DHTW and Secretary, Department of Social Services (Social security second review)
[2025] ARTA 2289
•29 October 2025
DHTW and Secretary, Department of Social Services (Social security second review) [2025] ARTA 2289 (29 October 2025)
Applicant:DHTW
Respondent: Secretary, Department of Social Services
Tribunal Number: 2025/1920
Tribunal:Senior Member S Trotter (second review)
Place:Brisbane
Date:29 October 2025
Decision:The Tribunal affirms the decision under review.
Names used in all published decisions are pseudonyms. Any references appearing in square brackets indicate that information has been removed from this decision and replaced with generic information so as not to identify involved individuals as required by subsections 201(1A) - 201(1B) of the Social Security (Administration) Act 1999.
Catchwords
SOCIAL SECURITY – disability support pension – long standing mental health condition – whether evidence of diagnosis by specialists required by the legislation – osteoarthritis – Dupuytren’s contracture – COPD – coeliac disease – fatty liver - whether other conditions fully diagnosed, treated and stabilised – whether impairment rating of 20 points can be assigned – decision under review affirmed
Legislation
Social Security Act 1991
Social Security (Administration) Act 1999
Social Security (Tables for Assessment of Work-related Impairment for Disability Support Pension) Determination 2011Cases
MDXJ v Secretary, Department of Social Services [2020] FCA 1767
Secondary Materials
Nil
Statement of Reasons
This application is about whether Mrs DHTW (the Applicant), who is 65 years of age, meets the medical qualification requirements for grant of disability support pension in relation to a claim made by her on 25 January 2024.
On 17 February 2024, Services Australia – Centrelink (Centrelink) on behalf the Respondent[1] decided to reject the Applicant’s claim for disability support pension on the basis that she did not have an impairment rating of 20 points as required.
[1] Services Australia delivers social security payments and services and is overseen by the Department of Social Services. The Respondent is responsible for the overall management and administration of the Department of Social Security. Centrelink is the Government Agency that delivers social security payments and services as part of Services Australia and as the Agency with whom pension and benefit applicants/ recipients interact, the Respondent may be variously referred to as Centrelink or the Respondent throughout these Reasons.
On 28 March 2024, the Applicant sought review of the decision to reject her claim, and, on 2 November 2024, a Centrelink authorised review officer affirmed the decision.
On 27 February 2025, following application on 9 December 2024, the Administrative Review Tribunal (the Tribunal) on first review affirmed the decision of the authorised review officer.
On 15 March 2025, the Applicant lodged an application with the Tribunal seeking second review of the decision to reject her claim for disability support pension.
The Applicant and the Respondent’s representative participated in a hearing before me on 4 September 2025, with the Applicant and her husband both giving sworn evidence.
In addition to the oral evidence and submissions at hearing, I took into the account the documents provided by the Respondent pursuant to section 25 of the Administrative Review Tribunal Act 2024 on first review, pages 1 to 465, marked Exhibit 1 and the Statement of Issues, Facts and Contentions (SIFC) of the Respondent dated 4 August 2025.
ISSUES
The statutory provisions setting out the qualification requirements for disability support pension are contained in the Social Security Act 1991 (the Act).
The medical qualification requirements for disability support pension include those set out in paragraphs 94(1)(a), (b) and (c) of the Act. Each requirement much be satisfied for a person to be medically qualified for disability support pension as at the relevant date. The relevant date is the date of claim, or in certain circumstances within 13 weeks of the date of claim.
Paragraph 94(1)(a) of the Act requires that a person has a physical, intellectual or psychiatric impairment.
To satisfy paragraph 94(1)(b) of the Act, a person must have an impairment rating of at least 20 points under the Impairment Tables in operation in relation to date of claim. As at the date of the Applicant’s claim, the applicable Impairment Tables were those contained in the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 (the Impairment Tables). All references to the Impairment Tables in these Reasons are references to that Determination.
Subsection 8(3) of the Impairment Tables requires that an impairment rating can only be assigned to an impairment if:
(a) the condition has been diagnosed by an appropriately qualified medical practitioner;
(b) the condition has been reasonably treated;
(c) the condition has been stabilised; and
(d) the condition and the resulting impairment is more likely than not, in the light of available evidence, to persist for more than 2 years.
Subsections 8(4), (5), (6) and (7) of the Impairment Tables address what is required to be satisfied for a condition to be considered diagnosed, reasonably treated and stabilised. Diagnosis requires corroborating evidence as set out in the requirements for the relevant Table (subsection 8(4)).
Each Impairment Table includes a set of descriptors, which provide examples of functional impact (impairment) of conditions, to which an applicant’s symptoms are compared to arrive at a point allocation. Symptoms and impairment must be corroborated by medical or similar evidence before they can be taken into account (see subsection 10(1) of the Impairment Tables and the introduction to each Table).
To satisfy paragraph 94(1)(c) of the Act a person (not part of the supported wage system) must also have a “continuing inability to work”. This term is defined in subsection 94(2) of the Act.
It follows from the relevant statutory provisions that the issues for me to determine are:
(a) Did the Applicant have a physical, intellectual or psychiatric impairment for the purposes of her 25 January 2024 claim? And, if so,
(b) Can an impairment rating be allocated in relation to each condition impacting the Applicant for the purposes of her 25 January 2024 claim and, if so, how many points can be allocated? And, if so,
(c) Can a total of 20 points or more be allocated in relation to the Applicant’s 25 January 2024 claim? And, if so,
(d) Did the Applicant have a continuing inability to work for the purposes of the 25 January 2024 claim for disability support pension?
CONSIDERATION
Medical certificates from the Applicant’s general practitioner in evidence before me included certificates dated 21 January 2020, 17 April 2020, 16 July 2020, 19 October 2020, 21 January 2021, 15 April 2021, 15 July 2021, 12 October 2021, 26 July 2022, 10October 2022, 20 July 2023, 28 September 2023, 18 January 2024 and 18 November 2024,[2] all noting the medical conditions and details impacting the Applicant as follows:
[2] Pages 11, 13, 15, 17, 19, 21, 23, 25, 33, 35, 37, 39, 79 and 97 of Exhibit 1.
Condition – depression/anxiety
Date of onset – 21 January 1994
Temporary exacerbation of a permanent condition
Prognosis – 13–24 months
Symptoms – anxiety, poor sleep, poor concentration
Past, current and planned treatment – xyprexa, ProzCondition – osteoarthritis
Date of onset – 21 January 2010
Temporary exacerbation of a permanent condition
Prognosis – 3–12 months
Symptoms – pain, reduced activity
Past, current and planned treatment – paracetomal, gym programA Patient Health Summary from Dr Hooper dated 25 January 2024[3] further includes as follows:
[3] Page 78 of Exhibit 1.
