Emerge Australia supports people with ME/CFS to submit their best Disability Support Pension (DSP) application.
Emerge Australia has created this resource for people who live with ME/CFS and Long COVID, and who want to apply for the DSP. While ME/CFS and Long COVID both include many disabling symptoms, this resource focuses on the impact of post-exertional malaise, which is the main symptom of these conditions. This is because that symptom is clearly stated in Impairment Table 1.
The first step in preparing a DSP application is to visit the Services Australia website for full details about DSP eligibility and the application process. Emerge Australia has provided resources to help you prepare an application, but this does not replace the need to check details with Services Australia.
What is the DSP?
The DSP provides financial help for people who live with a physical, intellectual or mental health psychiatric condition that is likely to persist for more than two years and stops them from working. If the person applying for the DSP is already receiving an income support payment, they won’t need to meet mutual obligation requirements while Services Australia assesses their DSP claim.
Not everyone with a disability or medical condition can access the DSP. The Services Australia website provides information about eligibility.
To be eligible to apply, you must:
- be at least 15 years and 9 months, and not yet eligible for the age pension
- have been an Australian resident for at least 10 years (with no break in residence for at least five years)
- meet Services Australia income and assets tests.
Your condition must also:
- be likely to persist for more than two years
- stop you from working at least 15 hours a week in the next two years
- impact your capacity to undertake activities
- have an impairment rating of 20 points or more
- be diagnosed, reasonably treated and stabilised.
If you do not meet an impairment rating of 20 points or more in one Services Australia Impairment Table, you may still be eligible if you:
Understanding the Impairment Tables
Services Australia uses Impairment Tables to decide access to the DSP. There are 15 different Impairment Tables that Services Australia uses to assess if a person meets the general medical rule for DSP. Each of them cover a different impairment, such as physical exertion and stamina, limb, brain, communication, visual, hearing and mental health.
For the purposes of the DSP, Services Australia defines an impairment as a ‘loss of functional capacity affecting a person’s ability to work, that results from the person’s condition’.
Each table includes two main parts.
- Part 1 covers the medical assessment of a disabling condition, making sure the condition is diagnosed, reasonably treated and stabilised.
- Part 2 assesses the effect those conditions have on the person’s ability to work and assigns an impairment rating.
To meet the general medical rule, you will need to:
- have a rating of 20 points or more on a single Impairment Table, or
- have a rating of 20 points or more in total on more than one Impairment Table and meet the Program of Support rules.
Your DSP application needs to address both these issues, showing that your condition has been diagnosed, reasonably treated and stabilised, and that you are impaired significantly enough to qualify for the DSP.
Each Impairment Table has specific diagnosis and specialist medical evidence requirements. People who live with ME/CFS generally use Table 1 (Physical Exertion and Stamina) and Table 7 (Brain Function).
Part 1 and Part 2 are covered in more detail below. The Impairments Tables can be accessed here.
Part 1 – Providing medical evidence of diagnosis, treatment, stability and permanence
For Part 1 of the Impairment Tables, all medical reports need to provide evidence that the condition has been:
- diagnosed by an appropriately qualified medical practitioner – requires a report from your treating doctor and a report from a medical specialist
- reasonably treated – requires documentation of what treatment or rehabilitation you have had and if it is ongoing
- stabilised – requires evidence that reasonable treatment has been undertaken and significant functional improvement in the future is unlikely
- permanent – that the condition and the resulting impairment is more likely than not, based on the available evidence, to persist for more than 2 years.
Note: A medical report can include mention of any doctors who have diagnosed you with ME/CFS and if there has been further follow-up or secondary diagnosis.
Part 1 – Example medical letter
We have provided an example of a medical letter for a hypothetical person named Mary. This letter addresses Part 1 of the eligibility requirements, but it is an example only and should not be replicated. It is to be used as a guide only to help you describe your post-exertional malaise.
This example does not replace a medical assessment of disability and is not to be submitted as part of a DSP application.
In dd/mm/yyyy, Mary was diagnosed with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), where the core disabling symptom is post-exertional malaise.
Mary was initially diagnosed with ME/CFS by Dr Smith in 2011. In 2015, this diagnosis was further assessed by Dr Jones who confirmed the diagnosis of ME/CFS.
