TJYS and National Disability Insurance Agency

[2021] AATA 3409

TJYS and National Disability Insurance Agency [2021] AATA 3409 (20 September 2021)

Division:NATIONAL DISABILITY INSURANCE SCHEME DIVISION

File Number(s):      2019/7783

Re:TJYS

APPLICANT

AndNational Disability Insurance Agency

RESPONDENT

DECISION

Tribunal:Deputy President B W Rayment OAM QC

Date:20 September 2021

Place:Sydney

The reviewable decision is set aside and in substitution it is decided that the support as claimed is a reasonable and necessary support.

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

Deputy President B W Rayment OAM QC

CATCHWORDS

NATIONAL DISABILITY INSURANCE SCHEME – reasonable and necessary supports – where claimed support is an assistance dog – whether claimed support is reasonable and necessary pursuant to s 34 of the National Disability Insurance Scheme Act 2013 – whether claimed support is likely to be effective and beneficial for the applicant – whether the claimed support represents value for money – whether there are comparable supports that achieve the same outcome at lower cost – whether the claimed support is likely to pose a risk to the applicant or others – decision under review set aside and substituted

LEGISLATION

National Disability Insurance Scheme Act 2013 (Cth)

National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth)

SECONDARY MATERIALS

Including Specific Types of Supports in Plans Operational Guideline – Assistance Animals

REASONS FOR DECISION

Deputy President B W Rayment OAM QC

20 September 2021

1. The question in this review is whether the provision of an assistance dog is a reasonable and necessary support for the applicant, a nine year old girl who is a participant in the National Disability Insurance Scheme (NDIS).  In December 2018 the applicant was diagnosed with Autism Spectrum Disorder (ASD) (with level 2 repetitive restricted behaviours (requiring substantial support) and level 1 social communication (requiring support). The diagnosis followed testing and clinical diagnosis by a registered psychologist, Ms O, and her assistant who is a provisional psychologist. Ms O also wrote a report included in the T Documents and she, like the other persons who treat the applicant, supports the applicant’s claim for an assistance dog.

2. TJYS lives with her parents and two younger siblings.  She goes to primary school.

3. A consultant physician also diagnosed TJYS with the following:

   a.Specific Learning Disorder in the area of reading, with dyslexia symptoms;

   b.Severe receptive language delay with mild expressive delay;

   c.Reactive anxiety symptoms with sensory/routine triggers; and

   d.Variable toileting difficulties with anxiety triggers.

   TJYS currently accesses a range of therapeutic supports for her disabilities, which include:

   a.Fortnightly occupational therapy with J--- M---, Central Coast OT – therapy sessions are conducted at school;

   b.Monthly occupational therapy with S--- R--- at Sense Ability; and

   c.Fortnightly speech therapy with S--- L--- of S--- L--- Speech Pathology.

4. Ms Kim Boettcher of counsel appeared for the applicant, instructed by Legal Aid NSW and Ms Christina Trahanas of counsel appeared for the respondent, instructed by HWL Ebsworth Lawyers. The parties have defined the relevant issues by their respective Statements of Facts Issues and Contentions (SFICs).

5. The applicant’s SFIC makes a case for the relief claimed, suggesting that it meets the various statutory and other requirements. The respondent’s SFIC places emphasis on three possible answers to the applicant’s claim, set out in paragraph 6, which is in the following terms:

   The Respondent contends that, at this time, funding the ACE Program is not a reasonable and necessary support because it does not meet the criteria under:

   a)s 34(1)(d) of the Act as the available evidence does not show that the ACE Program will be, or is likely to be, effective and beneficial for the Applicant, having regard to current good practice;

   b)s 34(1)(c) of the Act and r 5.1(c) of the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth) (Rules) as the available evidence does not show that the ACE Program represents value for money and the ACE Program duplicates other supports delivered through the NDIS; and

   c)r 5.1(a) of the Rules as funding the ACE Program is likely to pose a risk to the proposed assistance dog to be provided by the program, which may in turn pose a risk to the Applicant.

6. In paragraph 8, the respondent also said:

   The Applicant also seeks funding for travel required to obtain the ACE Program: ASFIC [33]. The ASFIC does not address this support separately to funding for the ACE Program and the Applicant has not otherwise particularised this request. The Respondent contends that funding travel to access the ACE Program is not a reasonable and necessary support for the same reasons that funding the ACE Program is not a reasonable and necessary support.

