(a) Miss Thornhill satisfies paragraphs 94(1)(a), (b) and (c) of the Social Security Act 1991 and, subject to satisfying any other relevant criteria, has been qualified for disability support pension from the date of her claim, which was lodged on 21 November 2023_._

SOCIAL SECURITY - disability support pension - spinal, shoulder and upper arm disorders - impairment rating - medical and job capacity reports - impairment tables - possible under-reporting of impairments - terminology in assessment determination - moderate upper arm and severe spinal and overall impairment - no improvement or worsening since relevant period - functional impact - continuing inability to work - "moderate" - "severe" - decision under review set aside and remitted

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 is an application for review of a decision by Services Australia - Centrelink (Centrelink) dated 19 December 2024 that the applicant, Miss Thornhill, was not entitled to receive disability support pension from 21 November 2023.
2. On 7 September 2023, Miss Thornhill submitted a claim for disability support pension in respect of her spinal, shoulder and upper arm disorders (folio 68 of the hearing papers). It appears that Centrelink did not treat her claim as having been made until certain further information had been provided, and that information was provided on 21 November 2023. On 29 July 2024, Centrelink rejected Miss Thornhill's application on the basis that she did not have an impairment rating of 20 points or more. Centrelink informed Miss Thornhill of this by letter dated 30 July 2024 (folio 206).
3. On 9 September 2024, Miss Thornhill requested a review of Centrelink's decision (folio 179). On 19 December 2024, an authorised review officer of Centrelink provided their decision, rejecting Miss Thornhill's application for disability support pension (folio 17). They decided that Miss Thornhill met the required impairment rating of 20 points but did not meet the "program of support" requirements in the applicable legislation.
4. On 17 March 2025, Miss Thornhill applied to the Administrative Review Tribunal (the Tribunal) for a review of Centrelink's decision. On 16 June 2025, the Tribunal conducted a hearing by MS Teams videoconference. Before the Tribunal were hearing papers supplied by Centrelink numbered 1 to 218 (the hearing papers). Miss Thornhill was supported by her mother, [Mrs A], and provided evidence on affirmation.
5. The Tribunal has had careful regard to all of the evidence and documents provided to it. Reference below is made only to the documents and evidence relevant to this decision.

1. The statutory provisions relevant to this review are contained in Part 2.3 of the Social Security Act 1991 (the Act), the Social Security (Administration) Act 1999 (the Administration Act) and the Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 (the Determination).
2. The issues for consideration in this application are, in relation to the period 21 November 2023 to 20 February 2024:
   • Did Miss Thornhill have any physical, intellectual or psychiatric impairments? And, if so,
   • Did the impairments rate at least 20 points under the Impairment Tables? And, if so,
   • Does Miss Thornhill have a continuing inability to work because of the impairments?

1. Disability support pension is an income support payment for people who are unable to support themselves through employment due to a physical, intellectual or psychiatric impairment. Section 94 of the Act sets out the requirements to qualify for disability support pension. In order to qualify, the person applying must have one or more conditions that are diagnosed, reasonably treated and stabilised, and that meet 20 points or more under the Impairment Tables in the Determination. The conditions must stop the person from working or undertaking a training activity at least five hours a week for the next two years.
2. Where (as in this application) the decision the Tribunal is reviewing relates to the rejection of a claim, an applicant may meet the medical qualification provisions as at the date they made their claim or at any time within the following 13 weeks.[1]
3. As noted above, Miss Thornhill initially uploaded her claim form for disability support pension on 7 September 2023. She was informed by Centrelink on 14 November 2023 that she needed to provide further information (folio 170), and apparently uploaded these documents, including a consent to disclose medical information form on 21 November 2023 (folio 86. In all the circumstances, the Tribunal finds, as Centrelink did, that the claim was made on 21 November 2023. The Tribunal finds that the relevant period under review in this matter is 21 November 2023 to 20 February 2024.
4. The Court has held that any subsequent change in a person's conditions or impairments is irrelevant to the Tribunal's consideration of that issue except if it casts light on the position during the relevant period.[2]

Issue 1: Does Miss Thornhill have a physical, intellectual or psychiatric impairment?

