SOCIAL SECURITY - Disability Support Pension - impairment arising from medical conditions - not fully diagnosed, treated and stabilised - unable to be rated under Impairment Tables - decision under review affirmed

Names used in all published decisions are pseudonyms. Any references appearing in square brackets indicate that information has been omitted from this decision and replaced with generic information pursuant to subsection 201(1A) of the Social Security (Administration) Act 1999.

1. This review considered whether Mr Phelps met the requirements for payment of disability support pension (DSP) on 12 December 2022.
2. Mr Phelps is [an age]-year-old man who lodged a claim for DSP on 12 December 2022 and wrote in his application that he had a lumbar spine condition and a mental health condition. On 26 June 2023, his application was rejected because he did not have any medical conditions able to be rated under the Impairment Tables. He requested review of this decision, and on 18 July 2025, an authorised review officer affirmed the original decision.
3. On 12 August 2025, Mr Phelps requested a review of the decision by the Administrative Review Tribunal (the Tribunal).
4. On 3 October 2025, a hearing was undertaken. Mr Phelps attended the hearing and spoke with the Tribunal by telephone conference. The Tribunal had before it a collection of documents provided by Centrelink and the applicant that constituted the hearing papers (folios 1-161).
5. Relevant aspects of the evidence before the Tribunal will be referred to in the Tribunal's consideration of the issues.

1. The statutory provisions relevant to this review are contained in the Social Security Act 1991 (the Act) and the Social Security (Administration) Act 1999 (the Administration Act).
2. The issues which arise in this case are:

(a) Whether Mr Phelps has any physical, intellectual or psychiatric impairment;

(b) Whether his impairments rate at least 20 points under the Impairment Tables; and

(c) Whether he has a continuing inability to work.

1. Provisions relating to whether a person is qualified for DSP and whether DSP is payable to the person are contained in Part 2.3 of the Act.
2. Subsection 94(1) of the Act states, in part, that:

(1) A person is qualified for disability support pension if:

(a) the person has a physical, intellectual or psychiatric impairment; and

(b) the person's impairment is of 20 points or more under the Impairment Tables; and

(c) one of the following applies:

(i) the person has a continuing inability to work;

1. In accordance with subclause 4(1) of Schedule 2 to the Administration Act, the Tribunal is required to determine Mr Phelps' eligibility for DSP on 12 December 2022, being the date on which the claim for DSP was lodged.
2. The "relevant period" for this review extends for 13 weeks after the date of claim. That is, should the Tribunal conclude Mr Phelps did not meet the qualifications on 12 December 2022, but would do so within 13 weeks of this date, the Tribunal would consider whether the early start date rule in subclause 4(1) of Schedule 2 to the Administration Act allows the Tribunal to grant DSP from that later date.

Issue 1 - Does Mr Phelps have a physical, intellectual or psychiatric impairment?

1. As stated above, paragraph 94(1)(a) of the Act provides that the first qualification for DSP is that a person has a physical, intellectual or psychiatric impairment.
2. In oral evidence at the hearing, Mr Phelps told the Tribunal that he suffered from a spine condition and a mental health condition that caused impairment.
3. The Tribunal noted the documentation in the hearing papers confirmed that Mr Phelps had impairment arising from his medical conditions.
4. Given that Mr Phelps suffered from impairment arising from his medical conditions, he satisfied paragraph 94(1)(a) of the Act for both dates of claim.

Issue 2 - Does Mr Phelps' impairment rate 20 points or more?

1. Paragraph 94(1)(b) of the Act provides that the second qualification for DSP is that the person's impairments rate 20 points or more under the Impairment Tables.
2. The Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2011 contains the Impairment Tables and the rules for applying the Impairment Tables when deciding if a person is qualified for DSP for a claim lodged on 12 December 2022.
3. An impairment rating can only be assigned to a condition if the condition is permanent for the purposes of DSP, that is, that the condition is expected to persist for more than 24 months and was "fully diagnosed" and "fully treated and stabilised" on the date of review, and there is unlikely to be any significant functional improvement in the condition within the next two years enabling the person to undertake work.

1. The Tribunal noted the written evidence in the hearing papers and oral evidence at the hearing related to the medical conditions. This information is discussed further below under the relevant medical conditions.

