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

[2016] AATA 607

Spratt and Secretary, Department of Social Services (Social services second review) [2016] AATA 607 (15 August 2016)

Division	GENERAL DIVISION
File Number	2015/6026
Re	Margaret Spratt
APPLICANT
And	Secretary, Department of Social Services
RESPONDENT

DECISION

Tribunal	Senior Member D R Davies
Date	15 August 2016
Place	Brisbane

The decision under review is affirmed.

........................[Sgd]................................................

Senior Member D R Davies

Catchwords

SOCIAL SECURITY – Disability Support Pension – post traumatic stress disorder – hearing loss – tinnitus – whether conditions were permanent – whether fully diagnosed treated and stabilised – impairment tables – whether impairments of the applicants attracted ratings of 20 impairment points – level of impairment – some conditions not fully treated or stabilised – decision under review affirmed

Legislation

Social Security Act 1991 (Cth) ss 26, 94
Social Security (Administration) Act (Cth) ss 41, 42

Cases

Bobera and Secretary, Department of Families, Housing, Community Services and Indigenous Affairs [2012] AATA 922
Fanning and Secretary, Department of Social Services [2014] AATA 447
Gallagher v Secretary, Department of Social Services [2015] FCA 1123

Secondary Materials

Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (Cth) ss 5, 6, 11

REASONS FOR DECISION

Senior Member D R Davies

15 August 2016

INTRODUCTION

1. This is a review of the decision of the Administrative Appeals Tribunal Social Services and Child Support Division (“AAT1”) dated 23 October 2015 affirming Centrelink’s decision to reject Mrs Margaret Spratt’s Application for Disability Support Pension (“DSP”).

2. On 4 June 2015, Mrs Spratt lodged a claim for DSP.  Her claim form[1] listed her disabilities as mild – profound bi-lateral hearing loss, tinnitus bi-laterally and Post Traumatic Stress Disorder (“PTSD”), depression, anxiety.

   [1] Exhibit 1, T Docs, T9, page 54.

3. A medical report completed by Mrs Spratt’s General Practitioner, Dr Saman Perera in support of her claim nominated the conditions having the most impact on her as mild to profound hearing loss bilaterally, followed by PTSD, depression and anxiety and constant bi-lateral tinnitus[2].

   [2] Exhibit 1, T Docs, T11, page 67-72.

4. On 16 July 2015 Mrs Spratt attended a face to face assessment with a Job Capacity Assessor (“JCA”) who recommended that a total of 20 impairment points be assigned to her impairments being 10 points in respect of the hearing loss and 10 points in respect of PTSD with no points for the tinnitus[3].

   [3] Exhibit 1, T Docs, T10, pages 57-63.

5. Mrs Spratt’s claim was subsequently rejected by a decision made on 16 July 2015.  The decision to reject the claim was affirmed by an Authorised Review Officer (“ARO”)[4]. This decision was affirmed by the AAT1 who found that Mrs Spratt had a total impairment rating of 5 points and she therefore did not qualify for a DSP at the time of the claim [5].

   [4] Exhibit 1, T Docs, T13, pages 77-82.

   [5] Exhibit 1, T Docs, T2, pages 13-19.

6. Before I deal with the issues raised by this Application, I will highlight the key legislative provisions.

   THE LEGISLATIVE FRAMEWORK

7. Section 94 of the Social Security Act 1991 (Cth) (“Act”) prescribes the criteria necessary to qualify for DSP. For present purposes, the three primary requirements are:

   ·That the person has a physical, intellectual or psychiatric impairment;

   ·That the persons impairment is 20 points or more under the Impairment Tables;

   ·And that the person has a continuing inability to work.

8. The Social Security (Administration) Act 1999 (Cth) makes it clear that qualification for DSP and assessment of the relevant impairment ratings are to be determined as at the date of claim which in this case is 4 June 2015. There is, however, an exception where the person is not qualified on that date but “becomes qualified” within 13 weeks of lodging the claim, in which case the start date for DSP is the date the person becomes qualified[6].  Therefore the relevant period for considering whether Mrs Spratt qualified for DSP is between 4 June 2015 and 3 September 2015.

