The Tribunal's reasoning
47 In the terms of the distinction between "reasons" and "reasoning" that I considered earlier, Ms Negri submitted that the Tribunal's written reasons disclosed reasoning that departed substantially from the reasoning revealed in its oral reasons. She submitted, therefore, that I should have regard to the Tribunal's oral reasons rather than its written reasons in assessing whether ground 1 is made good.
48 Ms Negri relies upon purported differences as between the oral and written reasons in the Tribunal's application of Table 1 to Ms Negri's fibromyalgia. Orally, the Tribunal said as follows (emphasis added, paragraph numbers added for ease of reference):
[1] So the first point with respect to the legislation is whether there's, let's say the physical/mental issue. I think the Secretary even concedes that there is. You've got fibromyalgia. I notice over the period of time there has been a bit of change in how particularly the applicant wants to contemplate how things are.
[2] For example, I'll make the point I heard nothing specifically about a sore back, and therefore take it that that was not relevant, particularly sort of the lumbar spine and maybe the cervical spine. Now, I'm impressed and I want to state that I think Dr Sillcock is an experienced practitioner in her craft and I note that she assessed the applicant on 5 May 2014. She then provided a report which is dated 5 September 2014. In her oral evidence if we all had a dollar for the times she said, "Gee, it's hard, isn't it" maybe we could all retire. That's sort of a rhetorical comment.
[3] Dr Sillcock, with the benefit of hindsight appears to indicate that she got it wrong. That was her term. And thinks that her call - again, a colloquial use of the word - of 10 points, was erroneous and it should have been 20 at the time. She conceded maybe it should be 15. It's very difficult because we're dealing with hindsight and it's sort of not six months; it's moving beyond 12 and 24 months. The applicant in her oral evidence, very blurred, a lot of memory issues, and whether or not that is related to medication or not, it's impossible to state but certainly the transcript would show that on probably a score, up to a couple of scores of occasions she can't remember. I think she is very honest and that's terrific.
[4] It's awkward that fibromyalgia is a diagnosis of exclusion. So there's no specific test and, you know, you eliminate everything else and that's what you're left with. Certainly when we look at table 1, you both agree that table 1 is relevant to where we are and both of the submissions were along the lines of sort of cherry-picking stuff that's written down in the table. I'm interested in the overall functional assessment, and like everybody said today, it's hard. I specifically look at, you know, say, where there's the 10 points, the moderate functional impact:
Experiences frequent symptoms.
[5] So then we can go, you know, the shorter Oxford definition of frequent, as opposed to the 20 points table, where it's:
Usually experiences symptoms.
[6] I take "usual" to be, say, 90 per cent of the time it's always there, and this is extremely difficult in a disease process or illness process where it fluctuates. Usual versus frequent. So we've heard two to three days, that's less than 50 per cent of the week. We can do some of these things, and we can't do some of the other things. I know the relevant questioning was directed at each of the sub-points that are listed at the various clauses. It's very hard but to me it is the overall functioning. It's difficult but we're in February 2015 looking back to a three-month period late 2012 to early 2013.
[7] I sensed that a lot of the commentary or the oral evidence, I should say, from Dr Sillcock related to things today. I sensed that a lot of the oral evidence of the applicant indeed related to things today, and I think that's a course of normal human nature. You remember what it's like today and yesterday and perhaps the week before. It's one of those fluctuating generally deteriorating disease trajectories. So that brings us to what are we going to with respect - well, it brings me, the tribunal, to what are we going to do with respect to the relevant period.
[8] It's really on the balance, given that it is a fluctuating and I'll accept generally deteriorating time course, things are getting worse rather than getting better. As a consequence, this tribunal determines that the relevant allocation of points is 10 points during the relevant period.
49 The Tribunal's written reasons were as follows, at [37]-[41] of its reasons for decision (italicisation in original, bold emphasis added):
[37] The Tribunal is satisfied that the Applicant's fibromyalgia is permanent as required by the Act, so it does attract impairment points under the Impairment Tables. Fibromyalgia causes periods of severe incapacity, as well as periods of manageable symptoms associated with chronic pain and fatigue. Such times are unpredictable. The Tribunal considers that the Applicant's and Dr Sillcock's testimony relate to a time close to the present, rather than to the relevant period. Despite many attempts to direct her attention to the relevant period, the Applicant was frequently unable to remember her experiences within the relevant period with any degree of precision, tending to assume everything was as it is today; or to refer to her recent experience of pain. There is no test result available to provide a measure of clinical events related to fibromyalgia
[38] Dr Sillcock relied on what the Applicant told her, and the Applicant has a poor memory of specific events in the relevant period. Dr Sillcock is, at best, guessing what the Applicant's circumstances may have been like 18 months before she met the Applicant. Her report was dated four months after the examination she undertook, and she formed her views through a prism of giving the Applicant the benefit of any doubt. Dr Sillcock noted the difficulty of assigning an impairment rating in such circumstances. She belatedly altered her opinion to a more favourable one for the Applicant, awarding an increase from 10 points to 20 points under Impairment Table 1 because she thought the Applicant was somewhere in between the two settings in the Table.
