Stojchevski and Secretary, Department of Family and Community Services

Case

[2004] AATA 917

2 September 2004

No judgment structure available for this case.

Administrative

Appeals

Tribunal

 

DECISION AND REASONS FOR DECISION [2004] AATA 917

ADMINISTRATIVE APPEALS TRIBUNAL      )

)          No N2004/124

GENERAL ADMINISTRATIVE DIVISION )
Re JOHN STOJCHEVSKI

Applicant

And

SECRETARY, DEPARTMENT OF FAMILY AND COMMUNITY SERVICES

Respondent

DECISION

Tribunal Dr J D Campbell, Member

Date2 September 2004

PlaceSydney

Decision The decision under review is affirmed.

[Sgd] Dr J D Campbell
  Member

CATCHWORDS

SOCIAL SECURITY - disability support pension - impairments assessment - continuing inability to work – decision affirmed

Social Security Act 1991, section 94, Schedule 1B

REASONS FOR DECISION

2 September 2004   Dr J D Campbell, Member

1. In this matter, Mr Stojchevski (“the Applicant”) seeks review of a Social Security Appeals Tribunal (“SSAT”) decision dated 6 January 2004, which assessed the Applicant’s impairments at 15 points under the Impairment Tables in Schedule 1B of the Social Security Act 1991 (“the Act”) and concluded that he did not qualify for disability support pension (“DSP”) under section 94(1)(b) of the Act.

2.      In so finding, the SSAT affirmed the decision by a delegate of the Secretary, Department of Family and Community Services (“the Respondent”) dated 22 September 2003, which was reviewed by an authorised review officer (“ARO”) and affirmed in a decision dated 11 November 2003.

background

3.      The Applicant lodged a claim for DSP with Centrelink on 22 May 2003.  In this document, the Applicant nominated the following medical details as to his disabilities:

a.Depression

b.Cervical spine injuries

c.Degenerative changes in acromioclavicular joints of both shoulders, and a traumatic deformity of the inferior aspect of the glenoid on the right side.

4.      The Applicant detailed  that his disabilities made it difficult to (T6)

a.sit, stand, drive a car, use public transport, lift, carry, bend and concentrate all the time; and

b.walk and sleep often; and

c.read, write and remember sometimes.

5.      Diagnostic reports forwarded with the lodgement application included an x-ray report of the cervical spine and both shoulders, which was reported upon by Dr Bryant, radiologist, on 15 November 2002 (T4, p17) as follows:

CERVICAL SPINE

There is an exuberant anterior osteophyte formation at C5/6 with some lesser   change above. Degenerative disc disease is present at C6/7.

There is some bony narrowing of the C7/T1 neural foramen bilaterally.

BOTH SHOULDERS

There is post traumatic deformity of the inferior aspect of the glenoid on the right side.

There is some degenerative change in both acromio-clavicular joints.”

6.      On 9 July 2003, Dr Kolmacic completed a treating doctor’s report (T9) in which he described the Applicant’s conditions in the following terms:

a)Painful left shoulder, with full thickness tear left supraspinatus

·     pain in left shoulder since November 2002, with pain remaining at time of examination when left arm abducted and/or elevated

·     pain in left shoulder limits him from undertaking a full range of activities. Will remain limited for three to 24 months.

b) Osteoarthritis both hips with left more problematic

·     pain and restriction of movement both hips, with the left hip being more problematic since November 2002

·     pain and restriction of movement affects his everyday activities and will continue for more than 24 months.

c)Depression

·     well managed and has minimal or limited impact on ability to function. Previous ECT therapy.

7.      Reports of further investigatory studies were submitted with the treating doctor’s report.  They included:

·Nuclear medicine studies which were reported, on 3 July 2003 as demonstrating mild to moderate degenerative arthritis affecting both hips but being more marked on the left.  Further mild arthritic changes were noted in the right acromioclavicular joint (T7).

·A left shoulder ultrasound which was reported, on 3 July 2003, as demonstrating a full thickness tear of the anterior supra spinatus tendon, with a second tear in the mid tendon and considerable synovitis in the left acromioclavicular joint (T8).

8.      On 23 July 2003, a report from Dr Kecmanovic, a consultant psychiatrist, detailed the Applicant’s history of mental illness since arriving in Australia in 1967 and his hospitalisation at Pacific Hospital, Kogarah, in 1969.  Dr Kecmanovic stated that the Applicant presented to him with symptoms of dysthymia, increased his moclobemide to 600mgms and suggested a review in six weeks (T10).

