Carol Campbell and Secretary, Department of Social Services - [2014] AATA 226

[2014] AATA 226

Division GENERAL ADMINISTRATIVE DIVISION

File Number(s)

2013/2828

Re

Carol Campbell

APPLICANT

And

Secretary, Department of Social Services

RESPONDENT

DECISION

Tribunal
Senior Member A K Britton

Date 17 April 2014

Place Sydney
The Tribunal:

(a) sets aside the decision under review; and

(b) in substitution for that decision decides that Ms Campbell was qualified for payment of Disability Support Pension on 5 October 2012.

.......................[SGD].................................................
Senior Member A K Britton
CATCHWORDS
SOCIAL SECURITY — Disability Support Pension — Whether psychological condition was fully diagnosed — Interpretation of Impairment Tables — meaning of expression “fully treated” —— meaning of phrase in Tables “with evidence from a clinical psychologist”
LEGISLATION
Social Security Act 1991 (Cth) – ss 94(1)(b); 94(1)(c); 94(2)(aa); 94(3); 94(3B); 94(5);
Social Security (Administration) Act 1999 (Cth) – ss 13; 42; Sch 2 cl 4(1);
CASES
Re Pelka and Secretary, Department of Social Services [2014] AATA 81
Re Yazdari and Secretary, Department of Social Services [2014] AATA 34
SECONDARY MATERIALS
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed, 1994
Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (Cth)
REASONS FOR DECISION
Senior Member A K Britton
17 April 2014