1. A critical requirement for qualification for disability support pension is that a person suffers from an impairment.[3] This is defined as a loss of functional capacity affecting a person's ability to work that results from the person's "condition".[4] The person's "condition" is a diagnosed medical condition or disorder. There must therefore, as a first step in any application for disability support pension, be medical evidence of a diagnosis of one or more conditions.
2. The Tribunal has reviewed carefully the medical evidence in the hearing papers. The Tribunal notes in particular: the reports from [Dr B], [Clinic 1] (later called [Clinic 2]) dated 16 August 2019 (folio 106), 21 April 2020 (folio 109) and 19 December 2023 (folio 114), the ultrasound report dated 8 June 2021 (folio 39), the MRI report from [Diagnostic Imaging] dated 9 June 2022 (folio 42), the report of [Dr C], orthopaedic surgeon, dated 14 July 2022 (folio 45), the discharge referral report from [Hospital] report of [Mr D], neurosurgeon, dated 1 September 2022 (folio 53) and his letters dated 31 August 2023 (folio 111), 16 November 2023 (folio 112), and 12 August 2022 (folio 47), and the certificate of capacity dated 6 October 2023 completed by Miss Thornhill's GP, [Dr E] (folio 82).
3. The Tribunal notes the following medical evidence from after the relevant period in particular: the letters from [Dr B] dated 29 February 2024 (folio 116) and 15 August 2024 (folio 124), the letters from [Mr D] dated 2 May 2024 (folio 118), 11 July 2024 (folio 122) and 1 August 2024 (folio 123), the report from [Clinic 2] dated 1 July 2024 (folio 120), the letter from [Dr E] dated 2 August 2024 (folio 96), the medical certificate signed by [Dr E] dated 13 August 2024 (folio 99), and the impairments questionnaire completed by [Dr E] on or about 12 November 2024 (folio 136).
4. Based on the available medical evidence, the Tribunal finds that as at the relevant period, Miss Thornhill suffered from the following conditions which were diagnosed by an appropriately qualified medical practitioner: spinal, shoulder and upper arm disorders.
5. The first requirement in section 94 of the Act is therefore satisfied.

Issue 2: Did Miss Thornhill's impairments rate at least 20 points under the Impairment Tables?

1. Qualification for disability support pension requires that the person's impairments rate 20 points or more under the Impairment Tables.[5] Rating an impairment can only take place once the condition causing that impairment is diagnosed by an appropriately qualified medical practitioner (which has been addressed above), has been reasonably treated and stabilised, and where the condition and the resulting impairment is more likely than not, in the light of available evidence, to persist for more than two years.[6]

Reasonably treated and stabilised and likely to persist for more than two years

1. In determining whether a condition has been "reasonably treated", the Determination requires consideration of:
   • What treatment or rehabilitation has occurred in relation to the condition; and
   • Whether treatment is continuing or is planned in the next two years and is likely to result in significant functional improvement.[7]
2. "Reasonable treatment" is treatment that is available at a location reasonably accessible to the person, is at a reasonable cost, can reliably be expected to result in a significant functional improvement, is regularly undertaken or performed, has a high success rate; and carries a low risk to the person.[8] These issues must be addressed by medical evidence.
3. A condition is "stabilised" if either:
   • The person has undertaken reasonable treatment for the condition and any further reasonable treatment is unlikely to result in significant functional improvement; or
   • The person has not undertaken reasonable treatment for the condition and:
     • Significant functional improvement is not expected, even if the person undertakes reasonable treatment; or
     • There is a medical or other compelling reason for the person not to undertake reasonable treatment.
4. The medical evidence referred to above supports that, as at the relevant period in this matter, Miss Thornhill had undertaken, in relation to her spinal, arm and shoulder disorders, a significant amount of treatment, including surgery and pain management. Noting the medical evidence referred to above and the treatment Miss Thornhill has undergone to date, the Tribunal finds (as Centrelink did) that her conditions of spinal, shoulder and upper arm disorders are reasonably treated, stabilised and more likely than not to persist for more than two years.

