[2025] UKUT 365 (AAC)

At a hearing on 16 February 2024, the Tribunal upheld the Secretary of State’s decision and dismissed the appeal.

The Tribunal proceeded on the basis that the only matter in issue was whether the ten specific, documented accidents relied on had “caused” the injury. The Tribunal concluded that they had not.

The Tribunal noted that there was no dispute that the ten incidents relied on were indeed “accidents” and that Mr Watson was at the time of each accident an “employed earner” as required by the legislation. It directed itself at [10] of the Decision Notice (which stood as the Tribunal’s Statement of Reasons) that:

“Mr Watson … needed to demonstrate to the Tribunal on a balance of probability that (i) the ten accidents caused or contributed to his loss of faculty; (ii) but for these accidents, his loss of faculty would not have occurred and (iii) these accidents were an effective cause of his loss of faculty.”

Its conclusion is summarised at [3]-[4] as follows:

“3.

Mr Watson’s neurological loss of faculty and resulting disability at the time of the decisions was likely to have been caused by constitutional factors and the process of routine footballing activity such as repeatedly heading the ball and/or numerous other undocumented incidents over the years that he played football. The Tribunal could not be satisfied that the ten accidents claimed either individually or collectively were an effective cause of Mr Watson’s brain injury.

4.

Applying its medical expertise, the Tribunal found on the balance of probability that had the ten accidents claimed not occurred, Mr Watson would have been in the same position in terms of his loss of faculty at the time of decision.”

The Tribunal held that the majority of the ten accidents “appeared minor at the time” as the appellant continued to play following the accidents, though it noted at [12] that “The most serious of these accidents occurred in January 1980 when a goalkeeper mis-punched the ball and contacted Mr Watson’s head. He was briefly unconscious but continued to play for the remainder of the match. He was subsequently seen in hospital and treated for concussion”. (Counsel at this hearing drew my attention to his wife’s diary, which contains a fuller account of this incident in which she describes how at the end of the match the appellant “was running around without a clue where he was, unaware that he had scored and after the final whistle had to be shown where the dressing-rooms were” and that on driving him home “He could not remember his way home, he could only vaguely remember the bungalow, he had forgotten all about Christmas some six weeks before, and he kept repeating the same questions over and over again”.)

At [13], the Tribunal found:

“In addition to these ten accidents, Mr Watson regularly suffered head injuries when playing football and when training. Mrs Watson confirmed that there were likely to have been many more undocumented injuries … The ten claimed accidents represented a fraction of the injuries Mr Watson sustained in the course of training for and playing in football matches. …”

The Tribunal considered the appellant’s medical evidence and two academic articles on which the appellant relied (including the Nowinski article referred to above) and observed at [18]:

“Neither study assisted in terms of determining whether impacts from accidents, such as a clash of heads or a punch to the head during a football game was more contributory to impacts from day to day process, such as regularly heading the ball during matches or training. Research in this respect remains limited. In 2016, the Industrial Injuries Advisory Council (IIAC) declined to prescribe neurodegenerative diseases in professional sportspeople given the limitations in the evidence base. Whilst it was pointed out … that the IIAC is reconsidering its position in this respect, the Tribunal was considering the position as it stood.”

Although the diagnoses of probable Alzheimer’s and probable CTE relied on precisely the same physiological symptoms and CT scan results, the Tribunal considered separately the probable causes for each condition.

At [20] the Tribunal concluded in relation to Alzheimer’s that:

“Mr Watson’s probable Alzheimer’s Disease was likely to have constitutional causes. The medical evidence reflected that Mr Watson’s neurological problems are more due to Alzheimer’s rather than CTE. He has a family history of dementia /cognitive impairment. The contribution of the ten claimed accidents to that condition, if any, was minimal. The loss of faculty Mr Watson sadly suffers from was likely to have occurred in any event as a result of his probable Alzheimer’s Disease.”

At [21]-[23] the Tribunal concluded in relation to CTE:

“21.

The process of Mr Watson repeatedly heading the leather ball was clearly a significant risk factor for developing CTE. This was noted by Dr Denning in his conclusion that there was no reason to doubt a contribution of CTE to Mr Watson’s impairment. This is important because the repeated heading of the ball by Mr Watson in the course of his employment is a process rather than accident and cannot give rise to entitlement to IIDB because the conditions Mr Watson suffers from are not prescribed as noted above. Whilst medical literature may have established a link between neurodegenerative disease such as Alzheimer’s Disease and CTE with playing various sports, the evaluation of those sports has been considered holistically with no differentiation between which portions are caused by accidents within sport and which are caused by the process of playing sport.

22.

Mr Watson sustained head injuries, which for the most part appeared minor to the Tribunal, following each of the documented accidents. However, he also sustained a large number of other, undocumented injuries as well as his repetitive heading of the ball, both in training and in playing football matches. Given this background, the Tribunal could not be satisfied on the balance of probability that ‘but for’ these ten accidents, that Mr Watson’s brain injury would not have occurred.

23.

The Tribunal did not find that the ten accidents complained of were an effective cause of Mr Watson’s probable CTE. The Tribunal noted that it would be sufficient that the incidents, whether singly or in combination, were an effective cause of Mr Watson’s injury. They did not have to be the sole or main cause. This was not the case. The probable 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. In addition to the ten mostly minor incidents noted, Mr Watson was regularly involved in other incidents which were not documented and from which he regularly sustained injuries. Against that background, there were likely to be constitutional causes of Mr Watson’s probable Alzheimer’s Disease which could not be distinguished from the CTE condition.”

The mention in that last paragraph of “constitutional causes” as a contributing factor is a reference back to the Tribunal’s finding of fact at [15] that “Mr Watson had a family history of dementia / cognitive impairment in his two older brothers, who had also played professional football”.