“Section 6: (1) A person (P) has a disability if:- (a) P has a physical or mental impairment, and (b) the impairment has a substantial and long-term adverse effect on P’s ability to carry out normal day-to-day activities.” (5) A Minister of the Crown may issue guidance about matters to be taken into account in deciding any question for the purposes of subsection (1). (6) Schedule 1 (disability supplementary provisions) has effect. Schedule 1 Part 1 – Long term effects: 2(1) The effect of an impairment is long-term if- (a) It has lasted for at least 12 months, (b) It is likely to last for at least 12 months, or (c) It is likely to last for the rest of the life of the person affected. (2) If an impairment ceases to have a substantial adverse effect on a person’s ability to carry out normal day-to-day activities, it is to be treated as continuing to have that effect if that effect is likely to recur. 5(1) An impairment is to be treated as having a substantial adverse effect on the ability of the person concerned to carry out normal day-to-day activities if: (a) measures are being taken to treat or correct it, and (b) but for that, it would be likely to have that effect. (2)‘Measures’ includes, in particular, medical treatment… Guidance: Meaning of ‘substantial adverse effect’: B1. The requirement that an adverse effect on normal day-to-day activities should be a substantial one reflects the general understanding of disability as a limitation going beyond the normal differences in ability which may exist among people. A substantial effect is one that is greater than the effect which would be produced by the sort of physical or mental conditions experienced by many people which have only ‘minor’ or ‘trivial’ effects (this is stated in the Act at s212(1). Meaning of ‘normal day-to-day activities’: D2. …In general, day-to-day activities are things people do on a regular or daily basis, and examples include shopping, reading and writing, having a conversation or using the telephone, watching television, getting washed and dressed, preparing and eating food, carrying out household tasks, walking or travelling by various forms of transport and taking part in social activities.”
“24. During the three and a half month period between July/August 2007 to November 2007 the Claimant was unable to function fully on a day-to-day basis. She was unable to get out of bed for several days at a time because she felt unwell and fatigued. She was unable to go shopping and was unable to do very much house work such as cleaning and vacuuming. 25. During the period from July 2010 to the end of October 2010, following the Claimant’s resignation she had two bouts of diarrhoea and visited her GP. From beginning of August 2010 to mid September 2010 the Claimant went on holiday to New Zealand for approximately six weeks and during her trip she had a chest infection at the beginning of September 2010. For both the diarrhoea and the chest infection the Claimant used antibiotics. At that time the Claimant always kept a spare course of antibiotics so that she could use these should she get an infection. 27. The Claimant was fit to work from the date of her resignation on 25 th July 2010 to the end of October 2010.”
“35. In answer to a question from us as to the last time the Claimant suffered chronic fatigue up until October 2010 the Claimant could not recall. However, in her first witness statement (C1) she stated that during the period from May 2008 to July 2010 there were times when she felt she had no other choice than to take sick days, and this was at the point when she was experiencing multiple symptoms, for example, an infection and fatigue. 36. The Claimant’s evidence was not able to demonstrate that her impairment had an adverse effect on normal day-to-day activities during the relevant period up to October 2010. Both the Claimant and Professor Grimbacher agree that Selective IgA does not itself have any effect on the Claimant’s ability to carry out normal day-to-day activities. We therefore, find the Claimant’s impairment did not have either an adverse effect, or a substantial adverse effect, on her ability to carry out normal day-to-day activities at the relevant time.”
“32. …… ‘On the Claimant’s capacity to carry out the normal day-to-day activities, selective IgA deficiency does not have any effect….It is important to note the selective IgA deficiency renders patients susceptible to recurrent infections, hence during the time of infections, patients’ ability to work is obviously severely impaired and results in sick leave, however, when infections are controlled and especially during summer months when infections are less prevalent, there is no detectable impairment of patients with this immune dyscrasia.’”
“26. The Claimant is prescribed medication related to her Selective IgA. From the end of March 2011 (which is after the relevant period ended in October 2010) she was prescribed a prophylactic antibiotic which she now takes everyday to help prevent her get (sic) infections. She is prescribed Fexofenadine 180 mgs which is a very strong antihistamine which she takes everyday. She has been taking this for ten years. She is prescribed Citalopram 10 mg everyday. She stopped taking Citalopram for a period but started taking it again from December 2010 (after the relevant period). In January 2010 she started a trial in relation to a Vitamin B12 injection. The trial is to determine the best frequency. Initially she had the injections every week, then every month for six months and now it is every three months for a year. The Claimant’s regime will next be considered in November 2011. The Claimant is also prescribed Nasonex nasal spray which she has taken everyday for the last three years. The Claimant told us that the above medication, excluding the Citalopram are the relevant medications for keeping her well as a result of her Selective IgA. ……. 38. The relevant medication taken by the Claimant for the Selective IgA at the relevant time included Fexofenadine, a Vitamin B12 injection and Nasenex nasal spray. In addition, when the Claimant suffered from an infection she normally took antibiotics.”
