Krasniqi 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 (NDIS) for Mr Krasniqi. Mr Krasniqi sought access on the basis of diagnoses including Complex Regional Pain Syndrome (CRPS), Irritable Bowel Syndrome (IBS), and persistent depressive disorder with anxious distress. The NDIA's internal review had affirmed the initial decision to refuse access.

The Administrative Appeals Tribunal (AAT) was required to determine whether Mr Krasniqi met the criteria for access to the NDIS under either the disability pathway or the early intervention pathway. Specifically, the Tribunal needed to consider whether Mr Krasniqi's impairments were permanent or likely to be permanent, and whether they resulted in a substantially reduced functional capacity in relevant domains. The Tribunal also had to assess whether the conditions met the requirements for early intervention.

The Tribunal found that Mr Krasniqi's CRPS was not permanent, or likely to be permanent, as there were known, available, and appropriate evidence-based treatments that had not been fully trialled, such as an intensive pain management program, orthotics, hydrotherapy, and psychological counselling. Furthermore, even if considered permanent, the Tribunal was not satisfied that his CRPS caused a substantial functional impairment in mobility, noting he could still walk and manage daily living activities, albeit with limitations. Similarly, while IBS was acknowledged, there was insufficient evidence of a substantial functional impairment in self-care. Regarding his depressive disorder, the Tribunal found it was not established as permanent due to a lack of evidence of appropriate treatment having been undertaken. Consequently, Mr Krasniqi did not meet the disability requirements for NDIS access. The Tribunal also determined that Mr Krasniqi did not meet the early intervention requirements, as his conditions were long-standing and required clinical management more appropriately funded through the health system, rather than the NDIS.

Accordingly, the Tribunal affirmed the NDIA's decision. Mr Krasniqi was found not to meet any of the requirements for entry to the NDIS.