Current Medications:
Coveram 5/10 5m; 10mg Tablet (Perindopril, Amlodipine)
Prozac 20mg Pulvules (Fluoxetine Hydrochloride)
Spiriva Respimat 2.5mcg Inhalation (Tiotropium bromide)
Zyprexa 5mg Tablet (Olanzapine)Active Past History:
Chronic Obstructive Pulmonary Disease
Osteoarthritis2006 Bipolar Affective Disorder
2008 Coeliac Disease
23/07/2013 Hypertension
21/09/2016 Fatty Liver
10/09/2019 Left Wrist fractureIn her 12 March 2024 application for internal review by Centrelink,[4] the Applicant stated as follows:
Why decision was made to reject my claim when I have an impairment of over 20 points.
The letter reads that I have to have an impairment of 20 or more points.
1) My conditions have been diagnosed by a G.P., psychiatrist, psychologist, X-rays and lung tests.
2) The conditions are and have been reasonably treated.
3) The depression/anxiety I have had/has been treated for nearly 30 years and is stabilised but will never be fully “cured”.
[4] Page 84 of Exhibit 1.
On 16 April 2024, Dr Hooper certified as follows in relation to the Applicant:[5]
…is receiving medical treatment for depression/anxiety – taking anti depressant daily with zyprexa for anxiety and poor sleep Psychiatrist assessment has been done. She also has COPD and takes 3 medications for this. Osteoarthritis and dupuytrens limit her joint function. Coeliac is controlled by diet bt (sic) presents difficulties when dining out.
[5] Page 85 of Exhibit 1.
On 7 May 2024,[6] Dr Hooper referred the Applicant to a psychologist under a Mental Health Care Plan for opinion and management for mixed anxiety and depression.
[6] Pages 90 to 95 of Exhibit 1.
In her request for second review, the Applicant states that she has been treated by different medical professionals for her mental health issues for over 30 years and that that is ground for her impairment rating to be eligible for a pension. She stated that it is unfair to be discriminated against because she has been unable to afford specialist care. It was Centrelink that advised her to apply for disability support pension and she assumed it would therefore be approved quite quickly, so there was no reason to make specialist appointments in the public health system as the wait time was going to be 12-plus months.
The Applicant told me at hearing that she has a further letter from her doctor dated 15 May 2025 stating that the mental health condition impacting upon her has been diagnosed, reasonably treated and stabilised and she disputes the claim being rejected on the basis that it wasn’t. She said that she had not provided the letter to the Tribunal because she did not realise she should. She said that she has been receiving treatment for 30 years. She also said her arthritis has got a lot worse and she is seeing a physiotherapist and is having dry needling and taking two new medications for that condition.
The Respondent’s position is that the Applicant cannot be allocated 20 points under the Impairment Tables for the purposes of her 25 January 2024 claim, including because:
(a) the Applicant’s psychiatric conditions were not diagnosed, reasonably treated and stabilised as there is no verification of diagnosis from a psychiatrist or psychologist;
(b) there is limited evidence of a diagnosis relevant to the Dupuytren’s contracture condition for a diagnosis to be established;
(c) coeliac disease was diagnosed, reasonably treated and stabilised, but no impairment rating can be assigned due to a lack of corroborating medical evidence; and
(d) the COPD, osteoarthritis and fatty liver conditions were diagnosed but not reasonably treated and stabilised.
Issue 1: Did the Applicant have a physical, intellectual or psychiatric impairment for the purposes of her 25 January 2024 claim?
Having reviewed the medical reports in evidence, I am satisfied that as of 25 January 2024 the Applicant had impairments caused by mental health conditions, Dupuytren’s contracture, coeliac disease, COPD, osteoarthritis and fatty liver. I therefore find that paragraph 94(1)(a) of the Act is satisfied in relation to the Applicant’s 25 January 2024 claim. As already noted, the Respondent accepts that paragraph 94(1)(a) of the Act was satisfied as of 25 January 2024: paragraph 4.12 of the Applicant’s SIFC.
Issue 2: Can an impairment rating be allocated in relation to each of the conditions impacting the Applicant for the purposes of her 25 January 2024 claim and, if so, how many points can be allocated?
I considered each of the identified conditions impacting the Applicant in turn.
The Applicant’s position is that she has been impacted by mental health conditions for over 30 years. The Applicant’s husband’s evidence was that the Applicant was originally assessed as having postnatal depression several years ago. He said there were some pretty horrific and anxious times, and it included time his wife spent in a psychiatric ward for about six weeks. He said it has never really ceased since then – there has been a pattern of depression and anxiety that she has suffered continuously, with her taking medication the whole time and seeing doctors and being referred to various specialists. However, they do not have a lot of that documented. He said the treatments were horrific in their pricing and at one stage the psychiatrist was a weekly thing costing a lot of money. He said that it is a long-term disease which has been treated by medication with the Applicant going through quite lengthy periods of time without any medical intervention, but then things flare up every now and again causing difficulties. He said that the Applicant has changed her medication many times because sometimes certain medication has not suited. He said that the Applicant had seen a psychiatrist in the past – going back quite a few years she used to see someone once a month - they just couldn’t afford to continue doing it.
I note, as discussed with the Tribunal on first review, that the Applicant saw a psychiatrist following the birth of her son and was prescribed medication. She also saw another psychiatrist about 8 to 10 years ago and was prescribed further medication. I asked the Applicant and her husband whether there had been any diagnosis or consultation with a psychologist or psychiatrist in addition to the Applicant’s general practitioner’s diagnosis, contemporaneous to the date of the Applicant’s 25 January 2024 claim for disability support pension. I noted that the documentation showed that the Applicant was referred to a psychologist after she made the claim, on 7 May 2024. The Applicant said she ended up seeing a psychologist but could only afford two sessions. She said she mainly went to talk to her, the psychologist, because of this process (the disability support pension process) as she really needed to talk to someone because she had so many things bottled up.
The Applicant read out the letter from her doctor, Dr Hooper, dated 15 May 2025, at hearing. She said that it states that the Applicant is ‘receiving medical treatment for numerous conditions which have been diagnosed, reasonable treated and stabilised’.
I discussed with the Applicant my concern that the necessary medical evidence was not before the Tribunal in relation to the required diagnosis of a mental health condition such that it can be taken into account for the purposes of her claim for disability support pension.
Notably in that regard, impairment associated with mental health functioning is rated under Table 5 of the Impairment Tables. The introduction to Table 5 states ‘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).
The Applicant said she does not understand because she has been treated for 30 years, she has seen psychiatrists and psychologists and the condition has been diagnosed, reasonably treated and stabilised. She said she could go back to the psychiatrist and ask him if he can say he saw her, but she is not sure if he is still around from 30 years ago. I noted that, even if that evidence was available, it is not necessarily evidence of a supporting diagnosis (in addition to the diagnosis by her general practitioner) of the condition impacting her contemporaneous to the time of her 25 January 2024 claim as required.
The Applicant’s husband said it just does not seem fair nor right. He said the proof that the condition has been treated and maintained is the fact that his wife is still with us at all – their son is now 30 and she is still here. They have managed the ups and downs over a long time – if the condition hadn’t been treated, he does not think he would still have his wife here with him.
