Example document — fictitious patient. Every report published here is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious: names, dates of birth, service numbers, units, locations and treating clinicians have been withheld or altered and all dates changed. It must not be relied upon as a record of any real claim.
Diagnostic Assessment — Acne
Example 1 of 2 · fictitious patient (Veteran H)
Example document — fictitious patient. This report is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious and bears no relationship to any real person, living or deceased. Names, dates of birth, contact details, service numbers, units, locations and treating clinicians have been withheld or altered and all dates have been changed. It must not be relied upon as a record of any real claim.
Diagnostic Assessment
Acne
SOP Codes: The specific SOP codes for acne would need to be referenced from the DVA CLIK website for both Balance of Probabilities and Reasonable Hypothesis determinations.
ADF History the veteran, M113 Crewman/RAAC Assistant Instructor, 06 November 1988, Continuous Full Time Service ended 30 Apr 1992, continued in General Reserves until approximately 2001.
Occupational History As an M113 Crewman in the Royal Australian Armoured Corps, the veteran service involved significant physical demands and environmental exposures in hot and humid conditions. His duties included working in confined spaces within armoured vehicles, wearing protective equipment and clothing that could be occlusive, exposure to diesel fumes, and deployment to tropical environments including an overseas deployment where heat and humidity would be significant factors affecting skin health.
History Mr John the veteran an M113 Crewman in the Australian Army, developed acne affecting his back during his military service, likely exacerbated by the requirement to wear occlusive protective clothing and equipment in hot and humid environmental conditions.
Timeline • 20 Aug 1990 Medical Board Examination Record documented the presence of acne, establishing that this skin condition was present during his military service and noted during routine medical assessment.
- 12 May 1991 Acne was specifically noted on back, requiring active medical treatment by the treating doctor, indicating the condition had progressed to require clinical intervention during his active service period.
Symptoms At the time of initial presentation, the veteran had visible acne lesions affecting his back that required medical attention. The condition was significant enough to be documented during routine medical examinations and required treatment by medical personnel. Current symptom status would require contemporary clinical assessment.
Imaging No imaging was performed for this condition as acne is diagnosed clinically based on visual examination and presentation.
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Acne (L70.9). Acne vulgaris is a common inflammatory skin condition affecting the pilosebaceous units, characterized by comedones, papules, pustules, and in severe cases, nodules and cysts. The condition typically affects areas with high concentrations of sebaceous glands including the face, chest, and back. The pathophysiology involves follicular hyperkeratinization, increased sebum production, colonization by Cutibacterium acnes (formerly Propionibacterium acnes), and inflammatory response.
The temporal relationship shows the condition was present and documented during his active military service, with evidence of progression requiring medical intervention.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? The veteran first experienced symptoms prior to 20 August 1990, as this was when acne was first documented during his Medical Board Examination Record [CHART REVIEW document].
When did the veteran first present to a health/medical provider for this condition? The veteran first presented for medical attention by 20 August 1990 during his Medical Board Examination, with subsequent treatment by the treating doctor on 12 May 1991 [CHART REVIEW document].
When was the condition confirmed/formally diagnosed? The condition was confirmed and documented on 20 August 1990 during the Medical Board Examination Record, with ongoing clinical management by the treating doctor on 12 May 1991 [CHART REVIEW document].
When did the veteran first present to you (or your practice) for this condition? 16 August 2015
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed through clinical examination by military medical personnel. The key signs included visible acne lesions on the back requiring medical treatment. The diagnosis was made clinically based on the characteristic appearance of acne lesions. Documentation shows the condition was noted during routine medical examinations and required active treatment by the treating doctor [CHART REVIEW document].
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Wearing occlusive clothing or equipment in hot and humid conditions - MET
- The veteran role as an M113 Crewman required wearing protective clothing and equipment in confined vehicle spaces, particularly during deployment to an overseas deployment's tropical climate, creating occlusive conditions that can exacerbate acne through increased heat, humidity, and friction.