9.      A further treating doctor’s report dated 30 July 2003 was forwarded by Dr Todorovic (T11).  In this report, Dr Todorovic listed the Applicant as suffering from the following conditions:

a) Dysthymia: depression since 1967

·     difficulties sleeping, low mood, unhappy about himself

·     decreased concentration, no energy

·     difficulties interacting with other people.

b) Osteoarthritis: cervical spine, both hips, acromioclavicular joints and knees

·     gradual onset, with seating tolerance five to 10 minutes, standing tolerance 10 to 15 minutes, walking tolerance 30 minutes, difficulties with strenuous walk.

10.     On 2 September 2003 Dr Paul, a medical adviser with Health Services Australia (“HSA”), detailed the following as regards diagnosis of the Applicant’s conditions, clinical features thereof and assessment per the various assessment tables (“T12”):

a) Left shoulder pain – onset 2002: full thickness tear of left supraspinatus tendon; degenerative changes in acromioclavicular joint; reduced abduction and rotation by 25 per cent; no effect on manual handling.

Assessment per Table 3:             5 points – lack of strength/mobility in non dominant arm with little effect on manual handling

b) Bilateral hip pain - onset 2003: worse on left side; radiates to knees if standing    for more than one hour; able to walk for more than one hour.

flexion to 75 degrees; able to partially squat to 50 per cent.

Assessment per Table 4:               10 points – loss of strength/mobility with moderate interference and restricted ability to squat.

c) Depression:   causes low mood, concentration and motivation poor memory and a reduced ability to cope with stress

Assessment per Table 6:  nil points – mild but regular symptoms

d) Neck pain –

onset November 2002                 x-ray evidence of osteophyte formation C5/6; disc degeneration C6/7, full range movement with some pain

Assessment per Table 5.1 -           nil points – full range of movement.

11.     Dr Paul considered that the Applicant could only work seven hours per week without any intervention programs and that he was unfit for heavy work.  With educational, vocational or on the job training, Dr Paul considered the Applicant’s work capacity was 30 plus hours per week in a light low skilled job which did not involve prolonged sitting, standing or repetitive use of left arm.

12.     On 22 September 2003, the Respondent determined that the Applicant’s combined impairment rating was 15 points and therefore he did not qualify for DSP.  On 7 October 2003, the Applicant provided further details to Centrelink concerning the history of his mental illness, indicating that his depression had worsened since 1995, as evidenced by his prescribed medication (T15).  The Respondent reviewed the earlier decision in light of the material provided and affirmed the earlier decision on 20 October 2003 (T17).

13.     A further report of a CT scan of the lumbar spine dated 6 November 2003 was forwarded to Centrelink in which Dr Bryant recorded some disc bulging from L3 to S1, but no focal protrusions, no compression of adjacent thecal sac, but some facet joint osteoarthritis (T19)  On 11 November 2003 the ARO affirmed the earlier decision (T21).

14.     On 18 November 2003 Dr Guirgis, a consultant orthopaedic surgeon, examined the Applicant and reported (T22) that:

·movements of the cervical spine demonstrated a loss of less than 25 per cent of the normal range of movement;

·movements of thoraco lumbar spine demonstrated a loss of one quarter of the normal range of movement of the thoraco lumbar spine;

·diagnosis of generalised degenerative disorder

-cervical and lumbar discopathy and spondylosis

-osteoarthritis shoulders, hips and knees

-chronic rotator cuff arthropathy of left shoulder

-signs and symptoms of chronic pain/anxiety/depression.

15.     Dr Giurgis assessed the Applicant’s impairments as follows:

Cervical spine function (Table 5.1) 5 points. Loss of about one quarter of normal range of movement.

Lumbar spine function (Table 5.2)  10 points. Loss of one quarter of normal range of movement as well as back pain or referred pain: with any physical activities and with standing for about 30-minutes and with sitting or driving for about 60-minutes.

Upper limb function (Table 3) 5 points. Demonstrable … loss of strength, mobility, coordination, dexterity and/or sensation of non-dominant upper limb which causes moderate interference with hand function and handling.

