Graham and Secretary, Department of Social Services (Social services second review)

Graham and Secretary, Department of Social Services (Social services second review) [2019] AATA 1090 (31 May 2019)
Division:GENERAL DIVISION
File Number(s): 2017/6272
Re:Tanya Graham
APPLICANT

AndSecretary, Department of Social Services
RESPONDENT

DECISION
Tribunal:Member C Edwardes
Date:31 May 2019
Place:Perth

The decision under review is affirmed.
...................................[sgd].....................................
Member C Edwardes
CATCHWORDS
SOCIAL SECURITY – disability support pension – medical conditions – PTSD, depression and anxiety – chronic abdominal pain – hearing loss – infectious diseases – cervical spine – hyperparathyroidism – other – qualification period – fully diagnosed treated and stabilised – 10 points – no program of support – decision affirmed.
LEGISLATION
Social Security Act 1991 (Cth) – ss 94, 94(1), 94(1)(a), 94(1)(b), 94(1)(c), 94(2),
94(3B), 94(3C)
Social Security (Administration) Act 1999 (Cth) – s 179, Sch 2 cl 4(1)
CASES
Bobera and Secretary, Department of Families, Housing, Community Services and Indigenous Affairs [2012] AATA 922
Drake and Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634
Harris v Secretary, Department of Employment and Workplace relations (2007) 158 FCR 252
Ulukut and Secretary, Department of Social Services [2014] AATA 399
SECONDARY MATERIALS
Social Security (Active Participation for Disability Support Pension) Determination 2014 (Cth) – ss 5, 7(1), 7(2)
Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (Cth) – ss 3, 6(1), 6(2), 6(3), 6(4), 6(5), 6(6), 6(7), 7, 8(1), 9, 10, 11, 11(1)(c), Table 5.
Guide to Social Security Law, Department of Social Services, version 1.254.
REASONS FOR DECISION
Member C Edwardes
31 May 2019
THE APPLICATION

This is an application for the review of a decision of the Social Services and Child Support Division of the Administrative Appeals Tribunal (the AAT1) dated

21 September 2017 (T2 5-14, R1). The AAT1 affirmed a decision of the Department of Human Services (Centrelink) to reject the Applicant’s claim for Disability Support Pension (DSP) lodged on 3 February 2016 (T30 209-238, R1).
On 3 February 2016, the Applicant lodged a claim for DSP involving the following medical conditions: PTSD, anxiety and depression, chronic abdominal pain, hearing loss, and ‘other conditions’ such as infectious diseases, cervical spine condition, hyperparathyroidism, non-alcoholic steatohepatitis, rheumatoid arthritis, previous breast cancer, hypertension, asthma, oesophagitis, migraine, type 2 diabetes, constipation and morbid obesity (T30 234).
The claim was rejected by Centrelink and the Applicant was advised of this rejection by letter dated 29 August 2016 (T46 289, R1). The application was rejected on the basis that the Applicant did not have an impairment rating of 20 points or more under the Impairment Tables found in the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (Cth) (the Determination). The tables contained within the Determination are referred to as the ‘Impairment Tables’.
The Applicant requested a review of the decision by Centrelink. The review was undertaken by an Authorised Review Officer (ARO) of the Department of Human Services, which found that the decision to reject the Applicant’s claim was correct. The Applicant received notification of that review on 1 March 2017 (T51 310-316, R1).
The ARO advised the Applicant of a number of findings of fact (T51 311, R1):
·You have the following permanent conditions: gallbladder disorder and right breast carcinoma.
·Your conditions of chronic groin pain, hyperthyroidism, osteoporosis, depression and anxiety, liver disease, hypertension, partial hearing loss, rheumatoid arthritis, osteoarthritis, kidney disorder, vertigo, morbid obesity, hernia, diverticular disease, diabetes mellitus and asthma are not accepted as being permanent as they have not been fully treated and stabilised.
·Your total impairment rating is nil points.
·You do not have an impairment rating of 20 points or more.
·You do not have a continuing inability to work 15 hours per week or more because of your impairment.
As a result of the decision of the ARO, the Applicant lodged an application with the AAT1. The AAT1 affirmed the decision in an AAT1 decision dated 21 September 2017 (T2 14). The AAT1 determined that the Applicant’s medical conditions generated no impairment points under the Impairment Tables (T2 9-14, R1).
The AAT1 made the following findings:
Condition 1 – abdominal pain and suspected parathyroid tumour
…
32.The tribunal determined that, at the time of her claim, in February 2016, Miss Graham’s condition of recurrent abdominal pain was not fully diagnosed, not fully treated or fully stabilised. This means that this condition cannot be assigned an impairment rating.
Condition 2 – mental health problems
…
39.The tribunal determined that, at the time of her claim, in February 2016, Miss Graham’s mental health problems were not fully treated or fully stabilised. This means that they cannot be assigned an impairment rating.
Condition 3 – arthritic pain
…
43.The tribunal is satisfied that there is arthritic change in the neck and that surgical treatment is not indicated. In light of the impending appointment at RPH pain clinic the tribunal determined that the condition is not fully treated or fully stabilised. It cannot be assigned an impairment rating.
Condition 4 – hearing loss
…
46.The tribunal determined that, at the time of her claim, in February 2016, Miss Graham’s hearing loss was not fully treated or fully stabilised. This means it generates no impairment points.
Other conditions
…
48.The tribunal had insufficient clinical information to allocate impairment points for any of these conditions.
(Original emphasis.)
As a result of the AAT1 decision, the Applicant applied to the General Division of the Administrative Appeals Tribunal (the Tribunal) on 23 October 2017 for a review of the AAT1 decision dated 21 September 2017 (T1 1-4, R1).
The Applicant provided the following reasons for lodging this claim, as stated in her Application for review (T1 4):
Tanya has a long standing and chronic history of mental health issues that significantly affect her ability to function in daily life and in the community. Of particular reference is a diagnosis of Post Traumatic Stress Disorder 2003 [sic] which is causing significant and incurable impairment.
Tanya would like to submit further supportive documentation as further evidence that this medical condition is longstanding, has been formally diagnosed, and has been on many occasions been unsuccessfully treated with both medications and psychological therapies.
Tanya would also like [sic] opportunity to explain reasons for re-commencing cognitive behavioural therapy in September 2016. Tanya would also like to provide documentation as evidence that this treatment is to assist with crisis management strategies rather than curative therapy.
In relation to reference to ‘the matter being further complicated’ by an admission to FSH under neurology with proposed cognitive function testing (item 38) this is a different issue and not related to Tanya’s mental health issues.
RELEVANT LEGISLATION
The relevant provisions governing eligibility for DSP are contained in the Social Security Act 1991 (Cth) (the Act) and the Social Security (Administration) Act 1999 (Cth)

