(i) AT investigation for Lift Recliner Chair

(ii) Hi-Lo bed and self-propelled shower commode

1. Over the course of the hearing, the Applicant agreed that certain requests were no longer issues in contention or were resolved between the parties to be included in the plan dated 9 February 2026. Those relating to additional requests for capital funding were withdrawn by the Applicant because his current accommodation cannot accommodate them.
2. The only remaining issue in dispute was eligibility for SDA. The Applicant's request was as follows:

Building Type: Villa/duplex/townhouse, one resident, with onsite overnight assistance.

Location: New South Wales, Penrith or Queensland, Gold Coast.

National Disability Insurance Scheme Act 2013 (Cth) (the NDIS Act)

1. Section 34 of the NDIS Act identifies what constitutes a 'reasonable and necessary' support under the scheme.
2. On 3 October 2024, and prior to the completion of this review, the National Disability Insurance Scheme Amendment (Getting the NDIS Back on Track No 1) Act 2024 ('the Amending Act') made a range of 'amendments' to the NDIS Act.
3. These amendments in respect of the requirements of section 34 of the NDIS Act will apply to this review.
4. Section 34 of the NDIS Act, as amended, now provides as follows (emphasis of amendments added by the Tribunal)

(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:

(aa) the support is necessary to address needs of the participant arising from an impairment in relation to which the participant meets the disability requirements (see section 24) or the early intervention requirements (see section 25)

(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 a NDIS support for the participant.

(a) the time at which the disability requirements or the early intervention requirements need to be met is the time the CEO decides to approve the statement of participant supports; and

(b) a participant's disability support needs arising from an impairment in relation to which the participant meets the disability requirements or the early intervention requirements may be affected by a variety of factors, including environmental factors or the impact of another impairment in relation to which the participant does not meet either of those requirements.

(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) (aa) to (f). (emphasis of amendments)

1. Subsection 34(1) of the NDIS Act is cumulative and therefore all of the criteria must be met.
2. Subsection 34(1) (aa) of the NDIS Act, which is an amendment, imposes an additional requirement of the criteria. This additional requirement is the consideration of whether the support is necessary to address the needs of the Applicant which arise from the impairment/s for which he meets the disability requirements.
3. Subsection 34(1)(f) of the NDIS Act is also an amendment; however, it is a replacement of an 'old provision' with a 'new provision'.
4. This new provision of subsection 34(1)(f) of the NDIS Act requires that the support is an 'NDIS support'.
5. Section 10 of the NDIS Act, made pursuant to the Amending Act, provides a definition of what constitutes an 'NDIS support' for the purposes of subsection 34(1)(f) of the NDIS Act (as amended). Section 10 of the NDIS Act provides as follows:

(1) Subject to subsections (4) and (9), a support is a NDIS support for a person who is a participant or prospective participant if the support is declared by National Disability Insurance Scheme rules made for the purposes of this subsection to be a NDIS support for:

(a) participants or prospective participants generally; or

(b) a class of participants or prospective participants that includes the person.

Note: The National Disability Insurance Scheme rules may declare a support for the purposes of this subsection by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003).

(2) Before making National Disability Insurance Scheme rules declaring a support for the purposes of subsection (1), the Minister must be satisfied:

(a) for rules to which paragraph (1)(a) applies--that the support is appropriately funded or provided through the National Disability Insurance Scheme for participants or prospective participants generally; or

(b) for rules to which paragraph (1)(b) applies--that the support is appropriately funded or provided through the National Disability Insurance Scheme for participants, or prospective participants, in the relevant class.

(3) National Disability Insurance Scheme rules may declare a support for the purposes of subsection (1) only if at least one of the following applies:

(a) the declaration of the support implements Australia's obligations under:

(i) the Convention on the Rights of Persons with Disabilities done at New York on 13 December 2006 or

(ii) any other agreement with one or more other countries

(b) the declaration of the support enables the provision of sickness benefits.

Note: For subparagraph (a)(i), the Convention on the Rights of Persons with Disabilities is in Australian Treaty Series 2008 No. 12 ([2008] ATS 12) and could in 2024 be viewed in the Australian Treaties Library on the AustLII website (http://www.austlii.edu.au).

(4) The National Disability Insurance Scheme rules may declare that a support is not a NDIS support for:

(a) participants or prospective participants generally; or

(b) a class of participants or prospective participants.

Note: The National Disability Insurance Scheme rules may declare a support for the purposes of this subsection by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003).

(5) Before making National Disability Insurance Scheme rules declaring a support for the purposes of subsection (4), the Minister must be satisfied:

(a) for rules to which paragraph (4)(a) applies--that the support is not appropriately funded or provided through the National Disability Insurance Scheme for participants or prospective participants generally; or

(b) for rules to which paragraph (4)(b) applies--that the support is not appropriately funded or provided through the National Disability Insurance Scheme for participants, or prospective participants, in the relevant class.

(6) The CEO may determine, in writing, that a support is taken to not be declared under subsection (4) in relation to a participant if:

(a) the support is prescribed by the National Disability Insurance Scheme rules for the purposes of this paragraph; and

(b) the support would, apart from subsection (4), be a NDIS support for the participant; and

(c) the participant applies to the CEO in accordance with subsection (7) for the determination; and

(i) the support would replace one or more other supports that are NDIS supports for the participant; and

(ii) the cost of the support is the same or lower than the total of the costs of the supports it would replace; and

(iii) the support would provide the same or a better outcome for the participant than the supports it would replace; and

(iv) any other conditions specified in the National Disability Insurance Scheme rules for the purposes of this subparagraph are met in relation to the support, the participant, or both.

Note 1: A determination may be revoked under subsection 33(3) of the Acts Interpretation Act 1901.

