Henshaw and Secretary, Department of Social Services (Social security)
[2025] ARTA 1284
•9 June 2025
Henshaw and Secretary, Department of Social Services (Social security) [2025] ARTA 1284 (9 June 2025)
Applicant: Mr Henshaw
Respondent: Secretary, Department of Social Services
Chief Executive Centrelink
Tribunal Number: 2025/M193657
Tribunal:General Member J Quinlivan
Place:Canberra
Date:9 June 2025
Decision:The Tribunal affirms the decision under review.
This means the review is not successful.
CATCHWORDS
SOCIAL SECURITY – Disability Support Pension – Impairment Table ratings – condition not fully treated and stabilised – reasonable treatment for functional improvement remained outstanding – independent acts of daily living – permanent structural changes – decision under review affirmed
Names used in all published decisions are pseudonyms. Any references appearing in square brackets indicate that information has been omitted from this decision and replaced with generic information pursuant to subsection 201(1A) of the Social Security (Administration) Act 1999.
Statement of Reasons
BACKGROUND
This review considered whether Mr Henshaw met the requirements for payment of disability support pension (DSP) on 14 February 2023 or 24 April 2024.
Mr Henshaw is [an age]-year-old man who lodged claims for DSP on 14 February 2023 and also on 24 April 2024 stating that he had the medical conditions of degenerative disease of the spine, emphysema and chronic obstructive pulmonary disease (COPD), and mental health conditions. He requested a review of the decision to reject the applications on 18 April 2023 and 13 May 2024, respectively. Following unsuccessful reviews, he requested a review by an authorised review officer. On 3 February 2025, an authorised review officer found Mr Henshaw was not qualified for DSP because he failed to meet the requirement to have a rating of 20 points or more under the Impairment Tables on either date of claim.
On 13 March 2025, Mr Henshaw requested a review of the decision by the Administrative Review Tribunal (the Tribunal). On 30 May 2025, a hearing was undertaken. Mr Henshaw attended the hearing and spoke with the Tribunal by telephone conference. The Tribunal had before it a collection of documents provided by Centrelink and the applicant that constituted the hearing papers.
Relevant aspects of the evidence before the Tribunal will be referred to in the Tribunal’s consideration of the issues.
ISSUES
The statutory provisions relevant to this review are contained in the Social Security Act 1991 (the Act) and the Social Security (Administration) Act 1999 (the Administration Act).
The issues which arise in this case are:
(a) Whether Mr Henshaw has any physical, intellectual or psychiatric impairment;
(b) Whether his impairments rate at least 20 points under the Impairment Tables; and
(c) Whether he has a continuing inability to work.
CONSIDERATION
Provisions relating to whether a person is qualified for DSP and whether DSP is payable to the person are contained in Part 2.3 of the Act.
Subsection 94(1) of the Act states, in part, that:
(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;
In accordance with subclause 4(1) of Schedule 2 to the Administration Act, the Tribunal is required to determine Mr Henshaw’s eligibility for DSP on 14 February 2023 or 24 April 2024, being the dates on which the claims for DSP were lodged.
The ‘relevant period’ for this review extends for 13 weeks after the date of claim. That is, should the Tribunal conclude Mr Henshaw did not meet the qualifications on 14 February 2023 or 24 April 2024, but would do so within 13 weeks of either date, the Tribunal would consider whether the early start date rule in subclause 4(1) of Schedule 2 to the Administration Act allows the Tribunal to grant DSP from that later date.
Issue 1 – Does Mr Henshaw have a physical, intellectual or psychiatric impairment?
As stated above, paragraph 94(1)(a) of the Act provides that the first qualification for DSP is that a person has a physical, intellectual or psychiatric impairment.
In oral evidence at the hearing, Mr Henshaw told the Tribunal that he lodged an application for DSP in 2023 and did not hear anything for a long time so he lodged another application in 2024. He feels Centrelink did not look at the paperwork as he had impairments from many conditions including his spine and his lungs, where he had growing nodules. He had mental health issues in the past but they had resolved with counselling. However, he had recently had to leave his living arrangement with his sister and was now going to have to relocate back to the city and this was causing him distress and causing a flare in his mental health symptoms. The drug and alcohol condition was old and resolved many years ago. He saw a psychiatrist who discussed this condition, but it was not a current condition and was in his past. He did not use drugs at this time. The medical conditions caused impairment.