(the Administration Act).
The Tribunal has jurisdiction to hear this matter pursuant to s 179 of the Administration Act. Section 179 of the Administration Act states that:
(1) Application may be made to the AAT for review (AAT second review) of a decision of the AAT on AAT first review made under subsection 43(1) of the AAT Act.
(Original emphasis.)
Section 94(1) of the Act provides the criteria for DSP, relevantly:
(1)A person is qualified for disability support pension if:
(a)the person has a physical, intellectual or psychiatric impairment; and
(b)the person’s impairment is of 20 points or more under the Impairment Tables; and
(c)one of the following applies:
(i) the person has a continuing inability to work;
…
Assessing impairments and assigning an impairment rating
The Impairment Tables referred to in s 94(1)(b) of the Act are found in the Determination.
Section 94(1)(b) of the Act requires the Tribunal to decide whether the impairments of the Applicant would generate an impairment rating of 20 points or more under the Impairment Tables. In Ulukut and Secretary, Department of Social Services [2014] AATA 399, Senior Member Isenberg explained the operation of the Impairment Tables as follows:
[5]… The Tables are function-based and describe functional activities, abilities, symptoms and limitations. They are designed to assign ratings to determine the level of functional impairment. Impairment is defined to mean a loss of functional capacity affecting a person’s ability to work that results from the person’s condition: s 3 of the Determination. A claimant’s impairment is to be assessed on the basis of what the person can, or could do, not on the basis of what the person chooses to do or what others do for the person: s 6(1) of the Determination.
[6]The Tables may only be applied after the person’s medical history has been considered. An impairment can only be allocated if a condition is permanent, i.e. fully diagnosed, treated and stabilised, and likely to persist for more than two years: s 6(2)-6(4) of the Determination.
Sections 6(5), 6(6), and 6(7) of the Determination provide guidance in assessing whether or not a condition is permanent. Section 8(1) of the Determination requires that symptoms reported by a person in relation to their condition can be taken into account only where there is corroborating evidence.
Sections 7 to 11 of the Determination provide guidance in how to assess information and evidence using Impairment Tables and how to assign impairment ratings. In particular,

s 11(1)(c) of the Determination states that:
If an impairment is considered as falling between 2 impairment ratings, the lower of the 2 ratings is to be assigned and the higher rating must not be assigned unless all the descriptors for that level of impairment are satisfied.
Continuing inability to work
As set out above in s 94(1)(c)(i) of the Act, a criterion for qualifying for DSP is that the person has a continuing inability to work. Pursuant to s 94(2) of the Act:
2.A person has a continuing inability to work because of an impairment if the       Secretary is satisfied that:
(aa)in a case where the person’s impairment is not a severe impairment within the meaning of subsection (3B) or the person is a reviewed 2008-2011 DSP starter who has had an opportunity to participate in a program of support – the person has actively participated in a program of support within the meaning of subsection (3C), and the program of support was wholly or partly funded by the Commonwealth; and
(a)in all cases – the impairment is of itself sufficient to prevent the person from doing any work independently of a program of support within the next 2 years; and
(b)in all cases – either:
(i)     the impairment is of itself sufficient to prevent the person from undertaking a training activity during the next 2 years; or
(ii)     if the impairment does not prevent the person from undertaking a training activity – such activity is unlikely (because of the impairment) to enable the person to do any work independently of a program of support within the next 2 years.
(Original emphasis.)
‘Severe impairment’ is defined in s 94(3B) of the Act:
A person’s impairment is a severe impairment if the person’s impairment is of 20 points or more under the Impairment Tables, of which 20 points or more are under a single Impairment Table.
(Original emphasis.)
Section 94(3C) of the Act states that a person has actively participated in a program of support (POS) if the person has satisfied the requirements specified in a legislative instrument made by the Minister.
Relevantly ss 5, 7(1), and 7(2) of the Social Security (Active Participation for Disability Support Pension) Determination 2014 (Cth) require generally that a person is to participate in a POS for 18 months in the 36 months prior to the date of the relevant claim for DSP.
Qualification Period
Section 94 of the Act must be read in conjunction with Schedule 2 clause 4(1) (cl 4(1)) of the Administration Act. In accordance with the requirements in cl 4(1), there is a 13 week qualification period for DSP applications. The Tribunal is required to determine the Applicant’s claim for DSP in the 13 week period commencing on the day on which the Applicant’s claim for DSP was registered by Centrelink, and concluding 13 weeks after that day. In the present case, the Applicant lodged the claim for DSP on 3 February 2016. Therefore, the 13 week period is from 3 February 2016 to 4 May 2016 inclusive, and is known as the ‘Qualification Period’.
For a claim to be successful, a person must be qualified for DSP during the Qualification Period. Changes in medical conditions that occur later are not relevant to the claim. They may however, be relevant to a future claim (See Bobera and Secretary, Department of Families, Housing, Community Services and Indigenous Affairs [2012] AATA 922 at [34]; and Harris v Secretary, Department of Employment and Workplace Relations (2007) 158 FCR 252 at [1]).
The Tribunal is also assisted by the Guide to Social Policy Law (the Guide). The Guide provides assistance to those who administer the Act. Whilst not bound to apply policy guidelines, the Tribunal will usually do so unless there are cogent reasons in a particular case not to do so (See Drake and Minister for Immigration and Ethnic Affairs (No 2) (1979) 2 ALD 634).
ISSUES
The key issue for the Tribunal to consider is whether the Applicant was qualified for DSP pursuant to s 94(1) of the Act during the Qualification Period.
This requires consideration of whether at the time of the Qualification Period:
(a)the Applicant had any physical, intellectual or psychiatric impairment;
(b)if so, whether these impairments attracted ratings of at least 20 points or more under the Impairment Tables; and
(c)if so, whether the Applicant had a ‘continuing inability to work’, defined in s 94(2) of the Act.
EVIDENCE
The matter was heard in Perth on 20 February 2019. The Applicant appeared in person and was supported by Ms Olivia Donjerkovich. The Respondent was represented by

