Rouse and Secretary, Department of Social Services (Social services second review)

[2021] AATA 1144

Rouse and Secretary, Department of Social Services (Social services second review) [2021] AATA 1144 (4 May 2021)

Division:GENERAL DIVISION

File Number:2020/2149          

Re:Ms Katherine Rouse   

APPLICANT

Secretary, Department of Social ServicesAnd  

RESPONDENT

DECISION

Tribunal:B. Pola, Senior Member

Date:4 May 2021

Place:Brisbane

Pursuant to s43(1)(a) of the Administrative Appeals Tribunal Act 1975 (Cth), the Tribunal affirms the decision of the Social Services and Child Support Division dated 25 March 2020.

......................................[SGD]......................................

Senior Member B. Pola

CATCHWORDS

SOCIAL SECURITY – Disability Support Pension – DSP – whether condition is fully diagnosed, fully treated and fully stabilised – whether 20 points or more under the Impairment Tables during the Qualification Period – decision under review affirmed

LEGISLATION

Social Security Act 1991 (Cth)
Social Security (Administration Act) 1999 (Cth)
Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (Cth)

Social Security (Active Participation for Disability Support Pension) Determination 2014 (Cth)

CASES

Bobera and Secretary, Department of Families, Housing, Community Services and Indigenous Affairs [2012] AATA 922
Drake and Minister for Immigration and Ethnic Affairs (1979) 2 ALD 60; (1979) 46 FLR 409
Fanning and Secretary, Department of Social Services (2014) 144 ALDA 133; [2014] AATA 447
Faulkner and Comcare [2007] AATA 1541
Harris and Secretary, Department of Employment and Workplace Relations [2007] FCA 404

REFERENCE MATERIAL

Social Security Guide, 3.6.3.10, version 1.281,1 April 2021

Social Security Guide, 3.6.3.100, version 1.281, 1 April 2021

The Medical Journal of Australia, “Chronic fatigue syndrome: progress and possibilities”, Carolina X Sandler and Andrew R Lloyd, 5 April 2020

REASONS FOR DECISION

B. Pola, Senior Member
4 May 2021

BACKGROUND

1.       On 3 May 2019, the Applicant, Ms Katherine Rouse, lodged a claim for the Disability Support Pension (herein referred to as the ‘DSP’) with Centrelink (herein referred to as the ‘Agency’)[1]. As part of that claim, the Applicant listed the following disabilities, illnesses, and injuries, “Chronic Fatigue Syndrome, Chronic sinusitis, Scoliosis, Torn Meniscus, Depression, Anal Fissure, Weak immune system, Hay Fever, Flat feet, Frequent Colds and Flus, Midfacial pain”[2].

[1] Exhibit 1, T37, pages 202 to 226.

[2] Exhibit 1, T36, page 176.

2.       On 20 June 2019, the Applicant was advised by the Agency that their claim for the DSP was rejected[3].

[3] Exhibit 1, T40, pages 261 and 262.

3.       The decision to reject the Applicant’s claim for the DSP was affirmed by an Authorised Review Officer (herein referred to as an ‘ARO’) after an internal review by the Agency on 10 February 2020[4].

[4] Exhibit 1, T45, pages 272 to 277.

4.       The Applicant applied to the Social Services and Child Support Division (herein referred to as the ‘SSCSD’) of the Administrative Appeals Tribunal (herein referred to as the ‘Tribunal’); to review the Agency’s decision to reject their claim for the DSP. On 25 March 2020, the SSCSD of the Tribunal affirmed the decision to reject the Applicant’s claim for the DSP[5].

[5] Exhibit 1, T2, pages 6 to 9.

5.       The Applicant applied to the Tribunal for a second review of this decision on  9 April 2020[6].

[6] Exhibit 1, T1, pages 1 to 4.

JURISDICTION

6.       This is an application to review a decision of the SSCSD of the Tribunal which affirmed a decision to reject the Applicant’s claim for the DSP.

7.       The Applicant’s claim of 3 May 2019 has been reviewed in accordance with s135 of the Social Security (Administration Act) 1999 (Cth) (the ‘Administration Act’) by an ARO, and subsequently reviewed by the SSCSD of the Tribunal.

8.       In accordance with s179(1) of the Administration Act, the Tribunal has jurisdiction to hear the Applicant’s DSP claim of 3 May 2019.

ISSUES

9.       The issue before the Tribunal for consideration is whether the Applicant was qualified to receive the DSP in relation to their claim lodged on 3 May 2019, and ending 13 weeks later on 2 August 2019[7].

[7] The Qualification Period is discussed in later paragraphs of this Decision.

10.     The issues for the Tribunal to resolve in respect of the Applicant’s claim for the DSP are:

(a) Whether the Applicant had impairments during the Qualification Period in accordance with s94(1)(a) of the Social Security Act 1991 (Cth) (herein referred to as ‘the Act’)?

(b)  Whether the Applicant’s impairments attract 20 points or more under the Impairment Tables contained within the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (‘the Determination’) within the Qualification Period?

(i)If so, did the Applicant have a continuing inability to work as defined in s94(2) of the Act for the purpose of s94(1)(c) of the Act?

RELEVANT LEGISLATIVE PROVISIONS

11.     The medical qualification criteria regarding eligibility for the DSP are set out in paragraphs (a), (b) and (c) of s94(1) of the Act:

“94    Qualification for disability support pension

(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;

(ii)the Secretary is satisfied that the person is participating in the program administered by the Commonwealth known as the supported wage system; and

…”

12.     To be medically qualified for a DSP, a person must therefore have a physical, intellectual or psychiatric impairment that has a rating of 20 points or more under the Impairment Tables; and a continuing inability to work which, in some circumstances, includes participation in a program of support.

13.     Section 26(1) of the Act provides that “[t]he Minister may, by legislative instrument, determine tables relating to the assessment of work-related impairment for disability support pension”.

14.     It is the Tribunal’s role to stand in the shoes of the original decision-maker[8] and determine whether the decision was the correct or preferable one on the material before the Tribunal[9].

[8]     Faulkner and Comcare [2007] AATA 1541 [27].

[9]     Drake and Minister for Immigration and Ethnic Affairs (1979) 2 ALD 60; (1979) 46 FLR 409, 419 per Bowen CJ and Deane J.

15. Given this, the Tribunal must make its decision in accordance with the Determination which came into effect from 1 January 2012. The following paragraphs outline key sections of the Determination.

16. Section 6 of the Determination provides that “[t]he impairment of a person must be assessed on the basis of what the person can, or could do, not on the basis of what the person chooses to do or what others do for the person”[10]. Further, the Impairment Tables in the Determination may only be applied to a person’s impairment after the person’s medical history, in relation to the condition causing the impairment, has been considered[11].

[10] Section 6(1) of the Determination.