Environmental exposure to heat and humidity - MET
- His deployment to an overseas deployment and general military service involved exposure to hot and humid conditions that can disrupt normal skin flora and increase sebaceous gland activity, contributing to acne development.
Note: If this condition had onset before 31 Apr 1995 and did not occur on warlike deployment, it would come under DRCA legislation. However, the documented episodes occurred during active service periods.
Sequelae This condition is not considered a sequelae of another known condition but rather a primary skin disorder related to occupational and environmental exposures.
Unintended Consequence This condition is not considered an unintended consequence of medical management. The acne appears to be related to occupational and environmental factors rather than medical treatment.
Inability to Attain Appropriate Medical Management The documentation shows the condition was recognized and treated by military medical personnel (the treating doctor), indicating appropriate medical management was available and provided during service. There is no evidence of inability to obtain appropriate clinical management. The Full Federal Court in Brew v Repatriation Commission (10 July 1990) provides guidance on the meaning of "inability" in both objective and subjective senses, but this does not appear to apply in this case as treatment was provided.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history. -see attached report
Example document — fictitious patient. This report is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious and bears no relationship to any real person, living or deceased. Names, dates of birth, contact details, service numbers, units, locations and treating clinicians have been withheld or altered and all dates have been changed. It must not be relied upon as a record of any real claim.
Diagnostic Assessment — Acne
Example 2 of 2 · fictitious patient (Veteran H)
Example document — fictitious patient. This report is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious and bears no relationship to any real person, living or deceased. Names, dates of birth, contact details, service numbers, units, locations and treating clinicians have been withheld or altered and all dates have been changed. It must not be relied upon as a record of any real claim.
Diagnostic Assessment
Acne (L70.9)
SOP Codes for Balance of Probabilities: No SOP available SOP Codes for Reasonable Hypothesis: No SOP available
ADF History
The veteran, Date of Birth: [withheld] M113 Crewman/RAAC Assistant Instructor, enlistment date 06 November 1988, discharge date CFTS ended 30 Apr 1992, continued in General Reserves until approximately 2001, separated from Army Standby Reserve 10 May 2007.
Occupational History
As an M113 Crewman and RAAC Assistant Instructor, the veteran military duties involved operating armoured vehicles in hot and humid conditions, wearing occlusive protective clothing including body armour and helmets, physical training in tropical environments, and deployment to an overseas deployment where environmental conditions were hot and humid. Military service requires prolonged wearing of protective equipment that can cause skin occlusion, increased sweating, and disruption of normal skin flora, particularly during field exercises, training activities, and operational deployments.
History
Mr John the veteran an M113 Crewman in the Australian Army, developed acne during his military service, first documented during his Medical Board Examination in September 1993 and subsequently requiring treatment in Jun 1994.
Timeline
- 20 August 1990 - Acne was noted during Medical Board Examination Record. noted on Medical Board ExaminationThis represented the first documented evidence of acne during his military service period.
- 12 May 1991 - Acne noted on back and treated by the treating doctor noted on back, treated by the treating doctor marked active treatment of the acne condition during his deployment period when environmental conditions would have exacerbated the condition.
Symptoms
At the time of initial documentation in September 1993, the veteran had acne noted during his medical examination. By Jun 1994, the acne was specifically noted on his back and required medical treatment by the treating doctor, indicating progression or worsening of the condition sufficient to warrant active medical intervention. Current symptoms are not documented in the available records as this condition was treated during service.
Imaging
No imaging findings are documented for this condition in the available records.
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Acne, ICD-10 code L70.9. There is currently no Statement of Principles available for acne conditions.
Acne is a common inflammatory skin disorder affecting the pilosebaceous units, characterised by the formation of comedones, papules, pustules, and in severe cases, nodules and cysts. The condition typically affects areas with a high density of sebaceous glands, including the face, neck, chest, and back. The pathophysiology involves increased sebum production, abnormal keratinisation of the pilosebaceous duct, proliferation of Propionibacterium acnes (now Cutibacterium acnes), and inflammatory responses.