7. The respondent’s SFIC also raises other matters for consideration including all aspects of s 34 of the National Disability Insurance Scheme Act 2013 (the Act) which is as follows:

   34 Reasonable and necessary supports

   (1)For the purposes of specifying, in a statement of participant supports, the general supports that will be provided, and the reasonable and necessary supports that will be funded, the CEO must be satisfied of all of the following in relation to the funding or provision of each such support:

   (a)    the support will assist the participant to pursue the goals, objectives and aspirations included in the participant’s statement of goals and aspirations;

   (b)    the support will assist the participant to undertake activities, so as to facilitate the participant’s social and economic participation;

   (c)    the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support;

   (d)    the support will be, or is likely to be, effective and beneficial for the participant, having regard to current good practice;

   (e)    the funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide;

   (f)     the support is most appropriately funded or provided through the National Disability Insurance Scheme, and is not more appropriately funded or provided through other general systems of service delivery or support services offered by a person, agency or body, or systems of service delivery or support services offered:

   (i)as part of a universal service obligation; or

   (ii)in accordance with reasonable adjustments required under a law dealing with discrimination on the basis of disability.

   (2)The National Disability Insurance Scheme rules may prescribe methods or criteria to be applied, or matters to which the CEO is to have regard, in deciding whether or not he or she is satisfied as mentioned in any of paragraphs (1)(a) to (f).

8. Rule 5.1 of the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (the Supports for Participants Rules) is as follows:

   A support will not be provided or funded under the NDIS if:

   (a)it is likely to cause harm to the participant or pose a risk to others; or

   (b)it is not related to the participant’s disability; or

   (c)it duplicates other supports delivered under alternative funding through the NDIS; or

   (d)it relates to day-to-day living costs (for example, rent, groceries and utility fees) that are not attributable to a participant’s disability support needs.

9. The respondent’s SFIC also makes reference to rules 3.1, 3.2 and 3.3 of the Supports for Participants Rules, which are in the following terms:

   Value for money

   3.1In deciding whether the support represents value for money in that the costs of the support are reasonable, relative to both the benefits achieved and the cost of alternative support, the CEO is to consider the following matters:

   (a)    whether there are comparable supports which would achieve the same outcome at a substantially lower cost;

   (b)    whether there is evidence that the support will substantially improve the life stage outcomes for, and be of long‑term benefit to, the participant;

   (c)    whether funding or provision of the support is likely to reduce the cost of the funding of supports for the participant in the long term (for example, some early intervention supports may be value for money given their potential to avoid or delay reliance on more costly supports);

   (d)    for supports that involve the provision of equipment or modifications:

   (i)the comparative cost of purchasing or leasing the equipment or modifications; and

   (ii)whether there are any expected changes in technology or the participant’s circumstances in the short term that would make it inappropriate to fund the equipment or modifications;

   (e)    whether the cost of the support is comparable to the cost of supports of the same kind that are provided in the area in which the participant resides;

   (f)    whether the support will increase the participant’s independence and reduce the participant’s need for other kinds of supports (for example, some home modifications may reduce a participant’s need for home care).

   Effective and beneficial and current good practice

   3.2In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to consider the available evidence of the effectiveness of the support for others in like circumstances. That evidence may include:

   (a)    published and refereed literature and any consensus of expert opinion;

   (b)    the lived experience of the participant or their carers; or

   (c)    anything the Agency has learnt through delivery of the NDIS.

   3.3In deciding whether the support will be, or is likely to be, effective and beneficial for a participant, having regard to current good practice, the CEO is to take into account, and if necessary seek, expert opinion.

10. The respondent’s SFIC also relies upon a policy guideline published by the respondent in November 2020 known as the Including Specific Types of Supports in Plans Operational Guideline – Assistance Animals, and that policy guideline is discussed below.

11. Each party has led expert evidence on the matters in issue.  The applicant’s mother has given evidence in the case. She and her husband are the primary carers of the applicant. 

12. The National Disability Insurance Agency (NDIA) commissioned a report from La Trobe University in 2016 about the use of assistance animals (AAs). The researchers decided to exclude the use of assistance dogs to assist vision-impaired and hearing-impaired individuals, because the use of assistance dogs for that purpose was well established to be beneficial and there was no need for further research.  Amongst the categories examined was the use of assistance dogs to assist children on the autistic spectrum. The researchers conducted their own research into three children with ASD or developmental disorder and seven parents of children with those conditions. The owners of assistance dogs used for those purposes all agreed that the NDIA should fund assistance dogs, and the report contained the following statements:

    The main advantages of AA ownership cited by owners were similar to those reported in existing scientific literature, such as increased independence, improved social interactions, companionship, and assistance with specific, impairment-related tasks. The main disadvantage reported was a lack of education around the role and rights of AAs in public spaces.