Mr Bishop from Mills Oakley.
The Tribunal would like to thank all parties for the assistance they provided during this hearing.
The Tribunal accepted the following evidence before it:
·Exhibit A1 – Applicant’s response to Secretary’s Statement of Facts, Issues and Contentions (SoFIC) dated 12 April 2019;
·Exhibit A2 – Medical report by the Health Professional Advisory Unit (HPAU) dated 30 July 2018;
·Exhibit A3 – Australian Victim of Terrorism Overseas Payment (AVTOP) Report dated 18 March 2014 and attachments;
·Exhibit A4 – Medical report by Dr Featherstone dated 20 April 2003;
·Exhibit A5 – Letter to Dr Middleton from Dr Featherstone dated 20 April 2004;
·Exhibit R1 – T documents (T1-T59);
·Exhibit R2 – Secretary’s SoFIC dated 19 December 2018; and
·Exhibit R3 – Applicant’s POS referral summary.
The Tribunal has reviewed all of the material and is satisfied that all relevant evidence was before it, and that both parties were provided an opportunity to address the evidence, either orally or in writing. Relevant aspects of the evidence and material before the Tribunal will be analysed and referred to below.
The Secretary made the following contentions in respect to the medical conditions of the Applicant (R1):
PTSD, anxiety and depression
36.On the basis of the HPAU opinion, the Secretary concedes that the applicant's PTSD, anxiety and depression were fully diagnosed, treated and stabilised during the qualification period. The Secretary also accepts that the impairment arising from the conditions appropriately rated 10 points under Table 5 of the Impairment Tables, satisfying descriptors (1)(b) – (e) of the moderate rating, and descriptor (1)(f) of the severe rating.
37.That is, the applicant suffered from moderate functional impairment in her ability to undertake social/recreational activities and travel, interpersonal relationships, concentration and tasks completion, and behaviour, planning and decision-making (1(b) – (e)). She also experienced severe functional impairment in her ability to undertake work/training during the qualification period (1(f)). This is supported by the evidence of the applicant's treating clinical psychology registrar, Mr Hughes, in his discussion with the HPAU advisor on 24 July 2018, noting that the applicant experienced difficulty in travelling alone to unfamiliar places, was "fairly socially isolated", struggled with concentration and showed tangential thinking (Attachment A). He also considered that the applicant's anxiety and intrusive thoughts impacted her ability to undertake work/training such that she suffered from a severe functional impact in that domain.
38.The Secretary contends that the impairment arising from the applicant's mental health conditions cannot attract a higher rating under Table 5 of the Impairment Tables during the qualification period. Mr Hughes did not consider the applicant to have any significant impairment in her ability to self-care and live independently, and noted that she had previously reported to have made friends overseas, she could probably concentrate for more than 10 minutes, and had "some organisational ability", using the example of her booking and attending specialist appointments (Attachment A). The applicant also has an extensive history of international travel such that she predominantly resided outside of Australia (returning regularly) from 2003104 until 28 January 2016 (T2/12; T58/340). The ability to undertake such travel unaccompanied is inconsistent with a severe functional impact on activities involving mental health function.
Chronic abdominal pain
39.On the basis of the HPAU opinion, the Secretary concedes that the applicant's chronic abdominal pain was fully diagnosed, treated and stabilised during the qualification period. The Secretary also accepts that the impairment arising from the condition appropriately rated 10 points under Table 10 of the Impairment Tables during the qualification period, satisfying descriptors (1)(a) and (c).
40.That is, the applicant's attention and concentration on a task were often (at least once a day but not every hour) interrupted or reduced by pain or other symptoms or personal care needs associated with the condition (1(a)), and she would often (once per month) be absent from work, education or training activities due to the condition (1(c)). This is consistent with the evidence of the applicant's general practitioner, Dr Middleton, in his discussion with the HPAU advisor on 12 July 2018, noting that the applicant would have "2 bad days/week" as a result of her abdominal pain (Attachment A). He also noted the applicant's self-reports of the pain affecting her ability to perform activities of daily living and her experiencing difficulty in leaving the house.
41.The Secretary contends that the impairment arising from the applicant's chronic abdominal pain cannot attract a higher rating under Table 10 of the Impairment Tables during the qualification period. This is on the basis that there is no medical evidence to indicate that at least two of the 20 point descriptors applied to the applicant during the qualification period. Whilst the applicant's self-reports to the AAT1 may be suggestive of this, symptoms reported by the applicant in relation to her condition can only be taken into account where there is corroborating evidence (see r 8(1) of the Impairment Tables Determination).
Hearing loss
42.On the basis of the HPAU opinion, the Secretary contends that the applicant's sensorineural hearing loss and variable tinnitus was fully diagnosed, but not fully treated and stabilised during the qualification period. This is on the basis that the applicant had not yet proceeded with further reasonable treatment during the qualification period, being the fitting of a hearing aid on her right side.
43.The Secretary's contention is supported by the following evidence:
(a)The report of Dr Dunbar, audiologist, dated 2 April 2014 that confirmed that, despite the applicant declining, she was "eligible for a hearing aid fitting on her right side under the government funded provided by the Office of Hearing Services" (T28/205); and
(b)The JCA report dated 29 August 2016 that recorded the applicant's selfreports of her not wearing hearing aids at that time (T45/282).
44.There is no evidence to suggest that the applicant had a medical or other compelling reason for not proceeding with the fitting of a hearing aid

(r 6(6)(b)(ii) of the Impairment Tables Determination). In any event, the Secretary contends that there is no medical evidence verifying the functional impairment arising from the condition during the qualification period. The JCA noted that the applicant "did not display any hearing difficulties in the interview room during the assessment" on 1 February 2017 (T50/301).
Infectious diseases
45.On the basis of the HPAU opinion, the Secretary contends that the impairment arising from the applicant's various infectious diseases cannot be assigned a rating under the Impairment Tables during the qualification period. This is on the basis that the diseases were temporary in nature (as confirmed in the HPAU opinion), and the impairment arising from the diseases was not likely to persist for more than 2 years in light of available evidence (r 6(3) of the Impairment Tables Determination).
Cervical spine condition
46.On the basis of the HPAU opinion, the Secretary contends that the applicant's cervical spine condition was fully diagnosed, but not fully treated or stabilised during the qualification period. The HPAU opinion confirmed that the applicant had not received any physiotherapy or other specific treatment prior to or during the qualification period. The applicant also confirmed at the AAT1 hearing that further reasonable treatment had been recommended, including (T2/13):
(a)Injections, as recommended by a pain specialist, which the applicant had not pursued; and
(b)Treatment at the pain clinic at the Royal Perth Hospital, with an initial appointment scheduled for after the AAT1 hearing.
47.The Secretary contends that, with further reasonable treatment, such as that noted above, there is no evidence to suggest that significant improvement in spinal function was not likely to occur.
Hyperparathyroidism
48.The Secretary contends that the applicant's hyperparathyroidism was not fully diagnosed, treated or stabilised during the qualification period. The report of Dr Ranaweera, consultant physician and diabetologist, dated 6 July 2016, confirmed that the diagnosis was only a "suspicion", and that further investigations were required given the applicant's Sestamibi scan of the parathyroid gland did not reveal an adenoma (T42/270).
Other conditions
49.In respect of the applicant's other conditions, including non-alcoholic steatohepatitis, rheumatoid arthritis, previous breast cancer, hypertension, asthma, oesophagitis, migraine, type 2 diabetes, constipation and morbid obesity, the Secretary contends that there is insufficient medical evidence as to the diagnosis, treatment, prognosis or functional impacts. In the absence of such, the conditions cannot be considered fully diagnosed, treated and stabilised during the qualification period.
50.In respect of the applicant's fibromyalgia, which was reported by

Dr Middleton to have been diagnosed in September 2016, the Secretary contends that the condition cannot be considered fully diagnosed, treated and stabilised in circumstances where the diagnosis was confirmed approximately four months outside the qualification period (Attachment A). Similarly, the applicant's self-reported benign positional vertigo cannot be considered fully diagnosed, treated and stabilised given the lack of evidence to verify the diagnosis, and the recommendation for the applicant to consult a vestibular physiotherapist (T28/205).
Overall Impairment Rating
51.The Secretary concedes that the applicant satisfied s 94(1)(b) of the Act during the qualification period, having a total impairment rating of 20 points under the Impairment Tables.
(Original emphasis.)