The Tribunal noted the documentation in the hearing papers confirmed that Mr Henshaw had impairment arising from his medical conditions.
Given that Mr Henshaw suffered from impairment arising from his medical conditions, he satisfied paragraph 94(1)(a) of the Act for both dates of claim.
Issue 2 – Does Mr Henshaw’s impairment rate 20 points or more?
As stated above, paragraph 94(1)(b) of the Act provides that the second qualification for DSP is that the person’s impairments rate 20 points or more under the Impairment Tables.
Mr Henshaw lodged 2 claims for DSP. There was a change in the law between these 2 claims in relation to the applicable Impairment Tables, and so the Tribunal applied the relevant law for each date of claim.
The Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 contains the Impairment Tables and the rules for applying the Impairment Tables when deciding if a person is qualified for DSP for an application that was lodged on 14 February 2023. An impairment rating can only be assigned to a condition if the condition is permanent for the purposes of DSP, that is, that the condition is expected to persist for more than 24 months and was “fully diagnosed” and “fully treated and stabilised” on the date of claim and there was unlikely to be any significant functional improvement in the condition within the next 2 years enabling the person to undertake work.
The Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 contains the Impairment Tables and the rules for applying the Impairment Tables when deciding if a person is qualified for DSP for a claim lodged on 24 April 2024. The Impairment Tables state that an impairment rating can only be assigned to a medical condition for the purposes of DSP for a claim lodged on 24 April 2024 if the condition is expected to persist for more than 24 months and was diagnosed, reasonably treated and stabilised on the date of claim for DSP and there was unlikely to be any significant functional improvement within the next 2 years enabling the person to undertake work.
Evidence before the Tribunal
The Tribunal noted the written evidence in the hearing papers related to the medical conditions. This information is discussed further below under the relevant medical conditions.
In oral evidence at the hearing, Mr Henshaw gave the following evidence in relation to his medical conditions:
Spine condition
a) He developed a problem with his spine about 10 years ago when he was working and was injured. He saw a physiotherapist but was not properly assessed. The people assessing him missed that he had a damaged disc in his spine. It was not until much later that he had a CT scan and this was detected. He was also found to have bony spurs along his spine. His lower back was painful and his neck “cracked.” When he exerted himself he felt pain afterwards. Once he returned from leave, his employer sacked him. He tried to work with a [specified work team] but could not tolerate repeatedly bending over. He tried working in a [business 1] but his back condition flared. He had to have days off work.
b) He took tramadol for his back pain. He had gone to hospital several times for an injection when his pain was severe. The pain came and went. It might last 10 minutes or several hours. He had to be careful carrying heavy boxes or lifting things.
c) He had been treated with physiotherapy and a TENS machine in the past. He also had aqua therapy at this time. However, in recent years he preferred chiropractic therapy. He had attended a pain service once and saw the staff but they wanted him to visualise the pain and this was not really his thing. He was referred to a spine specialist for review but had not heard back from the hospital. His general practitioner wrote the referral.
d) The functional impact of his spine condition was that he could not repeatedly bend over. If he did the laundry, he had to put the washing basket on a chair and he used an inside hanger to avoid bending and stretching. Sometimes if he had a lot of dishes to wash, he found prolonged bending at the sink caused back pain. He could not carry heavy things or swing a heavy object. He was careful with his activities and approached tasks cautiously to avoid hurting his back.
Lungs
e) About 8 years ago he was sent to a lung specialist as he had a cough. The lung specialist told him he had emphysema and black spots in his lungs. The spots were growing. He could no longer run with his kids, but he could walk around ok.
f) In terms of management, he took puffers to help with breathing and had cut down his cigarettes from 50 a day to around 10 a day. He had a flu vaccination. He did not know if he was current with RSV or COVID vaccination. He did not have a written plan to action what to do should his breathing deteriorate. He took Asmol inhaler (short acting bronchodilator) and Spiriva (tiotropium bromide). The Tribunal noted Spiriva is a long acting muscarinic agonist (LAMA).
g) In response to questions from the Tribunal, Mr Henshaw stated that he was not on a prescribed long acting bronchodilator (LABA) or a long acting corticosteroid inhaler or COPD subtype medication. He had not attended a pulmonary rehabilitation program. He had never required hospitalisation for his lung condition. He had not seen the lung specialist since 2020. He could not recall the last CT for his lungs to check on the black spots in his lungs.
h) The main functional impact was that he could not jog or run. He could walk around but had to pace himself. He had modified his lifestyle.
