Adams and Secretary, Department of Social Services (Social security)

[2025] ARTA 2049

Adams and Secretary, Department of Social Services (Social security) [2025] ARTA 2049 (10 September 2025)

Applicant:  Mrs Adams

Respondent:  Secretary, Department of Social Services

Chief Executive Centrelink    

Tribunal Number:   2025/S194930

Tribunal:  Member J Quinlivan

Place:Canberra

Date:10 September 2025

Decision:The Tribunal affirms the decision under review.

This means the review is not successful.

CATCHWORDS
SOCIAL SECURITY – disability support pension – epilepsy, depression and intellectual impairment – consistent written, oral and medical evidence of impairment – discrepancies in evidence of occurrences/frequency of seizures – medication doses not stabilised and being actively reviewed – occasional non-compliance with medication schedule – no specialist diagnosis or treatment for mental health or intellectual impairment – no consideration of continuing inability to work – decision under review affirmed

Names used in all published decisions are pseudonyms. Any references appearing in square brackets indicate that information has been omitted from this decision and replaced with generic information pursuant to subsection 201(1A) of the Social Security (Administration) Act 1999.

Statement of Reasons

BACKGROUND

1. This review considered whether Mrs Adams met the requirements for payment of disability support pension (DSP).

2. Mrs Adams is a 31-year-old woman who lodged an application for DSP on 29 September 2023 writing that she had the medical conditions of epilepsy and depression. On 9 March 2024, a Centrelink officer found Mrs Adams was not qualified for DSP (the original decision) because her medical conditions did not attract an impairment rating of at least 20 points under the Impairment Tables. This decision was affirmed by an authorised review officer on 19 February 2025.

3. On 8 June 2025, Mrs Adams requested a review of the decision by the Administrative Review Tribunal (the Tribunal). On 5 September 2025, a hearing was scheduled. Mrs Adams attended the hearing and spoke with the Tribunal by telephone conference. She was represented by [Miss D]. The Tribunal was assisted by a qualified interpreter. The Tribunal had before it a collection of documents provided by Centrelink and the applicant, a copy of which had also been provided to Mrs Adams. These documents represented the hearing papers (folio 1–141 and A1–3).

4. Relevant aspects of the evidence before the Tribunal will be referred to in the Tribunal’s consideration of the issues.

ISSUES

1. The statutory provisions relevant to this review are contained in the Social Security Act 1991 (the Act) and the Social Security (Administration) Act 1999 (the Administration Act).

2. The issues which arise in this case are:

   a)Whether Mrs Adams has any physical, intellectual or psychiatric impairment;

   b)Whether her impairments rate at least 20 points under the Impairment Tables; and

   c)Whether she has a continuing inability to work.

CONSIDERATION

1. Provisions relating to whether a person is qualified for DSP and whether DSP is payable to the person are contained in Part 2.3 of the Act.

2. Subsection 94(1) of the Act states, in part, that:

   94(1)A person is qualified for disability support pension if:

   (a)the person has a physical, intellectual or psychiatric impairment; and

   (b)the person’s impairment is of 20 points or more under the Impairment Tables; and

   (c)one of the following applies:

   (i)the person has a continuing inability to work.

3. In accordance with subclause 4(1) of Schedule 2 to the Administration Act, the Tribunal is required to determine Mrs Adams’s eligibility for DSP on 29 September 2023, being the date on which the claim for DSP was lodged.

4. The “relevant period” for this review extends for 13 weeks after the date of claim. That is, should the Tribunal conclude Mrs Adams did not meet qualification on 29 September 2023, but did so within 13 weeks of that date, the Tribunal would consider whether the early start date rule in subclause 4(1) of Schedule 2 to the Administration Act allows the Tribunal to grant DSP from that date.

Issue 1 – Does Mrs Adams have a physical, intellectual or psychiatric impairment?

1. As stated above, paragraph 94(1)(a) of the Act provides that the first qualification for DSP is that a person has a physical, intellectual or psychiatric impairment.

2. In oral evidence at the hearing, the Tribunal was told that Mrs Adams had the medical conditions of epilepsy, depression and intellectual impairment. The medical conditions caused impairment.

3. The Tribunal noted the documentation in the hearing papers outlined impairment arising from the medical conditions.

4. Given the consistent oral and written evidence that Mrs Adams experienced impairment arising from her medical conditions, the Tribunal found that Mrs Adams satisfied paragraph 94(1)(a) of the Act.

Issue 2 – Do Mrs Adams’ impairments rate 20 points or more?

1. As stated above, paragraph 94(1)(b) of the Act provides that the second qualification for DSP is that the person’s impairments rate 20 points or more under the Impairment Tables.