   [6] See ss41 and 42, Schedule 2, Part 2 of the Social Security (Administration) Act 1999 (Cth).

9. Previous decisions of both the Tribunal and the Federal Court have emphasised that the Tribunal must look at the situation as it was, and the evidence that was available, at the time of the Application for DSP and the 13 weeks which followed it. Evidence, such as medical reports, that come into being after the relevant period may still be relevant, but only in so far as they are referrable to the person’s condition during the relevant period[7].

   [7] See Bobera and Secretary, Department of Families, Housing, Community Services and Indigenous Affairs [2012] AATA 922 [34]; Fanning and Secretary, Department of Social Services [2014] AATA 447 [32]; and Gallacher v Secretary Department of Social Services [2015] FCA 1123, [25], [28].

10. The Impairment Tables are contained in the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (“Determination”) a legislative instrument made under the Act.[8]

    [8] See s 26(1) of the Social Security Act 1991 (Cth) (“Act”).

11. The Tables are function based, rather than diagnostic based, and describe functional activities, abilities, symptoms and limitations. They are designed to assign ratings to determine the level of functional impact of impairment, and not to assess conditions.[9]  The impairment of a person is to be assessed on the basis of what they can, or could do, and not on what they choose to do or what others do for them.[10]

    [9] See s 5(2) of the Determination.

    [10] See s 6(1) of the Determination.

12. Under the rules for applying the Impairment Tables, an impairment rating can only be assigned if the persons condition causing the impairment is “permanent” and the impairment that results from that condition is more likely than not, in light of the available evidence, to persist for more than 2 years.[11]

    [11] See s 6(3) of the Determination.

13. In order for a condition to be considered “permanent” it must have been fully diagnosed by an appropriately qualified medical practitioner; been fully treated; been fully stabilised, and more likely than not, in light of available evidence, to persist for more than 2 years.[12]

    [12] See s 6(4) of the Determination.

14. In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated, the following factors are to be considered:

    ·Whether there is corroborating evidence of the condition;

    ·What treatment or rehabilitation has occurred in relation to the condition;

    ·And whether treatment is continuing or is planned in the next 2 years.[13]

    [13] See s 6(5) of the Determination.

15. A condition is “fully stabilised” if:

    (a)Either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in a significant functional improvement to a level enabling the person to undertake work in the next 2 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 2 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[14].

    [14] See s 6(6) of the Determination.

16. “Reasonable treatment” is treatment that:-

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

    (b)Is at a reasonable cost;

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

    (d)Is regularly undertaken or performed;

    (e)Has a high success rate;

    (f)And carries a low risk to the person.[15]

    [15] See s 6(7) of the Determination.

17. An impairment rating can only be assigned in accordance with the rating points in each Table. A rating cannot be assigned between two consecutive impairment ratings. If an impairment is considered as falling between two ratings, the lower of the two ratings is to be assigned and the higher rating must not be assigned unless all the descriptors for that level of impairment are satisfied.[16]

    [16] See s 11(1) of the Determination.

18. As regards to the requirement that the person have a continuing inability to work, all the criteria in s 94(2) of the Act need to be satisfied. In summary they are that the person must:

    (a)Have actively participated in a program of support (if the person does not have a severe “severe impairment” within the meaning of s 94(3B)); and

    (b)Be unable to work for at least 15 hours per week independently of a program of support; and

    (c)Be unable to participate in a training activity, or if the impairment does not prevent the person from undertaking a training activity, such activity is unlikely (because of the impairment) to enable him or her to do any work independently of a program of support within the next 2 years.

19. A person’s impairment is a “severe impairment” if their impairment is of 20 points of more under the Impairment Tables, of which 20 points or more are under a single Impairment Table.[17]

    [17] See s 94(3B) of the Act.

    ISSUES FOR THE TRIBUNAL

20. A considerable amount of medical evidence has been provided and it is accepted by the Secretary that Mrs Spratt suffered from a number of medical conditions and that she had impairments for the purposes of s 94(1)(a) of the Act.[18]

    [18] Exhibit 2, Secretary Statement of Facts and Contentions dated 11 May 2016 – para 20.

