London Fire & Emergency Planning Authority, R (on the application of) v The Board of Medical Referees & Anor

An injury award under the Firemens’ Pension Scheme turns on whether a qualifying injury caused or substantially contributed to the relevant infirmity. Where an accident activates symptoms in a previously asymptomatic degenerative condition, acceleration does not automatically exclude causation. There is no bright line between acceleration and aggravation. The issue is fact-sensitive and ordinarily for the medical decision-maker on the medical evidence. Judicial review does not permit substitution of the court’s own medical assessment where the board’s reasons disclose a conclusion it was entitled to reach.

A firefighter who had previously experienced no hip symptoms slipped while on duty. Medical evidence showed severe pre-existing degenerative change, with symptoms appearing after the accident and incapacity leading to medical retirement. The Fire Authority refused an injury award under the Firemens’ Pension Scheme Order, relying on a medical report which treated the condition as naturally occurring and merely accelerated by the accident.

A medical board allowed the firefighter’s appeal, concluding that the fall had caused the degenerative change to become symptomatic and arthritic. A deputy High Court judge dismissed the Authority’s judicial review challenge. The Authority appealed, arguing that the board had misapplied the causation rules, wrongly assessed the medical evidence and failed to give adequate reasons. The central issue was whether acceleration of symptoms, without proof of aggravation, could satisfy the requirement that the infirmity was occasioned by a qualifying injury.

1. Appeal dismissed. The Board’s decision was not amenable to judicial review on the grounds advanced, and the deputy High Court judge had correctly rejected the challenge.
2. Under rule B4, read with rules A9, A10 and A11 of Schedule 2 to the Firemens’ Pension Scheme Order, the relevant question was whether the qualifying injury caused or substantially contributed to the infirmity producing the firefighter’s incapacity. The accepted facts established permanent disablement and a qualifying injury. The disputed issue was causation.
3. There was no single legal answer where a qualifying injury affected a pre-existing degenerative condition. Each case depended on its facts and on the assessment of the medical board. A trivial injury might fail to establish the necessary causal link. The same could apply where the joint had already begun to show signs of arthritis before the injury.
4. Acceleration of the onset of symptoms did not, by itself, prevent a causal link. There was no bright line between acceleration and aggravation. The Board was entitled to conclude that the fall had been sufficient trauma to make the previously symptom-free joint arthritic, having regard to the absence of earlier pain or inflammation and the medical evidence.
5. The Board had not expressly considered aggravation, although the evidence might have supported that conclusion. That omission did not invalidate the decision because the reasons recorded in the proceedings disclosed a lawful and rational basis for the conclusion reached.
6. The practical difficulty that an injury award might later be difficult to reduce did not justify reading an absolute exclusion for accelerated symptoms into the scheme. If that consequence resulted from the regulations, it was for the regulations to address.

• Court of Appeal (Civil Division): Appeal dismissed. [2008] EWCA Civ 1515
• Queen’s Bench Division: Michael Supperstone QC, sitting as a deputy High Court judge, dismissed the judicial review challenge to the medical board’s decision.