JFXZ and National Disability Insurance Agency

This matter concerned an application by JFXZ, a 14-year-old participant in the National Disability Insurance Scheme, for review of a decision by the National Disability Insurance Agency (NDIA). JFXZ has Ehlers Danlos Syndrome (Type 3) and idiopathic scoliosis. The dispute centred on whether a dynamic SpineCor Comfort spinal brace and a dynamic movement orthotic suit constituted "reasonable and necessary supports" under section 34(1) of the *National Disability Insurance Scheme Act 2013* (Cth). The Administrative Appeals Tribunal (AAT) was required to determine this issue.

The Tribunal was tasked with considering several key legal issues. These included whether the requested supports were likely to cause harm to JFXZ, whether they would be effective and beneficial, and whether they represented value for money. Additionally, the Tribunal had to consider whether the supports were more appropriately funded through the NDIS or the general health system. A crucial aspect of the assessment was the lack of evidence demonstrating that the requested dynamic bracing system, as opposed to a rigid brace, was endorsed by a medical practitioner as medically appropriate for JFXZ, given her specific medical conditions.

In its reasoning, the Tribunal found that the evidence did not establish that the requested supports met the mandatory criteria under subsections 34(1)(c) (value for money) and 34(1)(d) (effectiveness and benefit) of the NDIS Act. Specifically, there was insufficient evidence to support the claim that the dynamic brace was medically appropriate or would be effective and beneficial for JFXZ, particularly in light of her complex medical history and the absence of clear medical endorsement for this type of treatment over other options. The Tribunal noted that while the parents expressed concerns about rigid bracing and believed dynamic bracing might offer long-term benefits, this was not substantiated by sufficient medical evidence.

Consequently, the Tribunal concluded that the requested supports did not meet all the mandatory criteria for "reasonable and necessary supports" under section 34(1) of the NDIS Act. Therefore, the Tribunal affirmed the NDIA's original decision, meaning the SpineCor brace and orthotic suit would not be included in JFXZ's statement of participant supports and funded by the NDIS.