Depression/Adjustment disorder (Table 6) 10 points.  Moderate and regular symptoms and generally functioning with some difficulty.”

issues

16.     The relevant issues in this matter are:

a) whether the Applicant suffers from any physical, intellectual or psychiatric impairment; and

b)whether the assessment of the Applicant’s impairments total 20 points or more pursuant to Schedule 1B Impairment Tables; and

c)whether the Applicant has a continuing inability to work.

decision

17. After a consideration of all the material and for the reasons outlined the Tribunal concludes that the Applicant does not satisfy sections 94(1)(b) and 94(1)(c)(i) of the Act, and as a consequence does not qualify for a DSP as sought in his claim lodged on 22 May 2003.

Applicant’s evidence

18.     The Applicant informed the Tribunal of the following:

·Born in Macedonia on 9 January 1946; attended and completed high school, leaving at age 19. Married in 1966 and experienced difficulty finding work in Macedonia.

·Migrated to Australia in April 1967.  Worked in a variety of labouring jobs (four years in a plastic mouldings factory; various factories for four to five years; containers for two years; Gordon and Gotch for four to five years).

·Worked for nine years as a customer liaison officer with the Commonwealth Bank until made redundant in 1989. Thereafter, worked as a security officer (gate keeper) at Garden Island for two years before being let go.  He was next employed for six months with the City Council in 1995, after which time he has been unemployed.

·Commenced receiving Newstart Allowance in 1996.  Is separated from his wife but they have been living under the same roof for many years.  His son suffered an eye injury in an explosion at Macquarie University some seven years ago.

19.     The Applicant detailed to the Tribunal his average day:

·     takes some pain tablets between 2am and 3 am

·     has coffee at 6.30am and lies in bed

·     takes dog for a walk for a few hundred meters

·     reading – magazines, newspapers

·     lunch – tuna sandwich

·     takes dog for a walk and then reads

·     dinner, some television and goes early to bed.

20.     The Applicant stated that he does his own cooking, makes his own bed and mostly does his own washing; with sheets being done externally at a laundry.  He does the yard cleaning, while his wife does the vacuuming.  The Applicant stated that he spends most of his time with a friend from Macedonia on the weekends, and that his son and grandson visit on the weekend for two to three hours.

21.     The Applicant stated that he has two brothers and one sister still living in Macedonia, and that he has not returned to Macedonia since 1989.  The Applicant stated that he owns a car, which he can only drive for two to three minutes because of difficulties with his neck.  The Applicant said that he does his own shopping, can walk a little more than 200 metres and reads a fair amount.

22.     The Applicant detailed to the Tribunal the following about his medical conditions:

Depression:Commenced 1969. Admitted to St George Hospital. Treated at that time with electro convulsive therapy (10 treatments).  Experiences symptoms of difficulty sleeping, headaches, palpitations and panic attacks (every second day), being withdrawn, feeling cranky, tearful at times, lack of concentration and mood variance (up and down).

Symptoms do not vary with seasons.

Treated with endep and moclobemide

Arthritis:Left shoulder is worse than the right and is associated with some limitation of movement, since a ligament tear some two years ago.  

Left hip causes more problems than right hip, pain associated with movements of left hip.

Pain in both knees, again left knee worse than right knee.

Cervical spine:       Complains of pain at back of neck moving into his head causing headaches. Understands that he has degenerative disease of C5, C6, C7.

Lumbar spine:         Understands that he has lumbar spondylosis.

23.     The Applicant also noted that when he stands, he needs to move around and that when he sits he needs to get up and walk around from time to time.  The Applicant stated that he is right handed and has seen Dr Todorovic, a general practitioner, since September 2003.

other medical reports

24.     In two reports dated 19 March 2004 (Exhibit A1) and 25 March 2004 (Exhibit A3) and six medical certificates (Exhibit A2) Dr Todorovic has repeatedly listed the Applicant’s medical conditions as continuing.  Further, Dr Todorovic concludes that the Applicant is permanently unfit for any strenuous work involving excessive pressure to his neck, lower back, shoulders, hips and knees.

25.     In a file review report dated 4 May 2004 (Exhibit R3), Dr Stewart, a medical adviser with HSA, concluded that the Applicant had been appropriately assessed at nil points under Table 6 for “mild but regular symptoms which tend to cause subjective distress”.  Similarly, Dr Stewart confirmed that the assessment under Table 5.1 should be nil points as the Applicant has a “nearly normal” range of movement of the cervical spine.  Dr Stewart opined that the Applicant’s impairments “are not sufficient to prevent him from doing light, low stress work. Nor would they prevent educational, vocational or on-the-job training”.

consideration and findings

26.     In this matter the Tribunal observes that there is no issue between the parties as to what impairments the Applicant suffers.  Having considered all the material, the Tribunal makes the following findings of fact in respect of impairments suffered and the symptomatology associated with each impairment.