Note 2: The National Disability Insurance Scheme rules may prescribe a support for the purposes of paragraph (a) by identifying a class of supports (see subsection 13(3) of the Legislation Act 2003).

(a) be in the form (if any) approved by the CEO; and

(b) include any information, and be accompanied by any documents, required by the CEO; and

(c) be made in accordance with any other requirements specified in the National Disability Insurance Scheme rules for the purposes of this paragraph, which may include requirements as to the circumstances in which an application may, or may not, be made.

(8) The National Disability Insurance Scheme rules may make provision for determining any matter for the purposes of subsection (6), including by prescribing requirements with which the CEO must comply, methods or criteria that the CEO is to apply, or matters that the CEO may, must or must not take into account, in deciding whether to make a determination under that subsection.

(9) A support is not a NDIS support for a participant or prospective participant if the support consists of the provision of:

(c) drugs, the possession of which is a contravention of a law of the Commonwealth, a State or a Territory.

Subsection 34(2) of the NDIS Act provides that the NDIS Rules may prescribe methods or criteria to be applied, or matters to which the CEO must have regard, in deciding whether the criteria under subsection 34(1) of the NDIS Act are met in respect of a requested support.

1. Section 35 of the NDIS Act provides for the making of rules in relation to prescribing reasonable and necessary supports or general supports that will be funded or provided under the NDIS. The relevant rules in respect of this review are the:

• National Disability Insurance Scheme (Supports for Participants) Rules 2013 ('Supports Rules')

• National Disability Insurance Scheme (Specialist Disability Accommodation) Rules 2021 ('SDA Rules')

• National Disability Insurance Scheme (Getting the NDIS Back on Track No.1) (NDIS Supports) Transitional Rules 2024 (Cth) ('Transitional Rules')

1. Rule 3 of the Supports Rules relates specifically to subsections 34(1)(c)-(e) of the NDIS Act and provides as follows:

3.1 In 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

3.2 In 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.

3.3 In 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.

3.4 In deciding whether funding or provision of the support takes account of what it is reasonable to expect families, carers, informal networks and the community to provide, the CEO is to consider the following matters:

(i) that it is normal for parents to provide substantial care and support for children; and

(ii) whether, because of the child's disability, the child's care needs are substantially greater than those of other children of a similar age; and

(iii) the extent of any risks to the wellbeing of the participant's family members or carer or carers; and

(v) whether the funding or provision of the support for a family would improve the child's capacity or future capacity or would reduce any risk to the child's wellbeing.

...................................................................................................

(c) for all participants - the desirability of supporting and developing the potential contributions of informal supports and networks within their communities.

1. Schedule 1 to the Transitional Rules identifies supports that are NDIS supports unless otherwise provided, for the purposes of subsection 10(1) of the NDIS Act. Likewise, Schedule 2 to the Transitional Rules identifies supports that are generally not NDIS supports for the purposes of subsection 10(1) of the NDIS Act.
2. In McGarrigle v National Disability Insurance Agency at [43], Mortimer J (as Her Honour then was) made the following observations in respect of these rules:

The [Supports Rules] are an important element of the legislative scheme, introducing the ability to modify the operation of ss 33 and 34 by, for example, excluding certain kinds of supports from inclusion in participant plans. It is through the Rules that the executive is able to implement...some policy decision-making about the nature and extent of supports to be provided or funded.[1]

1. The phrase 'reasonable and necessary' is not defined in the Act. It is a composite phrase and should be considered as such. In McGarrigle v National Disability Insurance Agency at [91], Mortimer J also stated as follows:

Whether a support is "reasonable" requires a different assessment to whether a support is "necessary". Again, it is not necessary in the context of this proceeding to be definitive about the nature and extent of the meaning of the phrase, or its components. It is enough to observe that using the concept of necessity would appear to tie one aspect of the CEO's assessment to an evaluation of the kinds of factors set out in s 34(1)(a) and (b) and (d). The word "reasonable" would appear to be directed at factors such as those set out in s 34(1)(c) and (f). That is not to say the meaning of each word is exhausted by the factors set out in s 34(1): rather, it is to illustrate the different work that each concept does as an adjective in the phrase "reasonable and necessary supports".[2]

1. The Full Court in National Disability Insurance Agency v WRMF also considered the meaning of reasonable and necessary supports, and stated as follows:

The phrase is a composite phrase. We accept the Agency's submissions that each limb of the phrase should be given work to do. That task is not difficult, or complicated with these two particular words, which are readily understood as conveying different meanings. However, the Parliament has chosen to use a composite phrase rather than to stipulate two distinct requirements, and therefore, as Gleeson CJ cautioned in XYZ v Commonwealth [2006] HCA25; [2006] HCA 25; (2006) 227 CLR 532 at [19], '[t]here are many instances where it is misleading to construe a composite phrase simply by combining the dictionary meanings of its component parts'.

... Both adjectives qualify the noun "support", but they do so as a composite phrase. It is not fruitful to split them off and consider them separately, just as it is neither fruitful nor appropriate to attempt any exhaustive or authoritative judicial definition of them.