The Applicant has made the following comments in response to the Respondent’s SoFIC (A1):
Between 1st Feb 2016 and 4th May 2016 (the qualification period) I attended my GP at Ellen Health 13 times for help and support for PTSD and pain relief from chronic abdominal health issues and pain. I was also in and out of Fiona Stanley Hospital 6 times via ED and as an inpatient and [sic] Fremantle Hospital during this time period.
…
Point 6 -
16th August 2016 JCA. I did not feel this was an adequate assessment, on the phone for 15 minutes.
Point 9 –
Assessment made by assessor incorrect [sic] interpretation of medical evidence E.G assessor advised I had gall bladder disease (my gall bladder removed RPH 2003). I have NASH liver disease and cholangitis – not gall bladder disease. She also mistook hyperparathyroidism for a thyroid disease. They are 2 different organs with different functions. There is no cure for hyperparathyroid disease, yet it has considerable impact on the body in relation to pain, balance, severe fatigue and other functionality issues.
Point 14 –
Disagree with the points allocated for both PTSD – 10 points and Chronic Abdominal Pain – 10 Points as the functional impairment of both conditions is severe.
Point 36 – 38
PTSD – Travel to Bali was part of my healing from the bombing. I was surrounded by others who understood what I had been through and I was also able to help and support others. In Bali I had domestic help/laundry service/food delivery in order to function. I felt safer in Bali, out of Australia, due to past severe domestic violence which occurred in the Eastern States – all documented. I am terrified to return to the Eastern States, hence have chosen to stay in Perth.
In response to travelling unaccompanied I was medicated with Valium (prescribed by Dr Middleton – Ellen Health) in order to manage the travel and was supported by airport staff to board and disembark planes. Being in Bali has been one of the only ways I have been able to manage these trauma [sic].
Note that the HPAU gave severe rating for point (f) of impairment table – work/training capacity. Contradictory statements.
Point 39 – 41
Chronic Abdominal Pain
Too sick and in pain all the time, heavily medicated and frequent presentations to ED for pain relief, also had dengue fever during this time.
Point 42 – 44
Frequent presentations to ED and unwell to be able to get hearing aid, have hearing tests. I had to continuously cancel, reschedule the appointments.
Point 45
Infectious diseases – multiple tropical diseases including Malaria has impacted Liver – asymptomatically malaria attacks. Documented at Fremantle hospital.
Point 46
Bali Med have been funding physio and acupuncture since 2003. All documented.
Point 49
This was historical information that I was not applying for DSP for.
The only issue was NASH (and cholangitis).
CITW- Point 52
Too unwell to engage and health continued to decline. Documented with medical certificates.
Point 65
Not in a state to be engaging in employment – mentally and physically and my situation has not improved since then and has continued to decline significantly.
1st Feb 2016 and 4th May 2016 (the qualification period) I attended my GP at Ellen Health 13 times for help and support for PTSD and pain relief from chronic abdominal pain. I was also in and out of Fiona Stanley Hospital 6 times via ED and as an inpatient.
HEARING
The Applicant was cross-examined by Mr Bishop at the hearing, and her evidence is contained accordingly below.
Program of Support (POS)
In her oral evidence at the hearing, the Applicant confirmed that for the period from 2013 until 2016, she did not participate in a POS. The Applicant stated that she was in Bali during this time.
Hearing Loss
In her oral evidence at the hearing, the Applicant agreed that she did not follow through with treatment which recommended that she wear a hearing aid.
Cervical Spine condition
In her oral evidence at the hearing, the Applicant stated the following:
·She had undergone physiotherapy and acupuncture treatment since early 2000.
·She has had significant mobility issues since the Bali bombing in 2003.
·She accepted she was referred to a pain clinic in 2018 and was introduced into the Step programme, well outside the Qualification Period.
Hyperparathyroidism
In her oral evidence at the hearing, the Applicant agreed that this condition had not been fully diagnosed, treated and stabilised (FDTS) during the Qualification Period.
Infectious Diseases
In her oral evidence at the hearing, the Applicant stated that this condition did not form part of her DSP application.
PTSD, Depression and Anxiety
In her oral evidence at the hearing, the Applicant stated the following:
·Bali provided emotional and spiritual support during her difficult times of depression and anxiety. Bali provided her with extended family support and new friendships.
·Bali enabled her to survive the trauma she underwent as a result of her personal issues and the after effects of the Bali bombing in 2003.
·She has significant trust issues.
·Balinese customs and spiritual beliefs enabled her to cope and deal with issues differently.
·She accepts her trips, primarily on her own to overseas countries, required her to make airfare bookings and navigate customs through airports.
·She was under medication during these times in order to address her anxiety.
·She returned to Perth from Bali in early 2016 as she was not well. She spent time in hospital and finally secured accommodation through the Uniting Church.
·She is currently residing in an old nurses’ quarters, through the Department of Housing. She has a bathroom and kitchen in close proximity to her room.
·She can call a taxi, using a trolley for support. She cannot walk up or down stairs. The Applicant reported that she is socially isolated.
Chronic Abdominal Pain
In her oral evidence at the hearing, the Applicant stated the following:
·Her pain escalated in late 2015.
·There is not a day in her life that she does not have pain in her abdomen, and stated that she manages it with Panadeine Forte.
·She walks to her doctor’s office which is 50 metres from her residence. Walking there and back takes approximately 60 minutes.
CONSIDERATION
Whether the Applicant suffered from a physical, intellectual or psychiatric impairment or impairments
On the basis of the evidence before the Tribunal, it is not in dispute that during the Qualification Period the Applicant suffered from the following medical conditions: PTSD, anxiety and depression, chronic abdominal pain, hearing loss, infectious diseases, cervical spine condition, hyperparathyroidism and other conditions such as non-alcoholic steatohepatitis, rheumatoid arthritis, previous breast cancer, hypertension, asthma, oesophagitis, migraine, type 2 diabetes, constipation, and morbid obesity.
There are medical reports which attest to the fact that the Applicant suffered from these medical conditions.
The Tribunal finds that the Applicant satisfies s 94(1)(a) of the Act.
Whether the Applicant’s impairments receive an impairment rating of 20 points or more under the Impairment Tables
The Tribunal will now assess the medical conditions of the Applicant as detailed in the written and oral evidence presented during the AAT1 hearing.
PTSD, anxiety and depression
The Applicant told the AAT1 in her oral evidence (T2 11 at [33], R1):
