Christopher Stephen Fraser v Ministry of Defence

A diagnosis of non-freezing cold injury is a clinical diagnosis based on the overall clinical history. It requires evidence of cold exposure, subsequent symptoms and signs compatible with the condition, and exclusion of other underlying causes. The court must weigh factors for and against the diagnosis, including the nature and duration of exposure, the timing and character of symptoms, contemporaneous records and the course of later symptoms. An expert opinion based on an inaccurate or incomplete history, or on reasoning that assumes the diagnosis and then explains away contrary evidence, may be rejected. A claimant must prove causation on the balance of probabilities.

The claimant, an Army chef, sued the Ministry of Defence for personal injury following a cold weather survival course in Norway in January 2018. Liability had been agreed at 90% for injuries caused by exposure to the cold, with causation and quantum to be determined individually.

It was admitted that the claimant suffered a small area of frostbite to his left ear. The disputed issue was whether he also sustained non-freezing cold injury affecting his hands. The claimant relied principally on vascular evidence, while the defendant relied principally on neurological evidence. The court also considered rheumatological evidence and the contemporaneous medical records.

1. Outcome. The claimant failed to establish on the balance of probabilities that he sustained non-freezing cold injury to his hands. He was entitled to compensation only for the admitted freezing injury to his left ear, for which the parties had agreed quantum of £5,000, subject to interest and the agreed liability apportionment.
2. Applicable diagnostic approach. Non-freezing cold injury is a clinical diagnosis requiring a history of cold exposure, subsequent symptoms and signs compatible with the condition, and exclusion of other underlying causative conditions. The diagnosis depends heavily on the clinical history, but the history must be assessed against contemporaneous records, the evidence at trial and the expert evidence.
3. Evaluation of the evidence. The court found that the claimant had rewarmed over breakfast without hand symptoms before the icebreaker exercise. He had no typical symptoms on rewarming after that exercise or when attending the medical centre. The later colour changes and knuckle pain were not attributable to non-freezing cold injury, and the deterioration in symptoms was inconsistent with its usual pattern. These matters made the diagnosis less likely, although none alone excluded it.
4. Expert evidence. Mr Cross’s diagnosis depended on a history inconsistent with the court’s factual findings, the other expert histories and the medical records. His reasoning worked backwards from the assumed diagnosis and sought explanations for contrary features. The court therefore preferred Dr Mumford’s conclusion that the clinical history and symptoms were inconsistent with non-freezing cold injury.
5. Final order. The claimant was to be compensated only for the ear injury. The parties were invited to agree the consequential order and calculate the final sum after interest and the agreed liability arrangement.