[11] Section 6(2) of the Determination.

17.     An Impairment Rating may only be assigned to an impairment if[12]:

(a)the person’s condition causing the impairment is permanent; and

(b)the impairment that results from that condition is more likely than not, in light of evidence, to persist for more than two years.

[12] Section 6(3) of the Determination.

18. Further, for a condition to be considered permanent pursuant s6(3)(a) of the Determination, the condition must also[13]:

(a)be fully diagnosed by an appropriately qualified medical practitioner; and

(b)be fully treated; and

(c)be fully stabilised; and

(d)be more likely than not, in light of available evidence, to persist for more than two years.

[13] Section 6(4) of the Determination.

19.     When considering whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether the condition has been fully treated, the following is also to be considered[14]:

(a)whether there is corroborating evidence of the condition; and

(b)what treatment or rehabilitation has occurred in relation to the condition; and

(c)whether treatment is continuing or is planned in the next two years.

[14] Section 6(5) of the Determination.

20.     A condition is considered fully stabilised if[15]:

(a)either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next two years; or

(b)the person has not undertaken reasonable treatment for the condition and:

(i)significant functional improvement to a level enabling the person to undertake work in the next two years is not expected to result, even if the person undertakes reasonable treatment; or

(ii)there is a medical or other compelling reason for the person not to undertake reasonable treatment.

[15] Section 6(6) of the Determination.

21.     Reasonable treatment is a treatment that[16]:

(a)is available at a location reasonably accessible to the person; and

(b)is at a reasonable cost; and

(c)can reliably be expected to result in a substantial improvement in functional           capacity; and

(d)is regularly undertaken or performed; and

(e)has a high success rate; and

(f)carries a low risk to the person.

[16] Section 6(7) of the Determination.

22. Section 6(8) of the Determination provides that “the presence of a diagnosed condition does not necessarily mean that there will be an impairment to which an impairment rating may be assigned”. While s6(9) of the Determination sets out circumstances to be considered in relation to pain.

23. Sections 7 through to 11 of the Determination provide guidance as to how Impairment Tables should be used to assess information and evidence, and how to assign Impairment Ratings.

24. In particular, s8(1) of the Determination provides that “symptoms reported by a person in relation to their condition can only be taken into account where there is corroborating evidence”.

25. While s11(1)(c) of the Determination provides that in assigning an Impairment Rating “if an impairment is considered as falling between 2 impairment ratings, the lower of the 2 ratings is to be assigned and the higher rating must not be assigned unless all the descriptors for that level of impairment are satisfied”.

Continuing inability to work

26.     As previously detailed in paragraph 11 of this decision, s94(1)(c)(i) of the Act states that in order to qualify for the DSP, a person must have a “continuing inability to work”. Section 94(2) of the Act requires that:

“(2)   A person has a continuing inability to work because of an impairment if the Secretary is satisfied that:

(aa)in a case where the person’s impairment is not a severe impairment within the meaning of subsection (3B) or the person is a reviewed 2008-2011 DSP starter who has had an opportunity to participate in a program of support—the person has actively participated in a program of support within the meaning of subsection (3C), and the program of support was wholly or partly funded by the Commonwealth; and

(a)in all cases—the impairment is of itself sufficient to prevent the person from doing any work independently of a program of support within the next 2 years; and

(b)in all cases—either:

(i)the impairment is of itself sufficient to prevent the person from undertaking a training activity during the next 2 years; or

(ii)if the impairment does not prevent the person from undertaking a training activity—such activity is unlikely (because of the impairment) to enable the person to do any work independently of a program of support within the next 2 years.”

27.     A severe impairment is defined in s94(3B) of the Act:

“A person’s impairment is a severe impairment if the person’s impairment is of 20 points or more under the Impairment Tables, of which 20 points or more are under a single Impairment Table.”

28.     Section 94(3C) of the Act states that:

“A person has actively participated in a program of support if the person has satisfied the requirements specified in a legislative instrument made by the Minister for the purposes of this subsection.”

29.     The Social Security (Active Participation for Disability Support Pension) Determination 2014 (Cth) (‘the Participation Determination’) came into effect from 3 January 2015, and sets out the requirements for active participation for those people required to demonstrate they have actively participated in a program of support (‘PoS’).

QUALIFICATION PERIOD

30.     Schedule 2, Part 2, clause 4(1) of the Administration Act outlines that the Qualification Period for a social security payment occurs within the 13 weeks after the day on which the claim is made. Where a person subsequently becomes qualified after the lodging of the claim, the commencement date for the DSP is the date on which the claimant becomes qualified[17].

[17] Part 2, clause 4(1)(d) of the Administration Act.

31.     For the purposes of this decision, the day which the Applicant’s claim for the DSP was received by the Agency was 3 May 2019[18], and concluded 13 weeks after that day. The Tribunal finds the 13 week period ended on 2 August 2019.

[18] Exhibit 1, T17, pages 115 to 116.

32.     This means that for a claim to be successful, the person must be qualified for the DSP during this Qualification Period, noting that changes in medical conditions which occur later are not relevant to this claim, but may be relevant to a separate future claim. Further evidence (medical or other) provided outside the Qualification Period may be considered, however only if it is referable to the Applicant’s condition during the Qualification Period[19].

[19] Bobera and Secretary, Department of Families, Housing, Community Services and Indigenous Affairs [2012] AATA 922 [34]; Harris and Secretary, Department of Employment and Workplace Relations [2007] FCA 404 [1]; Fanning and Secretary, Department of Social Services (2014) 144 ALDA 133; [2014] AATA 447 [31].

CONSIDERATION

33.     The application was heard in Brisbane on 22 March 2021, with the Applicant (who was self‑represented), and the Respondent (represented by Mr Summers) both appearing by telephone. The Tribunal considered oral submissions made by the Applicant and Respondent, in addition to submitted written evidence, as outlined in the Exhibit Register (Annexure 1) of these reasons.

34.     During the course of the hearing, the Tribunal heard evidence from two witnesses called by the Applicant, who gave evidence and provided statements to the Tribunal with respect to the Applicant and their medical conditions, namely:

(a)Ms Anneloes Warrener, a personal friend of the Applicant[20]; and

(b)Ms Anna Rouse, the Applicant’s sister[21].

[20] Exhibit 28.

[21] Exhibit 27.

Ms Warrener

35.     Ms Warrener is a nurse but confirmed that the evidence which she had given the Tribunal was done so in a personal capacity, not in a professional capacity as a nurse[22]. The Tribunal did not regard the evidence of Ms Warrener as particularly helpful, as this evidence was not corroborative medical evidence as required by the introduction to the relevant Impairment Tables in the Determination.

[22] Transcript 22 March 2021, page 36, lines 1 to 5.

