Ali Al Azraki and Secretary, Department of Families, Housing, Community Services and Indigenous Affairs

Case

[2013] AATA 205


[2013] AATA 205 

Division GENERAL ADMINISTRATIVE DIVISION

File Number

2012/2351

Re

Ali Al Azraki

APPLICANT

And

Secretary, Department of Families, Housing, Community Services and Indigenous Affairs

RESPONDENT

DECISION

Tribunal

Miss E A Shanahan, Member

Date 9 April 2013
Place Melbourne

The Tribunal affirms the decision under review.

.....................[sgd]...................................................

Miss E A Shanahan, Member

Catchwords

SOCIAL SECURITY – disability support pension – depression and/or post-traumatic stress disorder – chronic pain syndrome – motor vehicle accident – conditions not fully diagnosed, treated and stabilised – questionable impairment rating of 20 points – decision affirmed

Legislation

Social Security Act 1991, Schedule 1B
Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011

Social Security (Administrative) Act 1999, section 13(3A), Schedule D Clause IV

REASONS FOR DECISION

Miss E A Shanahan, Member

9 April 2013

  1. Mr Al Azraki applied to Centrelink for disability support pension (DSP), claiming that he suffered from several medical conditions. Centrelink rejected the application on the grounds that his claimed medical conditions were not fully diagnosed, treated and stabilised and therefore did not attract an impairment rating.  Mr Al Azraki sought a review of the decision by a Centrelink Authorised Review Officer (ARO). The ARO affirmed the decision on 22 February 2012. Mr Al Azraki then sought a review of the ARO’s decision by the Social Security Appeals Tribunal (SSAT). The SSAT affirmed the ARO’s decision on 23 May 2012.  Mr Al Azraki has now applied to the Administrative Appeals Tribunal (AAT) for review of the SSAT decision.

  2. Mr Al Azraki was represented by Mr Cameron Horn, a solicitor with Victorian Legal Aid (VLA).The Respondent was represented by Ms Cherie Canning, a solicitor employed by the Australian Government Solicitor (AGS).  The Respondent provided documentation, labelled as T (Tribunal), ST (Supplementary Tribunal) and SST (further Supplementary Tribunal) documents, in accordance with section 37A of the Administrative Tribunal Act 1976.   Mr Al Azraki tendered the letter of instruction to, and the report of, Dr Anthony Cidoni dated 16 November 2012 (Exhibit A1).  Dr Cidoni and Mr Al Azraki gave evidence before the Tribunal.  Mr Al Azraki was assisted by an interpreter in the Arabic language.

BACKGROUND TO THE APPLICATION

  1. Mr Al Azraki is a 46 year old refugee from Iraq. He arrived in Australia by boat from Indonesia in 1999, having spent the previous two years in Syria.  He was detained at the Woomera Detention Centre for 10 months before being granted a refugee visa.  In Iraq he worked as a television technician, learning his trade on the job.  Prior to fleeing Iraq, he spent approximately two years in the Iraqi army. 

  2. Following his acceptance as a refugee, Mr Al Azraki worked at fruit picking and as a farming hand in Mildura and Queensland.  During this outdoor work, he developed hives. His condition was diagnosed as urticaria and angioedema and was subsequently investigated by Dr F Kette in 2007 (T20, p108).  Dr Kette, an immunologist, performed tests for food and chemical intolerance.  The tests were negative.  As the urticaria appeared to be exacerbated by heat and sunlight, Dr Kette advised that if the Zyrtec prescribed for the condition did not control it, Mr Al Azraki should avoid hot environments and direct sunlight. 

  3. Mr Al Azraki has not worked in any capacity since 2004.  He has been in receipt of a Newstart allowance.  He has undertaken several rehabilitation programs and received employment assistance without being able to get a job. 

  4. On 19 July 2010 Mr Al Azraki was involved in a motor vehicle accident (MVA).  His vehicle, while stationary at a red light, was struck from behind by a bus.  The impact propelled his vehicle into the vehicle in front.  Mr Al Azraki claims a transitory loss of consciousness, or as described by Dr Yerra, being dazed for one to two seconds (T20, p112).  Given his report of loss of consciousness and complaint of pain in the neck, back and left leg, Mr Al Azraki was observed for 48 hours at Northern Hospital and underwent appropriate investigations.  CT scans and an MRI of the cervical spine were normal. 