I acknowledge the concerns raised by the Applicant and her husband at hearing. I accept that the Applicant has been impacted by a mental health condition for several years. However, I am required to apply the legislation relevant to whether the Applicant is medically qualified for disability support pension in relation to her 25 January 2024 claim. The legislation requires that in addition to diagnosis by a general practitioner, that diagnosis is also required by a psychiatrist or psychologist. There is no such evidence before me. Dr Hooper, in his 16 April 2024 letter, refers to ‘psychiatrist assessment (having) been done’ but there is no evidence of diagnosis from a psychiatrist before me. I am therefore not able to find that the condition has been diagnosed as required by subsection 8(3) of the Impairment Tables in order to consider what impairment rating might be applicable. It is possible that the psychologist that saw the Applicant after she was referred on 7 May 2024 may have confirmed a diagnosis. However, there is no such evidence before me and even if there were evidence from that psychologist, this post-dates the relevant period I am able to consider, that is 25 January 2024 (or possibly the 13 weeks after that date). No impairment rating can therefore be assigned in relation to the mental health condition impacting the Applicant.
I discussed with the Applicant at hearing that even if the evidence supported a finding that the condition was diagnosed (in accordance with the requirements in the legislation), I held a concern that there is not corroboratory evidence of the impact of the condition upon her.
As I have found that no impairment rating can be assigned, it is not necessary for me to further consider the issue in relation to the mental health condition impacting the Applicant and how many impairment points could be assigned. However, as already noted pursuant to subsection 10(1) of the Impairment Tables and the introductions to each Table, symptoms must be corroborated by medical evidence before they can be taken into account.
Dr Hooper in his various medical certificates notes symptoms of ‘anxiety, poor sleep, poor concentration’ and in his 16 April 2024 letter also refers to poor sleep. However, there is otherwise no corroboratory medical evidence corresponding to the descriptors in the relevant Impairment Table. The relevant Impairment Table in relation to mental health conditions is Table 5, which assigns impairment ratings for assessing functional impact of a diagnosed mental health condition. Table 5 is set out in full in Annexure A to these Reasons.
Dupuytren’s contracture
The Applicant’s evidence at hearing was that this condition really affects her left hand (which is virtually like a claw) and is also starting to affect her dominant hand, her right hand. Her doctor has said that she will have to have surgery.
The Respondent’s position is that there is limited medical evidence regarding this condition for it to be considered diagnosed. Further, it was submitted that in the absence of evidence of specialist referral, treatment recommendations or management strategies, the condition could not be found to be reasonably treated or stabilised.
There is limited evidence before me in relation to the Dupuytren’s condition impacting the Applicant. Dr Hooper’s 16 April 2024 letter refers to the condition limiting the Applicant’s joint function. Table 2 is the relevant Impairment Table in relation to a condition causing functional impairment when performing activities requiring the use of the upper limbs. Unlike as regards a mental health condition, there is no additional requirement in the Impairment Tables or legislation for a diagnosis by a particular medical practitioner. I am satisfied Dr Hooper is an appropriately qualified medical practitioner as required for diagnosis in the Introduction to Table 2. Based on Dr Hooper’s 16 April 2024, I infer he has diagnosed the condition. However, given the Applicant’s evidence at hearing that the doctor has said that she will have to have surgery for the condition, I am not able to find that the condition had been reasonably treated and stabilised for the purposes of the Applicant’s 25 January 2024 claim. It follows that no impairment rating can be assigned in relation to this condition for the purposes of the Applicant’s 25 January 2024 claim.
I have found that no impairment rating can be assigned in relation to this condition. If an impairment rating were able to be assigned, corroboratory evidence of impact upon the Applicant would be required for consideration of impairment pursuant to Table 2. Table 2 is set out in full in Annexure A to these Reasons.
Coeliac disease
The Applicant agreed with Dr Hooper’s statement of 16 April 2024 that this condition is controlled by diet and that it presents difficulties when she is going out but said that she does not really go out because of her mental health – she does not like leaving the house. She said it is quite expensive to follow the correct diet, but she is able to control the symptoms by watching her diet.
The Respondent’s position is that this condition can be considered diagnosed, reasonable treated and stabilised for the purposes of the Applicant’s 25 January 2024 claim however that there is no corroborating evidence of impact to allow assignment of an impairment rating under Table 10.
Again, unlike as regards a mental health condition, there is no additional requirement in the Impairment Tables or legislation for a diagnosis by a particular medical practitioner in relation to this condition. I am satisfied Dr Hooper is an appropriately qualified medical practitioner as required for diagnosis in the Introduction to Table 10, the relevant Impairment Table in relation to functional impairment from a condition related to digestive (or reproductive) system functions. Based on Dr Hooper’s 25 January 2024 and 16 April 2024 letters, I am satisfied that this condition has been diagnosed. I am further satisfied based on Dr Hooper’s letters that the condition is reasonably treated and stabilised. An impairment rating can therefore be assigned pursuant to Table 10. Table 10 is set out in full in Annexure A to these Reasons.
Given the corroboratory evidence from Dr Hooper that the condition is well-controlled with diet, an impairment rating of only 0 points may be assigned.
COPD
The Applicant’s evidence at hearing was that she is using inhalers and steroids in relation to this condition, but she wants to talk to her doctor about a new medication – an injection that you can have once a month. She said she copes with the condition during the day but at night she does not get much sleep because she struggles to breathe.
The Respondent’s position is that this condition was diagnosed for the purposes of the Applicant’s 25 January 2024 claim but was not reasonably treated and stabilised.
Again, unlike as regards a mental health condition, there is no additional requirement in the Impairment Tables or legislation for a diagnosis by a particular medical practitioner in relation to this condition. I am satisfied Dr Hooper is an appropriately qualified medical practitioner as required for diagnosis in the Introduction to Table 1, the relevant Impairment Table in relation to the functional impact of a condition when performing activities requiring physical exertion or stamina. Based on Dr Hooper’s 25 January 2024 and 16 April 2024 letters, I am satisfied that this condition has been diagnosed. However, there is limited evidence before me as to treatment of the condition and, further, the Applicant is seeking additional new treatment. On that basis, I am unable to find that the condition had been reasonably treated and stabilised for the purposes of the 25 January 2024 claim. It follows that no impairment rating can be assigned in relation to this condition.
I have found that no impairment rating can be assigned in relation to this condition. However, I repeat my earlier comments in relation to the requirement for corroboratory medical evidence in relation to symptoms if an impairment rating were able to be assigned in relation to this condition. Table 1 is set out in full in Annexure A to these Reasons.
Osteoarthritis
The Applicant’s evidence at hearing was that she has been seeing a physiotherapist for the osteoarthritis condition and receiving massage and dry needling treatment, which has helped a bit. She said she is also on new medication which she started about a month ago. In response to a query as to whether she has seen a specialist about the osteoarthritis, the Applicant said that the doctor has said to see how she goes with the physiotherapy and dry needling and the new medication first.
The Respondent’s position is that this condition was diagnosed for the purposes of the Applicant’s 25 January 2024 claim but was not reasonably treated and stabilised.