21. However the Secretary contends that Mrs Spratt’s impairments do not attract a rating of 20 points or more under the Impairment Tables and that she does not satisfy s 94(1)(b) of the Act, and that some of the impairments are not fully treated.

22. The issues for me to consider are:

    (a)Whether at the relevant time, Mrs Spratt’s impairments were fully diagnosed, fully treated and fully stabilised;

    (b)Whether at the relevant time Mrs Spratt’s impairments attracted ratings of 20 impairment points or more under the Impairment Tables; and

    (c)If so, and unless one of Mrs Spratt’s impairments was a severe impairment attracting a rating of 20 points or more, whether Mrs Spratt had a continuing inability to work within 2 years of the relevant period.

    CONSIDERATION

    Were Mrs Spratt’s impairments fully diagnosed, fully treated and fully stabilised?

23. I address this by reference to Mrs Spratt’s various medical conditions.

    Hearing Loss, Tinnitus Conditions

24. The Secretary concedes that Mrs Spratt’s hearing loss is long-standing and is fully diagnosed with supporting evidence from an Audiologist.  The Secretary concedes that Mrs Spratt’s hearing loss condition is also fully treated and stabilised and can therefore be rated under Table 11 of the Impairment Tables.[19]

    [19] Exhibit 2, para 31.

25. However the Secretary contends that Mrs Spratt’s tinnitus condition cannot be considered to be fully treated and stabilised.

26. Mrs Spratt has been in the care of her General Practitioner, Dr Saman Perera for a number of years.  He has provided a number of reports relating to her various medical conditions which are contained in exhibit 1 and in the further exhibits which were before this Tribunal.

27. Dr Vida Percy, an Audiologist, has provided two reports in relation to Mrs Spratt’s hearing condition and hearing conditions.  Dr Percy provided a report dated 10 April 2015[20], which may be an incorrect date as it refers to a reassessment which he took on 19 February 2016.  Nevertheless he reports that Mrs Spratt’s hearing was initially assessed by him on 7 December 2012 when she reported to him that she had had stapedectomy surgeries in both ears some 12 years earlier at 2 years apart by an ENT Specialist Dr Bell-Allen.  Mrs Spratt reported giddiness while bending down or rising up along with tinnitus in both ears.  She had been fitted in February 2012 with Post-Auricular RIC Hearing Aids to both her ears.

    [20] Exhibit M.

28. In his report of 27 March 2015[21] Dr Percy reports that he saw Mrs Spratt on 27 March 2015 and she complained to him of tinnitus in both ears which fluctuates in pitch and bothers her. On examination and testing, Dr Percy found that Mrs Spratt in her right ear had moderate conductive hearing loss reverse slopes to mild mixed hearing loss and slopes to severe hearing loss. In her left ear she had mild sloping to severe mixed hearing loss.  He found that speech auditory results revealed good speech discrimination scores for loud, moderate and soft sound input levels bilaterally. He noted that Mrs Spratt mentioned that her tinnitus has become quite bothersome and causes excessive distress in both ears.  Mrs Spratt reported to him that she was undertaking a tinnitus rehabilitation program in Logan Hospital.

    [21] Exhibit 1,  T Docs T5, pages 47-48.

29. Dr Percy in his report dated 10 April 2015[22], which as previously mentioned may in fact be 2016, refers to a recent assessment of Mrs Spratt’s hearing on 19 February 2016.  At that assessment her hearing in her right ear was moderate reverse sloping to mild and slopes to profound mixed hearing loss. In her left ear, moderate reverse sloping to mild and slopes to profound mixed hearing loss. Her speech discrimination was good in quiet situations with adequate amplification. She reported having seen an ENT surgeon at Logan Hospital and had been discharged since then and she has been referred for an ongoing tinnitus management program at the Princess Alexandra Hospital. If that examination in fact occurred on 19 February 2016, then it is after the relevant period for the purposes of the DSP claim. To the extent that it indicates any change in Mrs Spratt’s condition from that which existed between 4 June 2015 and 3 September 2015, that change is outside the relevant period and is not relevant. However I consider that its findings are consistent with other evidence as to her hearing condition at the relevant time.