“42…..that if the medication is disregarded the claimant would be more susceptible to infection because of her impairment of Selective IgA, and she would be less able to recover than someone who did not have that impairment. Moreover, the claimant’s impairment makes her more prone to infection and there is a cause and effect relationship between the claimant’s impairment of Selective IgA and her infection. Further, if medical treatment is disregarded then infections are more likely to occur which will then result in a substantial adverse effect on the claimant’s ability to carry out normal day-to-day activities, namely getting to work, shopping, housekeeping and walking. The majority rely on Professor Grimbacher’s answer to Question 6, the relevant parts of which we have quoted above in our Reasons, and in particular Professor Grimbacher’s comment that Selective IgA renders people more ‘…susceptible to recurrent infections ….’, and that during the time of such infections the claimant’s ‘…. ability to work is obviously severely impaired and results in sick leave… .”
“43 ….that, if the claimant’s medication is disregarded then it is ‘likely’ (using the interpretation in the Boyle case that it ‘ could well happen’ ), the claimant will be prone to infections. However, the claimant gave unconvincing evidence when she was asked on several occasions how, when she had an infection, this affected her normal day-to-day activities. The claimant told us when she had an infection she had sometimes, but not usually, taken time off work and that she felt fatigued, but she was not able to tell us of any occasion after November 2007 when she was unable, for example, to go shopping or do the housework. Moreover, the claimant has had infections on various occasions since November 2007 but was unable to recall any occasion when the effects were similar to the period between August 2007 and November 2007. The minority considered the examples given in the Appendix to the Guidance as to when it would be reasonable to regard factors as having a substantial adverse effect on normal day-to-day activities. The minority finds the claimant has not shown between November 2007 to October 2010 that, if her medication was disregarded, it would be likely there was a substantial adverse affect (sic) on her ability to carry out normal day-to-day activities.”
“…there is a likelihood of recurrence in relation to the claimant contracting infections and that this ‘ could well happen’. Although Professor Grimbacher refers to this being ‘ unlikely to happen’ he then qualifies this initial statement by stating that the claimant will remain susceptible to infections in the future and that such infections ‘ …may always happen as infections also happen in completely healthy individuals …’ .”
“52. …that because the claimant’s impairment of Selective IgA is a condition that the claimant was born with and will last for the rest of her life, the fact that the claimant (who was born on 12 th October 1967) has only adduced evidence in relation to one period of substantial adverse effect during her life of approximately 3 months from July/August 2007 to November 2007 is not sufficient in itself to show that a substantial adverse effect on the claimant’s abilities to carry out normal day-to-day activities ‘ could well happen’ . Further, the evidence adduced by the claimant between November 2007 to October 2010 shows only that the claimant has had intermittent periods of short-term sickness mainly due to chest infections, diarrhoea and UTI. At times this may well have caused the claimant fatigue, but the claimant has not adduced evidence to show a substantial adverse effect on normal day-to-day activities during this period.”
“Dr Baxendale’s letter of 29 th March 2010 referred to in the judgment paragraph 30 relates that I continued to report persistent and ‘chronic fatigue’ as a component of my medical presentation and I would therefore argue that this symptom does, and continues to have the potential to have, a detrimental effect on my day-to-day functioning. When combined with a number of other factors, for example, an infection or several infections, as I am prone to experiencing, this can and does have a cumulative impact on my ability to function both physically and cognitively.”
“… as my symptoms are well controlled at present, the potential for substantial adverse effects are less likely to return than it would be should my medication regime and coping strategies be removed. The majority did therefore not misdirect themselves in applying the correct test of ‘ could well happen.”
“…evidence was not able to demonstrate that her impairment had an adverse effect on normal day-to-day activities during the relevant period up to October 2010.”
“37 …..the effect of any medical treatment within the meaning of paragraph 5, Schedule 1 to EqA and whether the claimant’s impairment is to be treated as having a substantial adverse affect (sic) on her ability to carry out normal day-to-day activities (the deduced effect).”
“20. Firstly, was there at some stage an impairment which had a substantial adverse effect on the applicant’s ability to carry out normal day-to-day activities? 22. Secondly, did the impairment cease to have a substantial adverse effect on the applicant’s ability to carry out day-to-day activities, and if so when? 24. Thirdly what was the substantial adverse effect? 25. This question needs to be answered with a degree of precision, for as we shall see, paragraph 2(2) requires the tribunal to consider whether that effect is likely to recur… 26. Fourthly, is that substantial effect likely to recur?”
“…that the Claimant was not able to get out of bed for several days at a time because of fatigue, was unable to go shopping and was unable to do very much housework such as cleaning and vacuuming.”
“…Professor Grimbacher does not appear to deal with the question as to whether the substantial effect of the Claimant’s impairment is likely to recur.”