Mental health condition
Mr Henshaw stated that his mental health condition came and went. It came when he was stressed and resolved with counselling. He was currently stressed as he was having to pack up and leave his sister’s house after she had stated she would be his carer. His mental health had been poor when his mother died. He had been her carer and her death had affected him badly. He had a few rough times in his life and his mental health improved when he went to live with his sister but now he was leaving, it had deteriorated again. He was moving back to Adelaide.
j) When his mental health was good he was good but when it was bad he felt terrible. When he got back to Adelaide he planned to look up his old doctor, [Doctor A], and ask for some help for his mental health.
k) He saw a psychiatrist once but he did not think they were interested in him and he did not go back. The psychiatrist was the one who mentioned his previous history with drugs and alcohol. However, he was past that now and these were not current concerns.
Consideration of evidence and findings
Spine condition
The Tribunal noted long standing medical evidence in relation to a degenerative spine condition. This information dated back to an imaging report of a CT of the lumbar spine dated 10 July 2014 and medical certificates by general practitioners [Doctor A] dated 13 February 2017, 5 May 2017, 14 December 2017 and [Doctor B] dated 28 December 2017 that documented degenerative changes in the lumbar and cervical spine. Management at this time involved medication, exercise and physiotherapy.
Verification of medical evidence forms completed by general practitioner [Doctor C] dated 5 November 2019 and 19 November 2020, and medical certificates dated 2 January 2021, 24 February 2021, 28 April 2021, 5 July 2021, 25 September 2021 and 11 December 2021 outlined the diagnosis of a spine condition causing back pain. Management included referral to [Clinic 1], gabapentin and pain management. The functional impact was described as being lower back pain and radiculopathy.
A patient health summary printed on 10 February 2023 documented a diagnosis of back pain and management with tramadol.
Chiropractic x-rays dated 30 July 2019 and 4 January 2022 and CT reports of the spine dated 27 March 2018 and 28 March 2023 documented degenerative changes in the spine.
A general practice management plan dated 12 April 2023 by general practitioner [Doctor D] included a referral to the pain management service in [Region 1]. The associated surgery consultation noted a history of chronic back pain and that Mr Henshaw was waiting to see a spine specialist.
Medical certificates by [Doctor D] dated 11 July 2023, 6 October 2023, 10 January 2024, and 15 March 2024 documented a diagnosis of thoracic and lumbar radiculopathy. The condition caused back pain and “+ROM.”
A report from the chronic pain service signed by [Physiotherapist A], physiotherapist, on 13 December 2023 and by [Psychologist A], psychologist, on 19 December 2023 noted that Mr Henshaw had attended the multidisciplinary pain clinic. Mr Henshaw had been offered physiotherapy by the pain clinic but had declined as he preferred to continue with community chiropractic therapy instead. Likewise, Mr Henshaw stated he declined psychological counselling from the pain service. [Psychologist A] recommended ongoing surveillance of his mental health in the community, and advised that Mr Henshaw could be referred back to the pain clinic for psychological therapy if required. Mt Henshaw was discharged from the service.
Letters completed by [Doctor D] on 23 May 2024 and 17 June 2024 outlined diagnoses of lumbar and cervical and thoracic radiculopathy, cervical spondylitis and facet joint arthritis.
A medical certificate completed by general practitioner [Doctor E] on 25 September 2024 documented a diagnosis of bilateral lumbar facet joint arthritis that caused low back pain.
In oral evidence, Mr Henshaw stated he had a spine condition for many years dating back to a workplace injury and his imaging studies showed a disc problem and bony spurs. He had been treated with allied health input including physiotherapy, aqua therapy and chiropractic therapy and attended a pain clinic. He had been waiting for a long time to see a spine surgeon and now he was going to have to move back to Adelaide.
Findings in relation to the claim lodged on 14 February 2023
The Tribunal noted the history of back pain dating back to an imaging study in 2014 and medical certificates in 2017. There was evidence of permanent structural changes identified on imaging studies. The Tribunal found the spine condition was a chronic condition that would persist for longer than 24 months.