Again, unlike as regards a mental health condition, there is no additional requirement in the Impairment Tables or legislation for a diagnosis by a particular medical practitioner in relation to this condition. I am satisfied Dr Hooper is an appropriately qualified medical practitioner as required for diagnosis in relation to the Introduction to Tables 1, 2, 3 and 4 (all possibly relevant tables depending upon the impact of the osteoarthritis upon the Applicant). Notably, at hearing on first review, the Applicant said that she has joint pain in her hands, knees, neck and shoulders. I have already referred to Tables 1 and Table 2 earlier in these Reasons. Additionally, Table 3 is the relevant Impairment Table in relation to the functional impact of a condition when performing activities requiring the use of lower limbs and Table 4 is the relevant Impairment Table in relation to the functional impact of a condition when performing activities involving spinal function, that is, bending or turning the back, trunk or neck. Based on Dr Hooper’s various certificates and his 25 January 2024 and 16 April 2024 letters, I am satisfied that this condition has been diagnosed. However, there is limited evidence before me as to treatment of the condition. Further, the Applicant has been seeking treatment, specifically physiotherapy and dry needling, subsequent to the 25 January 2024 claim which on her evidence have resulted in some improvement. On that basis, I am unable to find that the condition had been reasonably treated and stabilised for the purposes of the 25 January 2024 claim. It follows that no impairment rating can be assigned in relation to this condition.
I have found that no impairment rating can be assigned in relation to this condition. However, I repeat my earlier comments in relation to the requirement for corroboratory medical evidence in relation to symptoms if an impairment rating were able to be assigned in relation to this condition. I have already referred to Tables 1 and 2 being set out in full in Annexure A to these Reasons. Tables 3 and 4 are also set out in full in the Annexure.
Fatty liver function
The Applicant’s evidence at hearing was that every time she has a blood test, it comes up that she has fatty liver function, but she does not know why, and she does not know what she can do about that. She said her doctor has not said anything about it to her. She said she is not aware that this condition has any impact upon her separate to the impact of any of the other conditions.
The Respondent’s position is that this condition was diagnosed for the purposes of the Applicant’s 25 January 2024 claim but was not reasonably treated and stabilised.
Again, unlike as regards a mental health condition, there is no additional requirement in the Impairment Tables or legislation for a diagnosis by a particular medical practitioner in relation to this condition. I am satisfied Dr Hooper is an appropriately qualified medical practitioner as required for diagnosis in the Introduction to Table 10, the relevant Impairment Table in relation to functional impairment from a condition related to digestive (or reproductive) system functions. Based on Dr Hooper’s 25 January 2024 letter, I am satisfied that this condition has been diagnosed. However, there is no additional evidence as to the treatment of this condition, if any. I am therefore unable to find that the condition had been reasonably treated and stabilised for the purposes of the 25 January 2024 claim. It follows that no impairment rating can be assigned in relation to this condition.
I have found that no impairment rating can be assigned in relation to this condition. However, I repeat my earlier comments in relation to the requirement for corroboratory medical evidence in relation to symptoms if an impairment rating were able to be assigned in relation to this condition. I have already referred to Table 10 being set out in full in Annexure A to these Reasons.
Issue 3: Can a total of 20 points or more be allocated in relation to the Applicant’s 25 January 2024 claim?
Having considered the evidence before me, I find that the only condition impacting upon the Applicant which can be allocated an impairment rating for the purposes of the 25 January 2024 claim for disability support pension is coeliac disease. I have found that that condition attracts an impairment rating of 0 points under Table 10 of the Impairment Tables based upon the evidence. As this is less than the 20 points required, the Applicant does not satisfy paragraph 94(1)(b) and was not medically qualified for disability support pension for the purposes of the 25 January 2024 claim.
Issue 4: Did the Applicant have a continuing inability to work for the purposes of the 25 January 2024 claim for disability support pension?
Given my previous findings, it is not necessary to address the remaining identified issue of whether the Applicant had a continuing inability to work for the purposes of the 25 January 2024 claim.
Conclusion
I have found that paragraph 94(1)(a) is satisfied but not paragraph 94(1)(b) for the purposes of the Applicant’s 25 January 2024 claim. The Applicant therefore does not meet all the requirements necessary to medically qualify for disability support pension for the purposes of the 25 January 2024 claim. That claim must therefore be rejected. It follows that the decision under review is affirmed.
I accept that the Applicant has significant health challenges. However, the grant of disability support pension is required, pursuant to the legislation, to be assessed on corroboratory evidence of diagnosis, having been reasonably treated and stabilised and, further, corroboratory evidence of impairment is required for allocation of impairment ratings. I have no discretion to disregard the legislative requirements necessary to medically qualify for disability support pension.
This does not mean that the Applicant cannot qualify for disability support pension at some time in the future for the purposes of any later claim she may elect to make. The 25 January 2024 claim does not operate as a continuing claim. A new claim must be lodged should the Applicant wish to retest her eligibility for disability support pension at any time. It is a matter for the Applicant is she wishes to retest her eligible at any future time. I acknowledge the Applicant’s concern in relation to the cost of consulting medical professionals but also note that the Mental Health Care Plan was provided by Dr Hooper on 7 May 2024 for referral to a psychologist. A person is usually able to access nil or significantly reduced cost appointments pursuant to such a plan.
If an impairment rating of 20 points or more can be assigned at any point, if at least 20 points is not assigned pursuant to one Impairment Table, participation in a program of support (or exemption) pursuant to the Social Security (Active Participation for Disability Support Pension) Determination 2014, is also required.
There are also further conditions that are required to be satisfied as set out in paragraphs 94(2)(a) and (b) of the Act.
DECISION
The Tribunal affirms the decision under review.
Date of hearing: 4 September 2025 Applicant: Self-represented Respondent: Ms B Zhou Annexure A
Table 1 – Functions requiring Physical Exertion and Stamina
Introduction to Table 1
- Table 1 is to be used to assess the functional impact of a diagnosed condition when performing activities requiring physical exertion or stamina.
- The diagnosis of the condition causing the impairment must be made by an appropriately qualified medical practitioner.
- There must be corroborating evidence of the person’s impairment.
- Self-report of symptoms must be supported by corroborating medical evidence.
- Examples of corroborating evidence for the purposes of this Table include, but are not limited to, the following:
o a report from the person’s treating doctor;
o a report from a medical specialist confirming diagnosis of conditions commonly associated with cardiac or respiratory impairment (such as cardiac failure, cardiomyopathy, ischaemic heart disease, chronic obstructive airways/pulmonary disease, asbestosis, mesothelioma, or lung cancer);
o a report from a medical specialist confirming the diagnosis of conditions commonly associated with fatigue or exhaustion (such as diabetes mellitus, renal failure, end stage organ failure, widespread/metastatic cancer, chronic pain, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), lymphoedema and fibromyalgia), and providing details of treatment, functional impact and prognosis;
o results of exercise, cardiac stress, treadmill testing or actimetry linked blood pressure and heart rate monitoring.
