[2025] UKUT 365 (AAC)

Identification of the effective causes

Secondly, the Tribunal’s reasoning as to the effective causes of the appellant’s CTE was also flawed. In accordance with the principles set out above at [40]-[41], the Tribunal needed to decide, on the balance of probabilities, what the effective causes were of the appellant’s loss of faculty. In assessing this, it needed to take into account all the relevant evidence, including: (i) the views of the appellant’s treating clinicians, Dr Ganesan and Dr Dening, as to whether the causes included ‘just’ heading the ball or also specific head injuries suffered during his career; (ii) the IIAC review and current conclusion that the risk of CTE among footballers is not twice that in the general population; as well as (iii) other developments in the medical literature that the parties put before it as to the causes of CTE. The question of causation was a matter for the Tribunal to assess on the facts, using its own expertise as appropriate, but it needed to reach a conclusion that was not perverse and it needed adequately to explain the reasons for its conclusions.

The Tribunal in this case concluded that the CTE was “likely to have been caused by the process of Mr Watson’s repeated and regular heading of the football in the course of games and in training” ([23]) and also by the other undocumented incidents from which he sustained injuries, but that the ten documented incidents were not on the balance of probabilities a contributory cause ([24]). That conclusion suffers from the error of not considering whether the undocumented incidents were accidents (as already dealt with under ground 2 above), but it is also on its face inadequately reasoned as to causation.

The Tribunal has effectively decided for itself something that the IIAC has not accepted, and which (as I understand it) remains in significant dispute in the medical evidence, which is that routine heading of a football elevates the risk of CTE to the extent that it can be concluded on the balance of probabilities in a particular case that it is an effective cause of CTE. Without further explanation, that conclusion is unsustainable. It contradicts the conclusion of the IIAC from 2016. The Tribunal fails adequately to explain why it concludes that routine heading of the ball is an effective cause of his condition (i.e. has materially contributed to his loss of faculty or to the nature/extent of his loss of faculty), but that more significant head impacts that were recognised and documented at the time as being out of the ordinary (and some of which resulted in concussion) have not had any material impact on his loss of faculty, or the nature or extent of the loss of faculty. I am not saying that it would not be open to the Tribunal on remission to reach the same conclusion, but if it does, it needs to do a better job of explaining its reasoning.