Nevertheless, there is no doubt that the contextual use of the phrase in this Act links it to public funding to be provided to a participant. In that context, the phrase connotes supports which meet a threshold which justifies - by reference to the context, objects and guiding principles of the Act and the facts of the case - the expenditure of public funds for that support, for a particular participant. As we have already explained, the phrase also needs to be understood taking into account what has qualified a person as a participant, and the links between a person's impairment and their full participation in the community, in the same variety of ways as persons without a disability might choose to participate. [3]

1. The Agency also issues Operational Guidelines in relation to what are considered 'reasonable and necessary supports' in a participant's plan. There is no power conferred by the Act to make these Operational Guidelines, and they are issued in an exercise of executive power. While the Tribunal should take into account relevant government policy which is not inconsistent with the provisions or objects of the legislation,[4] the Tribunal is not bound by policy as found in Minister for Home Affairs v G where Mortimer J held:

Justice or injustice is not found within a policy. It is found by looking at the overall circumstances of an individual's case with the principal focus being on the purpose and context of the statutory power, not the executive policy framed to guide it.[5]

1. Section 33(5) of the NDIS Act provides for the consideration of the National Disability Insurance Scheme (Specialist Disability Accommodation) Rules 2021 (Cth) (the SDA Rules) and the National Disability Insurance Scheme (Supports for Participants) Rules 2013 (Cth) (the Supports Rules), which together provide the guidance when undertaking an assessment of eligibility for SDA housing, and whether it is a reasonable and necessary support to be funded.
2. Unless the Operational Guidelines are inconsistent with the provisions or objects of the legislation, they should be considered in a determination of what is a reasonable and necessary support. The relevant Operational Guidelines are:

• NDIS - Operational Guidelines - Reasonable and Necessary Supports; and

• NDIS - Operational Guidelines - Specialist Disability Accommodation.

1. Section 11 of the SDA Rules sets down that a participant is eligible to receive support for SDA if the participant has either an extreme functional impairment or very high support needs (Rules 12 and 13 of the SDA Rules) and meet the SDA needs requirement (Rule 14 of the SDA Rules).
2. According to SM French Wade Allen and CEO, National Disability Insurance Agency, the consideration of a request for SDA has 3 stages:

Stage 1: Ascertain if the participant is eligible to receive support for SDA (Rules 11-14).

Stage 2: Determine if support for SDA is reasonable and necessary having regard to the section 34(1) considerations.

Stage 3: Determine the building type, design category, location, and price limit for SDA (Rules 15-19). [6]

1. The Tribunal will follow this approach in its consideration of this matter.

1. The SDA Rules provide the criteria that a participant must satisfy in order to be 'eligible' for SDA (the 'eligibility criteria').
2. Importantly, eligibility for SDA does not equate automatically with an 'entitlement' to receive funding for SDA under the scheme.
3. Satisfaction of the 'eligibility criteria' has the effect of establishing only whether the Applicant meets the required criteria in order to be 'considered' for SDA. As such, there remains the additional mandatory requirement for a participant who has met the eligibility criteria to satisfy the mandatory criteria of section 34(1) of the NDIS Act.
4. SDA will therefore only be funded under the scheme in circumstances where a participant:
   • Firstly, meets the eligibility requirements prescribed under Rule 11 of the SDA Rules, and
   • Secondly, also meets the criteria prescribed by section 34(1) of the NDIS Act.

1. The Tribunal's role in conducting this review has been to reach its own conclusion as to whether the delegate's decision not to approve SDA for inclusion in the Applicant's SOPS is the correct or preferable decision.[7] That has involved the independent re-assessment of the evidence that was before the delegate when they made their decision, as well as the assessment of the additional documentary and oral evidence that was before the Tribunal at the time of the hearing.[8]
2. Rule 11 of the SDA Rules provides that a participant will be eligible for SDA if the CEO is "satisfied" of the matters set out in that Rule. In this independent review, the Tribunal must be satisfied in relation to each criterion. [9]
3. The Applicant bears the practical onus of placing before the Tribunal, or pointing to material before the Tribunal, that he has either an extreme functional impairment and/or very high support needs which meet the SDA needs requirement, and if so, that support for SDA is otherwise reasonable and necessary for him.[10]
4. The Tribunal will refer to some of the more salient aspects of the evidence. However, the fact that it does not refer to all parts of the evidence does not mean that the Tribunal has not taken all evidence before the Tribunal into account in reaching the correct and preferable decision.

1. The Tribunal has considered all the written evidence filed with the Tribunal and provided in the joint bundle, the oral evidence provided at the hearing, and the parties' oral closing submissions.
2. The following written documentary material was filed with and considered by the Tribunal:

The T-documents and Joint Tender Bundle (JTB), including the Respondent's Statement of Facts, Issues and Contentions (SOFIC) and the Applicant's Reasons for Application, and Table of Supports and Table of Evidence Justifying SDA Eligibility (EV1).

1. Additional material submitted into evidence included:

(i) the new NDIS plan and annexure, dated 9 January 2026 (EV 2); > > (ii) the report of the Applicant's Occupational Therapist Jesse Perry, dated 19 January 2026 (EV 3); and > > (iii) a letter from the Applicant's psychologist, Brendan Evans, Clinical Psychologist, dated 21 July 2025 (EV4).

2. The Tribunal notes that the report of Mr Hoogsgrate, Occupational Therapist[11] was relied upon by Ms Perry in her reports.
3. The principal hearing was conducted over 3 days by video on 10, 11 and 17 February 2026.
4. The Applicant was self-represented.
5. The Respondent was represented by Mills Oakley Lawyers.
6. Three witnesses presented oral evidence over the course of hearing:
   • The Applicant.
   • The Applicant's Occupational Therapist, Ms Perry.
   • The Indepenent Occupational Therapist, Ms Cummings.

1. The Applicant is a 51-year-old man, currently residing in a privately rented apartment in Queensland.
2. He has resided there as a tenant since 2012.
3. The Applicant met access to the National Disability Insurance Scheme (NDIS) on the basis of a physical impairment arising from an Above Knee Amputation, which occurred in March 2022 after a series of infections.
4. The Tribunal accepts that the Applicant currently utilises the following AT:

(a) 1 x indoor powerchair with moulded pressure care seat. > > (b) 1 x outdoor powerchair with 'Jay Fusion' foam/gel pressure relieving cushion.