36.     The statement of Ms Warrener to the Tribunal confirms that she is repeating what has been shared with her by the Applicant “… Most of this was shared with me by Kate herself. Kate has stated the following with me…”[23].  The Tribunal is therefore of the view that the evidence of Ms Warrener does not assist the Applicant in the present matter.

Ms Rouse

[23] Exhibit 28.

37.     The Tribunal heard evidence from the Applicant’s sister that she was not residing with the Applicant during the Qualification Period for the present matter, and the contact she had with her sister during this period was via telephone and email[24]. Although Ms Rouse is a trained psychiatric nurse, she confirmed with the Tribunal that she was providing evidence in a personal capacity[25].

[24] Transcript 22 March 2021, page 39, lines 42 and 43.

[25] Transcript 22 March 2021, page 42, lines 40 to 45.

38. The Tribunal has had regard to the statement of Ms Rouse, and her evidence, and is of a similar view as to that which was formed with respect to the evidence of Ms Warrener. In circumstances where (1) the witness did not reside with the Applicant; (2) the contact the witness had with the Applicant during the Qualification Period was via electronic means; and (3) the evidence of the Applicant’s witness is not considered corroborative medical evidence as stipulated by the introduction to the relevant Impairment Tables in the Determination; the Tribunal is therefore of the view that the evidence of Ms Rouse does not assist the Applicant in the present matter.

Section 94(1)(a) of the Act (physical, intellectual or psychiatric impairment)

39. The Tribunal is satisfied after review of the evidence before it that the Applicant suffered impairments during the Qualification Period in terms of s94(1)(a) of the Act, a point which was accepted by the Respondent[26]. The Tribunal is satisfied the following impairments are relevant for consideration as part of this application:

(a)Chronic Fatigue Syndrome;

(b)Mental health condition;

(c)Chronic sinusitis;

(d)Anal fissure; and

(e)Torn meniscus.

[26] Exhibit 2, page 7, paragraph 42.

40.     With respect to the other conditions listed by the Applicant in their application for the DSP lodged with the Agency on 3 May 2019, the Tribunal is of the view that upon review of the evidence before it, there is either (1) insufficient medical evidence to consider these impairments; or (2) the listed disabilities, illnesses or injuries are symptoms of other impairments[27].

Section 94(1)(b) of the Act (Is a person’s impairment 20 points or more under the Impairment Tables)

[27]   Exhibit 1, T36, page 176.

41. The Tribunal will now consider each impairment identified with respect to the application of s94(1)(b) of the Act, and in particular whether they meet the relevant provisions contained within the Determination.

(a) Chronic Fatigue Syndrome

42.     The Applicant has presented medical evidence dating as far back as 2012, regarding their medical history as it relates to their Chronic Fatigue Syndrome. The earliest medical evidence before the Tribunal specifically diagnosing the Applicant with Chronic Fatigue Syndrome is from 3 June 2015, from the Applicant’s General Practitioner (Dr Bai Xiao), which stated in a Medical Certificate that the condition was “permanent”, with symptoms of “constant fatigue, low concentration, poor physical tolerance”, a prognosis that it was “likely to persist”, and with respect to treatment, that the Applicant would require “ongoing support from GP, consider psychologist counselling”[28]. Subsequent medical certificates from 2015 through to 2019 (including from other General Practitioners), record the diagnosis of Chronic Fatigue Syndrome[29].

[28]   Exhibit 1, T19, page 91.

[29]   Exhibit 1, T20, page 93; T21, page 95; T23, page 146; T24, page 148; T25, page 150; T26, page 152; T27, page 154; T28, page 157; T29, page 159; T30, page 162; T31, page 165; T32, page 167; T35, page 174.

43.     Prior to this diagnosis from Dr Xiao in 2015, there are references in medical certificates from 2011 which describe the Applicant having symptoms of fatigue among other medical conditions[30].

[30]   Exhibit1, T10, page 70; T11, page 72; T12, page 74.

44.     The Tribunal has before it numerous medical examination records of the Applicant including urine, blood, saliva, spirometry, thyroid, echocardiogram, and CT chest with contrast, from the period of 2011 through to and including 2020 (with the Tribunal acknowledging that 2020 post dates the Qualification Period of this application). 

45.     A ‘Disability Support Pension Medical Eligibility Assessment Recommendation’ undertaken on 19 June 2019 by a registered nurse assessed the Applicant’s Chronic Fatigue Syndrome as not fully diagnosed, treated or stabilised due to a “lack of medical evidence customer has engaged in optimal reasonable treatment. The customer would benefit from engaging in Cognitive training. Talking with a counselor (sic). Psychiatrist review, Graded exercise program”[31].

[31] Exhibit 1, T39, page 259.

46.     A Health Professional Advisory Unit (‘HPAU’) report dated 5 February 2021, undertaken by a medical adviser, and based on medical records of the Applicant (the medical adviser disclaimed they did not personally interview or examine the Applicant) considered the Applicant’s Chronic Fatigue Syndrome to be fully diagnosed, fully treated and fully stabilised. The Tribunal refers to the following findings[32]:

“CFS is a diagnosis of exclusion i.e. a diagnosis made after eliminating other possible causes with appropriate examination and investigations. The patient’s symptoms should also fulfill the specific diagnostic criteria. There are a number of different diagnostic criteria (Fukuda, Canadian, NICE and International). These criteria variously include a mixture of prolonged fatigue, post-exertional malaise, unrefreshing or dysfunctional sleep, muscle and joint pain, cognitive symptoms, dizziness, nausea, etc. The provided medical evidence indicates that Ms Rouse had a respiratory infection in January 2011, which she never really recovered from. Subsequently she has had extensive investigations, including numerous blood tests, chest CT, echocardiogram, lung function testing and urine tests. These have all been essentially normal. When I spoke to her GP, Dr T Tin on 2/2/21 she confirmed that all investigations had been normal. The diagnosis of CFS is first mentioned in a 3/6/15 medical certificate by Dr B Xiao, a GP. It seems that Ms Rouse has not seen a non-GP specialist regarding CFS and the provided medical evidence does not specifically to the CFS diagnostic criteria. However, given the extensive investigations and the nature of her symptoms which appear to fit within the diagnostic criteria, I consider that her CFS condition was fully diagnosed, as of the qualification period. The medical evidence also reports a diagnosis of depression, but as this occurred after the onset of her CFS, it does not exclude a diagnosis of CFS.