·She has had mental health problems for most of her life. As a child she was [details omitted] abused. At the age of 14 she was suicidal and put on Valium. Over many years she saw a number of psychiatrists and psychologists, mainly in Sydney or the Gold Coast region. She had bad anxiety and panic attacks and was treated with various medications, including Xanax.
·In 2002 she was in Bali at the location of the bomb attack in a nightclub. She received some injuries but witnessed horrific sights of dead and severely injured people, many of whom where [sic] her personal friends.
·This experience has made her long-standing anxiety problems much worse. She has frequent flashbacks to the event and feels very anxious on many occasions. She can’t bear to be in crowds and cannot visit shopping centres or use public transport.
·Following the bombing she returned to Perth in 2003. Her GP diagnosed post-traumatic stress disorder (PTSD) and treats her with Valium. After trying several different ones she cannot tolerate anti-depressants.
·She received compensation from the government and went [sic] live with family in Penang for several years.
·In recent times she has been seeing a clinical psychologist, Bernard Hughes, for nearly two years. However she feels counselling makes her worse by reminding her of everything.
·As well as feeling very anxious, and having distressing flashbacks to the experience in Bali, she has great difficulty in thinking clearly. She has trouble recalling past events and their sequence. She was recently in FSH under the neurologists. They have told her she had a previous “mini-stroke” but said she has functional neurological disorder (FND). She is seeing a neuro-physiotherapist and is soon to undergo cognitive function testing.
·She lives on her own in a room that is part of an accommodation service in Fremantle. She rarely goes out and needs support with daily living, cooking and shopping. Many of the other residents are “druggies” and she does not socialise with them. She listens to music for relaxation.
Chronic abdominal pain
The Applicant told the AAT1 in her oral evidence (T2 11 at [10-11]):
·She has a long history of abdominal pain and has had many operations. These have included surgery for ectopic pregnancy, numerous ovarian cysts, endometriosis, removal of gallbladder, adhesions, bowel resection for volvulus and removal of kidney stones. These problems go back more than 35 years.
·As a result of these problems she was put on the invalid pension many years ago. This became the DSP. It was cancelled three or four years ago. She thinks that was because of her spending prolonged time overseas.
·In recent years she has been having recurrent attacks of pain, usually severe, mainly in the region of the left loin. She has had numerous attendances at hospital emergency departments. She has irregular bowel actions with intermittent constipation and diarrhoea. She has attacks of nausea and vomiting.
·No definite cause of the pains has been found. She has chronic liver disease. Recurrent kidney stones are suspected and she has been investigated and found to have overactive parathyroid glands. She has seen a number of specialists and is currently waiting for an appointment with an endocrine surgeon to see if anything can be done about the problem.
·For much of her adult life she has lived partly in South-East Asia, mainly in Penang, and partly in Australia. Since 2016 she has been resident in Australia on a permanent basis. She has had a number of operations in Asian hospitals.
Arthritic pain
The Applicant told the AAT1 in her oral evidence (T2 11 at [12-13]):
·At the time of the Bali bombing she was close to the site of the explosion. The blast threw her against a wall and she banged her head and upper chest. She noticed bad neck pain.
·In the aftermath of the explosion she was too busy helping others to bother too much about herself.
·When she returned to Australia in 2003 she saw her GP about the painful neck. He arranged X-rays and sent her for physiotherapy. She thinks she saw a pain specialist who suggested injections into the neck, but she can’t afford them.
·She has a very stiff painful neck, with pain radiating to her head. It is hard to move her head to the side or up and down. Because of this she has not driven a car for several years. She also has widespread pains in other parts of her body. Somebody has said she has fibromyalgia. Current treatment is with painkillers and physiotherapy.
·She has been referred to the pain clinic at RPH and has an appointment there soon after the current hearing.
Hearing loss
The Applicant told the AAT1 in her oral evidence (T2 11 at [13]):
·As a result of the Bali explosion she suffered hearing loss in her right ear. She had tests but did not get a hearing aid. Things have got worse and she is due to have another test soon.
Other conditions
The Applicant told the AAT1 in her oral evidence (T2 11 at [13-14]):
·When she was 25 she had two malignant lumps removed from her right breast. Follow up has been all clear. She has annual mammograms.
·She has had a number of tropical infections in the past, including Dengue fever, malaria and chikungunya. There have been no recent flare ups, although she sometimes has a slightly raised temperature.
·About three years ago her GP diagnosed type II Diabetes. It is well controlled by diet. She tests her own blood sugar levels on a regular basis and they are fine.
·She has been on blood pressure tablets for many years. The pressure is volatile and sometimes goes very high. She gets some dizzy spells and was told she had a transient ischaemic attack (TIA) recently.
Further, the Tribunal notes the medical report of Dr Armstrong from the Health Professional Advisory Unit, received on the 16 October 2018. Dr Armstrong made the following declaration at the commencement of her report (A2):
I have read the Guidelines for Persons Giving Expert and Opinion Evidence issued by the Administrative Appeals Tribunal (the Tribunal). I acknowledge that I have an overriding duty to provide impartial assistance to the Tribunal. No matters of significance have been withheld from the Tribunal.
Qualifications and experience
I obtained my medical degree in 1983, and have some 35 years’ experience as a medical practitioner. I completed GP training in the UK and was a vocationally registered GP. I worked in general practice here and in the UK for a number of years. I then worked as a medical officer in a specialist community mental health service in Australia for 15 years. I managed outpatients with serious psychiatric conditions, such as schizophrenia and bipolar disorder. I also admitted patients to hospital and/or applied for community treatment orders, as necessary. I have been employed by the Department of Human Services [in the HPAU] since August 2010 to provide medical professional opinions. I obtained a Graduate Diploma in Public Health in January 2015.
Disclaimer
The opinion provided in this report is based on a file review and detailed analysis of the referenced documents, and, when applicable, discussions with treating health professionals. The author has not personally interviewed or examined the applicant.
(Original emphasis.)
The Tribunal notes that in spite of the assessment by the Job Capacity Assessor (JCA) and the ARO which resulted in 0 impairment points being allocated to the medical conditions of the Applicant, the Respondent has accepted the assessment of