1. The Applicant lives with his pet dog, Rockstar ('Rocky').
2. The Applicant does not have access to any family or informal supports.
3. The Applicant is not currently employed or engaged in education.
4. During his oral evidence, the Applicant provided detailed information about his daily life and capacity to undertake tasks, his concerns and limitations in terms of his functional capacity within his current accommodation and the challenges of finding appropriate accommodation.
5. A large part of the Applicant's evidence was in relation to the care of his dog, Rocky. The Tribunal notes the joy and companionship that Rocky brings to the Applicant.[13]
6. The Applicant shared in detail the inadequacies of his current accommodation. A large area of focus was the absence of sufficient turning space for his wheelchair, which meant he required support to transition from the wheelchair to access and utilise other parts of the house - particularly the kitchen, laundry, toilet and shower.
7. The Applicant explained that his current accommodation was not fit for purpose:

The door widths are as wide as the wheelchair and as wide as me. I've done a lot of damage to the place I'm in because the door frames are not wide enough to support anyone in a wheelchair, even a manual one, because 690mm is the [width of the] chair and [the] door width is 700mm.

8. The Applicant stated that he had damaged his existing property, and that there was no scope to make any further modification to the property, as the landlord had not consented to this due to structural integrity concerns.[14]
9. The Applicant explained that his brother was living with him when he had the amputation. However, his brother departed the property in September 2023, and they haven't communicated since then.[15]
10. The Applicant stated that the fact that his brother no longer resides with him, has not been accounted for by the Respondent in his SOPS.[16]
11. The Applicant explained the challenges of using his prosthetic leg and stated that he:

...can't use it for more than 45 minutes. When you have an above knee amputation, it also severs the hamstring muscles. It sits high up in the groin. The sweat pools up in the sock, so the body fluid can cause skin break downs and abscesses and infections. Imagine thin fibreglass... right into the crease of groin...It needs the whole body weight to release the knee joint - after 3 or 4 steps the pain becomes excruciating, and it is exhausting with the heat and the sweat. When you take the sock and the silicone sleeve off there is a cup of liquid.... [A] prosthetic is not a one size fits all - I still need crutches and I am wide and can't get through a doorway. I use a wheelchair because it is the safest and most practical.[17]

12. The Applicant has no family in Queensland.
13. The Applicant stated that his aunt and uncle were located in Penrith, NSW and that he was considering moving to be closer to them, but they were now moving to another location, and he would not be able to rely on them as informal supports.
14. The Applicant stated that he would be willing to relocate to wherever appropriate SDA was available to him.
15. The Applicant explained that he was not in a financial position to privately rent accommodation that required modification and remain in his current accommodation, as this would require paying two sets of rent while the modifications were being undertaken.
16. The Applicant stated that he has requested an accessible home to:

...live without fear and humiliation, reduce supports, and allow him freedom and dignity.[18]

1. Ms Perry, the Applicant's Occupational Therapist is also an accredited SDA Assessor. She provided two Occupational Therapy Plan Review reports, dated 26 June 2025, and 19 January 2026[19].
2. Ms Perry's reports confirmed that the Applicant experienced:
   • Above the knee lower limb amputation of the right leg.
   • Post Traumatic Stress Disorder (PTSD).
   • Anxiety.
   • Depression.
3. Ms Perry completed the assessment for the first report in the Applicant's home on 8 April 2025 with the Applicant and his support coordinator present. She did not attend the Applicant's home for the writing of the second report.
4. Ms Perry provided an overview of the findings of her assessment with recommendations for the Applicant's future NDIS plans. In her report, Ms Perry suggested the following modifications to the Applicant's current property:
   • Automated front door.
   • Accessible bathroom, including accessible shower and toilet (understood to be due to circulation space, positioning of toilet and width of doorway).
   • Accessible kitchen, including a designated preparation space with cavity under the benchtops so the Applicant is able to use his powered wheelchair at the bench. [20]
5. In terms of mobility, transfers and bathing, Ms Perry stated that if the Applicant had a different fully accessible environment and appropriate AT, he would be able to do those daily activities:

a fully accessible home design is required due to [the Applicant's] severe limitations on mobilisation and transfers due to his need for use of a powered wheelchair for all mobilisations and inability to stand for longer than a standing pivot transfer. Without a supportive home environment which meets fully accessible design [the Applicant] ... will continue to be reliant on supports for completion of tasks that he would be independent with in a fully accessible design home.[21]

6. In relation to cooking and walking the dog, Ms Perry stated that the Applicant's independence would be greatly improved in a different living environment.
7. Ms Perry undertook a World Health Organisation Disability Assessment Schedule (WHODAS 2.O) assessment report which measures 36 items indicating impact on functional capacity in understanding and communicating, getting around (mobility), self-care, getting along with people, life activities (i.e., household, work, and/or school activities) and participation in society.
8. The Applicant's WHODAS 2.0 scores can be summarised as below:
   • Understanding and communicating 45.83% Moderate limitations.
   • Getting around 85.00% Extreme limitations.
   • Self-care 62.50% Severe limitations.
   • Getting along with people 55.00% Severe limitations.
   • Life activities 87.50% Extreme limitations.
   • Participation in society over the past 30 days 93.75% Extreme limitations.[22]
9. Ms Perry confirmed the Applicant's challenges with his prosthesis as follows:

The Applicant is unable to use prosthesis for extended periods due to removal of hamstring of affected limb. This results in severely decreased prosthesis use due to high falls risk and severely limited endurance when using prosthesis.[23]

1. In relation to core supports, Ms Perry recommended 8 hours per weekday for personal care and assistance with community participation in consideration of the Applicant's future NDIS plan, comprising:
   • 3 hours for morning routine (shower, toilet, stretching and breathing exercises, taking Rocky for walk).
   • 3 hours in the evening (same as morning).
   • 2 hours during the day for personal care and other supports such as cleaning Rocky's area, assistance in the kitchen and other miscellaneous tasks.[24]
2. Ms Perry noted that the Applicant would require 6 hours per day at a minimum to support his personal care needs living in an SDA.
3. Ms Perry also recommended 11 hours of support for each day of the weekend, comprising:
   • 3 hours for morning routine (shower, toilet, stretching and breathing exercises, taking Rocky for walk).
   • 3 hours in the evening (same as morning).
   • 5 hours of social and community support for both Saturday and Sunday.
4. The total weekly hours of support recommended by Ms Perry is 66 hours per week.

