Holmes and National Disability Insurance Agency

This matter concerned an application by Ms Holmes to the National Disability Insurance Scheme (NDIS) for access. The core dispute revolved around whether Ms Holmes met the disability requirements for participation in the NDIS, as set out in section 24 of the *National Disability Insurance Scheme Act 2013* (Cth). The Administrative Appeals Tribunal was required to determine if Ms Holmes' impairments resulted in a substantially reduced functional capacity in one or more of the specified activity areas.

The legal issues before the Tribunal were whether Ms Holmes' congenital heart disease, Tetralogy of Fallot, caused her fatigue and, if so, whether this fatigue resulted in a substantially reduced functional capacity to undertake activities such as communication, social interaction, learning, mobility, self-care, and self-management. The Tribunal also considered whether Ms Holmes met the early intervention requirements under section 25 of the Act.

The Tribunal's reasoning focused on the conflicting medical evidence regarding the cause of Ms Holmes' fatigue. While Ms Holmes believed her fatigue was directly related to her heart condition, the Tribunal gave greater weight to the opinion of cardiologist Dr. Patrick Disney. Dr. Disney, who had previously treated Ms Holmes, expressed a clear view that her heart was functioning well and that her fatigue was not related to her cardiac condition. Although an occupational therapist, Ms Dwyer, suggested a link, her opinion was not based on a medical examination and she deferred to Dr. Disney's expertise on cardiac matters. Consequently, the Tribunal was not satisfied that Ms Holmes' fatigue was attributable to her congenital heart disease.

As the Tribunal found that Ms Holmes' fatigue was not caused by her heart condition, it concluded that she did not meet the disability requirements under section 24 or the access criteria under section 21(1)(c)(i) of the Act. Therefore, the remaining considerations under section 24 and any question of meeting early intervention requirements under section 25 were rendered irrelevant. The Tribunal affirmed the Reviewable Decision of 14 April 2022.