Galea and National Disability Insurance Agency

This matter concerned an application for review of a decision by the National Disability Insurance Agency (NDIA) that the applicant did not meet the access criteria for the National Disability Insurance Scheme (NDIS). The applicant, who was diagnosed with Chronic Regional Pain Syndrome (CRPS) following a workplace injury, sought to demonstrate that his impairments resulted in a substantially reduced functional capacity. The NDIA had affirmed its initial decision upon internal review.

The Administrative Appeals Tribunal (the Tribunal) was required to determine whether the applicant met the disability requirements for access to the NDIS under section 24 of the National Disability Insurance Scheme Act 2013 (Cth). Specifically, the Tribunal had to consider whether the applicant's CRPS constituted a permanent impairment that resulted in a substantially reduced functional capacity to undertake communication, social interaction, learning, mobility, self-care, or self-management, and whether these impairments affected his capacity for social or economic participation and were likely to require lifetime support.

The Tribunal considered evidence from the applicant's treating doctor, who detailed the severity of his allodynia, his need for assistance with mobility, showering, dressing, eating, and drinking, and his social isolation without regular treatment. The doctor also noted that the applicant was unable to perform activities requiring physical exertion or stamina, or complete work and living tasks taking more than 10 minutes. However, the Tribunal also noted evidence from an osteopath indicating considerable improvement in the applicant's function and capacity for daily living activities since commencing treatment. The Tribunal's reasoning focused on the interpretation of "substantially reduced functional capacity" and the evidence presented regarding the applicant's current functional limitations and the impact of his impairments.

The Tribunal affirmed the decision under review, finding that the applicant did not meet the disability requirements for access to the NDIS.