Carol Campbell has applied to the Administrative Appeals Tribunal for review of the decision made by a Centrelink Authorised Review Officer and affirmed by the Social Security Appeals Tribunal (SSAT) to reject her claim for disability support pension (DSP) made on 5 October 2012. Ms Campbell made a further claim for DSP after the SSAT handed down its decision. That claim was accepted and Ms Campbell has received DSP since September 2013.
To qualify for DSP Ms Campbell must demonstrate that she has:
an impairment of 20 points or more (s 94(1)(b) of the Social Security Act 1991 (Cth) (the Act)), and
a “continuing inability to work” because of the impairment (s 94(1)(c)(i)), and
undertaken a “program of support” unless found to have a “severe impairment” (s 94(2)(aa)).
It is agreed that Ms Campbell has an impairment totalling 20 points under the Impairment Tables (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (Cth) (the Tables). However it is not agreed that Ms Campbell has a “severe impairment”, namely an impairment of at least 20 points under a single impairment table (s 94(3B) of the Act). Unless she is found to have a severe impairment, Ms Campbell will not qualify for DSP because she has not actively participated in a “program of support” for at least 18 months (ss 94(1)(c) and 94(2)(aa) of the Act). A person with a severe impairment is excused from the requirement to participate in a program of support.
Whether Ms Campbell has a severe impairment must be assessed by reference to the 13-week period from the day she made her claim for DSP, that is, 5 October 2012 to 4 January 2013 (ss 13, 42 and cl 4(1) of Sch 2 of the Social Security (Administration) Act 1999 (Cth)). I will refer to this period as “the claim period”.
Ms Campbell contends that during the claim period she had a severe impairment based on her psychiatric condition, which she asserts had an impairment rating of 20 points. That contention, she reasons, is consistent with the finding made by Centrelink nine months after the claim period. The respondent Secretary argues that Ms Campbell did not have a severe impairment during the claim because her psychiatric condition could not be assigned an impairment rating at that time as it was not “permanent”. Specifically, it had not been fully diagnosed.
Ms Campbell concedes that none of her claimed physical conditions resulted in severe impairment. I am satisfied that concession was properly made.
Statutory framework
As a precondition to assigning an impairment rating under the Tables, the claimed condition must be permanent, that is, diagnosed and fully treated and stabilised and more likely than not, in light of the available evidence, to persist for more than two years (ss 6(3) and 6(4) of the Tables).
The Tables define the terms fully diagnosed, fully treated and fully stabilised to mean:
Fully diagnosed and fully treated
(5)In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated for the purposes of paragraphs 6(4)(a) and (b), the following is to be considered:
(a)whether there is corroborating evidence of the condition; and
(b)what treatment or rehabilitation has occurred in relation to the condition; and
(c)whether treatment is continuing or is planned in the next 2 years.
Fully stabilised
(6)For the purposes of paragraph 6(4)(c) and subsection 11(4) a condition is fully stabilised if:
(a)either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next 2 years; or
(b)the person has not undertaken reasonable treatment for the condition and:
(i) significant functional improvement to a level enabling the person to undertake work in the next 2 years is not expected to result, even if the person undertakes reasonable treatment; or
(ii) there is a medical or other compelling reason for the person not to undertake reasonable treatment.
“Reasonable treatment” is defined by s 6(7) of the Tables to mean treatment that:
(a)is available at a location reasonably accessible to the person; and
(b)is at a reasonable cost; and
(c)can reliably be expected to result in a substantial improvement in functional capacity; and
(d)is regularly undertaken or performed; and
(e)has a high success rate; and
(f)carries a low risk to the person.
In applying the Tables, the Tribunal must take into account the following information (s 7 of the Tables):
(1)Subject to subsection (2), in applying the Tables the following information must be taken into account:
(a)the information provided by the health professionals specified in the relevant Table; and
(b)any additional medical or work capacity information that may be available; and
(c)any information that is required to be taken into account under the Tables, including as specified in the introduction to each Table.
Mental health conditions must be assessed under Table 5 of the Tables. The Introduction to Table 5 is set out in full in Annexure A to these reasons.
Background to Ms Campbell’s psychiatric condition
Ms Campbell came under the care of GP, Dr Bruce Stewart, in 2006. In May 2009 Dr Stewart referred her to psychologist, Ms Delma Gordon, for treatment. Ms Campbell has consulted Ms Gordon on a regular basis since that time. According to Ms Campbell, the frequency of those consultations is determined by the availability of funding. (The Medicare rebate is available to patients for services provided by a psychologist on referral by a GP under a Mental Health Plan. A cap applies to the number of consultations available. >
Since March 2011, Ms Campbell has taken Zoloft®, an anti-depressant medication prescribed by Dr Stewart. In May 2012, Dr Stewart increased the dosage from 50 to 100mg.
In a pro forma medical report dated 8 November 2012, Dr Stewart identified the “condition with most impact” on Ms Campbell as “anxiety and depression”. He wrote that the diagnosis was “confirmed” and gave the date of onset and diagnosis as 1998. Under the heading “Clinical features” he wrote:
History
