinion on the effects of an individual's medical problem on their capacity for work. What is important in this assessment is the effect of that problem on the person's ability to carry out either their own job or suitable alternative work. The exact nature of the medical condition is of lesser importance although, if this is occupational in origin, it may influence the doctor's opinion on the person's ability to return to his normal job.
Very seldom, if ever, will the doctor carrying out this assessment need to determine the exact nature of the underlying medical problem as the person's own doctor will have been issuing statements of incapacity on which the diagnosis of the medical condition is recorded. In many instances, the examining doctor will also have available a report from the person's own doctor giving more detailed information about their medical problem.
In all cases the BAMS doctor takes an appropriate medical and occupational history and conducts a general medical examination, concentrating on those aspects of the person's physical or mental disability identified as affecting the person's capacity for work. The situation is no different if the person is suffering from the effects of organophosphate exposure.
I hope you find this reply helpful. A copy will appear in the Official Report and a copy will also be placed in the Library.