[2024] UKUT 18 (AAC)

19 June 2012: “Acute back pain – lumber(First) not had previously, no neuro sx … tender over L3-5, rediced [sic] flexion …” (page C58)

22 June 2012: “re back pain / wants walking sticks … no longer needs she went to the hospital yesterday and got some” (page C58)

11 December 2012: “Acute back pain – lumbar(New) … acute low back pain recurred-wants referral to physiotherapy and anaelgesia” (page C56)

11 December 2012: “MED3 issued to patient(First) back pain 2 weeks”

16 January 2013: “Assault and headinjury [sic]; Duration 14/01/2013 – 28/01/2013” (page C56)

[between 23 September and 1 October 2013, applicant had hysteroscopy – page C54 (not clear from 23/9/13 entry whether it was the operation the next day, or just the pre-op assessment)]

1 October 2013: “still getting some pain in back since operation” (page C54) (comes after hysteroscopy whether or not caused by it)

7 October 2013: “Hysteroscopy NEC(Review) … still getting some pain in the back … another 1w given” (page C54)

6 December 2013: “back pain for a few months” (page C53)

7 December 2013: “Low back pain(First) … on and off for a year but getting worse this last 3-4 months esp over the last 2 weeks. there all the time in her lower back” (page C53)

5 June 2014: “flare of pain in back, has had this before. cocodamol helps” (page C48, first entry)

6 August 2014: “Low back pain(New) … wants an MRI scan. flares can last up to 3-4 weeks. this time has lasted 3-4 days very severe when it comes. used to have leg pain but now just low back. no neuro symp. seen here by NP dec/june. examined in dec. same symp as then. no trigger. never saw physio. was referred by nP in dec naproxen/cocodamol not helping … Diazepam 2mg tablets 1-2 for acute back pain … Tramadol 50mg capsules” (page C47)

7 August 2014: “diazepam and tramadol not touching pain. walking with a crutch. will come in for rv/exam” (page C47)

7 August 2014: “Low back pain(Review) … pain ++ diazepam x2 tramadol x2 today no effects … painand tenderness across whole of lumbar spine and paralumbar and sacrum. limited flexion. neg staright leg raise. but pain bilaterally on most movement of leg. flexion of hip causes pain in back + b/lateral” (page C46)

15 August 2014:“someone went into back of her car. having headache and back and neck pain. told by insurance needs to see GP. tablets help a bit for back but not helping neck/head … Whiplash injury (First)” (page C46)

15 August 2014:

First, I have included the entries for back pain after the hysteroscopy because I am including all the back pain entries I have found. The hysteroscopy itself cannot of course have been the cause of the pre-hysteroscopy back pain. I have not formed even a provisional view on whether a point can be made that all back pain prior to the hysteroscopy was caused by whatever gynaecological condition (if any) or other non-domestic-violence related condition caused the symptoms that merited the hysteroscopy.

Second, the first two post-RTA medical notes entries after the RTA refer to the post-RTA pain as “Whiplash injury”, and give whiplash its own entry separate from the “Low back pain entries” which preceded and succeeded the RTA date. While that distinction is not maintained in entries for back pain after those first two entries, the distinction suggests that, immediately after the RTA, injuries from the RTA were considered separate from the back pain that had appeared in the medical notes prior to the RTA. That later entries do not mention whiplash as separate from the back pain does not on the face of it appear to detract from that point.

Third, I accept that there are entries in the medical notes which show the applicant asking her GP to record that her back pain is from the RTA. For example, on 9 June 2016: “She is calling further regarding her letter. She would like me to say the back [sic] was attributed to the accident. She however had back pain prior to the accident in 2014” (page C23). There is also an entry on 6 June 2016 showing her asking her GP not to say in a letter that the applicant had been off work prior to August 2014: “I called pt as she has been off work prior to August 2014. she is adamant she wants letter to say off work since August 2014” (page C24). Those post-RTA entries cannot undo the pre-RTA back pain entries, but may mean that the applicant was trying to claim that pre-existing pain did not in fact pre-exist the RTA, for insurance purposes. That does not however detract from the fact that the pre-RTA entries record back pain.

Fourth, I have included the entry which records an assault and head injury not because it also mentions back pain, which it doesn’t, but for transparency and because it is an entry that might be an instance of the domestic violence and so might give context.