1. In oral evidence at the hearing, Mr Phelps stated in relation to the spine condition:

a) The decision to reject his claim for DSP was wrong because the Centrelink staff member who rang him to discuss the claim had mentioned that her relative had back surgery and was able to resume work within six months when he mentioned he was thinking of having a spine operation. He had lodged a complaint about this. When he was rung by a different Centrelink staff member about nine months later, he was advised to provide evidence of the dates of surgery planning and this would help his claim and he would be approved. He provided this evidence. > > b) He developed back problems many years ago. He was diagnosed by his doctor. > > c) In regard to treatment of his back condition, he had physiotherapy, chiropractic therapy, an exercise management plan and medication and he had seen a specialist. He had ceased medication as he did not feel it was helpful. He was not currently undertaking physiotherapy or chiropractic therapy as they had "let me go". He never saw neurosurgeon Dr [A] but did see neurosurgeon Dr [B] in May 2022. > > d) The neurosurgeon had explained what his management options were at the consultation. He mentioned surgery and spine injection. He had the cortisone injection and it helped, but only for two or three months. > > e) About a week and a half after the interview with a Centrelink staff member, he had booked for surgery at [Hospital 1]. The surgeon had postponed the operation a few weeks and he was scheduled for surgery [in] May 2023. He went to hospital but on the day of surgery he became scared and cancelled the operation. He left the hospital. He had not gone back to see the specialist to discuss this or explore other management. > > f) His back condition affected him. He was always about five to six out of 10 in pain, but at times it was worse than this. His pain was affected by the weather. The pain made him feel like not doing things like hygiene, showering, or going out. He had lost some movement in his spine and could only bend to his knees. Twisting was also more difficult. He was able to drive a car but could not drive for prolonged periods of time. Likewise, he could stand and sit, but not for prolonged periods of time

2. The Tribunal noted the following medical evidence in relation to the spine condition:

a) A referral dated 1 February 2022 from general practitioner Dr [C] to neurosurgeon Dr [A] requested a review for low back pain with right sciatica. The doctor wrote that the patient was asking about MRI and consideration for surgery, noting previous management trials of Mobic, simple core exercises, physiotherapy, weight reduction and possible dietician input. > > b) MRI reports of the lumbar spine dated 9 September 2021 and 15 November 2022 reported by radiologists Dr [D] and Dr [E] respectively were noted. The reports identified disc pathology at L3/4, L4/5 and L5/S1. > > c) An employment services assessor report dated [March] 2022 documented a baseline work capacity of 15 to 22 hours a week. > > d) A letter from neurosurgeon Dr [B] dated 27 May 2022 documented a diagnosis of low back pain for many years with a recent deterioration and pain radiating into the right leg. The surgeon wrote that Mr Phelps was unable to work. > > e) A team care referral dated 6 December 2022 outlined management of physiotherapy, core exercises and spine surgery under a spine surgeon to manage low back pain. In an associated visit note dated 6 December 2022 pasted into the document the general practitioner noted that the spine surgeon had advised spinal fusion of L3 to L5 due to disc disease at three levels, but it would take 3-6 months before surgery could be performed. Therefore a new course of physiotherapy was suggested for the interim. > > f) Medical certificates by Dr [C] dated 2 June 2022, 15 September 2022, 24 July 2023, 26 June 2024, 23 September 2024 and 19 May 2025 were noted. The first two medical certificates documented a diagnosis of low back pain with right sided sciatica managed with cortisone and analgesia. Prognosis was uncertain. The doctor wrote that microdiscectomy decompression surgery was planned. The later four medical certificates documented a diagnosis of L4 disc prolapse with sciatica with a prognosis greater than 24 months. Management of analgesia and core exercises was noted with a comment that the patient had declined surgery due to potential side effects. > > g) A Job Capacity Assessment report dated [May] 2023 documented a spine condition that was diagnosed but not treated and stabilised. A work capacity of 15-22 hours a week within two years was documented with appropriate interventions. > > h) An admission form dated [May] 2023 for [Hospital 1] for spine surgery was noted.

1. The Tribunal noted the medical certificates dated 2 June 2022 and 15 September 2022 documented an uncertain prognosis and the later medical certificates dated 24 July 2023, 26 June 2024, 23 September 2024 and 19 May 2025 documented a prognosis greater than 24 months.
2. The MRI reports dated 9 September 2021 and 15 November 2022 both documented structural changes.
3. In oral evidence Mr Phelps stated the spine condition had been present for many years.
4. On balance the Tribunal preferred the prognosis from the later medical certificates and the applicant, noting the presence of structural changes in the MRI reports, and found that the spine condition would persist for longer than 24 months.

1. The Tribunal found the spine condition was fully diagnosed because the condition had been diagnosed by Dr [C] and Dr [B] and the diagnosis was supported by relevant imaging studies reported by Dr [D] and Dr [E].

1. The Tribunal noted consistent evidence of treatment with analgesia, cortisone injection, core exercises and physiotherapy.
2. However when Mr Phelps was referred for specialist input into management, the specialist had recommended spine fusion with microdiscectomy. The general practitioner had written that this surgery was planned in medical certificates written on 2 June 2022 and 15 September 2022 immediately preceding the date of claim for DSP.
3. The Tribunal noted further evidence that surgery was actively planned with Mr Phelps completing admission paperwork and paying a deposit for surgery [in] May 2023.
4. In oral evidence Mr Phelps stated that he only decided against surgery on the day of admission when he became scared. He had not yet gone back to see the specialist to discuss alternative management options or to reconsider surgery options.
5. The introduction to the 2011 Impairment Tables stated the factors the Tribunal had to take into consideration in regarding if a medical condition was fully treated and stabilised. The introduction stated:

(5) In determining whether a condition has been fully diagnosed by an appropriately qualified medical practitioner and whether it has been fully treated for the purposes of paragraphs 6(4)(a) and (b), the following is to be considered:

(a) whether there is corroborating evidence of the condition; and

(b) what treatment or rehabilitation has occurred in relation to the condition; and

(c) whether treatment is continuing or is planned in the next 2 years.