1. Ms Cummings, Occupational Therapist, was engaged to provide evidence on behalf of the Respondent. She provided an Independent Medical Report and met the Applicant in his residence for 3 hours on 6 January 2026.
2. Ms Cummings considered that the Applicant had potential increased capacity in the areas of community access, dog walking, meal preparation and public transport. She contended that his support needs in those areas were minimal and stated that increased supports could result in reduced independence, self-efficacy, mental and physical health.[25]
3. In relation to the supports required for dog walking, Ms Cummings stated that she didn't have sufficient evidence that support was needed for walking the dog, but she felt that measures could be taken to mitigate some of the risk that was identified including:

...is their harness secure? Is there a retractable lead? Allowances for a long-handled scoop. I would consider these first rather than recommending another person assist. There are risks that aren't impairment related but for everyone such as aggressive dogs and getting off the lead, but the community can be quite helpful if the dog gets loose. These risks don't happen that often and are the same as for people who walk their dog...I didn't have the opportunity to observe him walk the dog, so I would need to see whether these recommendations are viable. I could observe them go to the lift in the car area - [the dog] wasn't on a lead and he could follow verbal commands, so I think there is capacity to build independence in that task. [26]

4. Ms Cummings recommended 2 hours per day for 1:1 individual supports, primarily to support the Applicant's in his transfers.[27]
5. In response to this recommendation, the Applicant stated that 2 hours per day was not sufficient:

...when I don't have support workers here, when I go through the morning [without the toilet] , then I have no access to the toilet, [I'm]...forced to use a bucket, and now [I] socially struggle and [am] starting to withdraw, it makes me feel isolated and it affects my anxiety.[28]

There is no doubt your bathroom is not suitable for your level of need ... I made the recommendations based on the regularity of bowel movements that was reported to me. The use of a commode would reduce the risk involved in using a bucket. [29]

7. She also confirmed her recommendation for 2 hours per week of 1:1 support for weekly shopping for heavy and bulky items.[30]
8. The Applicant responded that this did not account for periods of incidental shopping during the week and was insufficient because it took him 1 hour to get ready to go shopping, 30 minutes in travel time, and then he needed time for the support worker to unpack.[31]
9. Ms Cummings also confirmed 2 hours a week for preparation of meals that could be warmed using the air fryer and microwave, as well as to undertake his hobby of baking.
10. Ms Cummings sated that support was required for cooking and baking because the stovetop and oven were not positioned well and were not in her view, safe to use while in a motorised wheelchair in the Applicant's current accommodation.[32]
11. She stated that the Applicant could:

...put an item in the air fryer, use a microwave, and there are no barriers with making a sandwich or cereal. There is limitation in terms of space, handles on cupboards aren't ideal, but he can be fed with adequate nutrition and doesn't require daily support.[33]

12. A summary table is reproduced below: [34]

1. In relation to her methodology for calculating the number of hours required she stated that:

I break down what support is needed and how long it usually takes via observation of the tasks and clinical experience and home based experienced. [35]

2. The Applicant contended that Ms Cummings only regarded functional needs in her assessment, not mental health impact or knowledge of the Applicant's experience with prosthetics and did not observe him walking the dog.[36]
3. Ms Cummings acknowledged that she needed to view the Applicant undertake tasks to see if her recommendations were valid - and that he would need capacity building for this.[37]

1. The Tribunal now turns its consideration to the Applicant's circumstances to first determine eligibility for SDA funding under Rule 11 (comprising Rules 12-14).

Rule 11: Is the Applicant eligible to receive support for SDA?

1. Under Rule 11 of the SDA Rules, to be eligible for SDA supports a participant must:

(i) Have an extreme functional impairment with respect to mobility, self-care or self -management (Rule 12); or

(ii) Have very high person-to-person support needs (Rule 13); and

1. Therefore, to meet the 'eligibility requirements' for SDA, the Tribunal must be satisfied that the Applicant has either an 'extreme functional impairment' or 'very high support needs', and also that the Applicant meets the 'SDA needs requirement'.

Rule 12: Does the Applicant Have an extreme functional impairment with respect to mobility, self-care or self-management?

1. Under Rule 12, a participant has an extreme functional impairment if:

(a) the impairment results in extremely reduced functional capacity to undertake, or psychosocial functioning in undertaking, one or more of the following activities:

(b) the participant has very high needs for person to person supports in undertaking the activity even with assistive technology, equipment or home modifications

1. A threshold issue in this regard is the scope and content of each of those life activity areas. The terms "mobility", "self-care" and "self-management" are not defined, or their scope and content prescribed in the Act or in the SDA Rules. The SDA guidelines do give examples of tasks that fall within each life activity area.
2. The SDA Guideline provides the following guidance as to the tasks comprising the activities of mobility, self-care and self-management:[38]

Mobility - such as walking, climbing stairs, getting in and out of a bed or a chair, carrying or moving items, and getting out of the house.

Self-care - such as washing yourself, going to the toilet, getting dressed, eating, drinking, talking and taking medication.

Self-management - such as housework, following routines, making friends and relationships, maintaining boundaries and managing your behaviour.