2. The Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 contains the Impairment Tables and the rules for applying the Impairment Tables when deciding if a person is qualified for DSP.

3. An impairment rating can only be assigned to a medical condition for the purposes of DSP if the condition is expected to persist for more than 24 months and was diagnosed, reasonably treated and stabilised on the date of claim for DSP and there was unlikely to be any significant functional improvement within the next two years enabling the person to undertake work.

Evidence before the Tribunal

1. The Tribunal noted the written evidence in the hearing papers and the oral evidence provided at the hearing. The relevant aspects are discussed further below under each respective medical condition.

Consideration of evidence and findings

Epilepsy

1. In oral evidence, the Tribunal was told in respect of the epilepsy that Mrs Adams developed epilepsy in 2016. When she had a seizure she fell unconscious and was not able to care for herself or her children during or shortly after the seizure. She was under the care of a specialist and was treated with medication. However, she forgot to take her medication and so she relied upon her family to remind her to take it. Despite this forgetfulness, she felt she was compliant with medication. She did not recall having blood tests to monitor her blood levels of medication or her calcium levels that had been noted to be low (hypocalcaemia) in the past. She had blood tests in her recent pregnancy. She stated that she had approximately 2 to 3 seizures a month. However she stated that she did not have any seizures during her four pregnancies (in 2018, 2020, 2023 and 2025). She did not recall any new investigations to explore why her seizure activity might have increased since 2023.

2. In terms of functional impairment, in oral evidence the Tribunal was told that Mrs Adams was not allowed to drive a car. She also lacked confidence in managing her newborn baby because she was worried she might have a seizure when she was alone with the baby and other children. She did not go out alone as she was worried about having a seizure. If she had a seizure, then she would need to go to her room for one or two hours to recover. Once she bit herself and had blood in her mouth after a seizure and her children were upset. Between seizure attacks she was all right but still felt worried. Her sister-in-law came to her house twice a week to bring a meal and do some cleaning.

3. A letter from general practitioner [Dr A] dated 5 January 2021 documented a diagnosis of epilepsy managed by the [Suburb] neurology clinic.

4. A letter from neurologist [Dr B] dated 15 September 2023 documented diagnoses of primary generalised epilepsy, hypocalcaemia and depression. The neurologist wrote that the first seizure occurred in 2016. Mrs Adams was treated with levetiracetam (Keppra) and valproate. She had three children born in 2018, 2020 and 2023 respectively without complication. In May 2020 she had missed two tablets and had a seizure. In 2023 she had a probable seizure (? pseudo seizure). The specialist did not recommend any change in medication but advocated for medication compliance and suggested increasing social support as Mrs Adams was isolated managing three young children.

5. The claim for DSP was lodged on 29 September 2023.

6. A Job Capacity Assessment report (JCAR) dated 18 December 2023 documented a diagnosis of epilepsy but concluded the condition was not treated and stabilised. Mrs Adams was considered to have a work capacity of 15–22 hours a week within two years with intervention.

7. A letter from [Dr B] dated 5 February 2024 documented a diagnosis of primary generalised epilepsy and hypocalcaemia. He documented a normal neurological examination on that date. Management was changed. The dose of Keppra was increased to 1gm BD and Lamictal was prescribed at 50mg BD with a plan to increase to 100mg BD after 10 days.

8. A letter from [Dr B] dated 16 September 2024 documented a diagnosis of primary generalised epilepsy and hypocalcaemia. He documented a normal neurological examination. Management was changed. The dose of Keppra was maintained at 1gm BD and Lamictal maintained at 100mg BD, but Fycompa was added at a dose of 2mg nocte.

9. A letter from [Dr B] dated 13 December 2024 documented a diagnosis of primary generalised epilepsy and hypocalcaemia. He documented a normal neurological examination. No change in management occurred.

10. A letter from [Dr B] dated 5 May 2025 documented a diagnosis of primary generalised epilepsy and hypocalcaemia. He documented a normal neurological examination. Management was changed. The dose of Keppra was maintained at 1gm BD and Lamictal maintained at 100mg BD and Fycompa maintained at 2mg nocte. However a new medication Frisium was added at 0.5mg nocte.

11. A letter from [Dr B] dated 4 June 2025 documented a diagnosis of primary generalised epilepsy and hypocalcaemia and a new diagnosis of intellectual disability. He documented a normal neurological examination. Management was changed. The dose of Keppra was increased to 1.5gm BD and Lamictal increased to 150mg BD and the dose of Fycompa was increased to 4mg nocte. The Frisium was ceased due to sedating side effects.