- When determining whether a descriptor applies that involves a person performing an activity, the descriptor applies if that person can do the activity when they would be expected to do so and not only once or rarely.
- When assessing episodic or fluctuating impairments and conditions (such as migraines, chronic pain or transient ischaemic attacks), a rating must be assigned which reflects the overall functional impact of those impairments, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate.
- The examples used in descriptors are not an exhaustive list and are to be used only as a guide.
- Assistance means assistance from another person rather than any aids or equipment the person may use, unless specified otherwise.
Points Descriptors 0 There is no or minimal functional impact on activities requiring physical exertion or stamina.
(1) The person:
(a) is able to undertake exercise appropriate to their age for at least 30 minutes at a time; and
(b) has no or minimal difficulty completing physically active tasks around their home and community; and
(c) can undertake personal care activities such as showering or bathing and these activities do not prevent the person from undertaking a full range of activities in the same day.
5 There is a mild functional impact on activities requiring physical exertion or stamina.
(1) The person:
(a) experiences occasional symptoms such as mild shortness of breath, fatigue, pain, or mild post-exertional malaise, when performing physically demanding activities and, due to these symptoms, the person has mild difficulty:
(i) walking or mobilising in a wheelchair or other equivalent assistive technology to local facilities without stopping to rest; or
Example: going to local shops or supermarket, larger workplace, education or training campus.
(ii) performing physically active tasks or heavier household activities; and
Example 1: climbing a flight of stairs or mobilising up a long, sloping pathway or ramp if in a wheelchair.
Example 2: vacuuming floors or mowing the lawn.
(b) is able to perform most work-related tasks, other than tasks involving heavy manual labour.
Example: digging, carrying or moving heavy objects, concreting, bricklaying, or laying pavers.
10 There is a moderate functional impact on activities requiring physical exertion or stamina.
(1) The person:
(a) experiences frequent symptoms such as moderate shortness of breath, fatigue, pain, or post-exertional malaise, when performing day-to-day activities around the home and community and, due to these symptoms, the person has moderate difficulty:
(i) walking or mobilising in a wheelchair or other equivalent assistive technology far outside the home and needs to drive or get other transport to local facilities; or
Example: going to local shops or supermarket, workplace, education or training campus.
(ii) performing day-to-day household activities; or
Example: changing sheets, washing and putting away dishes or sweeping paths.
(iii) performing personal care activities such as showering or bathing and needs to plan and schedule showering or bathing around other activities to ensure they are not doing too much in any one day; and
(b) is able to:
(i) use public transport and walk or mobilise in a wheelchair around local facilities such as local shops, workplaces, or a supermarket; and
(ii) perform work-related tasks of a clerical, sedentary or stationary nature (i.e. tasks not requiring a high level of physical exertion).
20 There is a severe functional impact on activities requiring physical exertion or stamina.
(1) The person:
(a) usually experiences symptoms such as severe shortness of breath, fatigue, post-exertional malaise, or pain when performing light physical activities and, due to these symptoms, the person has severe difficulty:
(i) walking or mobilising in a wheelchair or other equivalent assistive technology from the carpark, into and around local facilities without assistance; or
Example: going to local shops or supermarket, workplace, education or training campus.
(ii) using public transport without assistance; or
(iii) performing light day-to-day household activities without requiring a long recovery period afterwards; or
Example: preparing a simple meal, dusting, folding and putting away laundry or light gardening.
(iv) performing personal care activities without assistance; and
Example: the activity will cause severe fatigue and the person needs to rest before and after showering/bathing, and can undertake minimal to no other activities for the rest of that day.
(b) has or is likely to have severe difficulty sustaining work-related tasks of a clerical, sedentary or stationary nature for a shift of at least 3 hours.
30 There is an extreme functional impact on activities requiring physical exertion or stamina.
(1) The person:
(a) is unable to perform activities requiring physical exertion or stamina; or
(b) experiences symptoms such as extreme shortness of breath, extreme fatigue or pain when performing any activities requiring physical exertion or stamina and, due to these symptoms, the person is unable to move around inside the home without assistance; or
(c) is unable to undertake personal care activities and needs assistance to use the bathroom or is reliant on bed baths or using wet wipes. Such activities result in severe fatigue; or
(d) is bedbound.
Note: this impairment rating level includes people who require Oxygen treatment.
Example: requiring the use of an Oxygen concentrator during the day or to move around.
Table 2 – Upper Limb Function
Introduction to Table 2 · Table 2 is to be used to assess the functional impact of a diagnosed condition when performing activities requiring the use of upper limbs.
· The diagnosis of the condition causing the impairment must be made by an appropriately qualified medical practitioner.
· There must be corroborating evidence of the person’s impairment.
· Self-report of symptoms must be supported by corroborating medical evidence.
· Examples of corroborating evidence for the purposes of this Table include, but are not limited to, the following:
o a report from the person’s treating doctor;
o a report from a medical specialist confirming diagnosis of conditions associated with upper limb impairment (such as arthritis or other condition affecting upper limb joints, paralysis or loss of strength or sensation resulting from stroke or other brain or nerve injury, cerebral palsy or other condition affecting upper limb coordination, inflammation or injury of the muscles or tendons of the upper limbs, chronic pain affecting the upper limbs, amputation or absence of whole or part of upper limb, lymphoedema, or peripheral neuropathy);
o a report from an allied health practitioner (such as physiotherapist, occupational therapist or exercise physiologist) confirming the functional impact;
o results of diagnostic tests (such as X-Rays or other imagery);
o results of physical tests or assessments.
· For the purposes of this Table, upper limbs extend from the shoulder to the fingers.
· If a person’s dominant upper limb is impaired, consideration should be given to their ability to adapt and use their non-dominant upper limb to perform tasks.
· When determining whether a descriptor applies that involves a person performing an activity, the descriptor applies if that person can do the activity when they would be expected to do so and not only once or rarely.
· When assessing episodic or fluctuating impairments and conditions (such as chronic pain), a rating must be assigned which reflects the overall functional impact of those impairments, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate.
· The examples used in descriptors are not an exhaustive list and are to be used only as a guide.
· Assistance means assistance from another person rather than any aids or equipment the person may use, unless specified otherwise.
Points Descriptors 0 There is no or minimal functional impact on activities using upper limbs.
(1) The person can pick up, handle, manipulate and use most objects encountered on a daily basis without difficulty.
5 There is a mild functional impact on activities using upper limbs.
(1) The person can manage most daily activities requiring the use of the upper limbs, but has mild difficulty with at least 3 of the following:
(a) picking up heavier objects;
Example: picking up and using large bulky tools such as a leaf blower, or picking up and pouring a full kettle.
(b) handling very small objects;
Example: picking up coins or picking up and using paper clips or pins.
(c) doing up buttons or tying laces;
(d) reaching up above head height or out to pick up objects.
Example: reaching overhead to retrieve a kitchen appliance, stocking deep or high shelves, hanging heavy washing overhead or changing a ceiling light bulb.