[39] The Tribunal finds that Dr Sillcock did not read the contemporaneous JCA report of 23 October 2012 by a registered psychologist and an accredited exercise physiologist until she was in the witness box. The Tribunal finds that Dr Sillcock's examination assessment is too remote from the relevant period to be useful and that it is too speculative to hold the weight that the Applicant favours. The Tribunal prefers the contemporaneous assessment of the JCA, which incorporates available medical reports and the contemporaneous history from the Applicant to Dr Sillcock's retrospective favourable guesses written almost two years after the date of claim and open to alteration on ungrounded intuition informed by the unreliable memory of the Applicant. That JCA assigned the condition 10 points under Impairment Table 1.
[40] The Tribunal notes that another JCA undertaken by another registered psychologist and accredited exercise physiologist on 31 January 2013, just after the relevant period but well before Dr Sillcock's examination, also informed by relevant medical reports and the Applicant's history, allocated only 5 points for fibromyalgia. The Tribunal accepts that this is consistent with the fluctuating history of fibromyalgia, and is consistent with Dr Lewis's observation of improvement in his letter of 7 March 2013.
[41] On the basis of the best information available to it, the Tribunal assigns the Applicant 10 impairment points under Impairment Table 1 for the fibromyalgia. The Tribunal notes that even Dr Sillcock would be obliged to do this based on her own evidence and consistent with the requirement of the Act to assign the lower of two ratings pursuant to s 11(1)(c) of the Impairment Tables.
50 I think it is readily apparent that the written reasons are expressed very differently to those given orally. The Tribunal has at least engaged in wholesale redrafting. But, that does not necessitate the conclusion that the reasons given after that process of redrafting were not an exposition of the reasoning for the Tribunal's decision when made on 26 February 2015.
51 The written reasons contain a background to the decision under review, including Ms Negri's medical history. They contain discussion of the witness statements and the oral evidence of Dr Sillcock and Ms Negri. There is an outline of the parties' submissions and quotation of the relevant sections of the Act and subordinate legislation. The oral reasons contain none of those things. The oral reasons are three pages long as against sixteen pages of written reasons. On the other hand, all of the material just mentioned that does not appear in the oral reasons, but does in the written reasons, is uncontroversial. For example, the addition of legislative extracts for the convenience of the reader is clearly permissible, even though it is entirely new.
52 The material that is controversial is in [34]-[48] of the written reasons. There is quite a lot of overlap as between those paragraphs and the oral reasons, albeit that the written reasons are expressed more formally. Paragraph [38] and the controversial aspects of [37] of the written reasons correspond substantially with [7], [3], and in part [4], of the oral reasons; [41], apart from the italicised portion, is effectively [8] of the oral reasons. In both oral and written reasons the Tribunal determined not to rely upon the evidence of Dr Sillcock and of Ms Negri. That was because that evidence focussed on Ms Negri's disabilities as at the present day rather than the period relevant to the Tribunal's task. Further, Ms Negri's evidence was not relied upon because she did not have a clear recollection of that time period, and Dr Sillcock's was not relied upon because she was in turn reliant upon Ms Negri's unclear recollection and had not made a contemporaneous assessment.
53 There are, however, two important differences as between the oral and written reasons. First, in the oral reasons the Tribunal referred to the dictionary definitions of "frequent" and "usual", and opined that "usual" meant 90 per cent of the time or more. The reasons continued to the effect that, as Ms Negri experienced symptoms less than 50 per cent of the time, she did not "usually" experience them. Those reasons did not appear in the written reasons. Instead (and this is the second difference), the Tribunal referred to Job Capacity Assessment reports ("JCA reports"), prepared by people whom I shall call Job Capacity Assessors ("JCAs"), and reasoned that they were more reliable because they were prepared contemporaneously. There is no express reference to the JCA reports in the oral reasons on this question. Another difference is that the written reasons refer to the legal consequence of Dr Sillcock's opinion being that Ms Negri's disabilities fell between two impairment point rankings, but this was said in passing and I do not think that the Tribunal really relied upon it. I will not consider that further.