The Tribunal found the spine condition was “fully diagnosed” because the condition had been diagnosed by [Doctor A], [Doctor C], [Doctor D] and [Doctor E] and their diagnoses were supported by relevant imaging investigations.
However, the Tribunal found the spine condition was not “fully treated and stabilised” on 14 February 2023 because a general practice management plan dated 12 April 2023 by [Doctor D] included a new referral to the pain management service in [Region 1] and the notes of the associated surgery consultation documented that Mr Henshaw was waiting to see a spine specialist. Both referrals had only recently been made and the treating doctors felt both were reasonable interventions at that time. Both a pain management service review and specialist review represented reasonable treatment that could result in functional improvement within 2 years.
As a result of this finding, the Tribunal is not able to rate the impairment arising from the spine condition on 14 February 2023 under the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011.
Findings in relation to the claim lodged on 24 April 2024
As stated in paragraph 31 above, the Tribunal noted the history of back pain dating back to an imaging study in 2014 and medical certificates in 2017. There was evidence of permanent structural changes identified on imaging studies. The Tribunal found the spine condition was expected to persist for longer than 24 months.
The Tribunal found the spine condition was diagnosed because the condition had been diagnosed by [Doctor A], [Doctor C], [Doctor D] and [Doctor E] and they were appropriately qualified medical practitioners.
The Tribunal found the spine condition was reasonably treated and stabilised on 24 April 2024 because there was evidence of management with allied health input including physiotherapy and chiropractic therapy, analgesic medication and specialist input had now been implemented with review from a multidisciplinary pain management service. Although Mr Henshaw had not yet seen a spine specialist, the Tribunal noted his oral evidence was that he had been waiting for a review for some time and this was yet to happen. He was now moving back to Adelaide and would need to secure a new referral for review by a spine surgeon and it was unlikely practical intervention would occur within the next 2 years.
As a result of these findings, the Tribunal was able to rate the impairment arising from the spine condition on 24 April 2024 under the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023.
The medical certificates by [Doctor D] dated 11 July 2023, 6 October 2023, 10 January 2024, and 15 March 2024 outlined functional impact of back pain and “+ROM”.
The report from the chronic pain service signed by [Physiotherapist A], physiotherapist, on 13 December 2023 noted that aggravating factors for the pain were standing straight, lifting and heavy work. Mr Henshaw was independent with all acts of daily living. Mr Henshaw was observed to remain comfortably seated during the assessment.
A medical certificate completed by general practitioner [Doctor E] on 25 September 2024 documented a diagnosis of bilateral lumbar facet joint arthritis that caused low back pain.
In oral evidence, Mr Henshaw stated that his neck sometimes cracked when he moved it and he had back pain that came and went and might last 10 minutes or a few hours. He was not able to repeatedly bend over to floor level. If he did the laundry, he had to put the washing basket on a chair and he used an inside hanger to avoid bending and stretching. He could not carry heavy things or swing a heavy object. He was careful with his activities and approached tasks cautiously to avoid hurting his back.
The Tribunal found that due to the spine condition, Mr Henshaw experienced back pain and there was limitation in his full range of spine movement and he would have difficulty with tasks involving repeated bending to knee height. However, he was able to be active around the house, was independent with acts of daily living and could sit for 30 minutes. He might need to move around at times to become comfortable.
In applying Table 4 – Spinal Function, this generated a rating of 10 points for moderate impairment.
Table 4 stated:
There is a moderate functional impact on activities involving spinal function.
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.
Respiratory condition
The medical certificate by [Doctor C] dated 5 November 2019 documented a diagnosis of COPD that resulted in coughing and ongoing shortness of breath with reduced energy. Management was documented as being the use of puffers and a respiratory review.
The verification of medical evidence form completed on the same date by [Doctor C] reiterated the diagnosis of COPD but also included a diagnosis of surveillance of pulmonary nodules. Impairment was described as ongoing coughing and shortness of breath. Past management of puffers and respiratory review was documented with the general practitioner stating that Mr Henshaw was seeing [Doctor F] and having surveillance for pulmonary nodules. There was a plan that management would include CT chest imaging every 6 months and ongoing specialist review.
