[2013] AATA 753
General information, not legal advice.
Administrative Appeals Tribunal of Australia
2013-10-22
Original judgment source is linked above.
SOCIAL SECURITY - disability support pension - whether applicant has continuing inability to work - whether applicant has "severe impairment" - whether applicant actively participated in program of support - decision affirmed
Social Security Act 1991, s 94(2), Sch 1B
(2) A person has a continuing inability to work because of an impairment if the Secretary is satisfied that:
(aa) in a case where the person's impairment is not a severe impairment within the meaning of subsection (3B) - the person has actively participated in a program of support within the meaning of subsection (3C); and
(a) in all cases - the impairment is of itself sufficient to prevent the person from doing any work independently of a program of support within the next 2 years; and
(b) in all cases - either:
(i) the impairment is of itself sufficient to prevent the person from undertaking a training activity during the next 2 years; or
(ii) if the impairment does not prevent the person from undertaking a training activity - such activity is unlikely (because of the impairment) to enable the person to do any work independently of a program of support within the next 2 years.
Note: For work see subsection (5).
A "severe impairment" is one where the impairment is of 20 points or more, of which 20 points or more are under a single Impairment Table[1]. The Secretary contents that none of Mrs Tey's impairments warrant a rating of 20 points or more and thus her impairment is not a severe impairment. The Secretary contends that Mrs Tey has not actively participated in a programme of support with the result that s 94(2)(aa) of the Act cannot be satisfied.
TABLE 3. UPPER LIMB FUNCTION
All upper limb problems are assessed under the upper limb Table (Table 3). Each arm is assessed separately. Determination of upper limb impairments must be based on a demonstrable loss of function.
Rating Criteria
NIL Can use dominant limb effectively and/or
Demonstrable evidence of loss of strength, mobility, coordination, dexterity and/or sensation of upper limb which causes mild interference with hand function or manual handling.
FIVE Demonstrable evidence of loss of strength, mobility, coordination, dexterity and/or sensation of nondominant upper limb which causes moderate interference with hand function or manual handling.
TEN Demonstrable evidence of loss of strength, mobility, coordination, dexterity and/or sensation of dominant upper limb which causes moderate interference with hand function or manual handling.
FIFTEEN Demonstrable evidence of major loss of strength, mobility, coordination, dexterity and/or sensation of nondominant upper limb which causes significant interference with hand function or manual handling.
TWENTY Demonstrable evidence of major loss of strength, mobility, coordination, dexterity and/or sensation of dominant upper limb which causes significant interference with hand function or manual handling or
Unable to use nondominant upper limb at all.
THIRTY Unable to use dominant upper limb at all.
Dr Balint described[7] Mrs Tey's arm symptoms as "pain and discomfort on and off". He also described it as giving her limited use of the arm and reducing her work endurance. On the basis of that description a rating of 10 points only is warranted. There is no demonstrable evidence of symptoms causing significant interference with her hand function or manual handling and, as I was able to observe in the course of the hearing, Mrs Tey was quite able to use her (dominant) right hand.
TABLE 4. FUNCTION OF THE LOWER LIMBS
Table 4 is used to assess lower limb not spinal function (see Table 5). Assess both limbs together. Determination of lower limb impairments must be based on a demonstrable loss of functions.
Rating Criteria
NIL Walks without difficulty on a variety of different terrains and at varying speeds for distances of more than 500m.
TEN Demonstrable loss of strength, mobility, stability, balance, coordination and/or sensation such as to cause moderate interference with walking and one or more of the following: climbing, squatting, sitting or kneeling or
Pain or claudication restricts walking to 250500m or less, at a slow to moderate pace (4km/h). Can walk further after resting.
TWENTY Demonstrable loss of strength, mobility, stability, balance, coordination and/or sensation such as to cause major interference with walking and one or more of the following: climbing, squatting, sitting or kneeling or
Pain or claudication restricts walking (4km/h) to 50250m or less at a time. Can walk further after resting or
Unable to walk or stand but independently mobile using a selfpropelled wheelchair.
THIRTY Pain or claudication restricts walking (4km/h) to 50m or less at a time. Can walk further after resting or restricted to walking in and around home and:
requires quad stick, crutches or similar walking aid, or
is unable to transfer without assistance.
FORTY Unable to walk or stand and mobile only in a motorised wheelchair or wheelchair with an attendant.
Dr Balint's report described Mrs Tey's symptoms in this way[8]:
Ongoing knee pain and discomfort with difficulties walking, especially on uneven surfaces and steps. Requires regular painkillers.
The report indicates that Mrs Tey cannot stand or walk over a longer period of time and has low endurance for any physical work. That description demonstrates that a rating of 10 points is appropriate. There was no evidence that Mrs Tey was experiencing major interference with walking or any of the other activities that would warrant a rating of 20 points.
4. A rating is only to be assigned after a comprehensive history and examination. For a rating to be assigned the condition must be a fully documented, diagnosed condition which has been investigated, treated and stabilised. The first step is thus to establish a working diagnosis based on the best available evidence. Arrangements should be made for investigation of poorly defined conditions before considering assigning an impairment rating. In particular where the nature or severity of a psychiatric (or intellectual) disorder is unclear appropriate investigation should be arranged.
5. The condition must be considered to be permanent. Once a condition has been diagnosed, treated and stabilised, it is accepted as being permanent if in the light of available evidence it is more likely than not that it will persist for the foreseeable future. This will be taken as lasting for more than two years. A condition may be considered fully stabilised if it is unlikely that there will be any significant functional improvement, with or without reasonable treatment, within the next 2 years.
In my view the Social Security Appeals Tribunal was right to conclude that there was insufficient evidence to determine that the back condition had been fully diagnosed, treated and stabilised. That being so it is not capable of being given a rating under the Impairment Tables.
I certify that the preceding 14 (fourteen) paragraphs are a true copy of the reasons for the decision herein of Deputy President PE Hack SC
[1] See s 94(3B), Social Security Act.
[4] Item 4 of Schedule 3 to the Social Security and Other Legislation Amendment Act.
[5] Item 2 of Schedule 3 to the Social Security and Other Legislation Amendment Act.