3.4 Proposed Ground 1: alleged failure to consider medical evidence
11 The first proposed ground of appeal asserts that the primary judge "erred by failing to consider the medical specialists provided as evidence were appropriately qualified medical practitioners".
12 The statutory framework within which the applicant's application for a DSP must be assessed is set out in the reasons of the primary judge at [7]-[10] below and includes the requirement that his mental health condition and alcohol dependence be diagnosed by an "appropriately qualified medical practitioner". That statutory framework may be summarised as follows.
(1) Section 94 of the Social Security Act provides that a person is qualified for disability support pension if (relevantly) the person has a psychiatric impairment and the person's impairment is of 20 points or more under the Impairment Tables.
(2) The Impairment Tables are contained in the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 (Cth) (the Determination), a legislative instrument made by the Minister under s 26(1) of the Social Security Act. The legislative instrument may contain ancillary or incidental provisions (s 26(2)) and "rules that are to be complied with in applying the tables referred to in subsection (1) and the provision referred to in subsection (2)" (s 26(3)).
(3) If a person makes a claim for a disability support pension, in determining the claim the Secretary must apply the instrument in force under s 26 on the day the claim was made or taken to have been made (s 27). The 2011 Determination came into force on 1 January 2012 and remained in force at all relevant times.
(4) Rules governing the determination of impairment are set out in s 6 of the Impairment Tables, the effect of which is relevantly that:
(a) an impairment rating can be assigned to an impairment only if the person's condition causing the impairment is permanent and the impairment is more likely than not to persist for more than two years (s 6(3)(a) and (b) respectively); and
(b) a condition is "permanent" for the purposes of s 6(3)(a) if relevantly the condition "has been fully diagnosed by an appropriately qualified medical practitioner" (s 6(4)(a)), is fully treated (s 6(4)(b)), is fully stabilised (s 6(4)(c)), and is more likely than not to persist for more than two years (s 6(4)(d));
(5) Table 5 of the Impairment Tables, in turn, applies to cases where the person has a permanent condition resulting in functional impairment due to a mental health condition (including recurring episodes of mental health impairment). Table 5 requires that the diagnosis of a mental health condition be made by an appropriately qualified medical practitioner (this includes a psychiatrist) with evidence from a clinical psychologist (if the diagnosis has not been made by a psychiatrist). It expressly provides that self-report of symptoms alone is insufficient.
(6) Table 6 of the Impairment Tables is to be used where a person has a permanent condition resulting in functional impairment due to (relevantly) excessive use of alcohol. The table provides that the diagnosis of the condition must be made by an appropriately qualified medical practitioner and that self-reporting of symptoms alone is insufficient. It requires corroborating evidence of the person's impairment.
13 In order to qualify for the DSP, it was necessary for the applicant to satisfy the requirements of s 94 of the Act (and therefore Table 5 and/or 6) as at the date of the claim or within 13 weeks of lodging the claim in accordance with the requirements of the Social Security (Administration) Act 1999 (the Administration Act), that is, between 10 June 2014 and 9 September 2014 (the claim period), as the AAT found at [8] of its reasons. The difficulty for the applicant is that he never had a diagnosis by an appropriately qualified medical practitioner for his claim for the DSP for the claim period. He relied upon two Centrelink medical reports provided by his general practitioner, Dr Choueifati, dated 29 April 2014 and 3 July 2014 respectively. Mr Daley also relied upon a Centrelink medical report dated 29 February 2012 in which Mr McKinley noted a diagnosis of "Bipolar" but the AAT found that he gave no rationale in support of the diagnosis and was not a clinical psychologist (AAT reasons at [23]-[24]). Similarly, the AAT found at [25] that Dr Scally, GP, noted a diagnosis of "?Bipolar /? Depression with psychotic features" in October 2010 but again the AAT found that he provided no satisfactory reasons for the provisional diagnosis. While the applicant also relied upon reports of Mr Tsomis, clinical and forensic psychologist, these post-dated the claim period and the AAT found that they did not make a specific diagnosis, let alone a diagnosis for the claim period. It is in this context that the AAT, while accepting that during the claim period Mr Daley suffered symptoms consistent with a mental health condition, nonetheless found at [37] that:
However, as there is no evidence of a diagnosis being made by a psychiatrist or clinical psychologist prior to or during the claim period, the requirements of Impairment Table 5 have not been satisfied, and a rating for functional impact on activities involving mental health function cannot be assigned.
14 Given those findings by the AAT, I do not consider that it is reasonably arguable that the primary judge erred in finding that there was no error of law apparent in the AAT's decision (that is, that the requirements of Impairment Table 5 had not been met and therefore that no rating could be assigned). As her Honour held:
35 The difficulty for Mr Daley was that there was no evidence before the Tribunal that a diagnosis of his condition had been made by a psychiatrist or a clinical psychologist before or during the claim period (or at all, for that matter). Mr Daley claimed to have seen a psychiatrist three times in 2010 but presented no evidence from the psychiatrist. He did see a clinical psychologist, Mr Tsomis, but not until November 2014, some two months after the claim period. Even so, he could have provided a diagnosis and an opinion on Mr Daley's impairment during the claim period based on the history he had received. But the letters submitted to the Tribunal from Mr Tsomis contained neither.
36 That was the reason the Tribunal held that the requirements of Impairment Table 5 had not been satisfied and a rating for functional impact on activities involving mental health function could not be assigned. Unless the Tribunal was satisfied that the mental health condition was fully diagnosed, treated and stabilised, the effect of s 94 of the Act when read with Impairment Table 5 is that the Tribunal was not entitled to assign a rating under the Table.
15 In the case of Mr Daley's alcohol dependence, the Tribunal found that the only reference to this condition prior to or during the claim period was in his GP's supplementary report of 3 July 2014 where it is listed as a condition that is generally well managed and causing minimal or limited impact on function. Furthermore, even if it accepted that an appropriate diagnosis of alcohol dependence was made prior to or during the claim period, the AAT found that there was no evidence of any concurrent or planned treatment for this condition (cf s 6(4)(a) and (5) of the Determination). In this regard, the primary judge correctly held that:
37 A similar obstacle [to the claim with respect to mental impairment] stands in Mr Daley's way in relation to the condition of alcohol dependence. In the absence of evidence that the condition had been fully treated and stabilised, the Tribunal was right in law to conclude that a rating under Impairment Table 6 could not be assigned.
38 Consequently, as a matter of law the Tribunal was precluded from providing impairment ratings under the Tables.
16 Mr Daley submitted that the AAT was not bound by technicalities, the implication being that the AAT might have some discretion in the application of the rules contained in the Determination. In this regard, it is true that s 33 of the AAT Act provides that proceedings before the Tribunal "shall be conducted with as little formality and technicality... as the requirements of this Act and of every other enactment and a proper consideration of the matters before the Tribunal permit" and that the AAT is not bound by the rules of evidence. However, that provision is concerned with matters of evidence and procedure. As counsel for the Minister submitted, it does not provide a basis on which the AAT can decline to apply the substantive criteria for the grant of a pension under the Social Security Act and applicable legislative instruments. Furthermore, it is clear from their terms that s 6 of the Determination and the requirements in Table 5 and 6 for diagnosis by appropriately qualified practitioners are rules under s 26(3) of the Social Security Act which do not permit the exercise of any discretion. It follows that ground 1 of the draft notice of appeal does not have any reasonable prospects of success.