10 There is a moderate functional impact on activities using upper limbs.
(1) The person has moderate difficulty carrying out at least 4 of the following:
(a) picking up a 1 litre carton full of liquid;
(b) picking up a light but bulky object requiring the use of 2 hands together;
Example: a cardboard box.
(c) holding and using a pen or pencil;
(d) doing up buttons, tying shoelaces or doing up a zipper;
Example: wearing clothing that goes on over the head to avoid doing up buttons.
(e) raising arms to dress or wash hair, or reaching into a cupboard at head height;
(f) using a standard computer keyboard, mouse or phone functions;
(g) carrying out a function such as grip and twist or pinch and pull.
Example 1: unscrewing the lid on a bottle or jar, or turning a tap.
Example 2: opening food packaging
20 There is a severe functional impact on activities using upper limbs.
(1) At least 3 of the following apply to the person:
(a) the person has limited movement or coordination in both upper limbs, has an amputation or nerve damage rendering an upper limb non-functional;
(b) the person has severe difficulty handling, moving or carrying most objects without assistance;
(c) the person has severe difficulty using a small object;
Example: holding and using a fork or spoon, holding and using a pen or pencil.
(d) the person has severe difficulty turning the pages of a book without assistance;
(e) the person has severe difficulty undertaking any activity that involves reaching overhead.
Example: accessing items above shoulder height, brushing hair.
30 There is an extreme functional impact on activities using upper limbs.
(1) The person has no function in both of their upper limbs or the person has no upper limbs.
Table 3 – Lower Limb Function
Introduction to Table 3
· Table 3 is to be used to assess the functional impact of a diagnosed condition when performing activities requiring the use of lower limbs.
· The diagnosis of the condition causing the impairment must be made by an appropriately qualified medical practitioner.
· There must be corroborating evidence of the person’s impairment.
· Self-report of symptoms must be supported by corroborating medical evidence.
· Examples of corroborating evidence for the purposes of this Table include, but are not limited to, the following:
o a report from the person’s treating doctor;
o a report from a medical specialist confirming diagnosis of conditions associated with lower limb impairment (such as arthritis or other condition affecting lower limb joints, paralysis or loss of strength or sensation resulting from stroke or other brain or nerve injury, cerebral palsy or other condition affecting lower limb coordination, inflammation or injury of the muscles or tendons of the lower limbs, chronic pain affecting the lower limbs, amputation or absence of whole or part of lower limb, lymphoedema, or peripheral neuropathy);
o a report from an allied health practitioner (such as physiotherapist, occupational therapist or exercise physiologist) confirming the functional impairment;
o results of diagnostic tests (such as X-Rays or other imagery);
o results of physical tests or assessments showing impaired function of the lower limbs.
· For the purposes of this Table lower limbs extend from the hips to the toes.
· The functional impact on lower limbs resulting from lumbar spine conditions, such as nerve pain or weakness in the lower limbs, is to be assessed under Table 3.
· When determining whether a descriptor applies that involves a person performing an activity, the descriptor applies if that person can do the activity when they would be expected to do so and not only once or rarely.
· When assessing episodic or fluctuating impairments and conditions (such as chronic pain), a rating must be assigned which reflects the overall functional impact of those impairments, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate.
· The examples used in descriptors are not an exhaustive list and are to be used only as a guide.
· Assistance means assistance from another person rather than any aids or equipment the person may use, unless specified otherwise.
Points Descriptors 0 There is no or minimal functional impact on activities requiring use of the lower limbs.
(1) The person has no or minimal difficulty performing activities involving standing, squatting or kneeling and rising to a standing position, negotiating stairs and walking around their home and in the community.
5 There is a mild functional impact on activities using lower limbs.
(1) At least one of the following applies:
(a) the person has mild difficulty walking on slopes or uneven ground; or
Example: walking to local facilities such as local shops, workplaces, a supermarket, or bus-stop where there is uneven terrain.
(b) the person has mild difficulty walking on level ground without stopping; or
Example: walking around local facilities such as local shops or a supermarket without stopping.
(c) the person has mild difficulty negotiating stairs; and
Example: is likely to require the use of a structural support, such as a hand rail to negotiate a flight of stairs.
(2) At least one of the following applies:
(a) the person has mild difficulty standing independently; or
Example: waiting in a slow moving queue or standing still.
(b) the person has mild difficulty squatting or kneeling, but does not require support to stand up again; or
Example: kneeling to tie a shoe and does not require support to stand again.
(c) the person can mobilise effectively but needs to use a walking aid to assist with walking or balance issues.
Example: tripping due to neurological conditions such as Multiple Sclerosis, Parkinson’s Disease or cerebellar function.
10 There is a moderate functional impact on activities using lower limbs.
(1) At least one of the following applies:
(a) the person has moderate difficulty walking on slopes or uneven ground; or
Example: the person has moderate difficulty walking far outside their home on uneven ground and needs to drive or get other transport to local facilities such as a local shop, workplace or supermarket.
(b) the person has moderate difficulty using stairs or steps without assistance or without using alternate methods; or
Example: the person may navigate stairs one at a time, sideways or require breaks, or navigates stairs with reliance on other structural support such as a hand rail to maintain balance.
(c) the person has moderate difficulty standing for short periods of time; or
Example: the person has moderate difficulty standing in a queue at a supermarket check out.
(d) the person has moderate difficulty kneeling or squatting and requires support of a stable object to stand again; and
Example: the person supports themselves using a coffee table to stand from a kneeling or squatting position.
(2) The person is able to use public transport or a motor vehicle and walk on level ground.
Example: is able to catch a bus and walk around in a workplace, shopping centre or supermarket.
Note 1: this impairment rating level includes a person who can:
(a) move around independently using a wheelchair and can independently transfer to and from a wheelchair; or
Example: the person can use a wheelchair accessible toilet independently.
(b) move around independently using walking aids such as a quad stick, crutches or walking frame.
Note 2: the person may require additional time and effort to move around a workplace, may need to use accessible entries, lifts and toilets, and may not be able to access some areas of a workplace or training facility.
20 There is a severe functional impact on activities using lower limbs.
(1) The person:
(a) has severe difficulty undertaking any of the following without assistance:
(i) standing up from a sitting position in a standard chair;
Example: the person has severe difficulty standing after being seated in a dining chair.
(ii) remaining standing independently;
(iii) walking around their home and in the community; and
Example: the person has severe difficulty walking from the carpark into local facilities and walking around local facilities such as shop or supermarket without assistance.
(b) requires assistance to use public transport.
Note: this impairment rating level includes a person who requires assistance to:
(a) move around in, or transfer to and from a wheelchair; or
Example: the person needs personal care assistance to use a toilet.
(b) move around using walking aids such as a quad stick, crutches or walking frame such as the person requires assistance from another person to walk on some surfaces and could not move independently around a workplace or training facility, even when using a walking aid.
Example: the person is at significant risk of, or has frequent falls due to balance or other issues.
30 There is an extreme functional impact on activities using lower limbs.
(1) The person is unable to mobilise independently.