    [22] Exhibit M

30. There is a report from Dr Sally-Ann Schilt, an Advanced Audiologist with Logan Hospital dated 2 April 2015[23].  This report is provided by her to Dr Perera.  Dr Schilt says that she saw Mrs Spratt on 31 March 2015 and Mrs Spratt reported intermittent feeling of being off balance with nil known triggers.  Mrs Spratt experienced true vertigo following stapedectomy surgery in the past which she reports has now been resolved.  Mrs Spratt reportedly saw Dr Parker (ENT) towards the end of 2014 for further investigation of her tinnitus.  She underwent a CT scan which showed normal results and no further action was taken at that time.  Mrs Spratt described her tinnitus as constant and bilateral.  She says it has significant impact on her daily living and is finding it difficult to cope with its impact becoming, distressed.   She finds she is unable to communicate effectively and reports intermittent headaches but no migraines.  Dr Schilt reports that Mrs Spratt has an upcoming appointment with a Clinical Psychologist in the near future which in Dr Schilt’s view is highly recommended.

    [23] Exhibit 1, T Docs T4, pages 45-46.

31. Dr Schilt’s clinical assessment was that there was mild to profound mixed hearing loss bilaterally. Positional testing was not assessed as vertigo was resolved and no concern was reported by Mrs Spratt.  Dr Schilt reports her impression of Mrs Spratt having significant concern and anxiety relating to constant bilateral tinnitus.  She notes:

    “Vertigo issues resolved, some unsteadiness”.[24]

    She reports that she discussed the case further with Dr Whitfield, the ENT Consultant at Logan Hospital.  He recommended referral to Princess Alexandra Hospital Audiology Department for further assessment and management of Mrs Spratt’s significant reported tinnitus. Dr Schilt states:

    “I have spoken to the Audiologist at the PA Hospital who requires a referral from yourself addressed to the PA Hospital Audiology Departing citing the reason for the referral as “Tinnitus Management” for Margaret to access these services.  She has also highlighted that this referral should be in conjunction with Margaret’s appointments with the Clinical Psychologist”.[25]

    [24] Exhibit 1, T Docs T4, page 46.

    [25] Exhibit 1,  T Docs T4, page 46.

32. Mrs Spratt in her application to the Tribunal for review makes a number of statements relating to her tinnitus:

    “The tinnitus has progressively gotten worse impacting on my daily life.  I am currently on a waiting list for a trial program at the PAH for “Tinnitus Management” which will try to help turn it into white noise……………..  This condition (tinnitus) in isolation would not validate me applying for disability support payment, which is why I have not until now, although in conjunction with my other disabilities, it is debilitating.  Better maintenance of this condition is achieved whilst free from mental distress and is advised to be done in conjunction with my mental health plan…..As stated earlier, and supported by attached documentation, there is no further investigation or treatment available to me via any hospital, there is only management training by the clinic at the PA”.[26]

    [26] Exhibit 1, T Docs T1, page 2.

33. In her evidence given to this Tribunal, Mrs Spratt admitted that she had not attended the Princess Alexandra Hospital for the Tinnitus Management referred to by Dr Schilt and also referred to by Mrs Spratt in her Application for Review as set out in the previous paragraph.  In her evidence to this Tribunal Mrs Spratt said that she had not attended the Princess Alexandra Hospital for any appointments with the Clinical Psychologist.  Mrs Spratt further said that the tinnitus management program was a trial management program.

34. Dr Perera in a brief report dated 9 May 2015[27]relevantly confirms that Mrs Spratt has constant bilateral chronic tinnitus and mild to profound mixed hearing loss bilaterally.  He considers these two conditions to be lifelong and confirmed and stabilised.

    [27] Exhibit 1, T Docs T7, page 50.

35. On the same date, 9 May 2015, Dr Perera provided a referral to the Princess Alexandra Hospital Audiology Department for opinion and management of Mrs Spratt’s tinnitus[28].

    [28] Exhibit D.