Mary has taken the following medications and non-pharmaceutical treatments to manage her ME/CFS:
List all relevant medications taken to manage/treat ME/CFS
List all relevant non-pharmaceutical treatments taken to manage/treat ME/CFS
Current research does not support the use of graded exercise therapy or cognitive behavioural therapy for ME/CFS, due to post-exertional malaise. Both therapies are not likely to improve Mary’s functional capacity and pose a risk of harm. For this reason, they are not recommended for Mary.
With all clinical or pharmaceutical-based treatments now tried, Mary’s disability is considered permanent and, considering available evidence, will persist for more than two years.
Part 2 – Providing medical evidence of impairment and inability to work
Use the Impairment Table to assess the impact ME/CFS has on your ability to work, remembering that:
- when assessing episodic or fluctuating impairments and conditions, the impairment rating must reflect the overall functional impact of those impairments, taking into account the severity, duration and frequency of the episodes or fluctuations, as appropriate
- a person who lives with ME/CFS must be able to perform an activity when they would be expected to do so and not only once or rarely. The impairment rating should not be solely based on the person’s presentation on the day of assessment
- assistance means help from another person, rather than any aids or equipment the person may use, unless specified otherwise.
To provide an example of a letter for people who live with ME/CFS, Emerge Australia has decided to focus on Table 1 – Functions requiring Physical Exertion and Stamina, with a rating score of 20 points.
However, you may find you fit better with other tables or ratings scores that are relevant to your condition. Impairment Table 7 – Brain Function is sometimes used and has ME/CFS incorporated into the Impairment Table’s introduction section.
If you are applying for the DSP, it is a good idea to keep a daily journal to record:
- the health professionals you have visited
- the frequency and support you needed to safely access and advocate during appointments
- any assessment of your home for equipment
- any support you receive, including NDIS or Aged Care for Under 65 packages
- how much physical or cognitive activity and energy you can use in one burst, and how much rest you need to maintain a stable state and not trigger post-exertional malaise.
Part 2 – Example medical letter
This letter focuses on Table 1 – Functions requiring Physical Exertion and Stamina. However, you may feel you fit better with other tables or ratings scores that are relevant to your condition. This letter is an example only. It does not replace a medical assessment of disability and is not for submission as part of your DSP application.
Table 1 – Functions requiring Physical Exertion and Stamina 20 points
Mary experiences a severe functional impact (20 points) on activities requiring physical exertion or stamina. She meets criteria (a) and (b) outlined in the DSP Impairment Table:
(a) Usually experiences symptoms such as fatigue, post-exertional malaise and pain when performing light physical activities. Due to these symptoms, Mary has severe difficulty:
- walking or mobilising in a wheelchair or other equivalent assistive technology from the carpark, into and around local facilities without assistance; or
- using public transport without assistance; or
- performing light day-to-day household activities without requiring a long recovery period afterwards; or
- performing personal care activities without assistance.
(b) Has, or is likely to have, severe difficulty sustaining work-related tasks of a clerical, sedentary or stationary nature for a shift of at least three hours.
Mary has severe difficulty undertaking the following activities related to these criteria, experiencing severe symptoms of fatigue, post-exertional malaise and pain.
(i) Walking or mobilising in a wheelchair or other equivalent assistive technology from the carpark, into and around local facilities without assistance:
Mary has severe difficulty leaving the house due to insufficient energy reserve. One trip to the supermarket will trigger post-exertional malaise, leaving her bedbound and unable to unpack the shopping. After this trip, Mary will be unable to participate in any activity, and it can take up to four days until the post-exertional malaise settles. During post-exertional malaise, Mary struggles to walk to the bathroom or the kitchen to get a glass of water.
(iii) Performing light day-to-day household activities without requiring a long recovery period afterwards:
For every 30 minutes of light activity, Mary needs approximately 60 minutes of rest to rebuild her energy reserve. If she was to continue to push past 30 minutes of light activity, she experiences post-exertional malaise and other debilitating symptoms. Mary would need to lie down until the symptoms stabilise and she has returned to her baseline. At times, this can be hours to days, depending on how much she exceeded her energy reserve. During post-exertional malaise, Mary’s functional capacity is impacted and she is unable to complete light activity.
(iv) Performing personal care activities without assistance:
When Mary showers and washes her hair, she needs to rest for up to two hours afterwards, as showering exceeds her energy reserve and triggers post-exertional malaise. Her energy reserve will remain lower than normal, and light activities will not be possible for the next 12 to 18 hours.