Provide details including etiology, precipitating factors, underlying causes, results and dates of investigations/procedures and specialist consultations (e.g. radiology, pathology, RTFs, specialist reports)
Had fall in 1998 that caused chronic neck and arm pain – this triggered her anxiety and depression.
Regular psychologist visits. Seen psychiatrist March 1999
Current symptoms
Provide details of the current clinical features and symptoms, including frequency and severity, experienced by the patient due to this condition. Be specific in indicating the severity of the medical impairment.
Panic attacks on a daily basis. She is very jumpy and has frequent diarrhoea. Also sleep disturbance. Her symptoms are moderate to severe.
Dr Stewart recorded Ms Campbell’s current treatment as “daily medication and regular visits to Ms Gordon” and that she will continue to need ongoing medication and counselling. In answer to a question about the impact of Ms Campbell’s anxiety and depression on her ability to function, he wrote “Can self-care but normal activities of daily living take a long time to complete”. In his opinion the condition was likely to persist for more than 24 months.
In a report dated 12 December 2012, prepared after the decision to refuse Ms Campbell’s claim for DSP, Ms Gordon wrote that Ms Campbell had been referred by her GP for “psychological intervention in relation to her anxiety and depression”. She wrote that Ms Campbell had been suffering panic attacks following an injury in 1997, which had been exacerbated by a further injury sustained during surgery.
In a letter dated 15 February 2013, a Centrelink Authorised Review Officer (ARO) notified Ms Campbell that the decision to refuse her claim for DSP had been affirmed. One of the reasons given for that decision was that Ms Campbell’s psychiatric condition had not been “fully diagnosed”:
The Introduction to Table 5 states that the diagnosis of the condition must be made by an appropriately qualified medical practitioner such as a psychiatrist with evidence from a clinical psychologist if the diagnosis has not been made by a psychiatrist. There is no evidence available to me that this condition had been diagnosed by a psychiatrist or that you have been assessed by a clinical psychologist. In the circumstances this condition is not considered to be fully diagnosed and accordingly an impairment rating cannot be assigned.
In April 2013, Ms Campbell consulted clinical psychologist, Shirley Liffman. Ms Liffman works in the same practice as Ms Gordon, who is not a clinical psychologist. Ms Liffman wrote that “currently Ms Campbell meets DSM-IV [American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed, 1994] criteria for panic disorder” but, in her opinion, Ms Campbell’s panic symptoms are best explained in the context of post-traumatic stress disorder (PTSD). She attributed the cause to domestic violence and a traumatic experience while undergoing surgery.
In a further report dated 10 March 2014, Ms Liffman wrote:
This letter is in regards to Centrelink’s interpretation of Ms Campbell’s previous diagnosis of post-traumatic stress disorder. I note that Ms Campbell’s initial GP referral stated that she was suffering from “anxiety and depression”, and that Centrelink has interpreted this as contradictory to her subsequent diagnosis of post-traumatic stress disorder.
I would like to point out that post-traumatic stress disorder (PTSD) is one of the anxiety disorders, and is commonly accompanied by depressive symptoms. It is commonplace that Ms Campbell’s initial diagnosis from her general practitioner was of a general nature, and subsequently refined upon consulting a mental health professional. Ms Campbell does indeed suffer from PTSD, which includes the symptoms of anxiety and depression. Her symptoms of anxiety and depression do not contradict her diagnosis of PTSD.
Further claim for DSP
In September 2013, Ms Campbell made a further claim for DSP. In a medical report dated 20 September 2013 Dr Stewart nominated PTSD as the condition with the most impact on Ms Campbell. Ms Campbell was referred to a Centrelink job capacity assessor who concluded that Ms Campbell’s PTSD was permanent and met the criteria for an assignment of 20 points. Ms Campbell was granted DSP from 20 September 2013.
Was Ms Campbell’s anxiety and depression fully diagnosed during the claim period?
The primary issue between the parties is whether, during the claim period, Ms Campbell’s anxiety and depression was “fully diagnosed”. Central to that issue is the proper interpretation of the following passage from the Introduction to Table 5 (emphasis added):
The diagnosis of the condition must be made by an appropriately qualified medical practitioner (this includes a psychiatrist) with evidence from a clinical psychologist (if the diagnosis has not been made by a psychiatrist).
The Secretary points out that the only available diagnosis in the claim period was that made by Dr Stewart. The Secretary submits that as a consequence it could not be said that Ms Campbell’s psychiatric condition was “fully diagnosed”. The Secretary contends that not only was Ms Liffman’s diagnosis made after the claim period, but it was for PTSD, not anxiety and depression, the condition diagnosed by Dr Stewart.
The Introduction to Table 5 requires the diagnosis of the subject mental health condition to be made by an “appropriately qualified medical practitioner”. Where, as in this case, the diagnosis is made by an appropriately qualified medical practitioner who is not a psychiatrist, the Introduction to Table 5 instructs that the diagnosis must be “with evidence from a clinical psychologist”.
Neither the Introduction to Table 5, nor the Tables themselves, provide guidance on the meaning of the phrase “evidence from a clinical psychologist”. Given its context, in my opinion it includes the opinion evidence of a clinical psychologist, that is, consistent with, or corroborative of, the diagnosis made by the appropriately qualified medical practitioner.