36. Dr Perera in his medical report in support of the disability support pension dated 3 June 2015[29] states that the hearing loss condition is stabilised and confirmed.  He says that the constant bilateral chronic tinnitus is diagnosed, treated and stabilised.  It affects most of the day to day functions, causes distress, difficult to concentrate.

    [29] Exhibit 1, T Docs T11, pages 64-74.

37. The Centrelink Health Professional Advisory Unit doctor, Dr Armstrong, completed an assessment of the medical evidence dated 7 March 2016[30].  Dr Armstrong reports that on 1 March 2016 she spoke with Dr Perera and he stated:

    “Mrs Spratt’s main complaint was tinnitus and vertigo.  Initially tinnitus was of moderate impact, but when she developed PTSD, depression and anxiety her tinnitus had a more severe impact….He hasn’t seen Mrs Spratt specifically about her tinnitus and vertigo symptoms for some time although she attends his surgery regularly…….Her vertigo symptoms are not being specifically treated.  Mrs Spratt does not usually have trouble hearing him and his conversations with her are “OK”.  Her balance seems not to be an issue when walking around his surgery…….Mrs Spratt has not reported any falls.  She had a mental health care plan last year but Dr Perera was not aware that she has not attended any psychology appointments since May 2015”.[31]

    [30] Exhibit I.

    [31] Exhibit I, page 8.

38. In her report of 7 March 2016, Dr Armstrong observes that standard treatment of tinnitus includes fitting appropriate hearing aids, masking or sound generated devices and Cognitive Behavioural Therapy (“CBT”).  CBT is particularly useful for those patients who have psychological issues and also improves the quality of life of patients with tinnitus.[32]

    [32] Exhibit I, page 9.

1. Dr Armstrong in the same report expresses the opinion that Mrs Spratt has had appropriate hearing aids fitted which have failed to improve her tinnitus but she has not yet had specific tinnitus education or tried masking or sound generated devices.  In particular she has not had CBT which is likely to be very helpful in reducing the perceived level of her tinnitus and associated psychological distress.[33]

   [33] Exhibit I, pages 9-10.

2. In relation to attendance at the Princess Alexandra Hospital Audiology Department, Dr Armstrong notes that she spoke to an Audiologist at the Princess Alexandra Hospital who told her that the waiting list was no more than 1 to 2 months. 

3. I am satisfied and find that Mrs Spratt’s hearing loss impairment is fully diagnosed, fully treated and fully stablised and can be assessed on the Impairment Tables.  As previously mentioned, this is conceded by the Secretary.

4. In relation to the tinnitus condition, it is apparent that Mrs Spratt has been recommended to have tinnitus assessment and management at the Princess Alexandra Hospital Audiology Department in May 2015 for which Dr Perera gave a referral, less than 1 month before she made this DSP claim.  It can be inferred from this referral that Dr Perera considers that this treatment will be of benefit to Mrs Spratt. It is also apparent that she had not sought an appointment at that Department for that program in the period between 4 June 2015 and 3 September, 2015.  As previously mentioned, in her evidence to this Tribunal, Mrs Spratt admitted that she had not sought such an appointment as at the time of the hearing.

5. Mrs Spratt gave evidence to the Tribunal that she had travelled overseas to Vanuatu and Bali on some 7 occasions between May 2012 and August, 2015.  She had also travelled to Bali to visit her mother for some 18 days and had only returned a week before the hearing of this Tribunal.  Mrs Spratt gave evidence that to travel from her home at Russell Island to Brisbane City requires a number of different methods of public transport and can take some 2 hours.  She also gave evidence that she had some 6 months ago travelled to Brisbane to see her daughter.  She also admitted that if the reason was sufficiently important she could undertake travel and had done so to visit the Logan Hospital.  Accordingly, I consider the treatment at the Princess Alexandra Hospital Audiology Department is reasonably accessible to her. As this treatment is available at a public hospital, there should be no cost associated with it.

6. Accordingly I find that in respect of Mrs Spratt’s tinnitus condition that further treatments are available and that those treatments have reasonable prospects of improving the tinnitus condition within 2 years.  I find that the tinnitus condition is not fully treated and fully stabilised and therefore cannot be rated under the Impairment Tables.