Dr Armstrong which allocates 10 impairment points to the medical condition of PTSD, anxiety and depression; and a further 10 impairment points to the condition of chronic abdominal pain (R1).
Dr Armstrong’s report makes the following comments in respect to each of the following medical conditions (A2):
1.        PTSD, depression and anxiety
Ms Graham has a long history of depression and anxiety, in relation to a history of traumatic events dating back to childhood. A 3/4/97 medical report by Dr R Raymond, a GP states that she had a “mental breakdown” in November 1996.

A 15/9/97 letter from Dr J Lichter, a psychiatrist states that she has had an anxiety and depressive disorder for 3 years, which was being treated with psychotherapy and antidepressant medication. A 23/11/03 letter from Dr Middleton, her GP said that she had symptoms suggestive of PTSD and had had counselling in Bali.

A 16/1/04 letter from Dr Middleton states that Ms Graham was taking antidepressants, initially an SSRI and now Hypericum [an over the counter herbal remedy, which may have some efficacy in the treatment of mild anxiety and depression], with a benzodiazepine as needed for panic. A 20/4/04 letter from

J Featherstone, an occupational therapist and counsellor indicates that

Ms Graham had attended twice for counselling, but she had been discharged, as she felt counselling was stirring up post-traumatic stress reactions. A 26/2/14 AVTOP report by Dr Middleton indicates that she has PTSD, but does not comment on specific treatment for this.
The current medical evidence indicates that Ms Graham is only prescribed Antenex [Diazepam, a benzodiazepine anti-anxiety medication] 5mg, as needed. However, in our 12/7/18 phone conversation Dr Middleton told me that she had had several previous trials of antidepressant medication, including Cipramil, Escitalopram and Nortriptyline, but she was unable to tolerate these medications. In our 24/7/18 phone conversation B Hughes, a clinical psychology registrar told me that he has been seeing Ms Graham since approximately the second half of 2016 [after the end of the qualification period]. An 18/9/17 letter from Mr Hughes states that she was referred for treatment of symptoms consistent with PTSD, depression, stress and severe anxiety with panic episodes. Mr Hughes told me that he had diagnosed Ms Graham with severe PTSD, due to a complex trauma history. He had provided about 7 sessions of trauma-focused CBT, which he thought had been of some benefit. However, Mr Hughes also told me that her frequent specialist and emergency department attendances had “got in the way of her treatment”, and she was no longer attending for psychotherapy sessions.
It seems that Ms Graham has not seen a psychiatrist since the late 1990’s and first saw a clinical psychology registrar [who are required to be supervised by a clinical psychologist, which I therefore consider meets the diagnostic requirements of table 5] after the qualification period. Nevertheless I consider that it is reasonable to rate her psychiatric conditions as fully diagnosed, as of the qualification period, as the 1997 medical evidence from Dr Lichter, a psychiatrist; the 2003, 2004 and 2014 evidence from Dr Middleton; and the reports by Mr Hughes seems to be consistent with diagnoses of depression, anxiety and PTSD. Ms Graham has had some treatment with antidepressant medication [which can also be effective for anxiety and PTSD], which she apparently could not tolerate. The first-line evidence based therapies for PTSD and anxiety are psychological - trauma-focused CBT, etc. It seems that Ms Graham had had very limited psychotherapy prior to her DSP claim, but nevertheless I consider that it is appropriate to rate these conditions as fully treated and stabilised, as of the qualification period, as they are very long-standing and apparently have not responded to previous therapies. In general it takes patients a prolonged period to respond to treatment if they have had a long period of trauma, as in Ms Graham’s case. I consider that even with further reasonable treatment it would take her much more than 2 years to significantly improve.
I consider that the appropriate impairment rating [as of the qualification period] on table 5 [mental health function] was 10 points for a moderate impairment, as the following descriptors [b, c, d and e] were met at that level and descriptor f was met at a severe impairment level:
(a)Self-care and independent living; Mr Hughes told me that he did not think Ms Graham had any significant impairment in this area, although in the 21/9/17 AAT1 hearing she reported needing support with daily living, cooking and shopping. Mild functional impairment.
(b)Social/recreational activities and travel; Ms Graham has been able to travel unaccompanied to familiar places overseas. Mr Hughes confirmed that she would have difficulty travelling alone to unfamiliar places and is “fairly socially isolated”. Moderate functional impairment.
(c)Interpersonal relationships; Mr Hughes said that she usually keeps to herself and her interpersonal relationships are affected by anxiety. Me Graham has previously reported that she has friends overseas. Moderate functional impairment.
(d)Concentration and task completion; Mr Hughes said that she struggles with concentration, but could probably concentrate for more than 10 minutes. He did not wish to comment further on Ms Graham’s cognitive functioning, as he had not performed cognitive testing. In the AAT1 hearing she indicated that she was soon to undergo cognitive function testing. Moderate functional impairment.
(e)Behaviour, planning and decision-making; Mr Hughes told me that he thought she had “some organisational ability”, as she has been able to make appointments with specialists. However her thinking is tangential and her conversation “jumps around”. The AAT1 decision also noted that it was difficult to obtain a clear history from Ms Graham and she jumped from 1 topic to another. Moderate functional impairment.
(f)Work/training capacity; Mr Hughes had some difficulty commenting on her work capacity, purely in relation to her psychiatric conditions, but he thought there would be a severe functional impairment due to her anxiety, intrusive thoughts and level of impairment. Severe functional impairment.
2.        Chronic abdominal pain
The medical evidence indicates that Ms Graham has a very long history of recurrent abdominal pain. A 18/9/89 medical report by Dr Berman, a GP states that she has severe gynaecological problems, has had multiple laparotomies with adhesions and had been hospitalised approximately 30 times for severe pain. A 14/11/1989 letter by Dr H Torode, an obstetrician and gynaecologist reports that Ms Graham had a “horrendous history” of recurrent pelvic disease and it was likely she would continue to have episodic bouts of pelvic pain. A 15/2/92 Australian Government Health Service [AGHS] assessment by a Dr Reefman allocated a 15% impairment rating for this condition. 29/10/03 and 6/11/03 hospital discharge summaries report episodes of abdominal pain and recent bowel surgery in Bali. A 23/11/03 letter by Dr Middleton states that Ms Graham had recently been diagnosed with left hydronephrosis [kidney swelling due to a blockage of urine outflow] and bilateral renal calculi [kidney stones]. She also had a laparoscopic mesh repair of an incisional hernia in 2013.
The current medical evidence states the cause of Ms Graham’s recurrent/chronic abdominal pain [now mainly left sided] is not known and she is still having investigations. A 21/4/16 upper abdominal CT showed uncomplicated diverticular disease in the sigmoid, which was confirmed by a May 2016 colonoscopy. Discharge summaries indicate that Ms Graham has had 2 admissions for exacerbations of her chronic abdominal pain - in April and June 2016. The 17/6/16 discharge summary indicates a diagnosis of post-viral nerve sensitivity.