  5. Mr Al Azraki’s pain in the left arm and his neck pain persisted.  At the instigation of his general practitioner Dr Attalla, Mr Al Azraki was assessed by three specialists: Dr S Raju Yerra, a neurologist; Dr Daniel Lee, a consultant in rehabilitation and pain medicine; and Dr Raid Al Humrany, a consultant psychiatrist.  Shortly after the MVA, Mr Al Azraki had developed symptoms of depression and anxiety.  No objective neurological defect was demonstrated, although an electromyogram (EMG) suggested a C6/C7 radiculopathy (a set of conditions in which one or more nerves are affected and do not conduct normally) which Dr Yerra felt was not of clinical significance.

  6. Dr Lee endeavoured to control Mr Al Azraki’s left limb pain with various medications, without success.  Mr Al Azraki was then referred to a pain management specialist for inclusion in a pain management and rehabilitation program.  The latter was only minimally beneficial.  Dr Al Humrany diagnosed an element of PTSD with a mixture of anxiety and mild depression.  He prescribed the anti‑depressant medication Avanza (15mg daily), recommended psychotherapy and strongly recommended attendance at a pain management clinic. Dr Al Humrany continued to see Mr Al Azraki on a regular basis for approximately one year.

  7. At the request of the Transport Accident Commission (TAC), Mr Al Azraki was seen by Associate Professor G Littlejohn of the Faculty of Medicine, Nursing & Health Sciences at Monash University.  Associate Professor Littlejohn was of the opinion that Mr Al Azraki had the clinical features of fibromyalgia, two of the causes of which were emotional and stress factors.  Associate Professor Littlejohn did not find any abnormalities on physical examination of Mr Al Azraki. Based on the history he obtained from Mr Al Azraki and the documentation with which he was provided, he was of the opinion that Mr Al Azraki’s symptoms had, in the main, preceded the MVA. Although predominantly in the left limbs, the symptoms also involved the neck, the right lower limb, weakness of the left hand with numbness of all fingers, and a global dysaesthesia (an unpleasant, abnormal sensation) involving all the left leg.  Mr Al Azraki complained of fatigue, weakness of both legs and hands, an inability to walk more than 200 metres and poor sleep.  Associate Professor Littlejohn opined that a return to work as quickly as possible would be of therapeutic benefit and that rest was contraindicated.

  8. VLA obtained an opinion from a psychiatrist, Dr Anthony Cidoni, who assessed Mr Al Azraki on 22 October 2012.  Dr Cidoni diagnosed a major depressive disorder (MDD) of two years duration.  He also identified some symptoms of PTSD of the same duration but insufficient to found a diagnosis of PTSD.  Dr Cidoni acknowledged the presence of a chronic pain syndrome, alternatively known as somatoform pain disorder.  He considered Mr Al Azraki unable to work for at least 15 hours per week within the next two years.  Applying Table 6 of the Tables for the Assessment of Work-related Impairment for Disability Support Pension in Schedule 1B (the old impairment tables) of the Social Security Act 1991 (the Act), he assessed Mr Al Azraki’s psychiatric impairment at 20 points.    Applying Table 5 of the Social Security (Tables for the Assessment of Work‑related Impairment for Disability Support Pension) Determination 2011 (the new impairment tables), he assessed Mr Al Azraki’s psychiatric impairment at 10 points

ISSUES BEFORE THE TRIBUNAL

  1. The Respondent correctly identified the issues as being:

  • the date of Mr Al Azraki’s claim; and

  • whether, as at the date of Mr Al Azraki’s claim or within 13 weeks of that date, Mr Al Azraki had:

    (a)a combined impairment rating of at least 20 points under the old impairment tables or the new impairment tables.; and

    (b)a continuing inability to work 15 hours per week.

  1. In relation to the date of Mr Al Azraki’s claim, it was noted that he telephoned a Centrelink office on 20 December 2011 regarding lodging a claim for DSP.  An appointment was made for him to attend Centrelink on 5 January 2012.  Mr Al Azraki was advised by letter that, to receive his payment from the earliest possible date, he needed to return his DSP claim form on or before 3 January 2012.  The claim form was lodged on 5 January 2012, together with the necessary medical reports.  As the Social Security (Tables for the Assessment of Work‑related Impairment for Disability Support Pension) Determination 2011 came into effect on 1 January 2012, there was a dispute between the parties as to the exact date of his claim in light of the change in legislation. 