    Owners generally reported a positive relationship with their provider organisation, although there were exceptions, including two owners whose AA had lost its public access rights due to behavioural problems. Several owners indicated that there was a general lack of support when an owner lost an AA due to old age or illness, and during the transition to a new AA. This issue was also underappreciated in existing research on AAs, as was consideration of animal welfare. However, owners reported that they prioritised their AA’s welfare, and ensured that the animal had plenty of downtime.

13. The recommendations to the NDIA made in the report were:

    1.The decision on whether an AA is a reasonable and necessary support should be made at the level of the individual, based on:

    a.the severity and impact of the disability on the person’s life,

    b.the specific supports able to be provided by an appropriately selected and trained AA, which we suggest should be at least three tasks that directly and clearly mitigate the impact of the owner’s disability (and thus cost of alternate supports), and

    c.the person’s ability to manage the needs of an AA, either alone or in conjunction with their support system.

    Within the scope of this study, there is currently no robust evidence in the literature attesting to the general effectiveness of AAs or their value for money as a support for people with disability. The limited evidence available along with the lived experience of users of AAs, suggests a range of potential benefits. These benefits may be relevant for consideration of reasonable and necessary funding under the NDIS for a range of potential participant supports, in addition to those already established and therefore excluded from this review (i.e. vision guide dogs and hearing dogs).

    2.While there were a range of potential benefits of AAs for children with ASD identified during the study, the use of tethering to an animal to prevent a child from bolting should not be the primary basis for consideration or funding of an AA. We note such restraint is not permitted in most Australian states and territories without an appropriate behaviour support plan, and there remain questions about the impact of such a role on the animal’s welfare.

    3.That costs for maintenance of an NDIS funded AA should meet expenses above what a pet owner would expect to incur (e.g. training, veterinary insurance, specialised harnesses/jackets, special diet). For individuals with severe financial hardship, all associated maintenance costs may require consideration. Available evidence does not, at present, allow determination of the total costs of acquiring, training and maintaining an AA over the course of its lifetime, so a market approach is recommended.

14. Although the researchers commented on certain limitations in the literature, they nevertheless made those recommendations to the NDIA.

15. It seems that in response to the report the NDIA agreed to support funding for assistance dogs on a case by case basis, as part of the NDIS.[1]

    [1] Further La Trobe University report on participant-trained assistance dogs of 2019 at page 9.

16. Oral evidence was led by the applicant from the applicant’s mother, Dr PB, and Ms JM, and by the respondent from Dr MS and Mr ZM.

17. The applicant’s mother is herself an occupational therapist. The applicant once had a pet dog, who died. In the Statement of Lived experience written by the applicant’s mother, it was said that after the dog died, the applicant began to run her fingers through her father’s hair and to touch the faces of friends and her grandmother. She seeks deep pressure and often asks her brother or sister to lie on top of her, and she uses weighted blankets on a daily basis.  She also takes a lighter weighted blanket to school, particularly when there is a  change of routine. These are among the things that suggested to the applicant’s mother that the applicant would benefit from an assistance dog, so as to calm her down and improve her general response to her environment.  For example, she experiences significant anxiety, has difficulty settling to sleep, and has melt downs.

18. As the statement of lived experience makes clear, all the therapists who see the applicant support the present application. That includes two occupational therapists (one seen weekly and the other monthly), her speech therapist and a psychologist who prepared a behaviour support plan for her.

19. In oral evidence the applicant’s mother said that the applicant becomes extremely overwhelmed in busy environments. A meltdown would involve her tensing up and crying. and seeking to exit the environment.  Changes of routine, such as a relief teacher taking over at school, cause her to be overwhelmed, leading her to be intolerant of her siblings, running off, and toileting regressions.

20. The Tribunal was shown a video of the applicant’s behaviour when she was in the presence of an assistance dog called Macey before school one day.  She petted the dog and her mother said she was very calm in the cafe, where she was usually very agitated.  Not shown on the video, she then went to a chemist’s with the dog and walked happily through.  Then she was dropped to school without the dog and her teacher reported to the mother that she had a great day. That experiment and the mothers evidence satisfied me that the applicant may well benefit from having regular contact with an assistance dog.  Other evidence discussed below was later led about the video shown to the Tribunal.