The treatment for CFS usually consists of psychological therapies (usually Cognitive Behavioural Therapy/CBT) and Graded Exercise Therapy (GET), however more recent medical literature suggests that these are of limited usefulness. The provided medical evidence indicates that Ms Rouse has mainly pursued alternative-type therapies, which have been of no benefit. She did have some psychological therapy from T McCabe in 2012 for depression, although it is not known what this treatment consisted of. An 11/11/20 letter by T Febo, a manager for the families and communities programmes of Centacare reported that she saw a social worker for 6 sessions of CBT in 2017–18 for support with strategies for managing chronic fatigue. Dr T Tin did tell me that she has participated in physiotherapy with no benefit (also stated in 17/8/20 letter by Dr Xiao). Ms Rouse reports that she uses energy conservation/pacing techniques. These techniques are supported by some of the recent literature. I therefore consider that her CFS condition was fully treated and stabilised, as of the qualification period, given that this condition has been present since at least 2015 and probably from 2011.

Table 1 (Functions requiring Physical Exertion and Stamina) is the appropriate Table to rate CFS under. There is limited medical evidence as to Ms Rouse’s functional impairment around the qualification period, although as the medical evidence does not indicate any improvement or exacerbation since that time I believe that it is reasonable to also use more recent information. In a 12/6/19 ESAT (Employment Services Assessment) interview Ms Rouse reported that she continued with light walking or stretching exercises when she was well enough. A 1/8/19 referral letter and mental health plan by Dr T Tin states that Ms Rouse enjoys reading, writing, painting and horse care. The 25/3/20 AAT1 decision states that she reported being able to walk for 5 minutes before stopping due to knee pain, could climb steps slowly, drive, do housework and go shopping. A 22/10/20 report by B McDonald, a clinical psychologist states that Ms Rouse has a greatly impaired ability to perform activities of daily living, must pace herself carefully and must rest at appointed times. Ms McDonald indicates that the symptoms of depression and CFS do overlap and it is difficult to disentangle these diagnoses. A 23/11/20 letter from Dr T Tin states that Ms Rouse has to rest and even lie down after 15 minutes, although does not specify what activity is being referred to. When I spoke to Dr T Tin, she told me that Ms Rouse would be able to walk around a shopping centre, use public transport and perform light day to day household activities without assistance (from another person), except when she is anxious. Dr Tin also thought Ms Rouse would be able to sustain sedentary work-related tasks for a continuous shift of at least 3 hours, except when she is anxious. Dr Tin was aware that Ms Rouse has written books, and provides some care for her horses, although she thought this was less than previously. I consider that the medical evidence is consistent with a 10 impairment point rating on Table 1, as descriptor a(ii) was met (difficulty performing day to day household activities due to her fatigue), as of the qualification period. The descriptors at the 20 impairment rating level would not have been met, as Dr T Tin indicated that Ms Rouse did not need assistance (from another person) to walk around a shopping centre or use public transport, and was able to perform sedentary work-related tasks for a continuous shift of at least 3 hours...”

[32] Exhibit 3, ST8, pages 77 and 78.

47.     The Tribunal has referred to the Medical Journal of Australia, with respect to clinical observations regarding Chronic Fatigue Syndrome, the Tribunal observes the following[33]:

“… Existing clinical practice guidelines recommend that the diagnosis of CFS should generally be made in primary care, as it does not typically require assessment by a specialist physician or psychiatrist, or complex laboratory investigations. It does require a careful history, a review of mental health, a thorough physical examination, and a few necessary investigations to exclude conditions which may not be suspected on clinical grounds, such as hypothyroidism. The majority of patients with CFS report that it took longer than a year to receive a diagnosis, often because the condition is regarded as a diagnosis of exhaustive exclusion rather than a positive recognition of the characteristic fatigue state. Necessary investigations include full blood count, urea, electrolyte and creatinine levels, liver and thyroid function tests, C‐reactive protein levels or erythrocyte sedimentation rate, and fasting blood glucose tests. Reassuringly, a systematic review of 26 studies examining CFS diagnosis in patients attending primary care with tiredness revealed a low prevalence of underlying medical conditions, including anaemia (2.8%), malignancy (0.6%), and other serious physical illnesses (4.3%). Depression was diagnosed in 18.5% of patients.

… Summary: Diagnosis of CFS should be made in primary care, by recognition of unexplained chronic fatigue affecting both physical and cognitive function, with a prolonged post‐activity exacerbation. Alternative explanations should be excluded by history, physical examination and a restricted list of laboratory investigations.

… considerable support can be offered in primary care, such as physical and pharmacological approaches for pain relief, management of mood disturbance or sleep disturbances when they are clinically significant, and appropriate counselling regarding the chronic illness. In addition, advice and support regarding pacing of activities to manage functional status is appropriate, as well as advice to avoid excessive rest.”

[33]    The Medical Journal of Australia, “Chronic fatigue syndrome: progress and possibilities”, Carolina X Sandler, Andrew R Lloyd, 5 April 2020.

48.     The relevant Impairment Table relating to the Applicant’s Chronic Fatigue Syndrome is Table 1 - Functions requiring Physical Exertion & Stamina. The Social Security Guide states that with respect to the diagnosis of conditions within this relevant Impairment Table[34]:

“The diagnosis of the medical condition causing the impairment must be made by an appropriately qualified medical practitioner. This includes a general practitioner or other specialist such as a cardiology, respiratory, rheumatology or other specialist physician”.

[34]   Social Security Guide, 3.6.3.10 – Guidelines to Table 1 – Functions requiring Physical Exertion & Stamina, version 1.281,1 April 2021.

49. The Determination also states that for a condition to be considered fully diagnosed, it needs to be fully diagnosed by an “appropriately qualified medical practitioner”[35]. An appropriately qualified medical practitioner is defined in s3 of the Determination, which states that this “means a medical practitioner whose qualifications and practice are relevant to diagnosing a particular condition”.

[35] Section 6(5) of the Determination.

50.     The Tribunal is of the view that the Applicant’s Chronic Fatigue Syndrome is considered fully diagnosed during the Qualification Period of this application, on the basis of multiple diagnoses from their treating General Practitioners, which is supported by the medical examination records of the Applicant previously outlined in the reasons of this decision. The Tribunal observes that this is consistent with recent medical literature regarding the diagnosis of Chronic Fatigue Syndrome.

51.     With respect to whether the Applicant’s Chronic Fatigue Syndrome is considered fully treated and fully stabilised, there are reports before the Tribunal indicating that the Applicant has undertaken numerous sessions of cognitive behavioural therapy with a social worker in 2017-18, which is confirmed in a letter provided from Centacare[36].

[36] Exhibit 3, ST5, page 36.

52.     The author of the HPAU report records that the Applicant’s treating General Practitioner (Dr T Tin) stated that the Applicant had undertaken physiotherapy with no benefit[37].

[37] Exhibit 3, ST8, page 78.

53.     The Tribunal is of the view that based on the evidence before it, the Applicant’s Chronic Fatigue Syndrome is considered fully treated and fully stabilised as at the Qualification Period for this application; as the evidence before the Tribunal indicates that the Applicant has engaged in a range of treatments supported by recent medical literature.