  2. At the commencement of the hearing, the Respondent advised the Tribunal that it accepted that Mr Al Azraki’s claim for DSP had been lodged on 20 December 2011 in light of special circumstances, which included the absence of effective communication between Centrelink and Mr Al Azraki.  The date of claim was thus no longer an issue.

  3. During the course of the hearing, Mr Horn conceded that Mr Al Azraki’s chronic pain syndrome had not been fully diagnosed, treated and stabilised. As a result, the only issue remaining before the Tribunal was the nature of Mr Al Azraki’s psychological disorder, its impairment rating and whether the rating described by Dr Cidoni reflected Mr Al Azraki’s psychological status at the time of his application or during the subsequent 13 week period. 

DR CIDONI’S EVIDENCE

  1. In his oral evidence, Dr Cidoni confirmed his diagnosis of MDD, as opposed to an adjustment disorder.  He said that while there were symptoms of PTSD, they were insufficient in number and severity to satisfy the Diagnostic and Statistical Manual of Mental Disorders (DSM) IV-TR requirements for such a diagnosis.  He was of the opinion that this was the diagnosis at the time of lodgement of Mr Al Azraki’s claim, although he himself did not see him until some 10 months later. 

  2. The Tribunal asked Dr Cidoni if the dose of Avanza prescribed by Dr Al Humrany was a normal dose. He replied that the usual dose was 30mg daily, not 15mg as prescribed for Mr Al Azraki.  With regard to other forms of treatment, Dr Cidoni was of the opinion that a course of cognitive behaviour therapy (CBT) was usually included in the treatment of this disorder but Mr Al Azraki had never had such a course.  While CBT may not yield a positive outcome, Dr Cidoni would recommend such therapy.  Similarly, he thought the course of rehabilitation treatment provided at Dorset Rehabilitation Centre over a period of two to three months was inadequate in terms of a trial of treatment, as in such a condition a six-month program of treatment would be needed.  Dr Cidoni felt that further treatment could be beneficial and was preferable.  Based on his assessment of Mr Al Azraki, Dr Cidoni assigned an impairment rating of 20 points using Table 6 of the old impairment tables. He appeared to have been so persuaded by the history given to him by Mr Al Azraki of persistent suicidal ideation since the MVA. 

EVIDENCE OF MR AL AZRAKI

  1. Mr Al Azraki’s evidence has been summarised under the heading of BACKGROUND TO THE APPLICATION.  He described his psychological symptoms as being continually nervous and unable to cope.  He said he couldn’t stand things going wrong. Mr Al Azraki stated he had derived no benefit from the use of Avanza and was now taking Cymbalta (15mg daily) but had not noted any improvement.  Mr Al Azraki had stopped seeing Dr Al Humrany as he felt the consultations and treatment were of no benefit.  He said his sleep remained disturbed and his libido low.  In answer to a question posed by the Tribunal, he said the only positive thing in his life was his children and he felt happy when playing with them.

  2. Mr Al Azraki informed the Tribunal he was now seeing a Dr Talib, who was a specialist in bones and muscles.  He was seeing Dr Talib once a month and continued to take Cymbalta, as prescribed by Dr Talib.  Mr Al Azraki denied that there had been any change in his symptomatology over the past 12 months.  Despite these comments, Mr Al Azraki said his flashbacks and nightmares had reduced, although his anxiousness and sleep disturbance were unchanged.  In contrast to what he had told several doctors, he expressed the opinion that the treatment he received (from the psychologist Ms Erica Lurie) at Dorset Rehabilitation Centre as part of his pain management course had been of benefit.  Ms Lurie had apparently told him that all his problems came from his mind and that he must put himself in a happy place.

  3. Mr Al Azraki informed the Tribunal that he had recently seen Dr Yerra, the neurologist, again. Mr Al Azraki had undergone repeat nerve conduction and EMG studies in both arms and both legs and the results were normal.

  4. The Centrelink records revealed that Mr Al Azraki travels overseas on a regular basis.  Mr Al Azraki confirmed that he returns to Iraq every 18 months, staying for periods between 2 weeks and 3 months.  Mr Al Azraki had married in Iraq in 2008 and his wife came to Australia in March 2010.  He said neither of them had any relatives in Australia and they returned to Iraq on a regular basis to visit both their families.  He denied any problems with travelling to and from Australia to Iraq. 