The temporal relationship shows acne first documented in September 1993 during military service and requiring treatment by Jun 1994, coinciding with periods of increased environmental stress and wearing of occlusive military equipment.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? September 1993, when acne was first noted during Medical Board Examination. [CHART REVIEW document]
When did the veteran first present to a health / medical provider for this condition? 20 August 1990 during Medical Board Examination by military medical personnel. [CHART REVIEW document]
When was the condition confirmed / formally diagnosed? 20 August 1990 during Medical Board Examination by military medical personnel, with subsequent treatment on 12 May 1991 by the treating doctor [CHART REVIEW document]
When did the veteran first present to you (or your practice) for this condition? 22 Jun 2014.
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions? Please attach any relevant correspondence and investigation results.
The diagnosis was confirmed through clinical examination by military medical personnel during the Medical Board Examination on 20 August 1990. The diagnosis of acne is typically made on clinical grounds based on the characteristic appearance of comedones, papules, and pustules affecting sebaceous gland-rich areas. The condition was subsequently noted specifically on the back and required treatment by the treating doctor on 12 May 1991, confirming the ongoing nature of the condition and its requirement for medical management. [CHART REVIEW document]
4. What do you consider to be the cause(s) of the condition in this veteran? Give consideration to constitutional and common risk factors, pre-existing injuries or diseases, and occupational or lifestyle risks, as well as direct causative mechanisms.
Note: As there is no Statement of Principles for acne, the following analysis considers occupational and constitutional factors:
Occupational skin irritation and occlusion - MET
- Military service required prolonged wearing of occlusive protective clothing, body armour, and helmets, particularly during training exercises and deployment to an overseas deployment's hot and humid environment. This creates conditions conducive to skin maceration, increased sweating, and disruption of normal skin flora.
Environmental factors - MET
- Deployment to an overseas deployment exposed the veteran to hot and humid tropical conditions that increase sweating and skin occlusion when combined with protective military equipment, creating an environment that promotes bacterial overgrowth and acne formation.
Disruption of skin microbiome - MET
- Military conditions involving prolonged wearing of protective equipment, limited access to optimal hygiene facilities during field exercises, and environmental stresses can disrupt the normal skin microbiome, leading to overgrowth of acne-associated bacteria such as Cutibacterium acnes.
Physical and psychological stress - MET
- Military training, deployment stress, and operational demands create both physical and psychological stress, which are known contributing factors to acne development and exacerbation through hormonal and inflammatory pathways.
The % contribution of the causes is 100% and significant.
Sequelae
This condition is not a sequelae of another known condition. Acne represents a primary inflammatory skin disorder affecting the pilosebaceous units.
Unintended Consequence
This condition is not an unintended consequence of medical management. The acne developed as a primary pathological process related to occupational and environmental factors during military service.
Inability to Attain Appropriate Medical Management
MET - The progression of acne from initial documentation in September 1993 to requiring active treatment by Jun 1994 indicates a period where appropriate preventive or early intervention management was not obtained, allowing the condition to worsen. This causes permanent worsening as acne can lead to scarring and long-term skin changes.
The Full Federal Court in Brew v Repatriation Commission (10 July 1990) enlarges on the meaning to be given to "inability" as the lack of the ability to get treatment in both an objective and subjective sense. Military operational requirements and field conditions may have limited access to dermatological care and optimal skin management during the critical period when the condition was developing and worsening.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
Example document — fictitious patient. This report is a sample prepared to show the standard, structure and depth of a VHC report. The veteran described is fictitious and bears no relationship to any real person, living or deceased. Names, dates of birth, contact details, service numbers, units, locations and treating clinicians have been withheld or altered and all dates have been changed. It must not be relied upon as a record of any real claim.
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