Dr Middleton told me he believed her chronic abdominal pain was multifactorial and I consider that is a reasonable assumption, given the multiple conditions she has that could be a cause of her pain. Dr Middleton also told me that her current treatment is analgesia as needed. I consider that her chronic abdominal pain was fully diagnosed, treated and stabilised, as of the qualification period, given her prolonged history, and previous extensive investigations and treatment, including surgery. Dr Middleton confirmed that he believed Ms Graham’s abdominal pain is not likely to settle.
The medical evidence around the qualification period states that Ms Graham had persistent left sided abdominal pain, but does not indicate the severity or frequency of this pain. In the 16/8/16 JCA interview Ms Graham reported that the abdominal pain affected her mobility and she was unable to lift heavy objects. Dr Middleton told me that Ms Graham attends the medical centre at least weekly and continues to attend hospital emergency departments frequently. Dr Middleton said “she reported” that the pain affected her ability to perform activities of daily living and made getting out of the house difficult. Ms Graham had bad weeks due to the abdominal pain and Dr Middleton felt this would probably approximate to 2 bad days/week. I believe it is reasonable to consider that this information is pertinent to the qualification period, as this is a long standing condition and Dr Middleton was very familiar with Ms Graham’s functioning during that time.
I consider that the appropriate impairment rating, as of the qualification period would be 10 points on table 10 [digestive and reproductive function], as descriptors (a) “the person’s attention and concentration at a task are often [at least once daily, but not every hour] interrupted or reduced by pain or other symptoms …” and (c) “the person is often [once per month] absent from work … due to the digestive or reproductive system condition” are met at that level. Descriptor (d) “the person is frequently [twice or more per month] absent from work …” would be met at the 20 impairment point level, however I consider that the provided medical evidence does not indicate that one or more of the other 20 point descriptors would have been met [“interrupted attention and concentration at least once per hour; inability to sustain work activity or other tasks for a total of more than 3 hours daily, even with regular breaks; and affecting the comfort or attention of co-workers”]. Ms Graham seems to have self-reported a more severe impairment, but this is not borne out by the medical evidence.
3.        Hearing loss
26/2/14 AVTOP report by Dr Middleton states that Ms Graham has possible sensorineural hearing loss in both ears, with reduced hearing in the right ear and variable tinnitus. A 2/2/14 letter by S Dunbar, an audiologist says that she reported hearing loss and tinnitus, which were both worse in her right ear. Investigations indicated that her hearing was mostly normal in her left ear and she had a mild sensorineural gently sloping hearing loss in her right ear. Ms Graham had excellent speech discrimination with appropriate amplification and a right sided hearing aid was recommended. However, Ms Graham declined to have a hearing aid fitted and the subsequent medical evidence indicates that she has still not proceeded with the use of hearing aids. I therefore consider that Ms Graham’s hearing loss condition was fully diagnosed, but not fully treated and stabilised, as of the qualification period. The 2/2/14 letter also states that Ms Graham reported poor balance and a referral to a vestibular physiotherapist was suggested, but the provided medical evidence does not indicate she has attended a vestibular physiotherapist. In the 16/8/16 JCA interview Ms Graham reported a diagnosis of benign positional vertigo, but this diagnosis is not recorded in the provided medical evidence. I therefore consider that an impaired balance and/or vertigo condition was not fully diagnosed, treated and stabilised, as of the qualification period.
4.        Infectious diseases
The medical evidence indicates that Ms Graham has had a number of infectious diseases. A 25/2/16 letter by Dr F Connelly, an infectious diseases registrar states that she has had dengue 6 times [most recently in February 2016], malaria in 2001, typhoid 3 times from 2014 until 2015, Chikungunya in June 2015 and Hepatitis B. Dr Connelly reports that Ms Graham stated she had ongoing fatigue, generalised aches and pains, and poor concentration. Dr Connelly said that her impression was a post-viral illness associated with Dengue, but did not comment on possible prognosis. Generally a post-viral illness would be expected to resolve within weeks to several months. Subsequent medical evidence does not indicate any permanent functional impairment from any of these infectious diseases, so an impairment rating is not warranted.
5.        Cervical spine condition
The 26/2/14 AVTOP report by Dr Middleton states that Ms Graham has had years of neck pain, with associated right upper limb neurological symptoms and pain, which had been treated with massage and acupuncture. A 5/3/14 cervical spine CT showed facet joint osteoarthritis on the left at C2/3, and C5/6 and C6/7 disc degenerative change, which was possibly related to a developmental immobile C4/5 segment. In the 16/8/16 JCA interview Ms Graham reported limited neck rotation and daily pain, and said she was unable to lift her right arm [she is right hand dominant] above her head. She reported previously taking pain medication and having physiotherapy, with no current treatment. A 21/11/16 [6 months after the end of the qualification period] letter by C Basile, a physiotherapist states that Ms Graham was first seen on that day, and her cervical spine range of movement was limited by pain to half the normal range of flexion and rotation. The provided medical evidence does not confirm any attendance at physiotherapy or other specific treatment prior to this date, so I agree with the 21/9/17 AAT1 decision in rating this condition as fully diagnosed, but not fully treated and stabilised, as of the qualification period. I also note that at the AAT1 hearing Ms Graham indicated that she had been referred to a pain clinic.
6.        Hyperparathyroidism
A 6/7/16 letter from Dr C Ranaweera, a physician states that Ms Graham has hyperparathyroidism, which was likely to be a primary condition, although she had had a normal parathyroid scan. In our 12/7/18 phone conversation Dr Middleton told me a diagnosis of a parathyroid adenoma had not yet been established. I therefore consider that a hyperparathyroidism condition was not fully diagnosed, treated and stabilised, as of the qualification period. The letter from Dr Ranaweera states that Ms Graham has proven osteoporosis and this condition can be associated with hyperparathyroidism. In the 1/2/17 JCA interview she reported having previous multiple wrist and ankle fractures, which Dr Middleton confirmed. However I believe that there is insufficient provided medical evidence to allocate an impairment rating for this condition.
7.        Other conditions
The medical evidence also lists a number of other conditions [nonalcoholic steatohepatitis, rheumatoid arthritis, previous breast cancer, hypertension, asthma, oesophagitis, migraine, type 2 diabetes, constipation and morbid obesity], but there is little provided information about the diagnosis, treatment, prognosis and functional impact of these conditions. I therefore consider that these conditions cannot be allocated an impairment rating.
In our phone conversation Dr Middleton confirmed that Ms Graham had been diagnosed with fibromyalgia in September 2016, which is 4 months after the end of the qualification period, so this condition cannot be considered for this DSP claim.
Summary
I consider that the appropriate impairment rating, as of the qualification period for Ms Graham was a total of 20 points across 2 tables [5 and 10], and I understand she has not completed or been exited from a programme of support, so the issue of a “continuing inability to work” does not need to be considered. I acknowledge that Ms Graham’s medical conditions will significantly affect her work capacity. She also has considerable barriers to work, in that she has not worked for many years, and has frequent and unexpected treatment needs for her abdominal pain. She could consider making a new DSP application as it seems that her physical health [in particular her abdominal pain] has deteriorated over the last 2 years.