21. The applicant has had a number of sessions with Macey, after which the applicant asked when she would see Macey again.  She said, ‘Macey makes me feel calm’. The applicant’s mother believes that an assistance dog would help the applicant in social settings, help prevent her from feeling overwhelmed, and help her be more open to communicating with her friends.

22. Ms O, the psychologist who wrote a report at T12A said that the applicant is considered to be a strong candidate for an assistance dog and that she was positioned to benefit from the opportunities it offers for sensory regulation and anxiety management.  She added that an assistance dog is likely to assist the applicant through developing social awareness.

23. The applicant’s mother said that she did not envisage the assistance dog going to school with the applicant, because she has a one-on-one assist with her at school.  Rather, the dog would stay at home during the school day, and be with the applicant before and after school.  The applicant would be walking the dog twice a day, with a parent accompanying her.

24. When the applicant’s mother was asked about a care worker possibly assisting the applicant rather than herself, she said that she had been with the applicant since she was born, and that she did not envisage a care worker taking over any of that duty, and that the applicant really struggles with changes of people and routines.

25. Dr PB is employed by the Centre for Service and Therapy Dogs Australia, which provides and trains assistance dogs for persons with a number of different conditions, including children on the autistic spectrum. Her job description is as Principal Psychologist of her company. She has met the applicant.  She arranged the interaction between the applicant and Macey.

26. During her cross-examination she explained that her role is to oversee each participant’s program, to look at their goals, and if they are an NDIS participant, whether those goals are worked towards within her company’s program. She also conducts research into the impact of assistance dogs on the owners of the dogs they provide.

27. In a document she prepared in relation to the reviewable decision of the respondent she explained that the intent of her organisation’s program is to assist the applicant herself, rather than her parents or therapists, to learn how to self-manage her emotional and sensory overload, how to build and implement social skills, and how to increase her independence with life skills. She compared an assistance dog with an untrained house pet acting as a companion animal.  She says household pets in some cases spontaneously develop alerting abilities, or provide a useful level of comfort.  She pointed out that companion animals can sometimes become fearful of their owner’s triggers and may respond avoidantly or in some cases aggressively.  Trained assistance dogs have public access rights, and companion animals do not have such rights. The companion dog which the applicant had was sometimes overwhelmed and left the applicant.

1. In describing the tasks to be performed by an assistance dog to mitigate the impact of the applicant’s symptoms she referred to the following four matters:

   ·Alerting to increasing distress to prevent escalation and meltdowns, enabling … to prophylactically employ known strategies to de-escalate when able, and when not, activating trained activities to reduce distress such as deep sensory pressure

   ·Sensory input as required to enable … to access the community more consistently by reducing/preventing sensory overload

   ·Assisting … to sleep independently and sufficiently by providing constant sensory input and a sense of safety

   ·Preventing … from crossing the road or walking unsafely in public (Note: this task does not involve restrictive practices)

2. She said that her company had trained assistance dogs for more than ten children under 10 years of age with autism.  After a three months trial period with another dog 95% or more continue with the program.

3. The company quoted $40,000 for the provision of an assistance dog and vet fees prior to handover, program design and delivery, supervision of the dog and all its socialisation, training and husbandry.  Three face to face meetings took place with the applicant, one by her director, one by Dr PB and a third by their dog trainer. The meetings took place at the applicant’s home between February and May 2019.  The three months trial has not yet commenced with the applicant and would involve 12 sessions in total at some time in the future, if the reviewable decision is altered. 

4. The respondent has challenged the evidence of Dr PB, pointing out amongst other things that the subject of her doctoral thesis has nothing to do with the present subject matter. It would be rare that a doctoral thesis topic would be directly relevant to expert evidence given in court or this Tribunal. Dr PB has been with her company for four years.  She was in my opinion well qualified to give the evidence which she gave because of her experience with her company and her field experience.

5. I next heard from Ms JM, an occupational therapist who sees the applicant fortnightly, primarily in her school environment but also in a clinical environment, in the community, and at home via telehealth, and has done so since July 2019.

6. In a report dated May 2020 she said that she believed that an assistance dog would assist the applicant by providing her with a constant source of regulating sensory input and reducing the applicant’s tendency to reach flight mode which stems from anxiety and sensory processing difficulties.  She also said that she believed that an assistance dog would provide intense deep pressure input and tactile stimulation which the applicant requires to remain regulated, and also provide the applicant with sensory and emotional input to get her through her morning routine.