7. In relation to Mrs Spratt’s vertigo, I note that this is not listed as one of her medical conditions in her application for DSP.[34]  Also as previously mentioned, Dr Schilt reports that the true vertigo following the stapedectomy surgery in the past has resolved[35] and that “vertigo issues resolved some general unsteadiness”.[36]  In her evidence to this Tribunal, Mrs Spratt said that it is constant unsteadiness and not true vertigo.  She said that if she is driving and she watches something go past to the side she feels as if she is drunk.  She said she refers to it as vertigo but it is unsteadiness.

   [34] Exhibit 1, T Docs, T9.

   [35] Exhibit 1, T Docs, T4, page 45.

   [36] Exhibit 1, T Docs, T4 page 46.

8. Accordingly, I consider that there is no evidence that Mrs Spratt has vertigo and that her statements about unsteadiness should be considered in the overall context of her hearing impairment.

9. It is therefore appropriate to consider the impairment rating in respect of Mrs Spratt’s hearing loss. 

   Impairment Table 11 – Hearing and other functions of the ear

10. As mentioned earlier, Mrs Spratt’s functional impairments involving hearing (communication) function or other functions of the ear are:

    ·Mrs Spratt in her application for review says “I have not been able to drive during the day for a year and at night for two years”.  She also states in an email of 15 November 2015 that her hearing disability of moderate bilateral hearing loss, fits into moderate functional impact in Table 11.[37]

    [37] Exhibit 1, T Docs, T1, pages 2-12.

    ·Dr Perera reports:

    oHearing affected, communication, driving, safety concerns[38];

    [38] Exhibit 1, T Docs, T11, page 69.

    oDifficulty in communication, driving difficult, and balance affected[39].

    [39] Exhibit C, page 6.

    ·Dr Perera in his conversation with Dr Armstrong said Mrs Spratt does not usually have trouble hearing him and his conversations with her are OK.  Her balance seems not to be an issue when she is walking around his surgery although this is only a small area.[40]

    [40] Exhibit I, page 8.

    ·Dr Armstrong also refers to her conversation with Dr van der Veen who said that during the consultation Mrs Spratt had to look at her as she relied on lip reading.[41]

    [41] Exhibit I, page 8.

    ·JCA report[42]:

    [42] Exhibit 1, T Docs, T10, page 60.

    oIn conversation with Dr Perera on 16 July 2015, that Mrs Spratt is able to drive and has not been restricted from driving by him.  Mrs Spratt can drive and has visited him alone without her carer present at times.

    oMrs Spratt told her that doctors have advised her against driving.  She uses bilateral hearing aids and lip reads and the phone is used on speaker phone. 

    oThe assessment was carried out by phone and was conducted without problem with regards to hearing/communication.

    ·Dr Percy reports:

    oRight ear moderate conductive hearing loss slopes to mild mixed hearing loss and slopes to severe hearing loss.

    oLeft ear mild sloping to severe mixed hearing loss.

    oGood speech discrimination scores for loud moderate and soft sound input levels bilaterally[43].

    ·Dr Schilt reports:

    oMrs Spratt reports intermittent feeling of off balance.

    oWears bilateral hearing aids.

    oMild to profound hearing loss bilaterally.

    oVertigo issues resolved some general unsteadiness[44].

    [43] Exhibit 1, T Docs, T5, page 47.

    [44] Exhibit 1, T Docs, T4.

11. Mrs Spratt appeared before the Tribunal on her own behalf by telephone. With the assistance of a device on her mobile phone with her hearing aids, she was able to hear and communicate during the hearing satisfactorily.

12. In view of the evidence , I consider that Mrs Spratt’s  functional impairment on activities involving hearing (communication function or other functions of the ear) under Table 11 aligns most closely with the descriptors for moderate functional impairment, in that even when using a hearing aid, she:

    ·Has difficulty hearing a conversation at average volume in a room with no background noise; and

    ·Uses a mobile telephone with a hearing device; and

    ·Is partially reliant on lip-reading in some situations; or

    ·Has more frequent difficulty with balance or ringing in the ears which interferes with communication ability or routine activities due to tinnitus.

