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NDIS Knock Back No. 2

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I have been working on my NDIS application since August 2022, with nearly six months of evidence collection, specialist appointments, and storytelling.

I was rejected again by the NDIS today after a request for an appeal was denied.

With me spending months explaining and evidencing that my trigger of FND is pain and not mental health or trauma etc., they have excepted this fact. However, now have stated my chronic pain is not ‘fully treated’ noting I have provided the following:

  • Evidence that my chronic pain was from a workplace injury over 22 years ago
  • I see a pain specialist and have letters from two dating back to 2018
  • I have increased treatment since 2017
  • Specialist medication therapy
  • Regular Physiotherapist, massage, and Pilates
  • Steroid injections, dry needling
  • Radio Frequency 3 times per year for three years
  • Multiple MRI’s
  • Multiple hospitalisations and the need to receive four separate rehabilitation in patient care,
  • Podiatrist review and treatment
  • 2021 having a spinal cord stimulator installed.
  • Referred to Neurologist to work in partnership with Pain Specialist in 2022.

This was my rejection response letter

I am not satisfied that this criterion has been met for your neurological impairment resulting from Functional Neurological Disorder and your physical impairment resulting from Chronic Pain.
Importantly, this criterion is not questioning the legitimacy or permanency of any diagnosis, but it is assessing the permanency of the impairment and functional impacts (for example, your reduced capacity for mobility, self-care etc.) that result from these diagnoses.

The NDIA acknowledges that you live with limitations that affect your functional capacity, that you have had to adjust the way you do things and rely on others for assistance. However, to meet this criterion, the evidence must demonstrate that you usually need disability-specific support to participate or complete activities in one or more of the six key activities assessed (communication, social interaction, learning, mobility, self-care and self-management).

I understand you require and benefit from equipment such as Canadian Crutches. Reliance on such items are not considered substantially reduced functional capacity as the items required are considered to be ‘commonly used items’ rather than specialist equipment or technology that is specifically designed to increase the functional capacity and participation of people with disability. Section 5.8 of Becoming a Participant excludes commonly used items. If a person can mobilise with a commonly used item, then it will not satisfy the requirements of Section 5.8.l

NDIS rejection letter dated 6/02/23

The example used in the NDIS instructions and guideline state that a commonly used item is like prescription reading glasses. This is a considerable stretch similar to a walking aide that still, for the most part, traps me in my home, car or workplace, unable to do things with my family and often misses out because of my inability to mobilise.

In short, the rejection was solely because I can use cheap, regularly available mobility equipment to enable me to walk and mobilise (even though this is done with great effort, prone to falls & need supervision and support when in crowded areas. I needed a prescription that you can’t buy from a chemist. Or need to be ‘more disabled’ (paraphrasing here)

So I am back to square one, encouraged by the NDIS to use my GP management plan and private health insurance to receive the support I require.

The purpose of applying for the NDIS was to ensure I maintained my current mobility.

It ensured I could continue to work, pay taxes, and have a somewhat ‘normal’ life.

Not returning to the hospital every 12-18 months with a significant flair-up and having to learn to walk each time (noting the impact on the health system and broader society).

I’m asking for a minimal plan from the NDIS, a modest request, one that each engagement seems like an impossible task.

The system is backward. It is set up to look for ways to reject someone’s application. The scheme is not looking for ways to help the vulnerable and those who genuinely require the service.

I want to work.

I want to have an opportunity to participate in civic and social activities.

I need to be able to support and be available for my family.

Without the NDIS support, I won’t be able to continue the above long-term.

I think I’ve got 3-6 months left until I will require more intensive support.

Disability Support Declined

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Late November 2022, I was optimistic and had a sense of hope that I would finally have the supports I needed to maintain my functional mobility, which in turn would enable me to live a somewhat ‘normal’ albeit modified life, after coming to terms with my functional neurological disorder (FND).

I had a modest goal, requesting minor equipment and support for 2-3 days per week (physio, massage, and hydrotherapy). This request to the NDIS would decrease the need for future extended hospitalisations, maintain my current mobility, and hopefully slow or best case cease any further functional decline. Therefore reducing the cost the the health system, maintaining my ability to drive, to participate in civic and family activities, and importantly being able to continue to work and provide for my family.

I applied for Australia’s National Disability Insurance Scheme (NDIS) after gathering the required evidence and producing a highly compelling report from FND Australia outlining my functional capacity from an Occupational Therapy perspective. I spent the last three months compiling reports, letters of support, working through the eligibility criteria and ticking each item off the list.

Along with time-consuming evidence gathering, this process is/was expensive in the past 3 months, separate from my already costly health insurance premium. I have spent well over $3000 on therapies, reports, and medical appointments. Not including the additional increase in my medication regimen.

In my previous blog, I wrote about the fact my disability is permanent. My current state is my new normal. The ironic thing is that the NDIS declined my application due to their opinion of my disability not being permanent or, in NDIS language, ‘fully treated’. This is despite having letters confirming my disability from at least six separate medical professionals.