(a) Cervical Spine:              Degenerative cervical spondylosis with disc       degeneration at C6/7.

Major symptom is pain in back of neck radiating to back of head causing headaches.

(b) Shoulders:  Degenerative changes in both acromioclavicular joints.

Full thickness tear left supraspinatus tendon.

Major symptom is pain in left shoulder when left arm abducted and/or elevated.

(c) Hips:Osteoarthritis both hips with left hip worse than right.

Major symptom is pain, with some restriction of movement and pain radiation to knees when standing for extended periods.

(d) Thoraco-lumbar spine:   Lumbar spondylosis with episodic low back pain

(e) Depression:  History of depressive episode in 1969. Symptoms of difficulty with sleeping, irritable mood, limited social interaction, limited activity and poor concentration. Treated with anti depressants and sedative. Continues care under general practitioner and psychiatrist.

27. The Tribunal, having made such findings of fact, concludes that the Applicant satisfies section 94(1) (a) of the Act, in that the Applicant suffers from both physical and psychiatric impairments.

assessment

28. The following assessments are made by the Tribunal in accordance with the appropriate Impairment Table under Schedule 1B of the Act:

Cervical Spondylosis

29.          The appropriate Impairment Table is Table 5.1, which states:

TABLE 5.1 CERVICAL SPINE

Rating                 Criteria

NIL  Normal or nearly normal range of movement.

FIVE                  Loss of quarter of normal range of movement.

TENLoss of half of normal range of movement and frequent/constant neck pain or loss of three quarters of normal range of movement with infrequent neck pain.

TWENTYLoss of three-quarters of normal range of movement and constant neck pain.

THIRTHYLoss of almost all movement, or complete ankylosis in position of function.

FORTY               Ankylosis in an unfavourable position, or unstable joint.”

30.           The Tribunal notes that there are no references, in the medical reports of Dr Kolmacic or Dr Todorovic, to an examination of the cervical spine nor documentation as to a range of movement.

31.           The Tribunal notes that on 2 September 2003, Dr Paul reported that the Applicant had a nearly normal range of movement of the cervical spine at clinical examination.  On 18 November 2003, Dr Guirgis reported a less than one quarter loss of normal range of movement of the cervical spine.

32.      As a consequence and pursuant to Table 5.1, the Tribunal concludes that the appropriate impairment rating for the cervical spondylosis is nil points, with the Applicant having a nearly normal range of movement of the cervical spine during the operative period.

Degenerative condition both shoulders

33.     The appropriate Impairment Table is Table 3 which provides:

TABLE 3                  UPPER LIMB FUNCTION

All upper limb problems are assessed under the upper limb Table (table 3).  Each arm is assessed separately.  Determination of upper limb impairments must be based on a demonstrable loss of function.

Rating  Criteria

NIL               Can use dominant limb effectively and/or

Demonstrable evidence of loss of strength, mobility, coordination, dexterity and/or sensation of upper limb which causes mild interference with hand function or manual handling.

FIVEDemonstrable evidence of loss of strength, mobility, coordination, dexterity and/or sensation of non-dominant upper limb which causes moderate interference with hand function or manual handling.”

34.     The Tribunal observes that the Applicant’s major upper limb complaint is concerned with the functioning of the left limb, resulting from the ruptured left supraspinatus tendon.  This causes pain with abduction and/or elevation of the left arm, and a loss of 25 per cent of the normal range of movement of the left shoulder, with consequential loss of strength and interference with manual handling and dexterity.

35.     The Tribunal in noting that the left arm is the Applicant’s non dominant arm concludes that the Applicant has a rating of five impairment points pursuant to Table 3.

36.     The Tribunal, in noting that none of the medical reports in evidence refer to a loss of function in the right upper limb, concludes that the Applicant has a nil impairment rating in relation to the right upper limb.

Thoraco lumbar spine spondylosis and bilateral hip pain

37.           The appropriate Impairment Tables are Tables 4 and 5.2 which provide:

TABLE 4           FUNCTION OF LOWER LIMBS

Rating  Criteria

NILWalks without difficulty on a variety of different terrains and at varying speeds for distances of more than 500m.