Table 4 – Spinal Function
Introduction to Table 4
- Table 4 is to be used to assess the functional impact of a diagnosed condition when performing activities involving spinal function, that is, bending or turning the back, trunk or neck.
- The diagnosis of the condition causing the impairment must be made by an appropriately qualified medical practitioner.
- There must be corroborating evidence of the person’s impairment.
- Self-report of symptoms must be supported by corroborating medical evidence.
- Examples of corroborating evidence for the purpose of this Table include, but are not limited to, the following:
o a report from the person’s treating doctor;
o a report from a medical specialist confirming diagnosis of conditions commonly associated with spinal function impairment (such as spinal cord injury, spinal stenosis, cervical spondylosis, lumbar radiculopathy, herniated or ruptured disc, spinal cord tumours, arthritis or osteoporosis involving the spine, or chronic pain affecting the spine);
o a report from an allied health practitioner (such as a physiotherapist, or occupational therapist), confirming loss of range of movement in the spine or other effects of spinal disease or injury.
- Restrictions on overhead tasks resulting from shoulder conditions should be rated under Table 2.
- Restrictions resulting from hip conditions should be rated under Table 3.
- Restrictions on lower limbs resulting from lumbar spine conditions, such as nerve pain and lower limb weakness, should be rated under Table 3.
- Upper or lower limb impairment resulting from a spinal condition such as nerve root compromise can be additionally assessed under Table 2 or Table 3 if the Table 4 rating does not fully account for the overall level of impairment.
- Where a person has nerve damage in an upper or lower limb or an impingement in the neck affecting the upper limbs, an additional rating on Table 2 or 3 can be considered.
- When determining whether a descriptor applies that involves a person performing an activity, the descriptor applies if that person can do the activity when they would be expected to do so and not only once or rarely.
- When assessing episodic or fluctuating impairments and conditions such as chronic pain, a rating must be assigned which reflects the overall functional impact of those impairments, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate.
- The examples used in descriptors are not an exhaustive list and are to be used only as a guide.
- Assistance means assistance from another person rather than any aids or equipment the person may use, unless specified otherwise.
Points Descriptors 0 There is no or minimal functional impact on activities involving spinal function.
(1) The person can:
(a) bend down to pick a light object off the floor, such as a piece of paper; and
(b) turn their trunk from side to side; and
(c) turn their head to look to the sides or upwards.
5 There is a mild functional impact on activities involving spinal function.
(1) The person has mild difficulty in:
(a) activities over head height such as activities requiring the person to look upwards; or
(b) bending to knee level and straightening up again; or
Example: the person cannot bend down from a standing position to put on socks or shoes.
(c) turning their trunk or moving their head such as looking to the sides or upwards.
10 There is a moderate functional impact on activities involving spinal function.
(1) The person is able to sit in or drive a car for at least 30 minutes, and at least one of the following applies:
(a) the person has moderate difficulty sustaining overhead activities such as accessing items above head height; or
Example: looking up to hang washing on a clothesline.
(b) the person has moderate difficulty moving their head to look in all directions; or
Example: turning their head to look over their shoulder;
(c) the person has moderate difficulty bending forward to pick up a light object placed at knee height; or
(d) the person has moderate difficulty standing up from a sitting position in a standard chair without assistance.
Example: the person has moderate difficulty standing after being seated in a dining chair.
Note 1: this impairment rating level includes a person who can:
(a) move around independently using a wheelchair and can independently transfer to and from a wheelchair; or
Example: the person can use a wheelchair accessible toilet independently.
(b) move around independently using walking aids such as a quad stick, crutches or walking frame.
Note 2: the person may require additional time and effort to move around a workplace, may need to use accessible entries, lifts and toilets, and may not be able to access some areas of a workplace or training facility.
20 There is a severe functional impact on activities involving spinal function.
(1) The person has severe difficulty with at least one of the following:
(a) looking upwards to perform any overhead activities; or
(b) either turning their head, or bending their neck at all, without moving their trunk; or
(c) bending forward to hip height; or
Example: the person cannot bend forward to wipe a table or pick up a light object weighing less than 1kg from hip height.
(d) remaining seated for at least 10 minutes.
Example: the person frequently changes positions between sitting and standing or frequently shifts weight in a chair when seated.
Note: this impairment rating level includes a person who requires assistance to:
(a) move around in, or transfer to and from a wheelchair; or
Example: the person needs personal care assistance to use a toilet;
(b) move around using walking aids such as a quad stick, crutches or walking frame and the person requires assistance from another person to walk on some surfaces and cannot move independently around a workplace or training facility, even when using a walking aid.
Example: the person is at significant risk of, or has frequent falls due to balance or other issues.
30 There is an extreme functional impact on activities involving spinal function.
(1) The person cannot perform activities involving spinal function.
Table 5 – Mental Health Function
Introduction to Table 5
- Table 5 is to be used to assess the functional impact of a diagnosed mental health condition (including recurring episodes of mental health impairment).
- 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.
- There must be corroborating evidence of the person’s impairment.
- Self-report of symptoms must be supported by corroborating medical evidence.
- Examples of corroborating evidence for the purposes of this Table include, but are not limited to, the following:
o a report from the person’s treating doctor;
o supporting letters, reports or assessments relating to the person’s mental health or psychiatric condition;
o 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 sufficient 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.
- When determining whether a descriptor applies that involves a person performing an activity, the descriptor applies if that person can do the activity when they would be expected to do so and not once or rarely.
- When assessing episodic or fluctuating impairments and conditions, a rating must be assigned which reflects the overall functional impact of those impairments, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate.
- The examples used in descriptors are not an exhaustive list and are to be used only as a guide.
Points Descriptors 0 There is no or minimal functional impact on activities involving mental health function.
(1) The person has no or minimal difficulties with at least 4 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 interpersonal relationships;
Example 1: the person goes out regularly to social and recreational events without support.
Example 2: the person has no or minimal difficulty forming and sustaining relationships.(c) travel and accessing the community;
Example 1: the person is able to travel to and from unfamiliar environments independently.
Example 2: the person is able to utilise community facilities, such as local shops or other familiar venues.(d) concentration and task completion;
Example 1: the person has no or minimal 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: the person has no or minimal difficulties in behaviour, planning or decision-making.
(f) work/training capacity.
Example 1: the person is able to cope with the normal demands of a job that is consistent with their education and training.
Example 2: the person is able to perform workplace tasks without posing a risk to the safety of themselves or co-workers due to ongoing mental illness.5 There is a mild functional impact on activities involving mental health function.
(1) The person has mild difficulties with at least 4 of the following:
(a) self-care and independent living;
Example: the person lives independently but sometimes neglects self-care, grooming or meals.
(b) social/recreational activities and interpersonal relationships;
Example 1: the person is not actively involved when attending social or recreational activities.
Example 2: the person has interpersonal relationships that are strained, with occasional tension or arguments.(c) travel and accessing the community;
Example 1: the person is sometimes reluctant to travel alone to unfamiliar environments.