While there can be no argument that the diagnosis made by the “appropriately qualified medical practitioner”, must be made no later than the end of the claim period, I do not agree with the contention put by the Secretary that the same time restriction applies to the “evidence from a clinical psychologist”. In my view the requirement that in the absence of a diagnosis by a psychiatrist there be “evidence from a clinical psychologist”, will be satisfied where that evidence was obtained or created after the claim period providing it relates to the person’s condition during the claim period.
So, for example, a GP may make a diagnosis based on his or her clinical judgment that a patient suffers from a relevant condition, commence treatment and six months later refer the patient to a clinical psychologist for a second opinion. If the second opinion confirms the original diagnosis but comes back one day after the claim period expires, on the Secretary’s argument the condition would not have been “fully diagnosed” during the claim period. Yet what the second opinion does is confirm the diagnosis of the condition that the patient had been suffering in the relevant period. The evidence obtained after that period, in effect, ratifies the diagnosis as a full diagnosis. Obviously the longer the delay in the receipt of the confirming evidence, the less weight it is likely to carry. That will depend on the circumstances of the individual case.
Applying that analysis, Ms Campbell is not prevented from relying on the opinion of clinical psychologist, Ms Liffman, solely on the grounds that it was obtained three months after the claim period. Accordingly, the requirement of “evidence from a clinical psychologist” will be satisfied if the evidence from Ms Liffman is: (i) consistent with, or corroborates, the diagnosis of Dr Stewart, and (ii) relates to the state of Ms Campbell’s mental health during the claim period.
In her report of 17 April 2013, Ms Liffman wrote that Ms Campbell met the diagnostic criteria for panic disorder under DSM-IV but considered Ms Campbell’s symptoms were best explained by PTSD-chronic. In a report prepared 12 months later, Ms Liffman pointed out that PTSD is one of a number of anxiety disorders and is commonly accompanied by depressive symptoms. She wrote that Ms Campbell’s “symptoms of anxiety and depression do not contradict her diagnosis of PTSD”. In a letter dated 13 March 2014 Dr Stewart endorsed that opinion.
The Secretary argues that Ms Liffman’s opinion neither supports nor confirms Dr Stewart’s diagnosis. The Secretary reasons that diagnoses of mental health conditions are not interchangeable, citing in support Re Yazdari and Secretary, Department of Social Services [2014] AATA 34 at [17]; RePelka and Secretary, Department of Social Services [2014] AATA 81.
The Secretary also asserts that the treatment for PTSD and an anxiety and depressive disorder are different and therefore it cannot be said that Ms Campbell’s condition was “fully diagnosed” and “fully treated” in the claim period. Even if it is accepted that the treatment for PTSD and an anxiety and depressive disorder is different, a proposition for which there is no evidence, it does not follow that Ms Campbell’s anxiety and depressive disorder was not fully treated in the claim period. Ms Campbell testified that the treatment she is currently receiving — anti depressant medication and psychological counselling — has remained unchanged since 2011. There is no evidence to suggest that Dr Stewart, Ms Liffmann or Ms Gordon considered this treatment regime to be inappropriate or that they had recommended different or additional treatment following the diagnosis of PTSD.
As the Secretary points out, the diagnostic criteria in DSM-IV for PTSD and anxiety and depressive disorders are not identical. Nonetheless, as pointed out by Ms Liffman, PTSD is one of a number of recognised anxiety disorders and is commonly associated with depressive symptoms. In her letter of 10 March 2014, Ms Liffman emphasised that a diagnosis of PTSD is not contradictory to a diagnosis of an anxiety and depressive disorder. Read together with her other reports I am satisfied that that evidence is consistent with, and supportive of, Dr Stewart’s diagnosis of an anxiety and depressive disorder.
For these reasons I find that Ms Campbell’s anxiety and depressive disorder was fully diagnosed, fully treated and fully stabilised and therefore permanent, during the claim period.
What is the appropriate impairment rating?
The parties agree that Ms Campbell’s osteoarthritis was a permanent condition within the claim period and should be assigned an impairment rating of five points under Tables 2 and 3 (upper limb and lower limb function, respectively) and 10 points under Table 4 (spinal function). I agree with that opinion.
I also agree for the reasons set out in the Secretary’s statement of facts, issues and contentions, that Ms Campbell’s urological condition was not permanent within the claim period.
The remaining issue to be decided is the appropriate rating of Ms Campbell’s anxiety and depressive disorder.
In September 2013 a Centrelink job capacity assessor found that Ms Campbell’s mental health condition, PTSD, had a severe functional impact and recommended a rating of 20 points, reasoning:
The specialist medical/psychological information supplied indicates that the impacts of Ms Campbell’s mental health condition results in severe impairment. Ms Campbell’s symptoms are sufficiently severe to interfere with performance of her basic activities of daily living (ADL’s), such as leaving the house to shop. She is also still experiencing multiple panic attacks per week in the course of attempting her ADL’s. Despite long term treatment, these issues have not resolved to the extent that Ms Campbell is able to consistently complete all necessary ADL’s. Ms Campbell is unfit to participate in regular employment, and taking into account her lack of response to treatment to date she is likely to remain unfit for work for the foreseeable future.