The Tribunal has been greatly assisted by the analysis and assessment undertaken by

Dr Armstrong in respect each of the medical conditions which the Applicant submits as part of her DSP application.
The Tribunal will now assess the medical conditions of the Applicant with relevant consideration afforded to the medical report of Dr Armstrong.
PTSD, depression and anxiety
The Tribunal accepts that on the evidence before it, the Applicant’s medical condition of PTSD, depression and anxiety are FDTS during the Qualification Period. The Tribunal accepts this is a longstanding condition.
The Tribunal notes the Applicant’s oral evidence which outlined her reasons for going to Bali, being the death of her son; the breakdown of her marriage; and her trauma from the Bali bombing; all resulting in a range of mental health issues. She did however live independently in 2016 and attended to her own care. She travelled by herself overseas and developed new friendships. The Tribunal observed her ability to concentrate for more than 30 minutes at the hearing and found whilst there were moments of difficulty she was able to articulate a coherent narrative. If this was her level of concentration and task completion in 2016 she would easily have satisfied descriptor (d). The Applicant told the Tribunal she was able to plan her overseas travel, book air tickets, and navigate through airports including customs.
The Tribunal, having reviewed the medical evidence, accepts the impairment assessment by Dr Armstrong in terms of the descriptors attributed to Table 5, and finds this condition to have an impairment rating of 10 points at the time of the Qualification Period. The Tribunal accepts on the basis of the Applicant’s evidence before this Tribunal at the hearing that the majority of descriptors between (a) and (e) in Table 5 are met in terms of moderate functional impact and descriptor (f) is categorised as severe.
The Tribunal observed the Applicant at the hearing and it may well be the Applicant’s condition has deteriorated since she made her application in 2016, however it finds for purpose of the Qualification Period that the condition is FDTS and generates an impairment rating of 10 points under Table 5.
Chronic abdominal pain
The Tribunal, on the evidence before it, accepts that the Applicant’s medical condition of chronic abdominal pain is FDTS. Again the Tribunal accepts this condition as longstanding.
The Tribunal notes the impairment assessment by Dr Armstrong which finds this condition to have an impairment rating of 10 points at the time of the Qualification Period. The Tribunal however, accepts on the basis of the Applicant’s evidence before this Tribunal that the escalation of her pain in the abdomen occurred only in late 2015.
The Tribunal also notes (T35 247, R1) the medical advice from Dr Middleton dated

29 April 2016, in which he states: ‘I am finding it difficult to make any progress with a diagnosis with her complex medical and surgical history’. This statement was made during the Qualification Period and supports the oral evidence received by the Tribunal from the Applicant.
The Tribunal finds the medical evidence does not support this condition being FDTS during the Qualification Period, and therefore the Tribunal finds that 0 impairment points are generated for this condition.
Hearing loss
The Tribunal accepts this condition is fully diagnosed, however is not fully treated and stabilised as there is no evidence to demonstrate at the time of this application that hearing aid are being used as recommended by the audiologist.
The Applicant confirmed at the hearing that she did not at the time of the Qualification Period wear a hearing aid, as was recommended as part of her treatment.
The Tribunal therefore determines that this condition was fully diagnosed but was not fully treated and stabilised at the time of the Qualification Period.
Infectious Diseases
The Tribunal accepts that the Applicant has been subjected to numerous infectious diseases, many of which may be attributed to her significant time living overseas. The Tribunal finds no medical evidence during the Qualification Period to suggest any form of permanent functional impairment for these infectious diseases.
Cervical spine condition
Whilst there is medical evidence to indicate longstanding neck pain and upper limb pain there is no evidence of ongoing treatment in terms of physiotherapy or pain management for that pain. On this basis this condition is fully diagnosed but not fully treated and stabilised during the Qualification Period.
The Applicant stated at the hearing that she had undergone physiotherapy and acupuncture since early 2000 for mobility issues. There is no corroborated medical evidence to support this contention. The only evidence before the Tribunal is from

Mr Basile at (T47 291, R1) stating in advice to Dr Middleton, dated 21 November 2016, that physiotherapy treatment had commenced.
The Tribunal finds therefore this condition is fully diagnosed but not fully treated and stabilised.
Hyperparathyroidism
The Tribunal finds very little medical evidence to indicate this condition was fully diagnosed. The Tribunal finds therefore this condition is not fully diagnosed, and not fully treated and stabilised.
Other conditions
These conditions, as outlined in Dr Armstrong’s report (A2 at [41]) and the decision of AAT1, are supported by very little medical evidence in the form of diagnosis or treatment attached to them which would allow the Tribunal to assess whether the Applicant’s other conditions are FDTS. The Tribunal finds the Applicant must have these medical conditions properly diagnosed and treated in order for them to be determined as fully stabilised, so that a proper and transparent assessment can be made as to any functional impairment.
WHETHER THE APPLICANT HAS A CONTINUING INABILITY TO WORK
The Tribunal finds that the Applicant has a total of 10 impairment points under the Impairment Tables and therefore fails to satisfy s 94(1)(b) of the Act. Given this finding, it is not necessary for the Tribunal to consider s 94(1)(c) of the Act.
CONCLUSION
The Tribunal finds that the Applicant satisfies s 94(1)(b) of the Act. The Applicant however, fails to satisfy s 94(1)(c) of the Act. Pursuant to s 94(3B) of the Act, the Applicant did not have a severe impairment.
Pursuant to s 94(3C) of the Act, there is no evidence to show that the Applicant actively participated in a POS.
The Applicant lodged her application for DSP on 3 February 2016. To have actively participated in a POS, this must have occurred for 18 months in the 36 months prior to the date of the claim. There is no evidence before the Tribunal to indicate that this occurred.
DECISION
For the reasons given above, the Applicant does not qualify for DSP. The decision is affirmed.

I certify that the preceding 75 (seventy -five) paragraphs are a true copy of the reasons for the decision herein of Member C Edwardes

...................................[sgd].....................................
Associate
Dated: 31 May 2019

Date(s) of hearing: 20 February 2019

Applicant: In person

Representative for the Respondent:

Solicitors for the Respondent:

Mr C Bishop

Mills Oakley Lawyers

[2019] AATA 1090

31 May 2019

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