1. In order to determine whether the Applicant has an extreme functional impairment under Rule 12, the Tribunal must consider the Applicant's impairments and the degree to which those impairments reduce the Applicant's functional capacity in one or more of the three specified life activity areas.
2. Under Rule 12(2), for the purpose of assessing whether a participant has an extreme functional impairment, the CEO (and Tribunal) may have regard to:

(a) any assessment or examination conducted in relation to the participant, including any assessment or examination functional capacity quested by the CEO under paragraphs 36(2)(b) or 50(2)(b) of the NDIS Act.

(b) the daily support requirements of the participant.

(c) any assessment tool specified by the CEO for this purpose; and

(d) any other matters the CEO considers appropriate.

1. The Tribunal is satisfied that the Applicant has an extremely reduced functional capacity to undertake mobility because of his Above Knee Amputation.
2. The Respondent acknowledged that the Applicant's amputation meant that he had substantial functional impairment but contended that it did not meet the threshold of extreme functional impairment under Rule 12(1)(a).
3. In Madeleine v National Disability Insurance Agency[39], it was considered that the threshold requirements to achieve functional capacity in relation to mobility were 'relatively modest':

[104] ...A person has functional capacity if they can move about their home, get in and out of a bed or a chair, and mobilise in the community. Movement in the home does not need to be achieved by walking; a person might even crawl from room to room. The Concise Oxford Dictionary defines mobile as movable, not fixed, free to move.

[105] The use of the phrase move around...to undertake ordinary activities of daily living in the Guideline is significant. It implies some expectation of how far a person needs to be able to move to undertake ordinary daily activities, say, getting to the bathroom to wash or toilet, getting to the kitchen to prepare food, perhaps getting to the front letterbox to collect mail. Implicit in this concept is that the distances involved will be relatively short.

1. On the basis of the evidence, the Tribunal is satisfied that:
   • The Applicant is unable to stand.[40]
   • The Applicant requires the use of a powered wheelchair for all mobilising (short and long distances).[41]
   • The Applicant completes standing pivot transfers with the use of his unaffected limb from his powered wheelchair to bed, toilet, and lounge chair which also requires bilateral upper limb strength. [42]
   • The Applicant is at risk of falls and injuries to his unaffected lower limb through excessive weight bearing.[43]
   • The Applicant experiences a decline in transfers from inappropriate height surfaces.[44]
   • The Applicant experiences phantom limb pain.[45]
   • The Applicant experiences reduced balance.[46]
2. Evidence of functional impairment was provided to the Tribunal in relation to each of the following activities: walking, climbing stairs, carrying or moving items, getting out of the house.
3. In relation to undertaking the tasks and actions involved in walking, the Tribunal finds that the Applicant, in his intrinsic state, is unable to walk, because his right leg is amputated above the knee. He was observed by Ms Cummings to be unable to stand unsupported for more than 30 seconds.[47] The Tribunal is satisfied the Applicant experiences extremely reduced functional capacity in relation to walking.
4. In relation to the tasks and actions involved in climbing stairs, the Tribunal finds that the Applicant, in his intrinsic state, is unable to do so because his right leg is amputated above the knee. The Tribunal is satisfied on this basis that the Applicant, experiences extremely reduced functional capacity in relation to stair climbing.
5. With respect to getting in and out of bed or a chair, the Applicant, in his intrinsic state cannot get into and out of a bed or a chair without using AT, equipment or with direct person-to-person assistance. He is able to prop himself up with his upper limb strength but is unable to maintain balance to undertake and complete these activities without support. The Tribunal is satisfied on this basis that the Applicant, in his intrinsic state, experiences extremely reduced functional capacity getting in and out of bed or a chair.
6. In relation to carrying or moving items, the Tribunal finds that the Applicant, in his intrinsic state, is unable to do so. In relation to shopping, the Tribunal is satisfied that the Applicant is not able to carry bags home, and that he needs support to unpack the shopping.[48] The Tribunal is satisfied that the Applicant has extremely reduced functional capacity to carry and move items.
7. In relation to getting out of the house, the Tribunal finds that the Applicant, in his intrinsic state, is unable to do so. He is unable to walk. Nor is he able to hop because he is unable to maintain body balance. He can only leave his home with the use of his prosthetic leg or a wheelchair.
8. The Tribunal finds that the Applicant is also reliant on supports for clearing his path of travel to provide safe access to required areas of his current home due to limited circulation space, and the inability to safely and correctly use AT items to their full potential.[49]
9. While the Applicant can drive and travel in a motor vehicle, he can only get into and out of the motor vehicle with person-to-person assistance, particularly in relation to packing his wheelchair into the car. The Tribunal is therefore satisfied on this basis that the Applicant, in his intrinsic state, experiences extremely reduced functional capacity to get out of the house.
10. The Tribunal finds that the Applicant's mobility is adversely affected by the challenges he faces in his current accommodation and finds that that there are periods where he does not have supports to pivot from his wheelchair to access the bathroom to toilet and shower.
11. The Applicant stated that he could:

...complete standing pivot transfers to my bed and lounge chairs but not to the toilet. The chair I have for the bathroom has no breaks on it. I have fallen 5 or 6 times because the chair slips away. I can't get to the toilet; I can only get to the ensuite door. Once on the toilet I can undertake toilet activities myself.[50] > > ...The difficulty with the shower is the same. The bottom of the shower has the hob that stops the water from getting out. We have to position the chair just before that and pivot and step out and that has caused me to fall. There is no door, it was replaced with shower. Sometimes water gets under it and I slip. The most significant fall I had was in December 2025, it jolted my shoulder, it's still affected at the moment. I have to have someone with me and here to shower. Once I am out of the wheelchair and into the bathroom chair, I can wash myself when I am in the shower. [51] > > ...The support worker is here in case I am standing and have a fall. If no one is here and I fall to the left or the right, I'm on the ground. [52]

12. The Tribunal is satisfied that the Applicant has an extreme functional impairment in the life area of mobility. This is sufficient to satisfy the criteria of 12(1)(a) without considering the other life areas.

