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Tribunal: Dr Louise Bygrave, Member

The applicant applied to the National Disability Insurance Agency (NDIA) to become a participant in the National Disability Insurance Scheme (NDIS) based on his conditions of fibromyalgia and chronic pain syndrome.

The NDIA decided the applicant did not meet the requirements to access the NDIS. The applicant requested an internal review and the NDIA affirmed the original decision. The applicant then applied to the AAT for review.

The applicant sought access to the NDIS for supports to assist him to self-care, self-manage and socialise. The applicant stated he had been living with his disability since 2008, and these conditions caused him substantial difficulties in all aspects of his life including problems with movement, concentration, mood swings, and activities related to daily living such as dressing, showering and household chores.

The issue for determination by the AAT was whether the applicant met one set of requirements for access to the NDIS called the ‘disability requirements’.[1] These requirements include, among other things, that the applicant’s impairment is, or is likely to be, permanent. Within the rules of the NDIS, an impairment is permanent if there are ‘no known, available and appropriate evidence-based clinical, medical or other treatments that would be likely to remedy the impairment’.[2]

In considering this question in relation to the applicant’s circumstances, the AAT referred to all the medical evidence before it, including evidence from specialist medical practitioners. The AAT acknowledged the evidence showed the medical treatment of fibromyalgia is difficult as it involves balancing treatment and care with supporting a person to continue activities of daily living. Based on all the evidence, the AAT could not be satisfied that the applicant had tried all available treatment options. The AAT was therefore not satisfied that the applicant’s impairments were permanent.

The AAT concluded the applicant did not meet the requirements for access to the NDIS and affirmed the NDIA decision.

Read the full decision on AustLII.


[1] Section 24 of the National Disability Insurance Scheme 2013 (Cth).