DOCUMENTARY EVIDENCE BEFORE THE TRIBUNAL

DR AL HUMRANY, TREATING PSYCHIATRIST

  1. Dr Al Humrany treated Mr Al Azraki from August 2010 until July 2011, a period of 11 months.  In his initial report to the referring general practitioner Dr Attalla, Dr Al Humrany made a diagnosis of elements of PTSD with a mixture of anxiety and mild depression, attributed entirely to the MVA one month earlier.  Mr Al Azraki’s symptoms were listed as experiencing flashbacks, nightmares which interfered with his sleep, lethargy, limited social interaction and loss of libido, with anxiety symptoms such as racing thoughts and an inability to drive his car unless accompanied by a passenger. There is no record of suicidal ideation as a symptom in any of Dr Al Humrany’s reports or clinical notes.  He prescribed the antidepressant medication Avanza (15mg daily) and recommended psychotherapy for three to six months and provided a referral to a pain management specialist (Exhibit A1).

  2. Dr Al Humrany provided a similar report to Maurice Blackburn Lawyers, who were representing Mr Al Azraki in his MVA claim, on 9 March 2011.  By this time there had been some improvement in Mr Al Azraki’s symptomatology, with the flashback phenomena and nightmares having improved.  His level of anxiety remained high in response to the failure of his physical symptoms to improve.  On this occasion, Dr Al Humrany’s diagnosis had changed somewhat to that of a chronic pain syndrome, an adjustment disorder with secondary anxiety and an episode of depression and an element of PTSD partially improved.  Dr Al Humrany attributed all of Mr Al Azraki’s psychological symptoms to his physical disabilities and chronic pain problems. 

  3. On 20 July 2012 Dr Al Humrany provided a detailed report to the TAC (Exhibit A1) attributing all of Mr Al Azraki’s psychiatric disorders to the physical disabilities and chronic pain problems, which in turn he attributed to the MVA.  The diagnosis was unchanged from an adjustment disorder with a mixture of secondary anxiety and an episode of depression with an element of PTSD partially improved.  Mr Al Azraki’s antidepressant therapy had recently been changed from Avanza (15mg daily) to Pristiq (50mg daily). 

DORSET REHABILITATION CENTRE PROGRAM

  1. Mr Al Azraki attended a rehabilitation course at this centre, between 28 October 2011 and 20 January 2012, at the direction of Dr Lee of the Melbourne Pain Group.  A discharge summary was provided.  It would appear he was assessed by the rehabilitation team on 20 December 2010. This course involved five sessions of physiotherapy, five sessions of attendances with an occupational therapist and four with a psychologist, Ms Lurie.  The physiotherapist, Mr David MacAdams, reported that Mr Al Azraki was unable to take on a comprehensive home exercise program or a progressive daily walk routine.  He was limited to performing a few simple stretches and walking up to three minutes per day.  In fact, his four-minute walk test prior to commencing the program covered a distance of 155 metres but after the program the distance he covered was reduced to 55 metres. 

  2. The occupational therapist, Ms Rhiannon Fitzgerald, described Mr Al Azraki as being pain-focused and fearful of increasing his physical activity.  Mr Al Azraki did not initially engage in the goals he had been set and did not achieve his long‑term goals for occupational therapy. 

  3. Ms Lurie, the psychologist, reported that Mr Al Azraki responded well to the education sessions on chronic pain and was keen to apply what he had learned.  She recommended that he would benefit from reinforcement of these strategies with further psychological treatment.

MR AL AZRAKI’S CLINICAL RECORD FROM THE COBURG FAMILY MEDICAL CENTRE

  1. Mr Al Azraki’s progress notes between 28 July 2010 and 9 December 2010 were provided by the Coburg Family Medical Centre.  These record the MVA, the negative investigations and ongoing complaints of pain in the left lower limb.  An ultrasound investigation of a swelling of a lateral aspect of the calf did not reveal any abnormality other than varicose veins.  The notes record referrals to various specialists including Dr Al Humrany, physiotherapists, a neurosurgeon and two multidisciplinary pain centres.  Dr Attalla had provided reports in support of Mr Al Azraki’s application for DSP on several occasions in 2010 and 2011, the conditions reported being severe chronic left leg pain, anxiety and depression.  He anticipated these conditions would persist for 3 to 24 months and somewhat improve.