54.     As previously outlined by the Tribunal, the relevant Impairment Table relating to the Applicant’s Chronic Fatigue Syndrome is Table 1 - Functions requiring Physical Exertion & Stamina. With respect to assessing the Applicant’s functional impairment as a result of their Chronic Fatigue Syndrome with reference to the Qualification Period for this application, the only corroborative medical evidence before the Tribunal confirming the Applicant’s functional abilities is the reported conversation which has occurred between the assessor in the HPAU report of 5 February 2021 and Dr Tin (as it related to the Applicant’s impairment during the Qualification Period of this application). The assessor records the following in their report[38]:

“Dr Tin thought this inability to move was related to anxiety, as it has happened before when she has had a panic attack. Dr Tin told me that Ms Rouse would be able to walk around a shopping centre, use public transport and perform light day to day household activities without assistance (from another person), except when she is anxious. Dr Tin also thought Ms Rouse would be able to sustain sedentary work-related tasks for a continuous shift of at least 3 hours, except when she is anxious. Dr Tin was aware that Ms Rouse has written books, and provides some care for her horses, although she thought this was less than previously.”

[38] Exhibit 3, ST8, page 77.

55.     In addition to the reported comments of Dr Tin, the Tribunal has had regard to the submissions of the Applicant at the hearing and before the SSCSD of the Tribunal, which were again put to the Applicant in the present hearing. The Tribunal refers to the following exchange at the hearing[39]:

[39] Transcript 22 March 2021, page 27, lines 17 to 46; page 28, lines 1 to 15 to 18.

“Respondent: This is a copy of the first tribunal decision, from last March, and paragraph, so in the middle of the page is what I’m going to be asking about here?

Applicant:      ---Yes.

Respondent:  This is the tribunal’s recording of what your evidence to them was, or what they have recorded your evidence to them in that tribunal was?

Applicant:      ---Yes.

Respondent:  They’ve recorded that back in March 2020 you said that you were able to climb steps slowly?

Applicant:      ---Yes.

Respondent:  You were able to drive, you were able to do housework and go shopping.  Now, has the tribunal recorded that evidence correctly?

Applicant:      ---I’ve never been a confident driver, a good or confident driver, and we live in a remote, rural location, and we bought this place sight unseen, we bought it - my Aunt helped us and we still owe her $55,000 - we - so, this - these roads are really, really busy, and a few people die on it every year, on our main, so there’s just - it’s steep, windy, lots of trucks, lots of mountains, I’m just not confident to drive in and out of town from here.  And now I can’t anyway, because I’m not well enough, I can’t even - I have to lie on my side, as you know, I have to lie on my side in the car if we go anywhere, so the driving part wasn’t right.

Respondent:  All right, so the driving wasn’t correct but you were able to go shopping, you were able to do housework, and you were able to climb steps slowly?

Applicant:      ---Yes, and I - with the housework and everything, I always sort of had to take breaks and rest.

Respondent:  Yes, and just moving onto the next sentence there, the tribunal’s also recorded that you believed you could use public transport if necessary?

Applicant:      ---Yes.

Respondent:  Could get into and out of a chair, and don’t use walking aids?

Applicant:      ---I just - - -

Respondent:  Has the tribunal recorded that correctly?

Applicant:      ---I use a walking stick if I’m walking in town, just to give me - you know, I’ve told you all the problems with the right knee, it just gives me a bit more confidence, and there’s no public transport anywhere within hours of here, it just doesn’t exist, we’re in a remote, rural place, but if I was in Sydney or Melbourne I could - but now I can’t, not at all.

SeniorMember: It’s the tribunal here, Ms Rouse, can I just confirm that we’re referring to what you could and couldn’t do back in - - -?

Applicant:      ---Yes, yes, sorry.

SeniorMember:         - - - at the time of the application, so back then, would it be correct to say that you could get on a bus back then, but perhaps now you can’t?

Applicant:      ---Yes, that’s right.

SeniorMember:        All right, thank you.”

[Tribunal underline for emphasis]

56.     The Tribunal acknowledges there are further reports submitted for consideration which refer to the Applicant’s functional ability, however these post date the Qualification Period for this application, and on this basis, they have been excluded from consideration as part of this application.

57.     Upon review of the available evidence before the Tribunal, the Tribunal is of the view that the impact of the Applicant’s Chronic Fatigue Syndrome on their functional ability is consistent with an impairment rating of 10 points per Table 1 - Functions requiring Physical Exertion & Stamina of the Determination. The Tribunal has transposed this table for ease of refence[40]:

[40] The Determination, page 13.

Points

Descriptor

10

There is a moderate functional impact on activities requiring physical exertion or stamina.

(1)    The person:

(a)    experiences frequent symptoms (e.g. shortness of breath, fatigue, cardiac pain) when performing day to day activities around the home and community and, due to these symptoms, the person:

  (i)  is unable to walk (or mobilise in a wheelchair) far outside the home and needs to drive or get another transport to local shops or community facilities; or

  (ii)  has difficulty performing day to day household activities (e.g. changing the sheets on a bed or sweeping paths); and

(b)    is able to:

  (i)  use public transport and walk (or mobilise in a wheelchair) around a shopping centre or supermarket; and

  (ii)  perform work-related tasks of a clerical, sedentary or stationary nature (that is, tasks not requiring a high level of physical exertion).

58.     The Tribunal is of the view that the Applicant meets descriptor (1)(a)(ii), as the evidence before the Tribunal is that the Applicant is able to perform day to day household activities but requires frequent rests. Additionally, the Tribunal is of the view that the Applicant meets descriptor (1)(b)(i), as the evidence of Dr Tin confirmed that the Applicant was able to walk around a shopping centre and utilise public transport (which was also consistent with the Applicant’s evidence at the hearing).

59.     The Tribunal is of the view that the Applicant does not meet the descriptor for a severe functional impact (20 points), as the evidence before the Tribunal does not indicate that the Applicant was unable to do the following as at the Qualification Period of this application:

(a)walk around a shopping centre without assistance; or

(b)walk from a car park to a shopping centre or supermarket without assistance; or

(c)use public transport without assistance; or

(d)perform light day to day household activities.

60.     Additionally, Dr Tin was of the view that the Applicant "would be able to sustain sedentary work-related tasks for a continuous shift of at least 3 hours, except when she is anxious”. The Tribunal is of the view that this is not consistent with the descriptor for (1)(b) of the severe functional impact table per Table 1 - Functions requiring Physical Exertion & Stamina of the Determination.

61.     In summary, the Tribunal finds that the Applicant’s Chronic Fatigue Syndrome met the descriptor for a “moderate” Impairment Rating, in accordance with Table 1 - Functions requiring Physical Exertion & Stamina of the Determination, prior to the Qualification Period for this application. Accordingly, the Tribunal assigns the Applicant 10 points in accordance with s94(1)(b) of the Act.