A letter dated 19 June 2020 by respiratory and sleep physician [Doctor F] stated that Mr Henshaw was under care for COPD and emphysema and his CT chest had shown emphysematous changes and nodules. The recent CT had shown that the nodules were increasing in size and the specialist stated that Mr Henshaw required further follow-up and a repeat CT of the chest.
A verification of medical evidence form completed by [Doctor C] on 19 November 2020 documented a diagnosis of COPD that was permanent and managed with CT imaging and specialist review. The functional impairment was a cough and pulmonary nodules.
A series of medical certificates by [Doctor C] dated 24 February 2021, 5 July 2021, 28 April 2021, 25 September 2021 and 11 December 2021 noted onset of back and chest pain . There was new pain in the thoracic area and the doctor wrote that Mr Henshaw was “pending further investigation with bloods for the chest, thoracic and spine pain ? cause.”
A patient health summary dated 10 February 2023 documented a diagnosis of COPD and management with Asmol inhaler (salbutamol), Spiriva inhaler (tiotropium bromide inhaler).
An Aboriginal health check completed on 24 January 2023 by [Ms A] noted a history of COPD and chest pains. No mention was made of the pulmonary nodules. Smoking of 15 to 20 hand rolled cigarettes a day and marijuana use were noted. Mr Henshaw stated he was thinking of quitting smoking at this time. However, the action plan did not mention further respiratory physician review and CT of the chest review, nor consideration of medication review.
Mr Henshaw lodged a new claim for DSP on 24 April 2024 and no longer listed COPD or lung nodules as a condition for which he sought DSP.
A report from the chronic pain service signed by [Physiotherapist A], physiotherapist, on 13 December 2023 and by [Psychologist A], psychologist, on 19 December 2023 did not address COPD or lung nodules as active conditions being managed at that time.
Subsequent letters from [Doctor D] dated 23 May 2024 and 17 June 2024, a medical certificate by [Doctor E] dated 25 September 2024 and [Agency 1] dated 8 October 2024 did not mention that there was an active lung condition on these dates.
In oral evidence, Mr Henshaw stated he had reduced his smoking from 50 to around 10 cigarettes a day and had had a flu vaccination. He had seen a respiratory specialist and was supposed to have black spots on his lungs monitored by CT scans. However, he had not returned for specialist care since 2020. He was only on a short acting bronchodilator and LAMA. He was not on a LABA or long acting corticosteroid or COPD subtype medication. He had not attended a pulmonary rehabilitation program and did not have a flare up plan in place.
Findings in relation to the claim lodged on 14 February 2023
The Tribunal noted the history of COPD and emphysema dating back to a medical certificate by [Doctor C] dated 5 November 2019 and the letter dated 19 June 2020 by [Doctor F] reported structural changes in the lungs from emphysema and the presence of growing lung nodules. The Tribunal accepted these were permanent structural changes and would persist for longer than 24 months.
The Tribunal found the lung condition was “fully diagnosed” because the condition had been diagnosed by [Doctor C] and [Doctor F] and their diagnoses were supported by relevant imaging investigations.
However, the Tribunal found the lung condition was not “fully treated and stabilised” on 14 February 2023 because Mr Henshaw had been advised to undertake regular specialist review and CT imaging of his lung nodules and it was likely that this would have led to further management that could enhance functional impairment. He had not seen a specialist for several years and the last CT of his chest was from 2020. In oral evidence, Mr Henshaw confirmed he was still smoking, had not attended a pulmonary rehabilitation program, and while he was on short acting salbutamol inhaled medication and a LAMA, he was not on a COPD specific subtype medication or LABA and there had been no consideration of adding a long acting inhaled corticosteroid. He also did not have a flare up plan in place. Thus, reasonable treatment remained outstanding on the date of claim that could have enhanced functional impairment within the next 2 years.
As a result of this finding, the Tribunal is not able to rate the impairment arising from the spine condition on 14 February 2023 under the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011.
Findings in relation to the claim lodged on 24 April 2024
As stated in paragraph 57 above, the Tribunal noted the medical evidence from 2019 and evidence of permanent structural changes identified on imaging studies. The Tribunal found the lung condition was expected to persist for longer than 24 months.