TENDemonstrable loss of strength, mobility, stability, balance, coordination and/or sensation such as to cause moderate interference with walking and one or more of the following: climbing, squatting, sitting or kneeling or

Pain or claudication restricts walking to 250-500m or less, at a slow to moderate pace (4km/h). Can walk further after resting.

TWENTYDemonstrable loss of strength, mobility, stability, balance, coordination and/or sensation such as to cause major interference with walking and one or more of the following: climbing, squatting, sitting or kneeling or

pain or claudication restricts walking (4km/h) to 50-250m or less at a time. Can walk further after resting or

unable to walk or stand but independently mobile using a self-propelled wheelchair.

TABLE 5.2     THORACO-LUMBAR-SACRAL SPINE

As spinal mobility is a composite movement, this Table measures overall mobility of the trunk including hip movement and is not intended to measure mobility of individual spinal segments.

Rating  Criteria

NIL           Normal or nearly normal range of movement.

FIVE         Loss of one-quarter of normal range of movement.

TENLoss of one-quarter of normal range of movement as well as back pain or referred pain:

·     with many physical activities and

·     with standing for about 30 minutes and

·     with sitting or driving for about 60 minutes

or

Loss of half of normal range of movement.”

38.     The Tribunal notes that the Applicant has lumbar spondylosis and arthritis in both hips with pain and loss of function being more severe in the left hip.  The Tribunal further notes that the Applicant complains of back pain which radiates to his knees if standing for more than one hour.  There is evidence before the Tribunal, from Dr Guirgis, that the Applicant had a loss of one quarter of normal range of movement of the lumbar spine at clinical examination.

39.     From the symptomatology and findings at clinical examination, the Tribunal concludes that the Applicant has an impairment rating of ten under Table 4 as the Applicant has a demonstrable loss of strength, mobility, balance and coordination which causes moderate interference with walking, sitting, climbing and squatting (partial).  In the alternate, the Tribunal concludes that the Applicant has an impairment rating of ten under Table 5.2 as he has a loss of one quarter of normal range of movement of the thoraco-lumbar sacral spine as well as back pain and referred pain with many physical activities and with sitting or driving for about 60 minutes.

40.     The Tribunal considers that the Applicant’s low back/hip impairments can be assessed under either table, with the appropriate assessment being the highest impairment rating.  In this matter, the Tribunal concludes that the Applicant’s low back/hip impairment has an impairment rating of 10.

Depression

41.           The appropriate Impairment Table is Table 6 which provides:

TABLE 6           PSYCHIATRIC IMPAIRMENT

Rating  Criteria

NILMild but regular symptoms which tend to cause subjective distress.  On most occasions able to distract themselves from this distress.  Minimal interference with function in everyday situations. Exacerbation of symptoms may cause occasional days of work. (eg There may be some loss of interest in activities previously enjoyed.  There may be occasional friction with family, colleagues or friends) Medical therapy or some supportive treatment from treating doctor may be required.

TENModerate and regular symptoms and generally functioning with some difficulty. (eg noticeable reduction in social contacts or recreational activities, or the beginnings of some interference with interpersonal or workplace relationships).  May have received psychiatric treatment which has stabilised the condition.  Minor effects on work attendance and/or ability to work but the impairment would not prevent full-time work (eg short periods of absence from work).”

42.           In considering issues under this Impairment Table the Tribunal notes the following:

·an episode of depression 1969, followed by many years of employment in a variety of jobs until unemployment in late 1995;

·an environment in which he has lived as separated but living under the same roof from his wife for 10 years;

·social interactions involving a friend, his son and grandchild on weekends;

·symptomatology involving difficulty in sleeping, low mood, feeling unhappy about himself, pain, lack of energy, decreased concentration, a reduced ability to cope with stress, tearfulness at times and irritability;

·an assessment by Dr Kolmacic, treating general practitioner, on 9 July 2003 that the depression was well managed and causing minimal or limited impact on his ability to function;

·an assessment by Dr Kecmanovic, consultant psychiatrist, on 23 July 2003, that the Applicant had symptoms of dysthymia, which he had difficulty in expressing.  The doctor increased his moclobemide to 600 mgs and requested a review in six weeks;

·an assessment by Dr Todorovic, treating general practitioner, on 30 July 2003 in which he described the Applicant’s mental health symptoms (Para 9 refers);

·an assessment by Dr Paul, medical adviser, on 2 September 2003 in which he assessed the Applicant’s mental health symptoms as mild but regular;

·an assessment by Dr Guirgis, consultant orthopaedic surgeon, on 18 November 2003 in which he made a diagnosis of depression/adjustment disorder, without nominating any mental health history or symptoms of the Applicant

·the Applicant’s history of his mental health symptoms to the Tribunal;

·an understanding that the Applicant has a new treating psychiatrist, namely Dr Sokolovic (noted in SSAT decision).