(b) Mental health condition

62.     The relevant Impairment Table to assess the functional impact of the Applicant’s mental health condition is Table 5 – Mental Health Function. The introduction to Table 5 – Mental Health Function, stipulates the following requirements before assessment of an Impairment Rating is undertaken (Tribunal underlining for emphasis):

Introduction to Table 5

·     Table 5 is to be used where the person has a permanent condition resulting in functional impairment due to a mental health condition (including recurring episodes of mental health impairment).

·     The diagnosis of the condition must be made by an appropriately qualified medical practitioner (this includes a psychiatrist) with evidence from a clinical psychologist (if the diagnosis has not been made by a psychiatrist).

·     Self-report of symptoms alone is insufficient.

·     There must be corroborating evidence of the person’s impairment.

·     Examples of corroborating evidence for the purposes of this Table include, but are not limited to, the following:

o   a report from the person’s treating doctor;

o   supporting letters, reports or assessments relating to the person’s mental health or psychiatric illness;

o   interviews with the person and those providing care or support to the person.

·     In using Table 5 evidence from a range of sources should be considered in determining which rating applies to the person being assessed.

·     The person may not have good self-awareness of their mental health impairment or may not be able to accurately describe its effects. This is to be kept in mind when discussing issues with the person and reading supporting evidence.

·     The signs and symptoms of mental health impairment may vary over time.

·     The person’s presentation on the day of the assessment should not solely be relied upon.

·     For mental health conditions that are episodic or fluctuate, the rating that best reflects the person’s overall functional ability must be applied, taking into account the severity, duration and frequency of the episodes or fluctuations as appropriate.

63.     Table 5 of the Determination[41] expressly stipulates that the diagnosis of a mental health condition (or impairment) “must be made by an appropriately qualified medical practitioner (this includes a psychiatrist) with evidence from a clinical psychologist (if the diagnosis has not been made by a psychiatrist)”. [Tribunal emphasis added]

[41] The Determination, page 22.

64.     The Tribunal has had regard to the medical history of the Applicant dating as far back as 2012, and notes:

(a)A Medical Certificate dated 15 March 2012 from Dr Aziz (General Practitioner), diagnosing the Applicant with “Depression with fatigue with Sinus infection”[42].

(b)A Medical Certificate dated 10 January 2018 and 9 April 2018 from Dr Xiao diagnosing the Applicant with “Depression”[43].

(c)A patient summary from Dr Xiao which states that the Applicant had “Depression – Reactive”, and was prescribed 10mg of amitriptyline, in a report printed on 5 June 2018[44].

(d)A patient summary from the Applicant’s file with their General Practitioner dated 18 February 2019 which states that the Applicant had had a past history of “Depression – Reactive”, and was currently prescribed 10mg of amitriptyline[45].

(e)A Medical Certificate dated 25 July 2019, from Dr Tin (General Practitioner), diagnosing the Applicant with “severe depression”, stating that the Applicant “… needs mental health plan CBT and Psychologist”[46].

[42] Exhibit 1, T12, page 74.

[43] Exhibit 1, T31, page 165; T32, page 167.

[44] Exhibit 2, T38, page 228.

[45] Exhibit 2, T38, pages 229 and 230.

[46] Exhibit 2, T41, page 264.

65.     With respect to the prescription of amitriptyline for the treatment of the Applicant’s depression, in the later reasons of this decision, the Tribunal outlines evidence which suggests that this particular drug seems to have originally been prescribed for the treatment of the Applicant’s mid-facial pain, as recommended by Dr Eliza Tweddle, not for the treatment of the Applicant’s depression.

66.     The Tribunal observes there is evidence from a psychologist Lainie Nicholson dated               18 September 2019, which is unable to be taken into consideration as it (1) post dates the Qualification Period for the application; and (2) the introduction to the relevant Impairment Table requires diagnosis to be made by a psychiatrist or clinical psychologist[47].

[47] Exhibit 2, T42, page 267.

67.     Further evidence has been submitted from a clinical psychologist (Beverley McDonald), diagnosing the Applicant with “major depressive disorder”, in a report dated 22 October 2020. Again, as this report post dates the Qualification Period for this application by some fourteen months and is not referrable to the Applicant’s mental health condition during the Qualification Period of this application; the Tribunal is therefore unable to refer to this report[48].

[48] Exhibit 14.

68.     In the absence of corroborating medical evidence regarding a diagnosis made by a psychiatrist or evidence from a clinical psychologist during the Qualification Period for this application, the Tribunal finds that the Applicant’s mental health condition was not fully diagnosed, therefore an Impairment Rating could not be assigned for the Applicant’s mental health condition.

(c) Chronic sinusitis

69.     The Tribunal has before it multiple imaging results, medical certificates and reports with respect to the Applicant’s chronic sinusitis condition, the Tribunal refers to the following:

(a)A medical imaging report of 10 February 2012, which stated “CONCLUSION: Suggestion of frontal and right maxillary sinusitis. No major compression of the nasal airway of nasopharynx”[49].

(b)A medical imaging report of 22 April 2015, following a CT scan which found “Very minor mucosal sinus disease. Otherwise the study is within normal limits”[50].

(c)A medical imaging report of 14 July 2017, describing previous nasal sinus surgery which occurred in 2013, and provided the following comment “Previous nasal surgery as detailed above. Minor region of mucosal thickening/minor nasal polyposis is evident as detailed above”[51]. The Tribunal observes that Dr Tweddle (Ear Nose and Throat surgeon) referred the Applicant for this imaging (discussed below).

(d)A Medical Certificate from Dr Xiao (General Practitioner) of 10 October 2017, which diagnoses the Applicant with “chronic sinusitis”, with symptoms of “sinus pain and discharge”, and a prognosis that the condition is “Likely to show considerable improvement within 2 years”[52].

[49] Exhibit 1, T36, page 192.

[50] Exhibit 1, T22, page 144.

[51] Exhibit 1, T36, page 193.

[52] Exhibit 1, T29, page 159; T30, page 162.

70.     There are letters from Dr Xiao referring the Applicant to an Ear Nose and Throat surgeon (Dr Tweddle) in 2017[53], however no accompanying report has been provided from Dr Tweddle as to the Applicant’s chronic sinusitis. The Tribunal observes a brochure provided by Dr Tweddle to the Applicant with respect to “Midfacial Pain Information”; containing an underlined passage stating that “Most patients with this condition respond to low-dose amitriptyline..”[54]. The Applicant’s Pharmaceutical Benefit Summary records indicate this was prescribed and dispensed in August 2017 onwards[55].

[53] Exhibit 1, T38, page 241.

[54] Exhibit 1, T38, page 244.

[55] Exhibit 3, ST10, page 117.