54 Analysis of whether reliance on the JCA reports in the written reasons constitutes departure from the reasoning revealed orally requires that those reports be set out. It did not seem to be controversial that, in its written reasons, the Tribunal adopted conclusions expressed in a JCA report dated 1 November 2012 ("November report"). As is discussed below and in relation to question 4, the Tribunal's reasons disclose, when fairly read, that it adopted the JCA's conclusions for the same reasons as were given in the JCA report. The Tribunal also referred to a report dated 1 February 2013 ("February report"). (It is worth noting, for avoidance of confusion, that the Tribunal gives the dates of the November and February reports as 23 October 2012 and 31 January 2013 respectively. Those were the dates of the assessments preceding the reports, not of the reports themselves).
55 The following passages in the November report, on pp 1-3, are relevant (emphasis added, errors in original):
Condition: Fibromyalgia Type: Permanent
...
Symptoms: Pain mainly felt around the lower back, left leg and pelvis impacting lower back, mobility and power. Pain appears to be exacerbated by the colder weather as self reported. Spasms of pain and general lethargy. Needs to alternate between sitting and standing to minimise back pains.
…
Impairment
Condition: Fibromyalgia
Impairment Table: 1 - Functions requiring Recommended Rating: 10 Physical Exertion and Stam
Functional Impact: There is a moderate functional impact on activities requiring physical exertion or stamina.
(1) The person:
(a) experiences frequent symptoms (e.g. fatigue) when performing day to day activities around the home and community and, due to these symptoms, the person:
(i) is unable to walk (or mobilise in a wheelchair) far outside the home and needs to drive or get other transport to local shops or community facilities; or
and
(b) is able to:
(i) use public transport and walk (or mobilise in a wheelchair) around a shopping centre or supermarket; and
(ii) perform work-related tasks of a clerical, sedentary or stationary nature (i.e. tasks not requiring a high level of physical exertion).
…
Supporting reasons summary:
The functional impacts arising from the clients condition are encompassed by 2 major limitations. This includes the lower back and generalised lethargy. For this reason, 2 tables (Spinal function and Functions requiring Physical Exertion and Stamina) were used to accurately assess the clients functional impacts. This was confirmed by the contributing assessor.
The Medical Report indicates severe fatigue, lethargy and ability to sit and stand as functional limitations. This was confirmed by the client during the assessment. The client spent around half of the time standing for the duration of the 40 minute interview. She did report that today "was a bad day", regarding how she was feeling. The client reported that as part of her routine to maintain her health she walks 20 minutes twice a day. She is able to go to the supermarket for light purchases and if she mops the floor at home that is all she would be able to do for the entire day. Equally, the client works from time to time in hospitality, averaging maybe once a month and prepares herself physically for these shifts ahead of time. As the clients functional limitations can vary day to day, taking into consideration what the client is able to do on an "average" day, the descriptors at 10 points on both tables is the most accurate rating of the functional limitations.
56 The February report contained the following relevant passages, on pp 1-2 and 5 (emphasis added):
Condition: Fibromyalgia Type: Permanent
…
Symptoms: MR notes severe fatigue, reduced endurance with inability to sit/stand > 15 mins, poor concentration sec. to pain and lethargy, multi joint pain, muscular spasms recurrently, low mood.
The client reported fluctuating in symptoms and severity of symptoms. The client stated that usually she has at least 2-3 'bad days' where she is unable to do anything due to reduced endurance and back pain, even her everyday stretches. The client reported that she manages self care tasks on her own, and on her 'good days' she is able to do her stretches, walk 30 mins twice a day, and bend forward to the floor to pick up light items. The client stated that she cooks dinner sometimes, does the washing sometimes, and attends to light general [tidying]. The client stated that she general[ly] is able to drive for approx. 20-30 mins, however could experience more back pain afterward.
…
Condition: Fibromyalgia
Impairment Table: 1 - Functions requiring Recommended Rating: 5 Physical Exertion and Stam
Functional Impact: There is a mild functional impact on activities requiring physical exertion or stamina. Based on information provided, the client's functional impacts do not meet 10 impairment points.
Supporting Reasons: MR notes severe fatigue, reduced endurance with inability to sit/stand > 15 mins, poor concentration sec. to pain and lethargy, multi joint pain, muscular spasms recurrently, low mood. The client reported fluctuating in symptoms and severity of symptoms. The client stated that usually she has at least 2-3 'bad days' where she is unable to do anything due to reduced endurance and back pain, even her everyday stretches. The client reported that she manages self care tasks on her own, and on her 'good days' she is able to do her stretches, walk 30 mins twice a day, and bend forward to the floor to pick up light items. The client stated that she cooks dinner sometimes, does the washing sometimes, and attends to light general [tidying]. The client stated that she general[ly] is able to drive for approx. 20-30 mins, however, could experience more back pain afterward.