After reviewing Ms Gordon’s clinical notes and discussing Ms Campbell’s case with Ms Gordon, Ms Liffman concluded that Ms Campbell’s clinical symptoms were of the same severity in March 2011 as when she saw her in March 2013 (see report of Ms Liffman, 28 November 2013). Ms Campbell’s account of symptoms given in oral evidence was consistent with that conclusion. The weight of evidence indicates that Ms Campbell’s psychiatric condition has remained largely unchanged since the claim period. I am satisfied that in the claim period her condition has a severe functional impact on activities involving mental health function and rated under Table 5, it should be assigned 20 points.
Did Ms Campbell have a continuing inability to work?
To qualify for DSP Ms Campbell must have a “continuing inability to work” throughout the period 5 October 2012 to 5 October 2014 (s 94(1)(c) of the Act). Ms Campbell will be taken to have a continuing inability to work if the impairments resulting from her mental health and osteoarthritis:
·are of themselves sufficient to prevent her doing any work independently of a program of support during the two year period commencing on the date of claim, and
·are of themselves sufficient to prevent her from undertaking a training activity during a two year period commencing on the date of claim, or
·if the impairments do not prevent her from undertaking a training activity ― such activity is unlikely (because of the impairment) to enable Ms Campbell to do any work independently of a program of support within the next two years.
Section 94(3) instructs that in deciding whether or not Ms Campbell has a continuing inability to work, regard must not be had to:
·the availability to the person of a training activity; or
·the availability to the person of work in the person's locally accessible labour market.
Section 94(5) defines “work” to mean work:
·that is for at least 15 hours per week on wages that are at or above the relevant minimum wage; and
·that exists in Australia, even if not within the person's locally accessible labour market.
The job capacity assessor who conducted the September 2013 assessment concluded that Ms Campbell was unable to work more than eight hours per week on account of her impairments. The assessor who had examined her 10 months earlier concluded that Ms Campbell had a work capacity of between 15-22 hours. The explanation for that discrepancy is that the former took into account Ms Campbell’s psychiatric and physical impairment; the latter only had regard to her physical impairment.
Ms Campbell has not worked since 2001 and left school in year 9. She has no formal qualifications and limited work experience. I agree with the opinion of the assessor who conducted the most recent assessment that between September 2013 and September 2015 Ms Campbell’s impairments of themselves have prevented or will prevent her working at least 15 hours per week independently of a program of support and undertaking a training activity. Given that Ms Campbell’s psychological condition has remained largely unchanged since the claim period, I am satisfied that she also had an “inability to work” in the intervening period between lodging her claim, the subject of these proceedings, and making a new claim in September 2013.
I am satisfied that in the two years from 5 October 2012, Ms Campbell has had or will have a continuing inability to work.
DECISION
Ms Campbell satisfied the criteria for DSP when she made her claim for DSP on 5 October 2012. The correct decision is therefore to set aside the decision under review.