    Accordingly, I assign 10 impairment points under this Table.

    Post-Traumatic Stress Disorder (PTSD) Depression, Anxiety

13. The medical report of Dr Marchione van der Veen, a Clinical Psychologist dated 30 May 2015[45]confirms that Mrs Spratt meets the diagnostic criteria of PTSD with associated persistent anxiety and depression symptoms.

    [45] Exhibit 1, T Docs, T8, page 51.

14. The Secretary concedes on the basis of this report that Mrs Spratt’s PTSD is fully diagnosed by an appropriately qualified medical practitioner.[46]  However the Secretary contends that Mrs Spratt’s mental health condition was not fully treated or fully stabilised at any time during the relevant period.

    [46] Exhibit 2, para 51

15. In Dr Perera’s report for disability support pension dated 21 February 2015[47] he notes Mrs Spratt’s condition as depression, adjustment disorder and that her current treatment is psychotherapy.  He says that she has experienced depressive feelings since 2012 with isolation and an ability to work which has affected her psychological wellbeing. The impacts on her are stated to be concentration difficulty, memory and tiredness.

    [47] Exhibit C.

16. Dr Perera in the mental health care plan dated 27 February 2015[48] notes the plan for Mrs Spratt is medication and psychologist. Referral is sought for diagnostic assessment and psycho-education. Access for Cognitive Behavioural Therapy with behavioural and cognitive interventions, is requested.

    [48] Exhibit D.

17. In Dr Perera’s medical report for the DSP dated 3 June 2015[49] he notes that the treatment for PTSD is to continue current psychotherapy treatment with psychologist.

    [49] Exhibit 1, T Docs, T11, pages 64-74.

18. Dr Perera in his report of 6 April 2016[50] notes that Mrs Spratt’s diagnosis of adjustment disorder, anxiety, depression and PTSD was supported by psychologists including Travis Gee, Dr Andrea Quinn and Dr van der Veen.

    [50] Exhibit N.

19. Dr Gee in his report of 19 February 2013[51] states that Mrs Spratt has attended his clinic twice on 12 October 2012 and 2 November 2012 following referral from her GP for a mental health care plan.  He says that Mrs Spratt has advised that she will be rebooking in April 2013 to continue with treatment for an adjustment disorder that relates to alleged domestic violence whilst in Vanuatu.  Dr Gee’s report of 26 May 2014[52] confirms that Mrs Spratt has been referred to him for assistance with psychological problems (anxiety/depression) arising from ongoing conflict with her employer in relation to other physical disabilities.

    [51] Exhibit D.

    [52] Exhibit D.

20. Dr van der Veen, a Clinical Psychologist in her report to Dr Perera dated 30 May 2015[53] confirms that she saw Mrs Spratt on two occasions, 24 April 2015 and 22 May 2015.  She reports that Mrs Spratt feels she has established a good report with Dr Andrea Quinn and recommends that she engage with therapy with Dr Quinn on the Island if possible.  She expresses the opinion that Mrs Spratt will require long term therapy focusing on emotional and cognitive processing of what has happened to her and focusing on what she can control in her day to day life.

    [53] Exhibit 1, T Docs, T8, pages 51-52

21. Dr Armstrong of Centrelink’s Health Professional Advisory Unit in her report of 7 March 2015[54] records that she spoke with Dr van der Veen on 26 February 2016 who said that she had not advised Mrs Spratt to have psychological therapy on an as needed basis and referred to her report which said Mrs Spratt requires long term therapy.

    [54] Exhibit I.

22. In her report, Dr Armstrong records that she spoke to Dr Quinn on 29 February 2016 and Dr Quinn said that she had only seen Mrs Spratt once on 13 March 2015 for an assessment. Dr Quinn told her that she had referred Mrs Spratt to a Clinical Psychologist for treatment as she thought this was necessary due to her significant trauma history.  Dr Armstrong in her report also records a conversation with Dr Perera on 1 March 2016 in which Dr Perera said that Mrs Spratt had a mental care plan last year but that he was not aware that she has not attended any psychological appointments since May 2015.  He said that he did not think that Mrs Spratt had attended any appointments with the psychologist Dr Gee.  Dr Perera said that Mrs Spratt did not take anti-depressant medication as she does not like to take them. At this stage Dr Perera has not considered referral to a psychiatrist.