  2. It would appear that Mr Al Azraki no longer attends the Coburg Family Medical Centre and now sees a Dr Mohtaji in Fawkner.  Dr Mohtaji provided the most recent medical report to Centrelink, diagnosing a chronic pain syndrome, depression and PTSD. He considered Mr Al Azraki’s allergic phenomenon to be well controlled and causing minimal impact on function.  He opined that the psychiatric condition and chronic pain syndrome would impact on function for more than 24 months and would fluctuate in its severity.

JOB CAPACITY ASSESSMENT

  1. Mr Al Azraki underwent six job capacity assessments between 2007 and 2012.  They all record that Mr Al Azraki’s command of the English language is good. The assessment of 19 January 2012 is relevant to this application.  The medical conditions considered by the assessor were chronic pain, depression, PTSD, allergic rhinitis and urticaria.  The allergic rhinitis and urticaria were considered to be well controlled although not fully treated as specialist review had been recommended.  Both the chronic pain and the psychiatric disorder were found to be permanent but not fully treated and stabilised.  As a result, an impairment rating was not attracted.

RELEVANT LEGISLATION

  1. Section 94 of the Act provides:

    (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;

    (ii) the Health Secretary has informed the Secretary that the person is participating in the supported wage system administered by the Health Department, stating the period for which the person is to participate in the system; and

    (2)A person has a continuing inability to work because of an impairment if the Secretary is satisfied that:

    (aa)in a case where the person’s impairment is not a severe impairment within the meaning of subsection (3B)—the person has actively participated in a program of support within the meaning of subsection (3C); and

    (a)in all cases—the impairment is of itself sufficient to prevent the person from doing any work independently of a program of support within the next 2 years; and

    (b)in all cases—either:

    (i)     the impairment is of itself sufficient to prevent the person from undertaking a training activity during the next 2 years; or

    (ii)     if the impairment does not prevent the person from undertaking a training activity—such activity is unlikely (because of the impairment) to enable the person to do any work independently of a program of support within the next 2 years.

  1. As the Respondent has conceded that Mr Al Azraki’s claim for DSP was lodged on 20 December 2011, the Social Security (Tables for the Assessment of Work‑related Impairment for Disability Support Pension) Determination 2011 is now irrelevant.

SUBMISSIONS

  1. Mr Horn submitted that Mr Al Azraki’s psychiatric diagnosis was MDD based on Dr Cidoni’s opinion of 16 November 2012 and that this diagnosis reflected exactly his condition at the date of his claim for DSP (on the 20 December 2011).  He argued that while Mr Al Azraki’s treatment had been suboptimal, the standard of the medical treatment was not the test applicable to qualify for DSP.

  2. The Respondent submitted that Mr Al Azraki’s depressive state was not fully treated or stabilised, given that Dr Cidoni recommended CBT and on-going attendance with a psychologist.  In addition, Mr Al Azraki’s medication had been changed during 2012 as well as in 2011 and it was too early to assess his response to Cymbalta.  The Respondent argued that at the time Mr Al Azraki lodged his claim for DSP the impairment rating would have been 10 points, as there was no history of suicidal ideation at that time and there had been some improvement in terms of his symptoms as a result of treatment prior to December 2011 (as the symptoms suggesting PTSD had abated).  The Respondent submitted that the latter improvement went to Mr Al Azraki’s longer term prognosis.

TRIBUNAL’S DELIBERATIONS

  1. The Tribunal accepts that Mr Al Azraki suffers from a psychiatric disorder characterised by depression and anxiety, whether it be a chronic adjustment disorder with secondary anxiety and depressed mood or MDD.  Neither psychiatrist has diagnosed PTSD. Although some of the symptoms of PTSD were initially present they were insufficient to make such a diagnosis.  As Dr Cidoni pointed out, the prime diagnostic symptom of PTSD, avoidance, was not a feature of Mr Al Azraki’s presentation.  Mr Al Azraki therefore satisfies section 94(1)(a) of the Act.

  2. Both psychiatrists have attributed Mr Al Azraki’s psychiatric disorder to his physical symptoms, diagnosed as a chronic pain syndrome secondary to the MVA.  The exact nature and aetiology of these physical symptoms requires further clarification, given they can also be considered as part of the psychiatric disorder, as opposed to its cause.