I certify that the preceding 44 (forty -four) paragraphs are a true copy of the reasons for the decision herein of Senior Member A K Britton
.................[SGD].......................................................
Associate
Dated 17 April 2014

Date(s) of hearing

26 March 2014

Date of final submission

11 April 2014

Applicant

In person

Solicitors for the Respondent Department of Human Services, Program Litigation and Review Branch
ANNEXURE A
Table 5 – Mental Health Function

Introduction to Table 5

·   Table 5 is to be used where the person has a permanent condition resulting in functional impairment due to a mental health condition (including recurring episodes of mental health impairment).

·   The diagnosis of the condition must be made by an appropriately qualified medical practitioner (this includes a psychiatrist) with evidence from a clinical psychologist (if the diagnosis has not been made by a psychiatrist).

·   Self-report of symptoms alone is insufficient.

·   There must be corroborating evidence of the person’s impairment.

·   Examples of corroborating evidence for the purposes of this Table include, but are not limited to, the following:

a report from the person’s treating doctor;

supporting letters, reports or assessments relating to the person’s mental health or psychiatric illness;

interviews with the person and those providing care or support to the person.

·   In using Table 5 evidence from a range of sources should be considered in determining which rating applies to the person being assessed.

·   The person may not have good self-awareness of their mental health impairment or may not be able to accurately describe its effects. This is to be kept in mind when discussing issues with the person and reading supporting evidence.

·   The signs and symptoms of mental health impairment may vary over time. The person’s presentation on the day of the assessment should not solely be relied upon.

·   For mental health conditions that are episodic or fluctuate, the rating that best reflects the person’s overall functional ability must be applied, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate.

Points

Descriptors

0

There is no functional impact on activities involving mental health function.

(1)        The person has no difficulties with most of the following:

(a)        self care and independent living;

Example: The person lives independently and attends to all self care needs without support.

(b)        social/recreational activities and travel;

Example 1: The person goes out regularly to social and recreational events without support.

Example 2: The person is able to travel to and from unfamiliar environments independently.

(c)        interpersonal relationships;

Example: The person has no difficulty forming and sustaining relationships.

(d)        concentration and task completion;

Example 1: The person has no difficulties concentrating on most tasks.

Example 2: The person is able to complete a training or educational course or qualification in the normal timeframe.

(e)        behaviour, planning and decision-making;

Example: There is no evidence of significant difficulties in behaviour, planning or decision-making.

(f)         work/training capacity.

Example: The person is able to cope with the normal demands of a job which is consistent with their education and training.

5

There is a mild functional impact on activities involving mental health function.

(1)        The person has mild difficulties with most of the following:

(a)        self care and independent living;

Example: The person lives independently but may sometimes neglect self-care, grooming or meals.

(b)        social/recreational activities and travel;

Example 1: The person is not actively involved when attending social or recreational activities.

Example 2: The person sometimes is reluctant to travel alone to unfamiliar environments.

(c)        interpersonal relationships;

Example: The person has interpersonal relationships that are strained with occasional tension or arguments.

(d)        concentration and task completion;

Example 1: The person has difficulty focusing on complex tasks for more than 1 hour.

Example 2: The person has some difficulties completing education or training.

(e)        behaviour, planning and decision-making;

Example 1: The person has unusual behaviours that may disturb other people or attract negative attention and may sometimes be more effusive, demanding or obsessive than is appropriate to the situation.

Example 2: The person has slight difficulties in planning and organising more complex activities.

(f)         work/training capacity.

Example: The person has occasional interpersonal conflicts at work, education or training that require intervention by a supervisor, manager or teacher or changes in placement or groupings.

10

There is a moderate functional impact on activities involving mental health function.

(1)        The person has moderate difficulties with most of the following:

(a)        self care and independent living;

Example: The person needs some support (that is, an occasional visit by or assistance from a family member or support worker) to live independently and maintain adequate hygiene and nutrition.

(b)        social/recreational activities and travel;

Example 1: The person goes out alone infrequently and is not actively involved in social events.

Example 2: The person will often refuse to travel alone to unfamiliar environments.

(c)        interpersonal relationships;

Example: The person has difficulty making and keeping friends or sustaining relationships.

(d)        concentration and task completion;

Example 1: The person finds it very difficult to concentrate on longer tasks for more than 30 minutes (such as reading a chapter from a book).

Example 2: The person finds it difficult to follow complex instructions (such as from an operating manual, recipe or assembly instructions).