12. A letter dated 2 September 2025 from counsellor and psychotherapist [Ms C] stated Mrs Adams had epilepsy.

Findings of fact

Prognosis

1. The Tribunal found the epilepsy was a permanent condition because there was evidence of the condition dating back to 2016 in the letters from [Dr B] and it was therefore a chronic medical condition likely to persist for another 24 months.

Diagnosis

1. The Tribunal found the epilepsy was diagnosed because the condition had been diagnosed by [Dr A] and [Dr B] in their letters, and they were suitably qualified medical practitioners.

Treated and stabilised

1. The Tribunal noted there was evidence that Mrs Adams had received treatment of medication and specialist review. However her medication doses had not yet stabilised and medications continued to be actively reviewed and modified from the date of claim until even the most recent review by [Dr B] on 4 June 2025. In 2023 Mrs Adams was only on low dose Keppra and valproate, yet in the most recent letter she was on Keppra at a dose of 1.5gm BD, Lamictal of 150mg BD and Fycompa of 4mg nocte after serial upward titrations.

2. There was also a discrepancy in the oral evidence of Mrs Adams reporting no seizures during her four pregnancies, including the most recent delivery in 2025, yet having seizures in between pregnancies at a frequency of 2 or 3 seizures a month. This was difficult to understand as usually seizure activity did not abate in pregnancy and occur only at other times. The Tribunal noted that [Dr B] had raised a concern in the letter dated 15 September 2023 that some seizure activity might be pseudo seizures related to her social situation and stress. [Dr B] wrote that Mrs Adams had experienced an initial and subsequent seizure in 2016 and had then had three pregnancies in 2018, 2020 and 2023 without event until May 2020 when she had a single seizure in the setting of suboptimal compliance. She then had a single seizure in 2023 just prior to his review on 15 September 2023. The specialist had questioned if this might be a pseudo seizure, noting her isolation at home with three young children. It was difficult to otherwise understand why the epilepsy was relatively stable from 2016 to 2023 and did not occur in pregnancy, yet otherwise occurred 2 or 3 times a month in recent years when not pregnant. Further investigation might clarify this situation and explore if some seizures were pseudo seizures related to the social situation and mental health comorbidities.

3. The Tribunal found the epilepsy was not reasonably treated and stabilised on 29 September 2023 as the treating specialist had continued to implement medication titration and add new therapies in an effort to stabilise the condition after the date of claim for DSP and relevant period of this review. It was also unclear to what extent the social situation and comorbid mental health pathology might be aggravating the seizure activity.

Application of the law

1. As the Tribunal has found the epilepsy was not reasonably treated and stabilised on the date of claim for DSP, it follows that functional impact cannot be rated under the Impairment Tables.

Depression

1. In oral evidence, the Tribunal was told in respect of the depression that Mrs Adams developed this condition when she lived overseas in [Country]. It was diagnosed by [Dr B] and [Dr A]. On the date of claim for DSP she was not on any management. However, in March of 2025 she had started to see [Ms C] who spoke her language and was a counsellor. She had some counselling by telephone and had also been visited at home. Mrs Adams remained on no medication for her mental health and had not seen a psychiatrist for specialist input into her mental health management.

2. In terms of functional impairment, in oral evidence the Tribunal was told that Mrs Adams was affected “too much” by her mental health condition. She wanted to scream and to cry out. She was not able to leave her house and was not able to undertake tasks with her children as she lacked confidence and was worried about having a seizure. She was frustrated that other people worked and got to go out and enjoy activities with their children but she stayed at home.

3. The only evidence of a mental health condition from a medical practitioner predating the lodgement of the claim for DSP was the listing of the condition of depression as a comorbidity in the letter by [Dr B] dated 15 September 2023. The condition was not mentioned subsequently by [Dr B] and was not mentioned by [Dr A] in the letter dated 5 January 2021.

4. A letter dated 2 September 2025 by [Ms C] stated that Mrs Adams had attended for five sessions of counselling between March and August 2025. The letter documented that Mrs Adams reported persistent stress and anxiety. However no formal mental health diagnosis was mentioned in the letter and no diagnostic tool was mentioned as being utilised in making a formal mental health diagnosis. Further, the Tribunal could not find mention of this practitioner as being a registered psychologist in the Australian Health Practitioner Regulation Agency website for lists of registered practitioners in psychology.

5. The Tribunal noted there was no evidence that the mental health condition had been diagnosed with input from a registered psychologist or a psychiatrist contained in the hearing papers.

6. The Tribunal noted the introduction to Table 5 – Mental Health Function specifically stated that diagnosis required evidence of input in diagnosis by a registered psychologist unless the diagnosis was made by a psychiatrist. The introduction also specified that diagnosis required the use of a relevant diagnostic tool.