  3. Dr Cidoni has assessed Mr Al Azraki’s impairment rating at 20 points and is of the opinion that this also reflects his position as at 20 December 2011. The old impairment tables under Schedule 1B of the Act describe the criteria for a 10‑point rating as:

    Moderate and regular symptoms and generally functioning with some difficulty (eg. noticeable reduction in social contacts or recreational activities, or the beginnings of some interference with interpersonal or workplace relationships).May have received psychiatric treatment which has stabilised the condition. Minor effects on work attendance and/or ability to work but the impairment would not prevent full-time work (eg. short periods of absence from work).

    and that the criteria for 20 points as:

    Psychiatric illness or disorder with either serious symptomatology OR impairment in function that requires treatment by a psychiatrist (eg. frequent suicidal ideation, severe obsessional rituals, frequent severe anxiety attacks, diagnosed psychotic illness with continuing symptoms). There is significant interference with interpersonal or workplace relationships with serious disruption of work attendance or ability to work.

  4. The work effects of the condition are not applicable to Mr Al Azraki as he has not worked since 2004 and does not claim to have had any psychiatric illness prior to 19 July 2010.  It appears to the Tribunal that the symptom that influenced Dr Cidoni’s assessment of 20 impairment points was frequent suicidal thoughts. This symptom was not identified by Dr Al Humrany during the 11 months he treated Mr Al Azraki, with treatment ceasing on 22 July 2011 some four months prior to Mr Al Azraki lodging his claim for DSP.

  5. While the Tribunal is not convinced that an impairment rating of 20 points is valid and believes that further medical opinion is required, this issue is not the salient point in this decision.  Dr Al Humrany and Dr Cidoni have recommended CBT and continuing attendance with a psychologist.  Dr Cidoni regarded a six month course as the norm.  In his evidence Mr Al Azraki stated he had benefited from the four sessions with Ms Lurie and that some of his PTSD type symptoms have abated.

  6. In its Statement of Facts and Contentions, the Respondent stated that Mr Al Azraki had undergone a six month pain management course.  This is not substantiated by the discharge summary from the Dorset Rehabilitation Centre.  Dr Lee, in a report dated 23 March 2012 (ST3), stated that he had not seen Mr Al Azraki since August 2011. Mr Al Azraki was overseas from 31 March 2011 until 14 June 2011. Hence his participation in the pain management course was delayed.  An earlier, so-called rehabilitation course had been provided over a period of five sessions by a physiotherapist and occupational therapist at the Coburg Family Medical Centre but no report of the results of this course has been provided to the Tribunal. 

  7. Mr Al Azraki’s prescribed anti-depressant medication has been changed on several occasions. Initially Avanza (15 mg daily) was prescribed.  Dr Cidoni considered this to be a sub-optimal dose, with 30 mg being the usual commencing dose.  After 12 months Dr Al Humrany substituted Pristiq for the Avanza. Mr Al Azraki took Pristiq for an unknown period.  According to Dr Cidoni’s report (Exhibit A1), Mr Al Azraki had commenced taking Cymbalta in approximately August 2012.  Clearly these changes in treatment indicate that Mr Al Azraki’s psychiatric disorder was not fully treated or stabilised and therefore it cannot attract an impairment rating.  Mr Al Azraki does not satisfy section 94(1)(b) of the Act.  It is not necessary for the Tribunal to consider whether he has a continuing inability to work.  

  8. As an aside, the Tribunal notes that Mr Al Azraki’s treatment has been fragmented and poorly co-ordinated.  Mr Horn described it as sub-optimal but submitted that the quality of the treatment was not a factor in the test of whether a DSP claimant had been fully treated.  The Oxford Dictionary (on‑line) defines sub-optimal as not of the best quality.  The Tribunal rejects Mr Horn’s submission.  The basic tenet of medicine is to relieve symptoms, if cure is not possible, with a view to the maintenance and/or improvement of the individual’s comfort, enjoyment of life and functional capacity by providing effective treatment meeting what is now referred to as best practice and evidence based medicine.

  9. As Mr Al Azraki does not satisfy section 94(1)(b) of the Act, the SSAT decision was correct. The Tribunal affirms the decision under review.  

I certify that the preceding 42 (forty -two) paragraphs are a true copy of the reasons for the decision herein of Miss E A Shanahan, Member

..................[sgd]......................................................

K. Randall, Associate

Dated 9 April 2013

Date of hearing 26 February 2013
Solicitors for the Applicant Mr Cameron Horn, Victoria Legal Aid
Solicitors for the Respondent Ms Cherie Canning, Australian Government Solicitor
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