7. Ms JM is an occupational therapist specialising in paediatrics, and some 90% of her patients are on the autistic spectrum.

8. Asked in cross-examination whether the applicant’s behaviour at school fluctuates, she said that it’s mostly the same, but she saw a big improvement when she had access to the dog over the weekend.  Asked whether the short-term positive effects of the dog on the applicant would be equally as beneficial as an assistance dog (presumably full-time), she replied in the negative because the beneficial positive effect lasted only two or three days. A later answer of Ms JM at Tr 115 made it clear that the “weekend with the dog” was a weekend with an assistance dog. The dog had been there on the Sunday, and the observations of Ms JM include a conversation with the teacher on the Monday morning, and the teacher said that her participation was much more than it usually would be.

9. The evidence of Ms JM was said to be unrealistic by the respondent. She expressed herself in terms which were emphatic, no doubt reflecting her strong belief that an assistance dog would be beneficial for the applicant.  Without adopting some of the superlatives she used, I found much of her evidence to be useful, including that evidence arising from her regular contact with the applicant’s school teacher, the applicant herself and the applicant’s mother.

10. During the respondent’s case, the first witness was Dr MS, a postgraduate researcher at the Veterinary Department at Sydney University. She has what she described as ‘a small amount of direct practical experience with assistance dogs.’  For two months she worked part-time with assistance dogs and assisted them in  a task unrelated to their service dog training. She has more extensive experience with companion dogs of various breeds.

11. She did a literature review for publications since the La Trobe University report of 2016.  She found that the studies showed that animal assisted intervention have the potential to improve social communication and engagement skills in children with autism, if the intervention lasts at least twelve weeks. She said that while there is no evidence that dog-assisted intervention would reduce autism or overall anxiety, there is evidence that the presence of a dog can have a calming effect.

12. Her report comments on the literature of Dr PB’s company and on possible difficulties experienced by the company in training assistance dogs.  The applicant’s evidence does not include any details from dog trainers employed by that company, and Dr PB herself is not a dog trainer. Dr MS did not seek to observe any dog training used in Dr PB’s company, and it is difficult to make findings of any kind in this review by taking account of her report. 

13. More generally, it is not suggested by the applicant’s evidence that her autism will be cured by the use of an assistance dog, or that such a dog will cure her anxiety, but rather that an assistance dog may clam her, and be beneficial for the applicant in  a variety of other ways, some of which are also discussed by Dr MS in her literature review.

14. For the most part, in my opinion, the evidence of Dr MS goes to matter which is not in contest on the review.  For example she stresses the need for adult supervision, if the applicant crosses the road with the dog at her present age, and that is common ground between the parties in the case.

15. I do not see that the evidence raises any concern about likely harm to the participant or any other person so as to engage rule 5.1(a).

16. She ventured views about the attitude of Macey in the video to being touched by the applicant when she rubbed her fur, and the like. Those views were not shared by other witnesses and I hesitate to make any findings to resolve any such differences.  The importance of the evidence concerning Macey is related to the response of the applicant.  Part of what is involved in the present application is that there is to be a period during which the applicant would be bonded with the assistance dog before the dog is handed over.

17. Importantly, the dog handler was present in the video and that person took no steps to stop the continued access to the applicant.  Other contact took place with the applicant before, and after the video was taken.  Macey showed no sign of aggression in the video.

18. On the third day of this case I heard from Mr ZM, a consultant psychologist. He is sceptical about the wisdom of acquiring an assistance dog for the applicant and suggests that instead, she should have regular psychological intervention, at first weekly and then fortnightly. He suggests that her cognitive assessment should be brought up to date, that her speech pathologist should see her more regularly, that her parents should be educated in her condition, including with a TEACCH program, and that she should be regularly reviewed by a paediatrician or a child psychologist and the like. Those supports are not mentioned in the reviewable decision. There was dispute by witnesses called by the applicant about Mr ZM’s evidence on those matters. I do not see the suggestions made by Mr ZM as comparable to the support claimed in this case or as relevant to the s 34 considerations mentioned below.

19. He ventured the opinion that a well selected and trained pet dog with whom she bonds will assist her equally as well as an assistance dog. He has experience with the former and none with the latter, and I am reluctant to make findings based upon his evidence. I prefer the opinion expressed by Ms O noted in [22] above to that opinion of Mr ZM.  Ms O had contact with the applicant and her mother.