Rule 12 (1) (b) the participant has very high needs for person to person supports

1. Rule 12(1)(b) requires very high needs for person-to-person supports in undertaking the activity even with assistive technology, equipment or home modifications.
2. The Tribunal is satisfied that the Applicant has a very high need for person-to-person supports in undertaking the activities of mobility, even with assistive technology, equipment or home modifications.
3. The Applicant's Statement of Lived Experience (SOLE)[53] and Table of Supports and Table of Evidence Justifying SDA Eligibility, outlines his reliance on support workers in his current accommodation. In relation to mobility, this includes:

• Clearing the path of travel to increase accessibility to permit use of a powered wheelchair.
• Taking public transport to destinations, he is unable to otherwise access.
• Accessing tables in the community due to need for moving/repositioning of chairs to permit wheelchair access.
• Opening doors within the community if not automated due to limited reach.
• Toilet transfers in the community when disability specific bathrooms are not provided.
• Carrying and unpacking shopping and moving large items.
• Walking and caring for his dog.
• Travel by car.[54]

1. The Tribunal also finds that the Applicant's impacted mobility also affects his ability to undertake self-care and self-management functions, as a result of the limitations of his current housing, including:

• Meal preparation.
• Domestic cleaning.
• Laundry.
• Showering.
• Toileting.

1. The Tribunal considers that the analysis of person to person supports needs to be taken in the Applicant's current circumstances.
2. The Respondent contended that the Applicant did not satisfy the threshold for very high needs for person-to-person supports. [55]
3. The SDA Rules and operational guidelines do not specify any threshold of hourly support that must be reached to satisfy this requirement.
4. In consideration of the Applicant's person-to-person support needs, the Tribunal prefers the evidence of Ms Perry over Ms Cummins. This is because Ms Perry has observed the Applicant's capacity in relation to a broader range of supports and has interacted with him over a longer period of time than Ms Cummings. She has a deeper knowledge of his experiences dog walking, and the challenges in relation to the use of his prosthesis, as well as the details of the Applicant's preferences and specific needs.
5. The Tribunal is satisfied that the evidence shows that the Applicant cannot manage daily activities like showering and toileting, cooking or preparing substantial meals other than those that can be reheated in a microwave or cooked in an air fryer, undertake domestic cleaning or laundry, or travel within the community to shop, attend medical appointments, and for other purposes, without person-to-person assistance.
6. The Tribunal finds that these person-to-person supports are substantially directed towards support for the Applicant's mobility within his home and in the community.[5]
7. The Tribunal finds that these are very high needs for person-to-person supports.

1. Based on the evidence the Tribunal is satisfied that the Applicant has an extreme functional impairment under Rule 12 of the SDA Rules.
2. On the basis that Rule 12 is satisfied, it is not necessary to consider Rule 13 of the SDA Rules.

Rule 14: Does the Applicant meet the SDA needs requirement?

1. Rule 14 of the SDA Rules prescribes the criteria for satisfaction that the Applicant has a 'needs requirement' and provides as follows:

A participant meets the SDA needs requirement if, when compared to other supports alone, combined specialist disability accommodation and other supports would have the effects specified in Rule 14(1)(a) to (e).

(1) A participant meets the SDA needs requirement if, when compared to other supports alone, combined specialist disability accommodation and other supports would:

(a) better assist the participant to pursue the goals, objectives and aspirations set out in the participant's statement of goals and aspirations; and

(b) be more effective and beneficial, where possible, in:

(i) mitigating or alleviating the impact of the participant's impairment upon the participant's functional capacity; and

(ii) preventing the deterioration of the participant's functional capacity; and

(iii) improving the participant's functional capacity; and

(iv) maintaining or promoting the participant's ability to build capacity, including in the medium or long term; and

(v) maintaining or promoting the participant's opportunities to develop skills; and

(c) if the participant has very high supports needs - be more effective and beneficial, where possible, in:

(i) reducing the participant's future needs for supports which might be required due to inappropriate accommodation; and

(ii) assisting the participant to pursue goals related to life opportunities and life transitions; and

(d) if the participant has an extreme functional impairment - be more effective in providing the participant with stability and continuity of support; and

(2) For the purposes of paragraph (1)(e), regard must be had to the following matters if the participant has very high support needs:

(a) whether combined specialist disability accommodation support and other supports would be likely to substantially improve the life stage outcomes for, and be of long-term benefit to, the participant.

(b) the cost of providing the participant with supports needed to live in accommodation other than specialist disability accommodation, taking into account:

(i) whether those supports may be shared with other participants; and

(ii) limitations of the participant's informal support network.

1. This requires a comparison of hypothetical outcomes for the participant from two hypothetical support arrangements, being:
   • 'other supports alone', and
   • the combination of SDA with other supports
2. 'Supports' are not defined in the NDIS Act. In McGarrigle v National Disability Insurance Agency Mortimer J considered that the term 'supports' referred to both services and activities that assist a participant in the scheme in accordance with the principles to be applied under the NDIS Act. Her Honour stated:

The word "support" must be given a broad construction in this context, and there is no need for the purposes of this proceeding to seek to give it any comprehensive meaning. Rather, the point to be made is that it is a practical description of the means by which a person with disability is assisted. It is not intended, in my opinion, to encompass funding, especially because what section 14 contemplates is that the Agency will "fund" a support. The Agency cannot "fund" funding.[56]

1. As a participant in the scheme, the Applicant is funded for 'formal supports'. These supports are specified and contained within his SOPS.
2. Based on the evidence before the Tribunal, it is satisfied that the Applicant's 'other supports' are comprised of the following formal supports provided under his SOPS:
   • Assistance with self-care activities and community participation funded for 24 hours per week.
   • Various Low-Cost AT Consumables.
   • Transport.
   • Occupational Therapy.
   • Physiotherapy.
   • Exercise Physiology.
   • Support Coordination and Psychosocial Recovery Coaches.
   • Home Modification Quotes.
   • Various AT, Repair and Rentals.
3. The Tribunal accepts that the Applicant's other formal supports include his:
   • General Practitioner.
   • Psychiatrist (privately funded).
   • Psychologist (via a mental health plan).
   • Podiatrist (community based).