Example 2: the person is sometimes reluctant to utilise community facilities such as local shops or other familiar venues.(d) concentration and task completion;
Example 1: the person has mild difficulty focusing on complex tasks for more than 1 hour.
Example 2: the person has mild 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 is sometimes more effusive, demanding or obsessive than is appropriate to the situation.
Example 2: the person has mild difficulties in planning and organising more complex activities.(f) work/training capacity.
Example: the person has occasional interpersonal conflicts or poses some risk to the safety of themselves or co-workers due to ongoing mental illness at work, education or training that requires 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 at least 4 of the following:
(a) self-care and independent living;
Example: the person requires 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 interpersonal relationships;
Example 1: the person goes out alone infrequently and is not actively involved in social events.
Example 2: the person has moderate difficulty making and keeping friends or sustaining relationships.(c) travel and accessing the community;
Example 1: the person will often avoid travelling alone to unfamiliar environments.
Example 2: the person will often avoid utilising community facilities such as local shops or other familiar venues.
(d) concentration and task completion;
Example 1: the person has moderate difficulty concentrating on longer tasks, and following along with the task, for more than 30 minutes (such as reading an article, watching a television program or playing a video game).
Example 2: the person has moderate difficulty following complex instructions (such as from an operating manual, recipe or assembly instructions).(e) behaviour, planning and decision-making;
Example 1: the person has moderate 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 or poses a risk to themselves or co-workers due to ongoing mental illness at work, education or training that requires 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 at least 4 of the following:
(a) self-care and independent living;
Example: the person requires 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 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 severe difficulty interacting with other people and usually needs assistance or support from a companion to engage in social interactions.(c) travel and accessing the community;
Example 1: the person travels alone only in familiar areas (such as the local shops or other familiar venues).
Example 2: the person usually avoids utilising community facilities such as public transport.(d) concentration and task completion;
Example 1: the person has severe difficulty concentrating on or following along with 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 has severe difficulty attending 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 at least 4 of the following:
(a) self-care and independent living;
Example 1: the person requires 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 interpersonal relationships;
Example: the person has extreme difficulty interacting with other people and is socially isolated.
(c) travel and accessing the community;
Example: the person is unable to travel away from their own residence without a support person.
(d) concentration and task completion;
Example 1: the person has extreme difficulty in concentrating on or following along with 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 extremely 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 due to ongoing mental illness.
Table 10 – Digestive and Reproductive Function
Introduction to Table 10
- Table 10 is to be used to assess the functional impairment of a diagnosed condition related to digestive or reproductive system functions.
- Digestive conditions may include cancer and other diseases that affect the mouth, salivary glands, oesophagus, stomach, intestines (small or large intestine), pancreas, liver, gall bladder, bile ducts, rectum or anus.
- Reproductive system conditions may include gynaecological diseases (such as severe and intractable endometriosis, ovarian cancer, cervical cancer, endometrial cancers) and conditions of the male reproductive system (such as prostate cancer).
- The diagnosis of the condition causing the impairment must be made by an appropriately qualified medical practitioner.
- There must be corroborating evidence of the person’s impairment.
- Self-report of symptoms must be supported by corroborating medical evidence.
- Examples of corroborating evidence for the purposes of this Table include, but are not limited to, the following:
o a report from the person’s treating doctor;
o a report from a medical specialist (such as a gastroenterologist, a gynaecologist, an urologist or an oncologist) confirming diagnosis of a digestive or reproductive system condition;
o results of investigations (such as X-Rays or other imagery, endoscopy or colonoscopy).
- Personal care needs associated with digestive conditions include, but are not limited to, the need to take medications when symptoms occur, care of special feeding equipment (such as Percutaneous Endoscopic Gastrostomy (PEG) button or special feeding tube), special diets or feeding solutions, strategies to relieve chronic pain, additional toileting and personal hygiene needs.
- Personal care needs associated with reproductive system conditions include, but are not limited to, strategies to relieve chronic pain or more frequent menstrual care.
- When determining whether a descriptor applies that involves a person performing an activity, the descriptor applies if that person can do the activity when they would be expected to do so and not only once or rarely.
- When assessing episodic or fluctuating impairments and conditions, a rating must be assigned which reflects the overall functional impact of those impairments, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate.
- The examples used in descriptors are not an exhaustive list and are to be used only as a guide.
Points Descriptors 0 There is no or minimal functional impact from symptoms associated with a digestive or reproductive system condition.
(1) The person is not usually interrupted at work or other activity by symptoms or personal care needs associated with a digestive or reproductive system condition.
5 There is a mild functional impact from symptoms associated with a digestive or reproductive system condition.
(1) At least one of the following applies:
(a) the person’s attention and concentration at a task are sometimes (on most days) interrupted or reduced by chronic pain or other symptoms or personal care needs associated with the digestive or reproductive system condition; or
(b) the person is sometimes (less than once per month) absent from work, education or training activities due to the digestive or reproductive system condition.
10 There is a moderate functional impact from symptoms associated with a digestive or reproductive system condition.
(1) At least 2 of the following apply to the person:
(a) the person’s attention and concentration on a task are often (at least once a day but not every hour) interrupted or reduced by chronic pain or other symptoms or personal care needs associated with the digestive or reproductive system condition;
(b) the person has moderate difficulty sustaining work activities or other tasks for more than 2 hours without a break due to symptoms of the digestive or reproductive system condition;
(c) the person is often (once per month) absent from work, education or training activities due to the digestive or reproductive system condition.
20 There is a severe functional impact from symptoms associated with a digestive or reproductive system condition.
(1) At least 2 of the following apply to the person:
(a) the person’s attention and concentration at a task is frequently (at least once every hour) interrupted or reduced by chronic pain or other symptoms or personal care needs associated with the digestive or reproductive system condition;
(b) the person has severe difficulty sustaining work activities or other tasks for a total of more than 3 hours a day, even with regular breaks, due to symptoms of the digestive or reproductive system condition;
(c) the person has severe difficulty travelling to or participating in community or social environments due to symptoms or management of the gastrointestinal or reproductive system functions, causing frequent disruption to daily activities due to avoidance of activities;
Example: the person avoids using lifts, public transport or being near others due to the nature of their condition.
(d) the person is frequently (twice or more per month) absent from work, education or training activities due to the digestive or reproductive system condition.
30 There is an extreme functional impact from symptoms associated with a digestive or reproductive system condition.
(1) At least 2 of the following apply to the person:
(a) the person’s attention and concentration at a task are continually interrupted or reduced by chronic pain or other symptoms or care needs associated with the digestive or reproductive system condition (such that pain or other symptoms are present all or most of the time);
(b) the person is unable to sustain work activity or other tasks for more than one hour without a break due to symptoms of the digestive or reproductive system condition;
(c) the person has extreme difficulty travelling to or being in social environments due to symptoms or management of the gastrointestinal or reproductive system functions, causing extreme disruption to daily activities and rarely engages in activities outside of the home;
(d) the person is rarely able to attend work, education or training activities due to the digestive or reproductive system condition.
0
1
0