(e)        behaviour, planning and decision-making;

Example 1: The person has difficulty coping with situations involving stress, pressure or performance demands.

Example 2: The person has occasional behavioural or mood difficulties (such as temper outbursts, depression, withdrawal or poor judgement).

Example 3: The person’s activity levels are noticeably increased or reduced.

(f)         work/training capacity.

Example: The person often has interpersonal conflicts at work, education or training that require intervention by supervisors, managers or teachers or changes in placement or groupings.

20

There is a severe functional impact on activities involving mental health function.

(1)        The person has severe difficulties with most of the following:

(a)        self care and independent living;

Example: The person needs regular support to live independently, that is, needs visits or assistance at least twice a week from a family member, friend, health worker or support worker.

(b)        social/recreational activities and travel;

Example: The person travels alone only in familiar areas (such as the local shops or other familiar venues).

(c)        interpersonal relationships;

Example 1: The person has very limited social contacts and involvement unless these are organised for the person.

Example 2: The person often has difficulty interacting with other people and may need assistance or support from a companion to engage in social interactions.

(d)        concentration and task completion;

Example 1: The person has difficulty concentrating on any task or conversation for more than 10 minutes.

Example 2: The person has slowed movements or reaction time due to psychiatric illness or treatment effects.

(e)        behaviour, planning and decision-making;

Example: The person’s behaviour, thoughts and conversation are significantly and frequently disturbed.

(f)         work/training capacity.

Example: The person is unable to attend work, education or training on a regular basis over a lengthy period due to ongoing mental illness.

30

There is an extreme functional impact on activities involving mental health function.

(1)        The person has extreme difficulties with most of the following:

(a)        self care and independent living;

Example 1: The person needs continual support with daily activities and self care.

Example 2: The person is unable to live on their own and lives with family or in a supported residential facility or similar, or in a secure facility.

(b)        social/recreational activities and travel;

Example: The person is unable to travel away from own residence without a support person.

(c)        interpersonal relationships;

Example: The person has extreme difficulty interacting with other people and is socially isolated.

(d)        concentration and task completion;

Example 1: The person has extreme difficulty in concentrating on any productive task for more than a few minutes.

Example 2: The person has extreme difficulty in completing tasks or following instructions.

(e)        behaviour, planning and decision-making;

Example 1: The person has severely disturbed behaviour which may include self harm, suicide attempts, unprovoked aggression towards others or manic excitement.

Example 2: The person’s judgement, decision-making, planning and organisation functions are severely disturbed.

(f)         work/training capacity.

Example: The person is unable to attend work, education or training sessions other than for short periods of time.

Division	GENERAL ADMINISTRATIVE DIVISION
File Number(s)	2013/2828
Re	Carol Campbell
APPLICANT
And	Secretary, Department of Social Services
RESPONDENT

Tribunal	Senior Member A K Britton
Date	17 April 2014
Place	Sydney

Date(s) of hearing	26 March 2014
Date of final submission	11 April 2014
Applicant	In person
Solicitors for the Respondent	Department of Human Services, Program Litigation and Review Branch