20. Mr ZM did not meet the applicant or her parents, or any of her therapists.  He did not disagree with a statement in one of the documents he reviewed that an assistance dog should be trialled for her.  He said that he did not think there was a problem with exploring an assistance dog and that he neither agreed nor disagreed with the suggestion in the document.

21. One of the documents tendered by the respondent is the document referred to in [10] above, a guideline on including specific types of support in plans, namely assistance animals. It speaks of a number of things, some of which are not raised by the evidence in the present case, and some of which arise in a general way. It stresses the need to consider statutory matters, including s 34 of the Act.

    Section 34 and related considerations

22. As to s 34(1)(a), the goals in the applicant’s plan at page 182 of the T documents and the final mentioned goal at the foot of page 182 of the T documents are relevant to this consideration. It is thought by the applicant’s mother that the applicant will be calmed by the sensory contact with the assistance dog, including the deep pressure contact, and that this will assist her to regulate her emotions, so as to participate in her morning routines, and developing her social skills and interactions at school and with her family. She will likely be able to avoid or reduce meltdowns due to sensory overload with the regular comfort of the assistance dog. The experiments conducted to date with Macey tend to confirm the evidence given in the applicant’s case. See also the findings I have made at [26] and [27] above. This requirement is satisfied.

23. As to s 34(1)(b), the same is true. Social participation for the applicant involves her school and her home environment at this stage of her life. The assistance dog is likely to assist that social participation, as mentioned in my findings based upon her mother’s evidence cited in [20] above. As the applicant herself said about Macey, she helps her feel calm, and the good reports from her teacher after at least two exposures to Macey suggests the same.

24. As to s 34(1)(c), a matter that also requires consideration of Part 3 of the Supports for Participants Rules, the main question is whether a companion pet would serve the same outcome. For this purpose it is necessary to attend to the evidence of Dr PB mentioned at paragraphs [27] and [28] above. A companion dog has different training from its breeder, and the objectives mentioned in [28] are not involved. An assistance dog is likely to be significantly more beneficial to the applicant than a companion dog.

25. Dr PB’s company is not for profit, in the sense that it does not distribute dividends but rather plows profits back into research and the like.  The benefits it provides do not appear on their face appear to involve excessive cost, and the contrary was not suggested in cross-examination of Dr PB.

26. Rule 3.1(b) should not be understood in my opinion as a sine qua non of being satisfied about s 34(1)(c) but rather as a relevant consideration. Dr PB saw the use of an assistance dog as ‘the best chance of reducing long-term costs such as high numbers of support worker hours’ as the applicant grows older.  See her response to the NDIA’s internal review decision at paragraphs 2 and 3.

27. As to s 34(1)(d), I regard the evidence of Dr PB as expert opinion within the meaning of rule 3.3 of the Supports for Participants Rules, as to current good practice; and her evidence together with that of other therapists of the applicant as sufficient evidence of the likely effectiveness of the support both for the applicant and for other children on the autistic spectrum.

28. As to s 34(1)(e) the assistance dog is intended as a supplement to the provision of help from the family, which I take to be very beneficial to the applicant at this time and which is intended by the parents to continue.

29. As to s 34(1)(f), no other system or services will fund or provide the same support as would be provided by an assistance dog.

30. The necessary considerations within s 34 are therefore satisfied in my opinion.

31. The support claimed is in my opinion necessary and reasonable, and will assist the applicant to realise her potential for physical, social and emotional development and will probably also assist her in her intellectual development by making her school learning more effective.

32. The reviewable decision will therefore be set aside and in substitution it is decided that the support as claimed is a reasonable and necessary support.

I certify that the preceding 59 (fifty -nine) paragraphs are a true copy of the reasons for the decision herein of Deputy President B W Rayment OAM QC

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

Associate

Dated: 20 September 2021

Date(s) of hearing:	19 and 20 May 2021, 8 July 2021
Date final submissions received:	22 July 2021
Counsel for the Applicant:	Ms K Boettcher, Frederick Jordan Chambers
Solicitors for the Applicant:	Ms C Virtu, Legal Aid NSW
Counsel for the Respondent:	Ms C Trahanas, Eleven Wentworth Chambers
Solicitors for the Respondent:	Ms S Hardie, HWL Ebsworth Lawyers