7. The introduction stated:

   The diagnosis of the condition causing the impairment must be made by an appropriately qualified medical practitioner (such as a general practitioner or a psychiatrist) with evidence from a registered psychologist (if the diagnosis has not been made by a psychiatrist).

   Diagnosis and evidence should make appropriate reference to the diagnostic tool used.

Findings of fact

Prognosis

1. The Tribunal could not make a finding in relation to the prognosis of the mental health condition as there was no prognostic evidence before it.

Diagnosis

1. The Tribunal found that the mental health condition was not diagnosed for the purposes of DSP because there was no evidence of a diagnosis by a psychiatrist or in the alternative by a registered psychologist and there was no evidence that referenced the use of a diagnostic tool for diagnosis.

Reasonable treatment and stabilisation

1. The Tribunal did not proceed to consider if the mental health condition was reasonably treated and stabilised in 2023 when the claim for DSP was lodged as it has found the condition was not diagnosed at this time. However it noted Mrs Adams was not on any medication and had not seen a psychiatrist and only commenced counselling in March 2025.

Application of the law

1. As the Tribunal has found the mental health condition had an uncertain prognosis and was not diagnosed for the purposes of DSP on the date of claim, it follows that functional impact cannot be rated under the Impairment Tables.

Intellectual disability

1. In oral evidence, the Tribunal was told in respect of the intellectual disability that Mrs Adams had always had this condition but it was not recognised by her doctors until recently. She had not undertaken any formal intelligence testing performed by a validated assessor. However [Dr B] had questioned Mrs Adams about her lifestyle and reported that she had an intellectual disability. They had been thinking of having an occupational therapy assessment undertaken but could not afford this assessment.  

2. In terms of functional impairment, in oral evidence the Tribunal was told that Mrs Adams found it difficult to decide what to do and would defer decisions to her husband. Another reason why she refused to leave her house alone was because she was scared she would not be able to find her way home again. She often misinterpreted information and made the wrong decision.

3. The only medical evidence of intellectual disability was in the letter by [Dr B] dated 4 June 2025 and letter by [Ms C] dated 2 September 2025. This evidence was dated well after the date of claim for DSP. Further, neither letter specified how or when the diagnosis of intellectual disability was made.

4. The Tribunal noted the introduction to Table 9 – Intellectual Function stated that diagnosis of an intellectual disability for the purposes of DSP required reference to a meaningful intelligence quotient score of 70 to 85 that had originated before the person turned 18 years of age. The assessment had to have been made by an appropriately qualified psychologist and made using an appropriate measure of intellectual functioning and adaptive behaviour with standardised scores and a percentile ranking.

5. The introduction stated:

   • Table 9 is to be used to assess the functional impact of a diagnosed condition resulting in low intellectual function (a meaningful intelligence quotient (IQ) score of 70 to 85), which originated before the person turned 18 years of age.
   • An assessment of the condition causing the impairment must be made by an appropriately qualified psychologist.
   • An assessment of intellectual functioning and adaptive behaviour is to be undertaken in the form of an individually administered and psychometrically valid, comprehensive, culturally appropriate and psychometrically sound standardised assessment that:

   o   provides robust standardised scores and a percentile ranking;

   o   demonstrates test validity and reliability based on current norms developed on a representative sample of the general population.

Findings of fact

Prognosis

1. The Tribunal could not make a finding in relation to the prognosis of the intellectual disability condition as there was no prognostic evidence before it. Further, there was no mention of this condition before the letter by [Dr B] dated 4 June 2025 and [Ms C] dated 2 September 2025.

Diagnosis

1. The Tribunal found that the intellectual disability condition was not diagnosed for the purposes of DSP because there was no evidence of a diagnosis made before the age of 18 years by an appropriately qualified psychologist utilising an appropriate measure of intellectual functioning and adaptive behaviour with standardised scores and a percentile ranking.

Application of the law

1. As the Tribunal has found the intellectual disability condition had an uncertain prognosis and was not diagnosed for the purposes of DSP, it follows that functional impact cannot be rated under the Impairment Tables.

Summary

1. The Tribunal has found that Mrs Adams did not have any medical conditions that were able to be rated under the Impairment Tables. Therefore, she did not satisfy paragraph 94(1)(b) of the Act.

Issue 3 – Does Mrs Adams have a continuing inability to work?

1. As the Tribunal has found that Mrs Adams failed to satisfy paragraph 94(1)(b) of the Act, the Tribunal did not proceed to determine whether she satisfied paragraph 94(1)(c) of the Act.

DECISION

The decision under review is affirmed. This means the review is not successful.

Date of hearing:	Friday 5 September 2025
Representative for the Applicant:	[Miss D]