43.        The Tribunal, in assessing the material outlined, concludes that the Applicant’s mental health symptoms are mild and regular which cause subjective distress to the Applicant.  There is some evidence to suggest exacerbation of symptoms, but again there is evidence of medical therapy to assist (increasing dose of moclobemide).  In making such an assessment the Tribunal relies upon the stated opinions of Drs Kolmacic, Kecmanovic and Paul, as well as the symptomatology as described by the Applicant and recorded in turn by Dr Todorovic.  The Tribunal places little weight on the report of Dr Guirgis as regards the mental health issue as he failed to detail the necessary history and clinical features which led to his diagnosis and assessment.

44.         The Tribunal concludes that within the operative period and for the reasons nominated earlier, the assessment of the Applicant’s psychiatric impairment is nil pursuant to Table 6.

45. The Tribunal, in summary, concludes that the combined impairment rating for the Applicant’s impairments is 15. As such the Tribunal finds that the Applicant does not satisfy section 94(1) (b) of the Act and does not qualify for a DSP.

46. The Tribunal, in addressing the issue of a continuing inability to work, notes in turn the Applicant’s impairments and the various doctors’ views as to whether the Applicant has a continuing inability to work as defined by section 94(2), (4) and (5) of the Act, namely:

Dr Kolmacic             -          no definitive comment

Dr Kecmanovic        -          no definitive comment

Dr Todorovic            -          no definitive comment in report of 30 July 2003

Dr Paul-           unfit for heavy work, but with educational, vocational or on-the job training fit for light low skilled work for more than 30 hours per week (25 September 2003)

Dr Guirgis-             no definitive assessment (18 November 2003)

Dr Todorovic         -             permanently unfit for any strenuous work involving excessive pressure to his neck, lower back, shoulders, hips and knees (19 March 2004)

-the impairment prevents the Applicant from doing his usual job or other work for which he is skilled for at least two years. The impairment will prevent the Applicant from undertaking educational or vocational training within the next two years (25 March 2004).

47.     The Tribunal, having assessed the material before it, notes the absence of a definitive comment from most doctors’ as to the Applicant’s ability/inability to work.  Dr Todorovic’s latest two reports, albeit outside the operative time frame for consideration in addressing the claim, are in the Tribunal’s opinion clearly contradictory as the earlier report states the Applicant is unfit for a particular type of work activity, and the latter, being a week later, is particular in defining the Applicant as unfit for work.

48.     The Tribunal, in addressing the issue, concludes that the Applicant does not have a continuing inability to work.  In so stating, the Tribunal is satisfied that the Applicant’s impairments do not prevent him from undertaking light low skilled activities for 30 or more hours per week within the next two years.  Further, the Tribunal concludes that the Applicant’s impairments do not prevent him from undertaking educational, vocational or on-the-job training during the next two years, with such training being likely to enable the Applicant to do work within the next two years.  In so finding, the Tribunal notes the symptoms experienced by the Applicant in the various reports and the assessment of his work capacity by Dr Paul.

49. In summary the Tribunal concludes that the Applicant has failed to satisfy the statutory requirements of having a continuing inability to work pursuant to sections 94(2), (4) and (5) of the Act and as such finds that the Applicant fails to qualify for a DSP pursuant to both sections 94(1)(b) and 94(1)(c)(i) of the Act.

50.     The Tribunal notes that it is evident that the Applicant changed his treating general practitioner three times during the period in question and his treating psychiatrist twice during the period in question.  The Tribunal believes that the assessment process in this matter would be assisted in the future by relevant reports from both the treating general practitioner and the treating psychiatrist.

51.     The Tribunal affirms the decision under review.

I certify that the 51 preceding paragraphs are a true copy of the reasons for the decision herein of Dr J D Campbell, Member

Signed:         A. Krilis.
  Associate

Date/s of Hearing  2 June 2004
Date of Decision  2 September 2004
Representative for the Applicant    self-represented        
Solicitor for the Respondent          G Richardson

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