71.     It is reported in the HPAU report of 5 February 2021, that Dr Tin stated the following with respect to the Applicant’s chronic sinusitis “When I spoke to Dr T Tin she confirmed that Ms Rouse had not had recent investigations for sinusitis and had been prescribed antibiotics for sinus infection on one occasion in 2019. Dr Tin was not sure if Ms Rouse had continuing symptoms from chronic sinusitis…”[56]. This recorded statement accords with the Applicant’s Pharmaceutical Benefit Summary records, which show amoxicillin and clavulanic acid being prescribed and dispensed[57].

[56] Exhibit 3, ST8, page 79.

[57] Exhibit 3, ST10, page 119.

72.     The Tribunal is of the view that there is a lack of diagnosis from an appropriately qualified medical practitioner regarding the Applicant’s chronic sinusitis condition, which (for example) could come from an Ear Nose and Throat surgeon, such as Dr Tweddle. Additionally, the Tribunal is of the view that there is a lack of medical evidence from an appropriately qualified medical practitioner indicating a prognosis; whether the condition had been optimally treated and is stabilised; and confirmation of whether the condition is permanent.

73. The Tribunal is of the view that the Applicant’s chronic sinusitis conditions is not considered fully diagnosed as at the Qualification Period in accordance with the Determination for this application, therefore an Impairment Rating could not be assigned for the Applicant’s chronic sinusitis.

(d) Anal fissure

74.     The Tribunal refers to the following evidence regarding the Applicant’s anal fissure:

(a)Medical  Certificates dated 12 July 2011 and 16 September 2011 from Dr Glen Mobilia (General Practitioner) diagnosing the Applicant with an “anal fissure”, reporting that the condition was “long standing”, with symptoms of “pain”, and that the prognosis “depends on surgical outcome”[58].

(b)A discharge summary from surgery completed by Dr Heinrich Schwalb, following an elective haemorrhoidectomy, where the Applicant had their fissure cut and stitched, on 26 August 2011[59].

(c)A Medical Certificate dated 25 July 2019 from Dr Tin diagnosing the Applicant with an “anal fissure”, with symptoms described as “severe pain in anus esp constipation unable to sit or stand due to severe pain had 3 stretches and colonoscopies since 2010 now settling”, and a prognosis that was “Uncertain”[60].

[58] Exhibit 1, T10, page 70; T11, page 72.

[59] Exhibit 2, T38, page 231; T48, pages 304 and 305.

[60] Exhibit 2, T41, page 264.

75.     The relevant Impairment Table for the consideration of the Applicant’s anal fissure is Table 10 – Digestive and Reproductive Function. The Social Security Guide states that diagnosis of a condition “must be made by an appropriately qualified medical practitioner. This includes a general practitioner or medical specialists such as a gastroenterologist, gynaecologist, urologist or oncologist”[61].

[61] Social Security Guide, 3.6.3.100 – Guidelines to Table 10 - Digestive & Reproductive Function, version 1.281, released 1 April 2021.

76.     The Tribunal is satisfied that the Applicant’s anal fissure has been fully diagnosed on the basis that a diagnosis has been made on multiple occasions from their treating General Practitioner, observing that the Applicant’s medical records show that the condition is long standing and has been treated as required on an intermittent basis.

77.     However, the Tribunal is of the view that there is a lack of corroborating medical evidence to establish that the Applicant’s anal fissure was permanent prior to or during the Qualification Period for this application, on the basis that (1) the Medical Certificate of Dr Tin of 25 July 2019 indicated that this condition was “now settling”; and (2) Dr Tin’s reported statement to the HPAU report of 5 February 2021, that the Applicant’s anal fissure “was “not too bad”, she has not been referred for surgical treatment and just needs to use some ointment…”[62].

[62] Exhibit 3, ST8, page 80.

78.     In circumstances where the Applicant’s anal fissure has been successfully treated in the past, the available medical evidence does not suggest that the condition is permanent prior to or during the Qualification Period for this application, the Tribunal is of the view that an Impairment Rating could not be assigned for the Applicant’s anal fissure.

(e) Torn meniscus

79.     The Tribunal heard evidence from the Applicant that they had sustained an injury to their right knee from a horse riding accident in 2012 (although the Tribunal observes that the medical evidence suggests this was more likely to have occurred in early 2013)[63]. The Tribunal has referred to the submitted medical evidence which indicated the following with respect to this impairment:

(a)Medical Certificates from Dr Xiao dated 26 March 2013, 21 June 2013, and 20 September 2013, which diagnosed the Applicant with a “right fibular fracture”, and “right meniscus tear”, with both impairments considered “Temporary”, with symptoms of “pain, partial weight bearing and restriction of movement”, with a prognosis of “Likely to show considerable improvement within 2 years”[64].

(b)An MRI dated 27 June 2013 of the Applicant’s right knee, which found that there was:

“Signal abnormality of the fibular head in keeping with the known fracture from the previous study of January 2013 has resolved in keeping with appropriate fracture healing. No significant abnormality of the adjacent conjoined tendon/lateral collateral ligament complex.

Non-displaced tear / signal abnormality at the junction of posterior horn and body of the medial meniscus extending to tibial articular surface is essentially unaltered from prior.

Oedema within the superior patellar fat pad and cortical irregularity of the superior pole of the patella can be seen with suprapatellar fat pad impingement. This is essentially unaltered from previous study of February 2011 and in the absence of significant anterior knee joint pain is of doubtful significance”[65].

[63] Transcript 22 March 2021, page 23, lines 35 to 47; page 24, lines 1 to 5.

[64] Exhibit 1, T16, page 83; T17, page 86; T18, page 89.

[65] Exhibit 1, T36, page 199; T38, page 250.

80.     The Tribunal is of the view that the Applicant’s torn meniscus was fully diagnosed based on the past medical certificates from Dr Xiao supported by medical imaging in 2013, however the Tribunal is of the view that there is a lack of medical evidence to support a finding that the Applicant’s impairment was fully treated and fully stabilised prior to or during the Qualification Period for this application.

81.     There is no medical evidence before the Tribunal from an appropriately qualified medical practitioner indicating (1) a prognosis for the Applicant’s torn meniscus in their right knee; (2) whether the condition is considered permanent (particularly when Dr Xiao has indicated the condition is “temporary”); (3) whether the Applicant has received optimal treatment and the condition is stabilised; (4) nor is there any evidence before the Tribunal confirming past or current treatments. To this point, the Tribunal refers to the reported comments of Dr Tin in the HPAU report of 5 February 2021, which stated the following in relation to the Applicant’s torn meniscus “… Dr T Tin was not aware of any current knee issues when I spoke to her…”[66].

[66] Exhibit 3, ST8, page 80.