This decision means I currently have no access to formal support. I graduated from the rehabilitation day program (another reason I don’t understand the NDIS rejection). My day program ceased as I had met the goals set, noting that the physio, rehab registrar etc., have stated that I have likely hit the functional capacity. My mobility will not improve, and I need to walk at a minimum with crutches and be supervised outdoors.

I have been meaning to write this blog since the 9th of December; this was the day I was knocked back from the NIDA. Honestly, I was too mad at the ‘system’, the person who phoned me to inform me, and the decision itself.

They have stated that my FND is not fully treated, and in the formal correspondence, it was noted;

Disability requirements
Based on the available evidence, Jeramy Hope does not meet the disability requirements as set out in Section 24 of the NDIS Act, specifically: Is your impairment likely to be permanent, Section 24(1)(b)2

‘The NDIS Act requires that we consider if you’ll likely have your impairment for your whole life.
Even when your condition or diagnosis is permanent, we’ll check if your impairment is permanent too. For example, you may not be eligible if your impairment is temporary, still being treated, or if there are remaining treatment options.
The available evidence confirms that Jeramy Hope has Functional Neurological Disorder and Chronic Pain.
However, this evidence does not indicate that all available and appropriate treatment options that are likely to relieve or cure Jeramy Hope’s impairments have been explored. These treatment options must be explored before this requirement can be met’.

The letter stated my ineligibility and was highly formal, just an essential; you must explore all treatment opportunities for my chronic pain and FND.

This was despite having a chronic pain diagnosis for over 20 years, having a spinal cord stimulator, and having evidence of explored therapies over the past seven years, in addition to my FND diagnosis confirmed by specialists for over six years, with clear evidence of various treatments explored, and not being effective.

On the phone call with the NDIS, the assessor went to inform me of his reasons why I was declined and areas that I need to explore and evidence if I was to reapply. His knowledge of my disability was limited, and the additional ‘evidence’ he requested was irrelevant to my disability or application. He went to say the following –

  • That I have not completed CBT and other behavioural therapy therapies (meaning he wanted me to receive phycological treatment, despite my FND being triggered by my chronic pain and not mental health).
  • I have not completed a fall prevention course (unsure why this was a requirement, however, the rehab sessions that were conducted 6 hours per week had a fall prevention and safety factor in them).
  • They did not believe that my crutches were medically prescribed (despite this being documented in my OT & Physio reports).
  • I needed a letter from my pain specialist – regarding my chronic pain (noting this was provided by my GP, pain specialist, and in medical reports submitted).
  • I needed a letter proving that I do not have mental health (i.e., my trigger of FND is pain, not mental health).

He suggested (on behalf of the NDIS)-

  • A Letter from my pain specialist outlining chronic pain – possibly try and link to FND (although already submitted, I have now have 2 additional letters to support my application).
  • A letter from my Neurologist stating that my FND is fully treated and triggered by pain. (I now have this letter ready for resubmission; however, I am not comfortable with the wording, so I am getting the letter adjusted).
  • Completing a fall course (I don’t even know what this is). (I have had confirmation in writing by two specialists confirming that it occurred in the hospital and day program during my rehab sessions).
  • Confirmation that my crutches are medically prescribed. (again, although this was done twice in the initial application, I had two specialists write letters confirming the prescription).
  • See a phycologist to confirm I do not have any mental health condition and would not benefit From CBT therapy. (my treating team advised me that this was not needed, however, to strengthen my application, my GP has written a letter confirming that I have not requested nor in his option require mental health support).

I have 120 days to request a review of the decision; this can include additional information, reports etc. I have already added four new reports, trying to get a 5th rewritten to strengthen my application. In the meantime, I am trying my hardest to maintain my mobility, continue with conditioning exercising, and hope I don’t have a flare-up that will require further hospitalisation.

I have had various professionals and disability industry experts review my evidence, and I have written an explanation email as a cover letter outlining the gaps the NDIS have perceived even though the information already being provided.

Finally, I reached out to a formal disability advocacy organisation, and a few days before Christmas, they confirmed they had agreed to pick up my case. We will work together in mid-January to review the current documentation and prepare an application, and if needed, seek legal advice before any further application is made.

For a scheme that should be in place to assist people with disabilities, they don’t make it easy, and even though I have been in the industry for over 20 years, I have become overwhelmed. As someone who would classify me as an expert, I have found it challenging to navigate the application process. I feel it is incredibly wrong as a person with a disability to provide proof beyond already supplied complex medical records. The cost to access the scheme is prohibitive to many, and I know I am fortunate that I can request more information, assist medical professionals with the language to use, and collate years of evidence to tell my story. Many others in the community don’t have access to the means or support needed to evidence disability. The hoops jumped, and inconsistency in a person being able to decide my fate is wrong and even more disappointing, as this is happening to many others more vulnerable than me.

I will continue to fight, jump through the hoops, and find a way to satisfy the NDIS requests once this is done and accepted into the scheme. I will contemplate the most appropriate way to lodge a complaint and provide a way for the NDIS to learn, develop and grow as a scheme, as no person with a genuine disability should need to go through this.