The Tribunal found the lung condition was diagnosed because the condition had been diagnosed by [Doctor C] and [Doctor F] and they were appropriately qualified medical practitioners.
The Tribunal found the lung condition was not reasonably treated and stabilised on 24 April 2024 for the same reasoning outlined in paragraph 59. Indeed, there appeared to have been no active management of the lung condition in the year before the claim for DSP was lodged. The detailed report from the chronic pain service signed by [Physiotherapist A], physiotherapist, on 13 December 2023 and by [Psychologist A], psychologist, on 19 December 2023 did not address COPD or lung nodules as active conditions. The letters from [Doctor D] dated 23 May 2024 and 17 June 2024, medical certificate by [Doctor E] dated 25 September 2024 and [Agency 1] dated 8 October 2024 did not mention an active lung condition. Reasonable treatment that was likely to elicit functional improvement within 2 years remained outstanding.
As a result of these findings, the Tribunal was not able to rate the impairment arising from the lung condition on 24 April 2024 under the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023.
Mental health conditions
The Tribunal noted medical certificates dated 28 July 2014, 25 August 2014 and 11 November 2014 by [Doctor A] documented a temporary diagnosis of anxiety and depression that was expected to show improvement. It was managed at that time with counselling and medication.
There was then a gap of 5 years until a medical certificate by [Doctor C] dated 5 November 2019 documented a diagnosis of depression that was treated with psychological review.
A verification of medical evidence form completed by [Doctor C] on the same date also outlined a diagnosis of depression managed with past psychological review and anti-depressant medication.
A second verification of medical evidence form completed by [Doctor C] on 19 November 2020 outlined a diagnosis of depression. The prognosis was stated to be unclear at that time. Management was psychologist review and cognitive behavioural therapy.
In a series of medical certificates written by [Doctor C] dated 2 January 2021, 24 February 2021, 5 July 2021, 28 April 2021, 25 September 2021 and 11 December 2021, a diagnosis of depression was documented. The prognosis was documented to be temporary with improvement expected within 13 to 24 months. Management was treatment with mirtazapine and a plan for Mr Henshaw to have further psychological review.
A patient health record printed on 10 February 2023 documented a diagnosis of depression and medication management of mirtazapine.
A letter from clinical psychologist [Doctor G] dated 21 January 2023 stated that Mr Henshaw had attended 6 counselling sessions. The exacerbation in mental health symptoms was attributed to the loss of his care giving role. The clinical psychologist felt that Mr Henshaw:
May require initial assessment and access to treatment for complex grief and other conditions.
A general practice mental health plan dated 23 January 2023 by general practitioner [Doctor H] recorded a DASS 21 score that was high and wrote a referral for psychological counselling with a plan for a further general practice mental health review in 6 months.
Mr Henshaw then moved to a new area to live.
The Aboriginal health check completed on 24 January 2023 by [Ms A] noted a high score to a K5 screening tool embedded within the health assessment paperwork. [Ms A] wrote that Mr Henshaw was to be referred to a psychiatrist stating:
Has mental health care plan and seeing counsellor in (deleted for privacy) – Plan to link into a psychiatrist.
However, the report from the chronic pain service signed by [Physiotherapist A], physiotherapist, on 13 December 2023 and by [Psychologist A], psychologist, on 19 December 2023 stated that Mr Henshaw was not under psychiatrist care. Instead, he was seeing a counsellor once a month through the [specified] health service. Mr Henshaw was offered psychological counselling through the pain service but declined. A recommendation was made to monitor his mood and that he could be referred back to the service for psychological counselling if required.
In oral evidence, Mr Henshaw stated his mental health condition came and went. When his mental health was good he was well and when a stressful event happened it deteriorated. He responded to counselling. He had seen a psychiatrist once but did not continue this care as he felt the psychiatrist was not interested in his situation. When he moved back to Adelaide he planned to link back with his old general practitioner to sort out his mental health. He was currently stressed by having to move out of his sister’s house after she was to be his carer.
Findings in relation to the claim lodged on 14 February 2023
The Tribunal noted the history of mental health conditions dated back to 2014. There was evidence that the condition was episodic in nature with a series of exacerbations caused by events in Mr Henshaw’s life causing symptom flares. These exacerbations had settled with counselling and medication. The Tribunal accepted that Mr Henshaw had had flares in his mental health function in 2014, 2019 and 2021 and his symptoms were currently elevated. The relapsing and remitting nature of the condition had now been present for over a decade and the Tribunal found it would continue to persist for longer than 24 months as a relapsing and remitting condition.