82.     The Tribunal is of the view that there is a lack of available medical evidence to find that the Applicant’s torn meniscus was fully treated and fully stabilised prior to or during the Qualification Period for this application. The Tribunal is of the view that an Impairment Rating could not be assigned for the Applicant’s torn meniscus.

Summary

83. The Tribunal has found that the Applicant’s impairments do not attract more than 20 points under the Impairment Tables during the Qualification Period, and therefore they do not satisfy s94(1)(b) of the Act.

84.     Accordingly, there is no need to consider whether the Applicant met the requirements of s94(1)(c) of the Act.

DECISION

85. Pursuant to s43(1)(a) of the Administrative Appeals Tribunal Act 1975 (Cth), the Tribunal affirms the decision of the Social Services and Child Support Division dated 25 March 2020.

I certify that the preceding 85 (eighty-five) paragraphs are a true copy of the reasons for the decision herein of Senior Member B. Pola

……………[SGD].………………

Associate

Dated: 4 May 2021

Date of hearing:  22 March 2021

Applicant:  Ms Katherine Rouse (Self-represented)   

Solicitor for Respondent:       Mr Andrew Summers (Services Australia)

ANNEXURE 1 – EXHIBIT REGISTER

EXHIBIT	DESCRIPTION OF EVIDENCE	PARTY	DATE OF DOCUMENT	DATE RECEIVED
1	T Documents (pages 1 to 413)	R	-	13 May 2020
2	Respondent’s Statement of Facts, Issues and Contentions (pages 1 to 24)	R	9 March 2021	9 March 2021
3	Respondent’s Supplementary T Documents (pages 1 to 133)	R	-	9 March 2021
4	Article: David Tuller, Trial by Error: More GET Drivel from Australia (four pages)	A	29 July 2019	8 December 2020
5	British Medical Journal – Ingrid Torjesen, NICE backtracks on graded exercise therapy revision to CFS guidance (two pages)	A	10 November 2020	8 December 2020
6	Centacare Southwest NSW letter (one page)	A	11 November 2020	8 December 2020
7	Commonwealth Risk Management - Inquiry based on Auditor-General’s report No. 18 (2015-16) Qualifying for the Disability Support Pension, an inquiry by the Joint Committee of Public Accounts and Audit (pages 1 to 27)	A	November 2016	8 December 2020
8	Independent Australia Article – Ted Roker, More Mental Health Funding is Needed in Queensland’s Rural Areas (pages 1 to 3)	A	21 October 2019	8 December 2020 15 March 2020
9	AusPsy Letter to Psychology Chair of Psychology Board of Australia re: Public consultation on revised area of practice endorsement registration standard (pages 1 to 24)	A	7 December 2018	8 December 2020
10	Bundle of Medical Records (35 pages): A.  Patient Health Summary, printed 10 November 2020 (11 pages) B.  Bundaberg Hospital Outpatient Referral Form, dated 25 January 2012 (three pages) C.  Letter from Dr Rashed Aziz, Eastside Medical Centre, dated 25 January 2012 (one page) D.  GP Mental Health Treatment Plan, Patient Assessment, dated 2 March 2012 (two pages) E.  ‘Better Access’ Mental Health Referral Cover Sheet – Dr Rashed Aziz referring Applicant to Ms Trudi McCabe, dated 2 March 2012 (one page) F.  Centrelink Medical Certificate by Dr Rashed Aziz, dated 15 March 2012 (one page) G.  Letter from Dr Rashed Aziz, Eastside Medical Centre, dated 29 March 2012 (one page) H.   ‘Better Access’ Mental Health Referral Cover Sheet – Dr Rashed Aziz referring Applicant to Ms Trudi McCabe, dated 18 April 2012 (one page) I.    Letter from Dr Rashed Aziz, Eastside Medical Centre, dated 4 February 2014 (one page) J.   MRI Knee GP: XR Right Knee report from Dr Bartek Szkandera with Dr Andrew Van Der Vliet, dated21 February 2011 (one page) K.  Eastside Medical Centre Patient Information Form (three pages) L.   Eastside Medical Centre Patient Summary requested, dated 25 January 2012 (one page) M. Letter from Director of Medical Services, Queensland Health, Orthopaedic Clinic referral acknowledgement, dated 30 January 2012 (one page) N.  CT report from Dr Eric Brecher, dated 17 August 2011 (one page) O.  Letter from Director of Medical Services, Queensland Health, Orthopaedic Clinic waitlist confirmation, dated 22 February 2012 (one page) P.  Letter from Carmen Wood, Optometrist (OPSM) to Dr Aziz re Applicant’s eye examination, dated 28 February 2012 (one page) Q.  Letter from Dr Hamish Love, Staff Specialist – Orthopaedics to Dr Aziz, dated 11 April 2012 (one page)	A	-	1 and 8 December 2020
11	Letter from Dr Thu Zar Mae Tin, Murgon & Wondai Family Medical Practice (one page)	A	23 November 2020	24 November 2020 15 March 2021
12	Letter and GP Mental Health Treatment Plan from Dr Thu Zar Mae Tin, Murgon & Wondai Family Medical Practice (seven pages)	A	1 August 2019	24 November 2020 8 December 2020
13	Details of Trudi McCabe, Psychologist seen by Katherine Rouse in 2012 at Bundaberg Psychology (one page)	A	-	12 November 2020
14	Psychologist Report of Beverly McDonald (pages 1 to 7)	A	22 October 2020	23 October 2020
15	Job Capacity Assessment Report (pages 1 to 9)	A	24 August 2020	10 September 2020
16	Letter from Dr Bai Xiao, Gardens Medical Group (one page)	A	17 August 2020	18 August 2020 15 March 2020
17	Riverina Podiatry Group notes (one page)	A	-	5 August 2020
18	QML Pathology Results (four pages)	A	-	5 August 2020
19	Referral to Gympie radiology (one page)	A	29 January 2021	2 March 2021 15 March 2021
20	Email chain from Applicant	A	-	15 March 2021
21	Email from Applicant to Respondent re appointment with doctor	A	15 March 2021	15 March 2021
22	Gympie Radiology, Echocardiogram Report (five pages)	A	18 February 2021	18 March 2021
23	Gympie Radiology, Holter ECG Report Summary (eight pages)	A	17 February 2021	18 March 2021
24	Email from the Applicant to Dr Armstrong, with attachment: ·     Image of the Applicant holding two books	A	19 March 2021	19 March 2021
25	Email from Beverley McDonald to the Applicant	A	19 March 2021	19 March 2021
26	Image of the Applicant sitting at a table	A	-	19 March 2021
27	Witness Statement by email of Anna Rouse (sister of the Applicant)	A	19 March 2021	19 March 2021
28	Witness Statement of Anneloes Warrener (friend of the Applicant) (one page)	A	19 March 2021	19 March 2021
29	Email from Queensland Community Support Scheme to the Applicant	A	17 March 2021	19 March 2021