HSPS and National Disability Insurance Agency

This matter concerned an application for review of a decision by the National Disability Insurance Agency (NDIA) to refuse access to the National Disability Insurance Scheme. The applicant sought access to the scheme on the basis of Autism Spectrum Disorder (ASD), fibromyalgia, osteoarthritis, and bilateral epicondylitis. The NDIA had determined that the applicant did not meet the disability requirements for access, specifically that their conditions were not permanent and did not result in a substantially reduced functional capacity.

The Tribunal was required to determine whether the applicant's conditions, namely ASD, fibromyalgia, osteoarthritis, and bilateral epicondylitis, were permanent impairments under section 24(1)(b) of the relevant legislation. Furthermore, the Tribunal had to consider whether these conditions resulted in a substantially reduced functional capacity to undertake, or psychosocial functioning in undertaking, any one or more of the activities listed in section 24(1)(c) of the legislation.

The Tribunal considered the evidence regarding the diagnosis of ASD, noting the treating psychologist's reliance on behavioural observation and historical information. While the psychologist acknowledged the preference for corroborative information from relatives, she maintained that such information was not essential for diagnosis, despite an initial file note indicating she could not fully verify the ASD diagnosis without collateral information. The Tribunal also examined the permanence of the applicant's other conditions. Expert evidence indicated that fibromyalgia, while often chronic, is responsive to treatment and can vary in intensity, leading to the conclusion that it could not be regarded as permanent in the same way as other health conditions.

The Tribunal affirmed the NDIA's decision. It found that the applicant's conditions, particularly fibromyalgia, did not meet the criteria for permanence as defined by the legislation. Consequently, the Tribunal concluded that the applicant did not satisfy the requirements for access to the National Disability Insurance Scheme.