The introduction to the Impairment Table 5 – Mental Health Function contained within the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 outlined the requirements for a mental health condition to be “fully diagnosed” for the purposes of DSP for a claim lodged on 14 February 2023. The introduction stated that a mental health condition was not fully diagnosed unless the diagnosis was made by a psychiatrist, or else by a medical practitioner with supporting diagnostic input from a clinical psychologist.
The Tribunal noted the diagnostic evidence from [Doctor A], [Doctor C], [Doctor H] and found that there was diagnostic input from medical practitioners. However, none of these doctors were specialist psychiatrists.
The Tribunal noted the letter from clinical psychologist [Doctor G] dated 21 January 2023. However, the letter did not articulate a formal diagnosis and instead stated that Mr Henshaw would require “initial assessment” and access to treatment at that time.
Likewise, the report from the chronic pain service signed by psychologist [Psychologist A] on 19 December 2023 did not outline a diagnostic formulation.
In oral evidence Mr Henshaw stated he had seen a psychiatrist but the tribunal had no evidence of when this occurred and and no evidence that a psychiatric diagnosis had been made.
The Tribunal found the mental health condition was not “fully diagnosed” on 14 February 2023 because there was no evidence of diagnostic input from a psychiatrist nor of diagnostic input from a clinical psychologist that corroborated the findings of the treating general practitioners.
As a result of this finding, the Tribunal is not able to rate the impairment arising from the mental health condition on 14 February 2023 under the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011.
Findings in relation to the claim lodged on 24 April 2024
As stated in paragraph 78 above, the Tribunal noted the medical evidence from 2014 and the relapsing and remitting chronic nature of symptoms over a decade and found the mental health condition was expected to persist for longer than 24 months.
The introduction to the Impairment Table 5 – Mental Health Function contained within the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 outlined the requirements for a mental health condition to be diagnosed for the purposes of DSP for a claim lodged on 24 April 2024. The introduction stated that a mental health condition was not diagnosed unless the diagnosis was made by a psychiatrist, or else by a medical practitioner with supporting diagnostic input from a psychologist.
There was evidence of diagnostic input from [Doctor A], [Doctor C] and [Doctor H]. However, none of these medical practitioners were specialist psychiatrists. Although Mr Henshaw stated in oral evidence that he saw a psychiatrist, there was no evidence of when this occurred or if the psychiatrist had made a formal mental health diagnosis.
Likewise, while Mr Henshaw had seen [Doctor G] and [Psychologist A], neither psychologist had documented a diagnostic formulation.
The Tribunal found the mental health condition was not diagnosed on 24 April 2024 because there was no evidence of diagnostic input from a psychiatrist nor of diagnostic input from a psychologist that corroborated the findings of the treating general practitioners.
As a result of these findings, the Tribunal was not able to rate the impairment arising from the mental health condition on 24 April 2024 under the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023.
Other medical conditions
Some medical certificates had raised concerns about a drug dependency disorder. However, in oral evidence, Mr Henshaw stated this was a past condition and no longer active. As a result, the Tribunal did not consider this condition further.
Summary
In relation to the claim lodged on 14 February 2023, the Tribunal has found that Mr Henshaw did not have any medical conditions that were able to be rated under the Impairment Tables. Therefore, he did not satisfy paragraph 94(1)(b) of the Act.
In relation to the claim lodged on 24 April 2024, the Tribunal has found Mr Henshaw has a rating of 10 points. As this is less than 20 points, Mr Henshaw did not satisfy paragraph 91(1)(b) of the Act.
Issue 3 – Does Mr Henshaw have a continuing inability to work?
As the Tribunal has found that Mr Henshaw failed to satisfy paragraph 94(1)(b) of the Act on either date of claim, the Tribunal did not proceed to determine whether he satisfied paragraph 94(1)(c) of the Act on these dates.
DECISIONF
The decision under review is affirmed. This means the review is not successful.
| Date of hearing: | Friday 30 May 2025 |
| Representative for the Applicant: | Not applicable |
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