Points	Descriptors
0	There is no functional impact on activities involving mental health function. (1) The person has no difficulties with most of the following: (a) self care and independent living; Example: The person lives independently and attends to all self care needs without support. (b) social/recreational activities and travel; Example 1: The person goes out regularly to social and recreational events without support. Example 2: The person is able to travel to and from unfamiliar environments independently. (c) interpersonal relationships; Example: The person has no difficulty forming and sustaining relationships. (d) concentration and task completion; Example 1: The person has no difficulties concentrating on most tasks. Example 2: The person is able to complete a training or educational course or qualification in the normal timeframe. (e) behaviour, planning and decision-making; Example: There is no evidence of significant difficulties in behaviour, planning or decision-making. (f) work/training capacity. Example: The person is able to cope with the normal demands of a job which is consistent with their education and training.
5	There is a mild* functional impact on activities involving mental health function. (1) The person has mild difficulties with most of the following: (a) self care and independent living; Example: The person lives independently but may sometimes neglect self-care, grooming or meals. (b) social/recreational activities and travel; Example 1: The person is not actively involved when attending social or recreational activities. Example 2: The person sometimes is reluctant to travel alone to unfamiliar environments. (c) interpersonal relationships; Example: The person has interpersonal relationships that are strained with occasional tension or arguments. (d) concentration and task completion; Example 1: The person has difficulty focusing on complex tasks for more than 1 hour. Example 2: The person has some difficulties completing education or training. (e) behaviour, planning and decision-making; Example 1: The person has unusual behaviours that may disturb other people or attract negative attention and may sometimes be more effusive, demanding or obsessive than is appropriate to the situation. Example 2: The person has slight difficulties in planning and organising more complex activities. (f) work/training capacity. Example*: The person has occasional interpersonal conflicts at work, education or training that require intervention by a supervisor, manager or teacher or changes in placement or groupings.
10	There is a moderate* functional impact on activities involving mental health function. (1) The person has moderate difficulties with most of the following: (a) self care and independent living; Example: The person needs some support (that is, an occasional visit by or assistance from a family member or support worker) to live independently and maintain adequate hygiene and nutrition. (b) social/recreational activities and travel; Example 1: The person goes out alone infrequently and is not actively involved in social events. Example 2: The person will often refuse to travel alone to unfamiliar environments. (c) interpersonal relationships; Example: The person has difficulty making and keeping friends or sustaining relationships. (d) concentration and task completion; Example 1: The person finds it very difficult to concentrate on longer tasks for more than 30 minutes (such as reading a chapter from a book). Example 2: The person finds it difficult to follow complex instructions (such as from an operating manual, recipe or assembly instructions). (e) behaviour, planning and decision-making; Example 1: The person has difficulty coping with situations involving stress, pressure or performance demands. Example 2: The person has occasional behavioural or mood difficulties (such as temper outbursts, depression, withdrawal or poor judgement). Example 3: The person’s activity levels are noticeably increased or reduced. (f) work/training capacity. Example*: The person often has interpersonal conflicts at work, education or training that require intervention by supervisors, managers or teachers or changes in placement or groupings.
20	There is a severe* functional impact on activities involving mental health function. (1) The person has severe difficulties with most of the following: (a) self care and independent living; Example: The person needs regular support to live independently, that is, needs visits or assistance at least twice a week from a family member, friend, health worker or support worker. (b) social/recreational activities and travel; Example: The person travels alone only in familiar areas (such as the local shops or other familiar venues). (c) interpersonal relationships; Example 1: The person has very limited social contacts and involvement unless these are organised for the person. Example 2: The person often has difficulty interacting with other people and may need assistance or support from a companion to engage in social interactions. (d) concentration and task completion; Example 1: The person has difficulty concentrating on any task or conversation for more than 10 minutes. Example 2: The person has slowed movements or reaction time due to psychiatric illness or treatment effects. (e) behaviour, planning and decision-making; Example: The person’s behaviour, thoughts and conversation are significantly and frequently disturbed. (f) work/training capacity. Example*: The person is unable to attend work, education or training on a regular basis over a lengthy period due to ongoing mental illness.
30	There is an extreme* functional impact on activities involving mental health function. (1) The person has extreme difficulties with most of the following: (a) self care and independent living; Example 1: The person needs continual support with daily activities and self care. Example 2: The person is unable to live on their own and lives with family or in a supported residential facility or similar, or in a secure facility. (b) social/recreational activities and travel; Example: The person is unable to travel away from own residence without a support person. (c) interpersonal relationships; Example: The person has extreme difficulty interacting with other people and is socially isolated. (d) concentration and task completion; Example 1: The person has extreme difficulty in concentrating on any productive task for more than a few minutes. Example 2: The person has extreme difficulty in completing tasks or following instructions. (e) behaviour, planning and decision-making; Example 1: The person has severely disturbed behaviour which may include self harm, suicide attempts, unprovoked aggression towards others or manic excitement. Example 2: The person’s judgement, decision-making, planning and organisation functions are severely disturbed. (f) work/training capacity. Example*: The person is unable to attend work, education or training sessions other than for short periods of time.