Introduction

In a number of recent cases in which I have been instructed, I have seen Claimant experts seek to argue that a “blotchy” or “mottled” presentation of the vascular component of Hand Arm Vibration Syndrome (“HAVS”) could lead to a positive diagnosis. In June 2025, this issue came to trial in Middlesbrough before HHJ Robinson in the case of Bennett v Altrad, in which I represented the Defendant. The Court heard oral expert evidence from both sides and dismissed the claim.

Background

The vascular component of HAVS, also known as secondary Raynaud’s Phenomenon, presents with clear colour changes in the fingers of the affected hand or hands. The classic description is that, during an attack, the Claimant’s fingers look like they have been “dipped in paint”. There should be a sharp demarcation line between affected and non-affected skin. This is a result of arterial vasospasm and vasoconstriction following damage caused to the structures of the hand by the use of vibrating tools.

In this case, the Claimant’s presentation did not include the normal sharp demarcation. Instead, on the basis of photographs provided by the Claimant, the presentation was one of a “blotchy” or “mottled” appearance of colour changes throughout the Claimant’s hand (not limited to the fingers).

The Claimant’s medical expert sought to argue that this was an “atypical” presentation of the vascular component of HAVS. The Defendant, relying on the evidence of Mr Stuart, contested this and argued that the Claimant did not have HAVS.

The matter came to trial in June 2025 in a two-day hearing before HHJ Robinson sitting in Middlesbrough.

The Arguments for the Claimant

The Claimant’s expert sought to argue that the Claimant had an atypical presentation of HAVS. He pointed to two case studies in support of this. However, on close consideration of the case studies relied upon by the Claimant’s expert, one of these was in fact a case of Raynaud’s Disease (as opposed to Raynaud’s Phenomenon) and the other included photographs that in fact showed a classical presentation with clear demarcation.

The Arguments for the Defendant

The Defendant pointed to a number of sources in support of its argument that the Claimant simply did not meet the criteria for a diagnosis of HAVS. In particular:

  • The IIAC definition of HAVS, which provides as follows:

The current definition of the VWF prescribed disease PDA 11 is:

“(a) Intense blanching of the skin, with a sharp demarcation line between affected and non-affected skin, where the blanching is cold-induced, episodic, occurs throughout the year and affects the skin of the distal with the middle and proximal phalanges, or distal with the middle phalanx (or in the case of a thumb the distal with the proximal phalanx), of—

(i)in the case of a person with 5 fingers (including thumb) on one hand, any 3 of those fingers, or

(ii)in the case of a person with only 4 such fingers, any 2 of those fingers, or

(iii)in the case of a person with less than 4 such fingers, any one of them or, as the case may be, the one remaining finger,

where none of the person’s fingers was subject to any degree of cold-induced, episodic blanching of the skin prior to the person’s employment in [a prescribed occupation]”

  • Dr Lawson’s Society of Occupational Medicine document “The Identification and Management of Hand Arm Vibration Syndrome (HAVS)” (2023).
  • Hunters Diseases of Occupation (10th ed), Chapter 47. This is an excellent “primer” on the medical issues relating to HAVS. This sets out that “blotchiness of the fingers may be a complaint. This is not normally considered to be Raynaud’s Phenomenon, which causes a uniform blanching. Mottling is a common normal skin appearance.”
  • The NICE Guideline for Raynaud’s Phenomenon, which states that a patient would typically present with: “Clearly demarcated blanching (due to vasospasm and vasoconstriction) which is necessary to make the diagnosis”.

The Decision of the Court

At the trial of the case, both experts gave evidence and were cross examined. The Claimant’s expert accepted that, applying the criteria in IIAC, NICE and Hunter’s, the diagnosis would not be made out. Nevertheless, he maintained that he had a “gut feeling” that the Claimant had HAVS.

HHJ Robinson dismissed the claim. He held that there was no objective evidence of HAVS. He found that the Claimant’s expert had been inconsistent, that his evidence had “oscillated” and had been confusing. The Judge preferred the evidence of Mr Stuart and held that the Claimant did not have HAVS. He held that there needed to be an objective basis for the diagnosis, and that this was absent from the Claimant’s case.

Practice Points

The main point to take from this decision is that a purported “atypical” presentation of the vascular component of HAVS should be treated with scepticism by Defendants. The decision underlines the importance of clear and objective evidence in support of a diagnosis, and it is my view that cases involving a “blotchy” or “mottled” presentation of purported Raynaud’s Phenomenon are unlikely to meet the criteria for a diagnosis of HAVS.

One issue that arose in this case was the importance of photographs showing the vascular attacks. This is highlighted in the IIAC 2019 Position Paper 43. Those acting for both Claimants and Defendants in these cases should seek to obtain clear photographs showing a vascular attack in order to confirm a diagnosis. Sometimes, for example if a Claimant has been started on nifedipine, this may not be possible.

I was instructed in this case by Jonathan Alexander-Mitchell of DAC Beachcroft.

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