Our Functional Neurological Disorder SIG continue their series delving into the casebook to examine strategies for handling FND claims. This second article looks at types of treatment while reinforcing our previous case study on the need for a full picture of preexisting issues.
This case arose from an incident in September 2017 when the claimant, an army staff sergeant, suffered injuries after tripping on a protruding screw when walking down the stairs at his barracks.
His injuries initially presented as a soft tissue injury to his back, but subsequently developed into chronic low back pain, psychological issues and a diagnosis of Functional Neurological Disorder. The symptoms linked to his FND diagnosis included altered sensation, reduced power and paralysis in the right leg, an exacerbation of previous migraines, along with bladder, bowel and sexual dysfunction. Our neurology expert had described FND as a genuine neurological problem, but one which takes origin on a psychological or psychiatric basis.
There was no dispute over the FND diagnosis made by his treating rheumatologist in June 2018. The claimant had an MRI scan of the head in May 2018, which was normal and showed his symptoms weren’t caused by a traumatic brain injury. The relevant medical experts in this case were neurology and neuropsychiatry, and they all agreed he’d developed FND. However, the claimant’s history threw up issues of causation which had to be addressed.
This included lower back pain beginning two years pre-accident, slurred speech after a minor injury with no organic cause eight years prior and a collapse at work three years before with left-sided weakness and no organic cause. He also had a complicated psychiatric history including a prior breakdown, anxiety and stress at home.
The neurologists agreed that the claimant had a pre-existing vulnerability to developing FND due to these issues, quantified at 10-15%. They also agreed that his FND would improve significantly with treatment. The treatment recommended was a multidisciplinary team (MDT) approach, necessary for FND. They recommended it be intense and over a short period of time (six weeks), and should include neurology, physiotherapy, occupational therapy and psychological input. This would have seen at least a 50% improvement.
The neuropsychiatric experts agreed that the FND was triggered by the index accident but were also in agreement that the claimant was already psychologically vulnerable and, on the balance of probabilities, it was likely that any further incident causing injury would have provoked FND.
The pleaded claim was significant at just over £1.6 million with pain, suffering and loss of amenity only £55k of this. Past losses were just under £200k with the majority of the claim relating to future loss of earnings, pension, care, aids and equipment and treatment, totalling £1.4 million.
The claimant was medically discharged from the army in August 2019, two years after the accident. The defendant argued that it was highly likely this would have happened anyway, given he was medically downgraded and upgraded at various times prior to the accident as a result of his pre-existing issues. It was also suggested that he was likely to have developed FND and related symptoms at some point regardless.
While the claim ultimately settled for £700k, this is a good example of why detailed consideration of pre-accident records and pre-existing issues that could lead to the development of FND symptoms, are important for causation arguments. The case also provides a good indicator of the type of treatments that may be recommended or necessary to treat FND and improve symptoms.
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