1. The Tribunal will therefore now go on to apply impairment ratings to Miss Thornhill's spinal, shoulder and upper arm disorders. This requires assessment of Miss Thornhill's impairments as at the relevant period (21 November 2023 to 20 February 2024) by reference to the Impairment Tables in the Determination. The Determination requires that information provided by specified health professionals and any additional available medical or work capacity information must be taken into account, but that symptoms reported by a person can only be taken into account where there is corroborating evidence within the meaning of the Determination.[9]
2. The impairments are to be assessed by reference to the appropriate Table in Part 3 of the Determination. If a condition causes multiple impairments, each impairment should be assessed under the relevant Table.[10] If multiple conditions cause a common impairment, however, a single rating should be assigned under a single Table.[11]
3. The Tribunal's task in reviews such as this one is somewhat artificial. It has to take account of the applicant's conditions and impairments in a period of time that has passed and where the applicant's condition and impairments have often worsened. Further, the Tribunal is restricted in most cases to the evidence that was obtained at the time of the claim for disability support pension, however limited that evidence is and, as noted above, can only use the applicant's own account of their impairments if it is supported by corroborating medical evidence.
4. Centrelink assessed Miss Thornhill's impairments by reference to Table 2 - Upper Limb Function, and Table 4 - Spinal Function. The Tribunal agrees that these are the correct Impairment Tables to use in this matter.
5. Centrelink decided that the impact on Miss Thornhill's upper limb function and her spinal conditions were, using the terminology of the Impairment Tables, "moderate" rather than "severe". The Tribunal sets out in an attachment to this decision the relevant extracts from Tables 2 and 4 for a "moderate" and "severe" impairment.
6. As well as the medical evidence referred to above, the Tribunal has taken note of the contents of a job capacity assessment report prepared for Centrelink dated 29 July 2024 (folio 89) and a second job capacity report dated 9 December 2024 (folio 134) (the December job capacity report).
7. Miss Thornhill told the Tribunal that the impact on her of her conditions had not worsened since the relevant period but nor had they improved as she had hoped. She has nerve damage in her hands and does not have feeling or sensation or grab in her hands. Her hands have been like this since her injury in 2010. Her right hand was a problem pretty much straight away and her left hand has become more and more affected. Her neck started to worsen over the last few years of her working life. She has had "electrical nerve pain" down her arms but said that that had improved greatly. However, she has difficulty carrying things and cannot, for example, pick up her phone. Preparing meals is very difficult as she often drops things but she no longer prepares fresh meals. Her mother takes her shopping and she mostly buys prepared salads or prepared meals. She drops cutlery most of the time but can use them. It can be dangerous drinking cups of tea as her hands do not feel the difference between hot and cold. She has difficulties holding a pen and has to grip it in multiple different ways, to find whatever her hand can do. She cannot turn the pages of a book, not just because of her hands but also because of her neck. It is difficult for her to look up and down. The position of her neck plus the requirement of holding a book and her hands to move the pages together mean she does not read a lot, including a lot of the documents she receives from Centrelink. She gives the documents to her mother and asks her to summarise them.
8. Miss Thornhill said that she does not wear clothes with zips or buttons although she does wear shoes with zips as she cannot use laces. She avoids using a keyboard as much as possible. Miss Thornhill cannot reach up overhead and has had most of her cupboards brought down, or the kitchen implements in those upper cupboards moved down. Breast height is the highest her arms will go. She said that she had her kitchen redone in this regard while she was still at work and her movements had been a problem like this for a long time.
9. Miss Thornhill said that she does not tend to use her outdoor clothesline, although she had the clothesline brought closer to the house and the path made higher to assist her. She mostly uses an inside clothes horse.
10. She said that bending forward "kills" her lower back and she would rather get down on her knees to crawl. When she is seated, she is constantly shifting or moving and has to stand up very often. She believes that is why driving a car is so difficult for her as you are stuck in a position with the seat belt and cannot move. She is also not comfortable having her arms up on the steering wheel. She has had a lot of near misses as regards falls but lives in a small home so is able to grab furniture to stop herself from falling. She does not use walking aids because she cannot use them, as she cannot grasp them. She is sure they would help her lower back and noted she was [an occupation] for many years. She also raised a number of issues regarding ongoing incontinence.
11. The Tribunal discussed with Miss Thornhill [Dr E's] response in November 2024 to the questionnaire sent to her by Centrelink. Miss Thornhill said that she went through the questions with [Dr E]. She said that she thought some of the questions were ridiculous, if you were at the level they were saying, there was no way you could live at home on your own. She said that they answered the questions honestly and considered the tables to be very strange. The Tribunal considers it possible that Miss Thornhill underreported her impairments.

