Application of the psychiatric impairment ratings scale: grounds 7 (e), (f), (g)
- The second set of grounds challenged the findings of the Appeal Panel with respect to the criteria specified in the approved guidelines for assessing psychiatric impairment. [39] Dr Hong applied the authorised rating scales to assess the degree of the plaintiff's impairment under each of the six prescribed categories. Before the Appeal Panel the appellant challenged his assessments under three, namely (i) social functioning, (ii) social and recreational activities and (iii) self-care and personal hygiene. He now alleges error of law on the part of the Appeal Panel in rejecting each challenge.
- As counsel for the defendant noted, and as the Appeal Panel noted, Dr Hong's assessment differed from that of the plaintiff's consultant psychiatrist, Dr Michael Robertson, on only one scale, namely self-care and personal hygiene. To conclude that the Appeal Panel erred in law in accepting the evidence of the plaintiff's own expert in regard to two categories would require a clear case of disregard of some critical element in the case. Senior counsel for the plaintiff submitted that Dr Robertson's report was dated, having been prepared in February 2019, but was not able to identify any change in the plaintiff's circumstances since then revealed in the evidence.
- To consider these grounds it is convenient to set out the effect of the plaintiff's supplementary statement, as did the Appeal Panel at this stage of its reasons. The supplementary statement covered 3 pages, parts of which involved commentary, such as "I felt that Dr Hong was not asking as many questions as I believed he should have about my condition." Such comments did not contain information or evidence, but constituted submissions as to the process undertaken by Dr Hong. It may have been matters of that kind which the Appeal Panel, applying Petrovic, disregarded. It was entitled to do so.
- Secondly, the plaintiff recounted statements he had made to Dr Hong which he believed were not accurately or completely addressed by Dr Hong in his reasons for his medical assessment certificate. Some of the complaints appear quite trivial, whilst others appear to have substance, if accepted. Whether they were trivial or substantial was a matter for the Appeal Panel. The Appeal Panel reasons identified a number of matters which it treated as "relevant evidence". [40]
- Thirdly, the plaintiff included additional information which had not been supplied to Dr Hong. For example, he stated:
"Dr Hong did not ask me whether I skip meals or binge eat. If he had asked me, I would have told him that I often skip meals and will often binge eat, particularly after dinner, which is very bad for my blood sugar levels. So I do not think that it is accurate to say that I eat regularly."
This additional material was expressly adverted to by the Appeal Panel. [41]
- By way of introduction to the further grounds, it is also appropriate to identify the provisions of the guidelines against which the plaintiff's condition was assessed, namely chapter 11 which is headed "Psychiatric and psychological disorders".
- Paragraph 11.11 sets out six tables comprising the "psychiatric impairment rating scale (PIRS)". Each scale requires a specified category of impairment to be assessed with a score, described as assigning a "class" from 1-5. [42] The numerical scores are translated to a percentage of whole person impairment. The plaintiff challenged the scores (classes) given by the Appeal Panel with respect to "social functioning" (table 11.4), "social and recreational activities" (table 11.2) and "self-care and personal hygiene" (table 11.1). Each table provides a range from "class 1" through to "class 5", with descriptions (sometimes referred to as "exemplars") for each class. Thus, with respect to social functioning, class 2 covers:
"Mild impairment: Existing relationships strained. Tension and arguments with partner or close family member, loss of some friendships."
Class 3 covers:
"Moderate impairment: Previously established relationships severely strained, evidenced by periods of separation or domestic violence. Spouse, relatives or community services looking after children."
- These examples are apposite because the plaintiff complained that he had been placed in class 2, rather than class 3, with respect to social functioning. Two observations may be made about such a complaint. First, as the guidelines indicate, "[e]valuation of psychiatric impairment is conducted by a psychiatrist who has undergone appropriate training in this assessment method". [43] It is, self-evidently, no function of this Court to review the classification by the Appeal Panel. Nor, as has occasionally been considered, would it be appropriate for this Court to identify from the reasons that the Appeal Panel has asked itself "the wrong question", thereby establishing error of law. While extreme cases where error may be established can be imagined, they will be readily apparent because the Appeal Panel has confused one appellant with another or made some equivalent manifest error, sufficient to constitute an error of law on the face of the record, or jurisdictional error.
- Although the three grounds challenging the exercise undertaken by the Appeal Panel in assessing the psychiatric impairments did not assert inadequacy of reasons, they were expressed as allegations that the Panel "did not apply focus to ascertaining whether on the facts" the plaintiff's circumstances fell within class 2 or class 3. That submission ran into the difficulty arising from the principles stated in Wingfoot, namely that the reasons were required to address the finding in fact made, and not possible alternative findings. Senior counsel for the plaintiff submitted, fairly, that a failure to refer to possible alternative findings might reveal a failure on the part of the Appeal Panel to address the plaintiff's case. However, that inference could not be drawn in the present circumstances. With respect to each specific table in the guidelines, the Appeal Panel set out the paragraphs identifying class 2 (as found by Dr Hong), followed by a statement that "[t]he appellant seeks a reclassification of a class 3 rating", the relevant provision for class 3 then being set out. The issue was thus expressly identified.
- In these circumstances, it would be sufficient to state that no error of law has been established with respect to the exercise undertaken by the Appeal Panel. There was no suggestion that par (c) of s 327 was in play: the Appeal Panel applied (as had Dr Hong) the correct criteria. To the extent that additional information was relied upon, the Appeal Panel considered those aspects of the supplementary statement of the plaintiff in relation to the criteria to which they related. That left only the question whether the plaintiff had established any change in the appropriate class resulting from that information and whether he had established failure on the part of the Appeal Panel to apply the correct legal criterion of "demonstrable error". In that respect, the Appeal Panel concluded, in the exercise of its professional expertise, that the additional information did not make any material change to the circumstances considered by Dr Hong. [44] It further stated that in respect of none of the categories, was error demonstrated. The specific issues raised by the plaintiff may, however, be shortly identified with respect to each category.