Rule 14(1)(a) - Would SDA combined with other supports better assist the participant to pursue the goals, objectives and aspirations set out in their Statement of Goals and Aspirations.

1. The Applicant's goals, outlined in his plan include:
   • Improving his mobility, strength and balance, to maintain his independence and safety within the home and the community.
   • Being supported to access the community, to participate in activities of interest, including maintaining his employment.
   • Being supported to complete tasks of daily living, to maintain his safety and independence within the home.
   • To live in a home that is suitable to accommodate his extreme functional impairment and very high support needs, and to be able to independently and safely navigate that home.
2. The Tribunal notes that three out of the four goals relate to maintaining independence and safety within the home.
3. The Respondent acknowledged the limitations of the Applicant's current accommodation, and conceded that the Applicant requires suitable accommodation, with wheelchair access and an accessible bathroom, laundry and kitchen.
4. The Respondent contended that this can be available from housing other than SDA.
5. The Applicant stated that his family and some informal supports are in Penrith NSW, and his original intention was to move to be closer to his family.
6. The Applicant informed the Tribunal that his family were now moving from Penrith, and he would be prepared to move to wherever there was suitable housing.[57]
7. The Applicant stated that his preference was to live alone.
8. The Tribunal accepts the evidence of the Applicant that his family are moving away from Penrith, and as a result, the Applicant's preferences are broad.
9. The Tribunal is satisfied that the Applicant's current accommodation is not suitable for his needs or to support him to work towards his goals. He will need support to move to more suitable accommodation.
10. The Tribunal finds that the Applicant's goals of:
    • Improving his mobility, strength and balance;
    • Maintaining his independence and safety within the home and the community;
    • Being supported to access the community;
    • Being supported to complete tasks of daily living; and
    • Living in a home that is suitable to be able to independently and safely navigate his home without significant restrictions.

• Purchased private housing; or
• Secured a private lease; or
• Secured social housing.

1. The Tribunal finds that the Applicant is open to wide geographic search parameters for appropriate accommodation to support him to reach his NDIS goals, including non-SDA options.
2. The Tribunal is not satisfied that it is only with a combination of SDA and 'other supports' that the Applicant will be able to pursue his goals.
3. The Tribunal finds the criteria under Rule 14(1)(a) of the SDA Rules is not satisfied.
4. As a result, the consideration of the remainder of Rule 14 requirements is not necessary.

1. Based on the evidence before it, the Tribunal is not satisfied that the Applicant meets the criteria under rule 11 of the SDA rules and is not 'eligible' for SDA.
2. Consideration of section 34 to determine whether SDA is reasonable and necessary, and Rule 15 of the SDA rules relating to type, design category, location and funding limit, are therefore not required.

1. It follows from these reasons that the Applicant does not satisfy the needs requirement for support for SDA. He is therefore not eligible for SDA, and his request for this support cannot be further considered.
2. The Tribunal affirms the original decision.

[1] McGarrigle v National Disability Insurance Agency [2017] FCA 308 at [43].

[2] McGarrigle v National Disability Insurance Agency [2017] FCA 308 at [91].

[3] National Disability Insurance Agency v WRMF [2020] FCAFC 79 at [149]- [151].

[4] Drake v Minister for Immigration and Ethnic Affairs (No 2) (1979) 46 FLR 409.

[5] Minister for Home Affairs v G [2019] FCAFC 79 at [18].

[6] Wade Allen v CEO, National Disability Insurance Agency [2025] ARTA 1359.

[7] Drake v Minister for Immigration and Ethnic Affairs (No 2) (1979) 46 FLR 409.

[8] Shi v Migration Agent's Registration Authority [2008] HCA 31; (2008) 235 CLR 286 at [45] - [46].

[9] National Disability Insurance Agency v Davis [2022] FCA 1002 (Davis) at [60].

[10] Beezley v Repatriation Commission [2015] FCAFC 165 (2015); 150 ALD 11 at [68]; HPSC and National Disability Insurance Agency [2021] AATA 727 at [85].

[11] Hoogstrate, Report, T7 JTB 1, pp. 59-271.

[12] Applicant, Reasons for Application, JTB 5, para. 8, p.457.

[34] Cummings, Report, JTB 22, para. 6.2, p.644.

[39] Madelaine v National Disability Insurance Agency [2019] AATA 4025 at [104]- [105].

[45] Cummings, Report, JTB 22, para. 3.1, p.623.

[46] Cummings, Report, JTB 22, para. 3.1, p.623.

[49] Hoogstrate, Report, T7 JTB1, p.64.

[53] Applicant, Statement of Lived Experiences JTB 8, pp.536-547; Table of Supports and Table of Evidence Justifying SDA Eligibility JTB 19, pp.562-581.

[54] Hoogstrate, Report, T7 JTB 1, p.62.

[55] Respondent's SOFIC, JTB 20, para. 21-22, p.587.

[56] McGarrigle v National Disability Insurance Agency [2017] FCA 308.