1. Centrelink appears to have relied on [Dr E's] responses to the questionnaire Centrelink had sent her (folio 136) and the December job capacity report which stated:

- High levels of recovery when using for a period of time

- Difficulties with ADLS' e.g., home care, bed making etc.

- Difficulty with driving i.e., holding arms up/horizontal

Can use a standard computer keyboard, mouse or phone function but uses left hand more

- Difficulty with grip e.g., unscrewing the lid on a bottle or jar.

Radiologist, [Dr F] (08/06/2021) notes 'Biceps tendon is intact. Subscapularis not seen due to limited range of movement. Supraspinatus and posterior cuff are intact. Dynamic assessment is limited due to pain. Unremarkable bursa. No signs of effusion'.

Descriptors Rating Summary - as per Date of Claim 21/11/2023 (Plus 13 weeks): As a result, based on all the available evidence the rating of 10 impairment points reflects the claimant's impairment in relation to their capacity to perform work-related tasks/activities and/or general activities of daily living; as per [Dr E] (06/12/2024) 1 (b, c, d, e, f and g) are deemed to be met.

1. [Dr E's] response to the questionnaire stated that Miss Thornhill's impairments by reference to Table 2 were "moderate".
2. Miss Thornhill's evidence to the Tribunal supports that the functional impact on her may in fact be severe (by reference to the activities of handling objects, using a small object and turning the pages of a book). However, the Determination requires there to be corroborating medical evidence of Miss Thornhill's evidence. On careful review of the evidence before the Tribunal, the Tribunal is unable to find that there is such corroborating medical evidence,. On the available medical evidence and taking into account the wording of Table 2, the Tribunal considers (as the Centrelink authorised review officer did) that the appropriate impairment rating for Miss Thornhill as at the relevant period (21 November 2023 to 20 February 2024) under Table 2 is "moderate", which requires assigning a 10-point impairment rating.
3. The Tribunal wishes to make it clear that when it says that the impact on Miss Thornhill's functioning of her conditions is "moderate" rather than "severe", it is using the terminology in the Determination, rather than commenting on the actual day-to-day effect on Miss Thornhill of her conditions. It is clear to the Tribunal that the effect on her is significant.

1. Centrelink appears to have relied on [Dr E's] responses to the questionnaire Centrelink had sent her and the December job capacity report which stated:

- Sitting; 15 minutes before needs to change position/ stand

- Steps/Stairs; can do but with a rail is preferable

- Walking on flat gradient is ok but slow - will lean on trolly is at supermarket.

Orthopaedist, [Dr C] (14/07/2022) notes 'Severe disease in the mid cervical spine as described especially at C4-5 where there is cord compression and myelomalacia. There is also right C3-4 and right C5-6 foraminal stenosis with the left C4-5 foramen also significantly compressed.

- Unable to look upwards and perform any activities that require extension of neck as part of movement.

- Limitation of rotation of neck, or flexion of neck to a capacity of about 20% of normal movement. If needs to look sideways or downwards, needs to move whole of trunk as well.

- Cannot remain seated for more than 15 minutes at a time, then needs to get up and move about and change positions.

[A/Prof. B] (15/08/2024) notes 'She has done very well after her cervical facet joint radiofrequency neurotomy with a marked reduction in her neck pain and she is very happy with the outcome. She finds that it only returns with heavy physical activity and understands she needs to modify that'.