23. Mrs Spratt in her Application for Review dated 15 November 2015[55] states:

    “Although evidence may suggest that I have had limited mental health care, I have actually been a participant in a mental health plan with my local GP for more than 3 years.  This began under the care of Dr Parker and resulted in an application for disabilities…..The result was that my mental health doctor was not qualified enough to diagnose.  My GP Dr Perera then referred me to Dr Quinn once she became available under the assumption that she was qualified enough to diagnose.  This was not the case so Dr Quinn then transferred me to Dr van der Veen.  I was then under consultation with Dr van der Veen until she professionally felt that she could fully diagnose me, and she did.  As part of her recommendation in the clinic, I am not visiting Dr Quinn on any regular basis as it is felt that this is not what works best in my situation.  Dr van der Veen stated that I should only see Dr Quinn when or if I feel I need her support but that I have a clear mental health plan and direction which is ‘managing to get through day to day through social isolation and trying to focus on painting…….I am continuing my connection with Dr Quinn and regard her as my lifetime doctor’.”

    [55] Exhibit 1, T Docs, T1, pages 2-3

24. Mrs Spratt in her evidence to this Tribunal said that the management of her PTSD has been with carers on Russell Island.  She said that Dr Quinn had left Russell Island and there was a new psychologist who she only knew as Julie.  Mrs Spratt also said that:

    ·She has not seen Dr Quinn since she saw Dr van der Veen in April and May 2015;

    ·It was several months later that she contacted Dr Quinn and spoke to her on the telephone for half an hour;

    ·It could be that she only saw Dr Quinn once;

    ·She spoke to Julie once on the telephone and Julie has a long waiting list and she has not yet seen Julie;

    ·She has not had any treatment from nor seen a psychologist or psychiatrist since she saw Dr van der Veen in May 2015;

    ·Dr Gee was not qualified to diagnose her and that she had seen Dr Gee about once every three months over a period of two years;

    ·She has not undertaken any CBT;

    ·She is currently taking the following medication – Lyrica, Tramedo, Zumenon.

25. I note that none of those medications are anti-depressants.

26. It is apparent that Mrs Spratt has not received any treatment from a psychologist or psychiatrist for her mental health condition since she saw Dr van der Veen in May 2015.  She is not taking any anti-depressant medication.  There is no evidence that medication of that type would not be reasonable treatment. She is also not undertaking any CBT.

27. Accordingly I am not satisfied that Mrs Spratt’s PTSD is fully treated and fully stabilised.

28. I consider that given the diagnosis of the severity of Mrs Spratt’s PTSD and associated depression and anxiety, it is reasonable to expect that she undertake further treatment which has been suggested by Dr van der Veen.

29. As I have mentioned previously, I consider that those treatments are reasonably accessible to Mrs Spratt either on Russell Island or nearby on the mainland or in Brisbane and should be available at a reasonable cost.

30. I find that the PTSD and associated depression and anxiety condition were not fully treated and fully stabilised at the relevant time. Accordingly no impairment rating can be assigned.

    OVERALL IMPAIRMENT RATING

31. In accordance with my findings, Mrs Spratt has a rating of 10 points under the Impairment Tables and therefore does not satisfy s 94(1)(b) of the Act.

    CONTINUING INABILITY TO WORK

32. In view of the conclusion I have reached above, it is unnecessary to consider whether Mrs Spratt met the third requirement for DSP, namely that she had a continuing inability to work.

    CONCLUSION

33. I do not consider that Mrs Spratt qualified for DSP in respect of her claim. Accordingly the decision under review is affirmed.

    
    
    

I certify that the preceding 71 (seventy-one) paragraphs are a true copy of the reasons for the decision herein of Senior Member D R Davies

......................[Sgd]..................................................

Associate

Dated 15 August 2016

Date of hearing	30 June 2016
Date final submissions received	4 July 2016
Applicant	In person
Advocate for the Respondent	Maleah Underhill