‘is a functional rather than disease based definition, with sputum production on most days for at least three months in the year for at least two consecutive years.’ 28.2 Note: to diagnose chronic bronchitis by the MRC definition, other conditions such as bronchiestasis, tuberculosis and asthma must be excluded, though these conditions may co-exist with chronic bronchitis. 28.3 You are asked to assess the claim to establish whether the Claimant has, or had, symptoms which fulfil the criteria for the MRC definition of chronic bronchitis. Part of your role is, as set out in the qualification to the definition above, to satisfy yourself that the Claimant has or had no other conditions causing the symptoms. Bronchiestasis is likely to be the most common of these. 28.4 The questions in the Claim Questionnaire are designed to elicit the key features which must be established before a diagnosis of chronic bronchitis due to working in mines can be considered. You should keep the following points particularly in mind, and may wish at this point to look again at the Claim Questionnaire. Question 26 … The claimant must have had a cough which produced sputum during, or in very exceptional circumstances shortly after, the period when he was working underground in a British Coal mine after4th June 1954 . Question 27 … This establishes whether the claimant was treated for his symptoms. If he was not then the necessary corroboration will not exist. [Emphasis added] Questions 28 and 29 … These are designed to establish whether the Claimant’s recollection of his symptoms fulfils the MRC criteria in terms of frequency and duration of cough with sputum. Question 30 … It is not necessary for the Claimant to establish that he still has problems now in order for him to qualify for compensation for chronic bronchitis suffered during the period when he worked undergroundin a British Coal mine. Questions 31 and 31 … Haemoptisis is not a feature of chronic bronchitis. A response to this question which indicates more than a single isolated instance of haemoptisis should indicate the possibility of other conditions, particularly bronchiectstasis, and may indicate the need for further investigation. Its presence may indicate that it, rather than chronic bronchitis, was the cause of any chronic cough documented in the records. Question 33. The section of the questionnaire dealing with matters related to chronic bronchitis ends at this point. Some Claimants will not have indicated any breathlessness in response to question 7, and these individuals are being assessed via a separate process. The Claimant whom you are seeing has stated that he does have problems with breathlessness and has filled in the remainder of the Questionnaire. Your opinion as to whether he has chronic bronchitis, however, should be based on this section and your review of the records and clinical assessment as below. 28.6 The records, if available, should contain corroboration of chronic bronchitis. However, there may be circumstances when even though there is no corroborative evidence in the records the Claimant nonetheless gives you such a persuasive history that you form a clear view that he did have chronic bronchitis whilst working underground in a British Coal mine (or, in very exceptional circumstances, shortly after). 28.7 Similarly, if records are lost, whilst you should be careful about diagnosing chronic bronchitis on the Claimant’s self reported symptoms alone, if you are satisfied in your judgment that the Claimant did have chronic bronchitis you should say so. Again the parties will, if necessary, resolve the lack of corroboration via the Disputes Procedure. 28.8 … 28.9 Records vary greatly in their quality and extent. You should also keep in mind that some Claimants may be more disposed to attend their GP or take time off work than others, even with similar symptoms. You are accordingly expected to use your experience and judgment as a Respiratory Specialist when forming your view as to whether or not there is sufficient corroboration in the records to substantiate the Claimant’s statement that, whilst he was working underground in a British Coal mine(or, in very exceptional circumstances, shortly after), he had symptoms which would satisfy the MRC criteria for a diagnosis of chronic bronchitis. Further, the same experience and your judgment should be used to form your view as to whether the Claimant has or had other significant respiratory conditions. 29.10 Corroboration of a diagnosis of chronic bronchitis would be suggested by the use of terms like the following recorded in the notes whilst working underground in a British Coal mine: Chronic bronchitis (one or more entries) Bronchitis (two or more entries) Cough and phlegm/sputum/spit ( “ “ “ ) Productive cough ( “ “ “ ) Acute exacerbation of chronic bronchitis (one or more entries) 28.11 The list cannot be exhaustive. Repeated entries for “chesty cough” would qualify, as would repeated prescriptions for expectorants. 28.12 Entries stating “acute bronchitis” would not qualify. 28.15 You should keep in mind the principle that you are not asked to give either the Claimant or the DTI the “benefit of the doubt”. You are asked whether, in your judgment and on the information available to you, it is more likely than not (i.e. you are more than 50% sure) that the Claimant did have chronic bronchitis when working underground at a British Coal mine. Similarly you are forming a view, on the balance of probabilities, whether or not the claimant had other Respiratory conditions which were wholly or partly responsible for a productive cough whilst working underground (or, in very exceptional circumstances, shortly after). Chronic Bronchitis (Question 28) ‘is a functional rather than disease based definition, with sputum production on most days for at least three months in the year for at least two consecutive years.’
‘From these authorities I deduce the principles, that the overall test is still the conduct of the reasonable and prudent employer, taking positive thought for the safety of his workers in the light of what he knows or ought to know; where there is a recognised and general practice which has been followed for a substantial period in similar circumstances without mishap, he is entitled to follow it, unless in the light of common sense or newer knowledge it is clearly bad; but where there is developing knowledge, he must keep reasonably abreast of it and not be too slow to apply it; and where he has in fact greater than average knowledge of the risks, he may be thereby obliged to take more than average or standard precautions. He must weigh up the risk in terms of likelihood of injury occurring and the potential consequences if it does; and he must balance against this the probable effectiveness of precautions that can be taken to meet it and the expense and the inconvenience they involve. If he is found to have fallen below the standard properly to be expected of a reasonable and prudent employer in these respects, he is negligent.’
‘The rule stated with all the Lord President’s trenchant lucidity. It contains an emphatic warning against a facile finding that a precaution is necessary when there is no proof that it is one taken by other persons in like circumstances. But it does not detract from the test of the conduct and the judgment of the reasonable and prudent man. If there is proof that a precaution is usually observed by other persons, a reasonable and prudent man will follow the practice in like circumstances. Failing such proof the test is whether the precaution is one which the reasonable and prudent man would think was so obvious that it was folly to omit it.’
‘The investigation is concerned with ‘fault’ which includes blameworthiness as well as causation. And no true apportionment can be reached unless both of those factors are borne in mind.’
‘A greater use of dust respirators could probably do more to eliminate dust disease among coal miners than any other course that is technically feasible at the present time – and at a fraction of the cost. Draft Proposals for the Provision and Servicing of Respirators, which represent a small step towards their greater use were agreed in principle by the Respirator Approval Sub-Committee … for submission to the Director General of Mining with a view to being issued as a Mining Department Instruction in due course.’
‘A greater use of dust respirators could probably do more to eliminate dust disease among coal miners than any other course that is technically feasible at the present time – and at a fraction of the cost. Draft Proposals for the Provision and Servicing of Respirators, which represent a small step towards their greater use were agreed in principle by the Respirator Approval Sub-Committee … for submission to the Director General of Mining with a view to being issued as a Mining Department Instruction in due course.’
‘Fairly normal on the flat but breathless on inclines and stairs.’
‘On the flat he can walk fairly normally but on inclines stops at 400 yards.’
‘After climbing a flight of stairs, has to stop because of breathlessness.’