Descriptors Rating Summary - as per Date of Claim 21/11/2023 (Plus 13 weeks): As a result, based on all the available evidence the rating of 10 impairment points reflects the claimant's impairment in relation to their capacity to perform work-related tasks/activities and/or general activities of daily living; as per [Dr E] (06/12/2024) 1 (a, b, and c) are deemed to be met.

1. [Dr E's] response to the questionnaire stated that Miss Thornhill's impairments by reference to Table 4 were "moderate".
2. Table 4 requires, in order for an impairment to be considered "severe", that a person has severe difficulty with at least one of the listed activities:
   • Looking upwards to perform any overhead activities.

• Either turning their head, or bending their neck at all, without moving their trunk.

1. The Tribunal considers that Miss Thornhill's evidence to the Tribunal supports a severe impact on her within the meaning of Table 4 but is required to have corroborating medical evidence.
2. Notwithstanding [Dr E's] statement in the questionnaire that the impacts under Table 4 were "moderate", the Tribunal notes [Dr E's] letter dated 2 August 2024 (folio 96), which is closer in time to the relevant period than her answers to the questionnaire and contains more detail. In that letter [Dr E] stated:

To answer to your questions of 11.7.24, I can confirm the following disabilities.

l. Unable to look upwards or perform any activities that require extension of neck as part of that movement.

b. Limitation of rotation of neck, or flexion of neck to a capacity of about 20% of normal

movement. If needs to look sideways or downwards, needs to move whole trunk as well.

d. Cannot remain seated for more than 15 minutes at a time, then needs to get up and move about and change positions.

1. Although the Tribunal does not have before it the questions [Dr E] was responding to, it is clear that she was addressing the "severe" section of Table 4. Notwithstanding that this letter was sent after the relevant period, the Tribunal considers that it can be relied upon as evidence of Miss Thornhill's impairments within the relevant period given its proximity in time and as there is no evidence of any injury or other event between the relevant period and 2 August 2024 that may have caused Miss Thornhill's conditions and/or their impact on her functioning to worsen.
2. That evidence supports that the impact on Miss Thornhill's functioning of her spinal conditions are more than moderate.
3. Noting again that Miss Thornhill is required to satisfy at least one of the impacts set out above, based on Miss Thornhill's evidence to the Tribunal and the letter of 2 August 2024 from [Dr E] as corroborating medical evidence, the Tribunal finds that the appropriate impairment rating for Miss Thornhill as at the relevant period (21 November 2023 to 20 February 2024) under Table 4 is "severe", which requires assigning a 20-point impairment rating.

1. The outcome of the Tribunal's consideration of Miss Thornhill's impairments is that it finds that, taken together, Miss Thornhill has an impairment rating of 30 points.

Issue 3: Does Miss Thornhill have a continuing inability to work because of the impairments?

1. The final requirement for qualification for disability support pension is that the person has a continuing inability to work because of their impairments or is participating in the supported wage system.[12] This requirement, in paragraph 94(1)(c) of the Act, is addressed further in subsection 94(2) of the Act:

(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) or the person is a reviewed 2008-2011 DSP starter who has had an opportunity to participate in a program of support - the person has actively participated in a program of support within the meaning of subsection (3C), and the program of support was wholly or partly funded by the Commonwealth; 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

(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.

1. If the person has a total impairment rating of 20 points or more under the Impairment Tables of which 20 or more points have been assigned from a single Table, they are taken to have a "severe impairment" and only need to be assessed under paragraphs 94(2)(a) and (b) of the Act.[13] As the Tribunal has found that Miss Thornhill's impairments should be assigned a rating of 10 points under Table 2 and 20 points under Table 4, this applies in her case.
2. It is clear on the available medical evidence that, as at the relevant period, Miss Thornhill's impairments were sufficient to prevent her from doing any work independently of a program of support within the next two years. The Tribunal notes in particular the issues with her hands and in remaining seated. The Tribunal also considers that the available medical evidence supports that Miss Thornhill's impairments are sufficient to prevent her from undertaking a training activity during the next two years (and notes that this appears to be supported by the medical certificates in the hearing papers).
3. The Tribunal therefore finds that Miss Thornhill satisfies the requirements of paragraph 94(1)(c), as addressed in subsection 94(2) of the Act, and that Miss Thornhill has a continuing inability to work because of her impairments.