...
Supporting reasons summary:
The client is suffering from FDTS conditions. These conditions have impacts on the client's ability to function. It is assessed that the client has an impairment rating of 5 under table 1 and 5 under table 4. The client reported difficulty with functioning on her 'bad days' due to a combination of impacts of her decreased endurance and back pain.
57 I have emphasised the last sentence of the November report. The essence of the assessor's reasoning there expressed is that, in light of the fluctuation in Ms Negri's symptoms, it is appropriate to assess an "average day". Another way of expressing that, as the Tribunal did at [4] and [6] of its oral reasons in particular, is to say that one is concerned with "overall functioning". If "moderate functional impact on activities requiring physical exertion or stamina" describes Ms Negri's "average day" or "overall functioning" in circumstances where Ms Negri does not experience symptoms every day, it must follow that on days where Ms Negri does experience symptoms the functional impact is greater: certainly still "moderate functional impact", and possibly "severe functional impact".
58 The essence of the reasoning in the November report, then, is that Ms Negri experiences symptoms that, when experienced, had at least a moderate and possibly a severe functional impact. The symptoms, as I explain below, were those identified in the heading "Functional Impact" and "Supporting reasons summary". However, those symptoms were not experienced every day, which is to say that her symptoms were fluctuating. Accordingly, it was appropriate to assess the "average day". Considering the average day, it was said, it was appropriate to assign 10 points under Table 1, which is to say that on average Ms Negri suffered from a moderate functional impact on activities requiring physical exertion or stamina.
59 The reasoning of the Tribunal as revealed by its oral reasons was, in my view, broadly the same. Reference was made to the symptoms said to be suffered by Ms Negri (albeit in extremely broad terms, and without making specific findings): "[w]e can do some of these things" - that is, the examples listed in the Table, which had been the subject of evidence and submission - "and we can't do some of the other things". However, those symptoms were not experienced every day: "[s]o we've heard two to three days, that's less than 50 per cent of the week". The "two to three days" evidence may have had its genesis in the February report, in which appears these sentences: "[t]he client reported fluctuating in symptoms and severity of symptoms. The client stated that usually she has at least 2-3 'bad days' where she is unable to do anything due to reduced endurance and back pain, even her everyday stretches." That passage was referred to in Dr Sillcock's cross-examination and, somewhat more obliquely, in the examination in chief of Ms Negri.
60 The frequency with which symptoms were experienced was relevant because Ms Negri's symptoms were fluctuating and therefore the Tribunal considered it necessary to make an "overall functional assessment". "On balance" - that is, on average - based on Ms Negri's symptoms, their severity, and their frequency, the Tribunal considered that Ms Negri suffered from a moderate functional impact on activities requiring physical exertion or stamina. Perhaps had the symptoms been more frequent - say, "90 per cent of the time" - the Tribunal would have considered that, on balance, the level of functional impact was severe, instead.
61 Viewed in that way, the overlap between the reasoning disclosed in the November report and the reasoning disclosed by the Tribunal's oral reasons is apparent. When it is seen that the reasoning of the Tribunal proceeded along similar lines to the reasoning in the November report, as set out in the previous three paragraphs, the second putative difference to which I referred at [53] above falls away. And, when it is understood that the references to, and definitions of, the words "frequent" and "usual" were part of the Tribunal's process of assessing overall functioning (or the "on average" or "on balance" functional impairment) of Ms Negri, in light of the fluctuating nature of her symptoms, then again it is apparent that the approach is not dissimilar to that adopted in the November report and the first putative difference to which I referred at [53] above falls away.
62 Before concluding on this issue, I must say that the foregoing view is one that I take after anxious consideration, and with substantial reservation. The correlation between what a Tribunal says orally and what it later says in writing (albeit with elaboration) should generally be quite clear. Here, the correlation was not clear. On a first reading of the written reasons, one is left with the impression that the Tribunal viewed the drawing of written reasons as an opportunity to start again. And, the absence of any express reference to the JCA reports in the oral reasons sits poorly with the decisive weight of the November report in the written reasons. The Tribunal in this case flirted dangerously with impermissible alteration to its reasoning. Certainly the kind of extensive re-writing in which it engaged is not to be encouraged. However, ultimately - and with some disquiet - I take the view that the two sets of reasons can stand consistently together. Put in another way, the reasoning process disclosed by the written reasons does not substantially depart from that disclosed by the oral reasons, even though there are dissimilarities as between the oral and written reasons.
63 Therefore, I will approach Ms Negri's grounds of appeal on the basis that the Tribunal's written reasons are its reasons, except that I will look to the oral reasons for the purposes of clarification if need be.