(6) For the purposes of paragraph 6(4)(c) and subsection 11(4) a condition is fully stabilised if:

(a) either the person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement to a level enabling the person to undertake work in the next 2 years; or

(b) the person has not undertaken reasonable treatment for the condition and:

(i) significant functional improvement to a level enabling the person to undertake work in the next 2 years is not expected to result, even if the person undertakes reasonable treatment; or

(ii) there is a medical or other compelling reason for the person not to undertake reasonable treatment.

(7) For the purposes of subsection 6(6), reasonable treatment is treatment that:

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

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

1. The Tribunal noted that the proposed surgery of spinal fusion and microdiscectomy was available through the public and private health system, was regularly performed, carried a good prognosis and acceptable risk profile and surgery was likely to elicit a reduction in pain and enhanced function. The surgery thus represented "reasonable treatment" for the identified spine condition.
2. The Tribunal further noted that there was no compelling reason for Mr Phelps to decline surgery. In oral evidence he indicated that he was concerned, but the reasons for this concern were not articulated and there was no evidence that he had made any attempt to go back to see the surgeon to determine if the surgeon shared a "compelling reason" for these concerns that might satisfy subparagraph 6(b)(ii) above.
3. The Tribunal found the spine condition was not fully treated and stabilised because reasonable treatment in the form of L3-5 spinal fusion with microdiscectomy remained outstanding on the date of claim and for the relevant period of this review.

1. As the Tribunal has found the spine condition was not fully treated and stabilised, it follows that impairment arising from the spine condition cannot be rated under the relevant Impairment Table.

1. In oral evidence at the hearing, Mr Phelps stated:

a) His mental health condition commenced about 10 years ago. > > b) He was first diagnosed by his former general practitioner and again by his current general practitioner. > > c) He saw a psychologist a few times in the past but was not currently seeing a psychologist. He had never seen a psychiatrist. He was treated with Efexor antidepressant medication. > > d) The functional impact of the mental health condition was that he was "all over the place". Sometimes he was good and other times he was not good. He had memory loss and would forget where he put something.

2. The Tribunal noted the following medical evidence in relation to the mental health condition:

a) Medical certificates by Dr [C] dated 24 July 2023, 26 June 2024, 23 September 2024 and 19 May 2025 were noted. The medical certificates documented a diagnosis of anxiety disorder with the prognosis recorded as being "long term". Management with medication was documented. > > b) The team care form dated 6 December 2022 noted medication of Efexor and a diagnosis of anxiety. > > c) A Job Capacity Assessment report dated [May] 2023 documented a mental health condition that was verified but not diagnosed, treated or stabilised. The assessor noted a motor vehicle accident in 2003 had resulted in the onset of this disorder and counselling occurred at this time. However no recent counselling was in place. Management with Efexor was noted.

1. The Tribunal accepted the consistent evidence from the medical certificates and the applicant that the mental health condition was "long term" and found the condition would persist for longer than 24 months.

1. The Tribunal noted evidence of the diagnosis of an anxiety disorder by Dr [C] in the medical certificates dated 24 July 2023, 26 June 2024, 23 September 2024 and 19 May 2025. However there was no evidence before the Tribunal of a diagnostic formulation made by a psychiatrist, or, in the alternative, by a clinical psychologist. This was required before a mental health condition could be considered to be fully diagnosed for the purposes of DSP for an application lodged on 12 December 2022.
2. The introduction to the mental health Impairment Table stated:

The diagnosis of the condition must 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).

1. The Tribunal found the mental health condition was not fully diagnosed for the purposes of DSP because there was no diagnostic input from either a psychiatrist or a clinical psychologist.

1. As a result of finding the mental health condition was not fully diagnosed, it follows that impairment arising from the mental health condition cannot be rated under the Impairment Tables.

1. The Tribunal has found Mr Phelps has no conditions that are able to be rated under the Impairment Tables and therefore he does not satisfy paragraph 91(1)(b) of the Act.

Issue 3 - Does Mr Phelps have a continuing inability to work?

1. As the Tribunal has found that Mr Phelps failed to satisfy paragraph 94(1)(b) of the Act, the Tribunal did not proceed to determine whether he satisfied paragraph 94(1)(c) of the Act.

The decision under review is affirmed. This means the review is not successful.