The Tribunal sets aside the decision under review and remits the matter for reconsideration in accordance with the order that:

(a) Miss Thornhill satisfies paragraphs 94(1)(a), (b) and (c) of the Social Security Act 1991 and, subject to satisfying any other relevant criteria, has been qualified for disability support pension from the date of her claim, which was lodged on 21 November 2023_._

There is a moderate functional impact on activities using upper limbs.

(1) The person has moderate difficulty carrying out at least 4 of the following:

(b) picking up a light but bulky object requiring the use of 2 hands together;

(d) doing up buttons, tying shoelaces or doing up a zipper;

Example: wearing clothing that goes on over the head to avoid doing up buttons.

(e) raising arms to dress or wash hair, or reaching into a cupboard at head height;

(f) using a standard computer keyboard, mouse or phone functions;

(g) carrying out a function such as grip and twist or pinch and pull.

Example 1: unscrewing the lid on a bottle or jar, or turning a tap.

There is a severe functional impact on activities using upper limbs.

(1) At least 3 of the following apply to the person:

(a) the person has limited movement or coordination in both upper limbs, has an amputation or nerve damage rendering an upper limb non-functional;

(b) the person has severe difficulty handling, moving or carrying most objects without assistance;

(c) the person has severe difficulty using a small object;

Example: holding and using a fork or spoon, holding and using a pen or pencil.

(d) the person has severe difficulty turning the pages of a book without assistance;

(e) the person has severe difficulty undertaking any activity that involves reaching overhead.

Example: accessing items above shoulder height, brushing hair.

There is a moderate functional impact on activities involving spinal function.

(1) The person is able to sit in or drive a car for at least 30 minutes, and at least one of the following applies:

(a) the person has moderate difficulty sustaining overhead activities such as accessing items above head height; or

Example: looking up to hang washing on a clothesline.

(b) the person has moderate difficulty moving their head to look in all directions; or

Example: turning their head to look over their shoulder;

(c) the person has moderate difficulty bending forward to pick up a light object placed at knee height; or

(d) the person has moderate difficulty standing up from a sitting position in a standard chair without assistance.

Example: the person has moderate difficulty standing after being seated in a dining chair.

Note 1: this impairment rating level includes a person who can:

(a) move around independently using a wheelchair and can independently transfer to and from a wheelchair; or

Example: the person can use a wheelchair accessible toilet independently.

(b) move around independently using walking aids such as a quad stick, crutches or walking frame.

Note 2: the person may require additional time and effort to move around a workplace, may need to use accessible entries, lifts and toilets, and may not be able to access some areas of a workplace or training facility.

There is a severe functional impact on activities involving spinal function.

(1) The person has severe difficulty with at least one of the following:

(a) looking upwards to perform any overhead activities; or

(b) either turning their head, or bending their neck at all, without moving their trunk; or

(c) bending forward to hip height; or

Example: the person cannot bend forward to wipe a table or pick up a light object weighing less than 1kg from hip height.

Example: the person frequently changes positions between sitting and standing or frequently shifts weight in a chair when seated.

Note: this impairment rating level includes a person who requires assistance to:

(a) move around in, or transfer to and from a wheelchair; or

Example: the person needs personal care assistance to use a toilet;

(b) move around using walking aids such as a quad stick, crutches or walking frame and the person requires assistance from another person to walk on some surfaces and cannot move independently around a workplace or training facility, even when using a walking aid.

Example: the person is at significant risk of, or has frequent falls due to balance or other issues.

[1] Under the "early claim" provisions at Clause 4 of Schedule 2 to the Administration Act.

[2] Harris v SDEWR [2007] FCA 404.

[7] Subsection 8(5) of the Determination.

[8] Subsection 8(7) of the Determination.

[9] Sections 9 and 10 of the Determination.

[10] Subsection 12(4) of the Determination.

[11] Subsection 12(6) of the Determination.