Mary is unable to do tasks requiring multiple energy types (physical, cognitive and orthostatic) without triggering post-exertional malaise. For example, she is unable to sit in an upright position (using physical exertion), and read and retain information (cognitive energy) for periods longer than 10 to 20 minutes at a time, before she exceeds her energy limits and must rest, or post-exertional malaise will be triggered.
(b) Has, or is likely to have, severe difficulty sustaining work-related tasks of a clerical, sedentary or stationary nature for a shift of at least three hours:
Mary is unable to participate in a normal morning routine. For example, preparing and eating breakfast, showering and getting dressed all require long rest periods and can deplete her daily energy reserve, leaving her bedbound due to post-exertional malaise. Mary would not be able to commute to a work location and then participate in any work, due to the depletion of energy reserves triggering post-exertional malaise. If she was able to find work from home, she would not be able to sustain an upright sitting position for more than 20 minutes or undertake cognitive activities for the same duration.
Some tips for your DSP application
- There are inconsistencies around the best treatments for ME/CFS. Some specialists and GPs still recommend graded exercise therapy or cognitive behavioural therapy. These are no longer considered to be best practice.
- We recommend that you and your medical team refer to your disability as ME/CFS or myalgic encephalomyelitis (ME), and use consistent language across all documentation.
- Avoid using chronic fatigue syndrome (CFS) on its own, as it is often misunderstood and confused with chronic fatigue, which is a symptom of many different conditions, rather than a disease in its own right.
- Use the full term of post-exertional malaise, not PEM. The abbreviation for post-exertional malaise, PEM, has not been introduced in the Impairment Table and may confuse things.
Program of Support
If you do not meet an impairment rating of 20 points or more in one Impairment Table, you may still be eligible for the DSP, if you meet the Program of Support rules.
A Program of Support helps people with disability to prepare for, find and keep a job. It may include help with:
- job preparation and job search
- work experience and training
- injury management.
To show that you have participated in a Program of Support in the three years before you claim, you must have either:
- participated for at least 18 months, or
- completed the program if it went for less than 18 months.
If your DSP claim is rejected because the Program of Support requirements have not been met, you will need to apply for the DSP again and provide evidence that you participated in:
- a Program of Support for the required period that has now been completed
- a Program of Support that was started, but medical conditions or disability stopped you from improving the ability to work by staying in the program.
Job Capacity Assessment
The Job Capacity Assessment looks at how your condition affects your ability to work. You may need to attend an assessment when you claim the DSP, or if you already get the DSP and are having a medical review.
Things you need to know about the Job Capacity Assessment include that:
- it is a free assessment
- a qualified health or allied health professional employed by Centrelink will complete the assessment
- you can bring a friend, family member or advocate with you
- if you are claiming the DSP and you do not attend, your claim may be rejected
- if you already get the DSP and do not attend, Centrelink may stop your DSP.
If Centrelink rejects your claim and you think that the decision is wrong, you can ask for the decision to be reviewed within 13 weeks.
If you review or appeal a decision:
- and Centrelink rejects your claim, ask them why
- Centrelink may tell you that you need to get more treatment or complete 18 months in a Program of Support. You may put in a new claim after you have completed these tasks
- there is no limit to the number of DSP applications you can make.
A free online resource called DSP Help has been launched to help people navigate the complex process of accessing the DSP.
This resource explains the DSP clearly in plain English, as well as the eligibility criteria, how to get suitable medical evidence and how to approach an application. An online chatbot also helps users navigate the application process.
The initiative is available nationally and is provided by Social Security Rights Victoria, an independent community legal centre providing free legal services for social security and Centrelink matters.
We are not able to provide an individual (one-on-one) advocacy service at present, but we will answer questions where we can. You can find a list of organisations that are able to give individual assistance in your local area by visiting the Disability Advocacy Finder.
How to help with your patient’s claim – Services Australia provides information for medical professionals who have patients wanting to apply for the DSP. This includes a sample letter asking your doctor to respond to the Impairment Tables for your DSP application
How to Claim – Steps to claim the DSP – includes links to my Gov
Claim for DSP form (SA466) – use this form to claim the DSP
Social Security (Tables for the Assessment of Work-related Impairment for Disability Support Pension) Determination 2023 – this information about the DSP legislation is provided by the Commonwealth Government
Disability Support Pension Medical Evidence Checklist for treating health professionals form (SA478) – your medical professional can use this form to evaluate your medical evidence and to make sure it includes relevant information about your condition(s)