Adjustment Disorder with Mixed Anxiety and Depressed Mood

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 — Adjustment Disorder with Mixed Anxiety and Depressed Mood

Example 1 of 1 · fictitious patient (Veteran V)

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

BOP Code: 24 of 2016 RH Code: 23 of 2016

ADF History

The veteran, Avionics Mechanic, 12 July 1990, 27 July 1996

Occupational History

As an Avionics Mechanic in the Royal Australian Air Force, the veteran was exposed to significant occupational stressors inherent to military aviation maintenance. This role required maintaining complex electronic systems under operational pressures, working in high noise environments requiring hearing protection, and performing duties in physically demanding conditions including confined aircraft spaces and flight line operations. The occupation involved exposure to aviation fuels, hydraulic fluids, solvents, and other industrial chemicals. Physical demands included manual handling of heavy equipment exceeding 20 kilograms, sustained awkward postures within aircraft fuselages, and repetitive movements. The military environment imposed additional psychological stressors including strict adherence to safety protocols, responsibility for aircraft serviceability affecting aircrew safety, and the inherent pressures of military service including discipline, hierarchy, and operational readiness requirements.

History

The veteran an Avionics Mechanic in the Royal Australian Air Force, developed adjustment disorder during his military service between 1994 and 2000. The condition arose following multiple physical injuries sustained during training and operational duties, concurrent family stressors including parental separation, and perceived institutional failures when his request for compassionate leave was denied.

Timeline

16 Jul 1990 - Initial physical injury sustained during field training at the RAAF base just days after enlistment. Documentation indicates "lower back pain" following training incident. This represents the beginning of a cascade of physical and psychological stressors that would contribute to adjustment disorder development. The injury occurred during recruit training exercises involving significant physical force, establishing an early pattern of vulnerability. Medical records show immediate presentation with pain and restricted range of motion requiring conservative management and activity modification.
Dec 1992 - Multiple physical injuries documented including ankle sprain on uneven ground during field training. Member twisted foot causing "Category 3 ground incident" requiring restricted duties for more than seven days. This accumulation of injuries created functional limitations and uncertainty about career progression. The pattern of recurring injuries began affecting psychological wellbeing through concerns about fitness for continued service. Physical limitations started impacting ability to perform full duties as Avionics Mechanic.
1995-1996 - Period of significant psychosocial stress with parents' marital separation occurring during service. Member requested compassionate posting and leave to provide family support which was "denied" by military administration. This denial was experienced as "administrative violence" and represented perceived institutional betrayal. The inability to support family during crisis while managing multiple physical injuries created overwhelming stress. Psychological distress sufficient to seek chaplaincy support documented during this period.
17 Jan 1992 - Additional physical injuries sustained during authorized football game including concurrent injuries to neck, back, and shoulder. Member fell experiencing "jarring injury to shoulder" with immediate pain and limited range of motion. Multiple body regions affected indicating significant trauma contributing to cumulative stress burden. These injuries further compromised ability to perform occupational duties and participate in military activities. The accumulation of physical disabilities intensified psychological distress about career viability.
1996-2000 - Progressive development of adjustment disorder symptoms in context of chronic pain and unresolved psychosocial stressors. Sleep disturbance and alcohol use emerging as maladaptive coping strategies for managing distress. Documentation indicates development of "adjustment disorder" requiring ongoing support through chaplaincy services. Symptoms interfered with military duties leading to consideration of medical discharge options. Psychological symptoms persisted despite attempts at conservative management through available military support services.
27 Jul 1996 - Discharged from RAAF on compassionate grounds with documented physical and psychological conditions. Medical discharge documentation notes "sporting injury" to lower back and hip with ongoing symptoms. Adjustment disorder established by time of separation from service with symptoms causing significant functional impairment. Discharge represented culmination of inability to maintain military service requirements due to combined physical and psychological factors.

Symptoms

At the time of initial development during service, the veteran experienced marked distress disproportionate to the severity of stressors, significant impairment in occupational functioning, emotional symptoms including anxiety and depressed mood, behavioral changes including social withdrawal, sleep disturbance, and increased alcohol use as maladaptive coping. These symptoms developed within three months of identified stressors and caused clinically significant distress.

Current symptoms demonstrate evolution from adjustment disorder to discrete anxiety and depressive disorders. He experiences persistent nervousness occurring more than half the days, difficulty controlling worry, excessive worry about multiple life domains, psychomotor restlessness, muscle tension, irritability with decreased frustration tolerance, chronic insomnia, persistent low mood, anhedonia, psychomotor retardation, feelings of hopelessness and worthlessness, emotional numbing, fatigue without apparent cause, marked social avoidance and complete withdrawal from social situations, significant difficulties with patience, crowd avoidance, and alcohol consumption of 10 standard drinks nightly. The adjustment disorder served as the initial psychiatric presentation that evolved into chronic mental health conditions.

1. What is the formal diagnosis of the condition claimed above?

The formal diagnosis is Adjustment Disorder with Mixed Anxiety and Depressed Mood (F43.22 per ICD-10). DVA SOP codes are BOP 24 of 2016 and RH 23 of 2016.

Adjustment Disorder is characterized by the development of emotional or behavioral symptoms in response to identifiable stressors occurring within three months of the onset of the stressors. These symptoms are clinically significant, evidenced by marked distress that is out of proportion to the severity or intensity of the stressor, or significant impairment in social, occupational, or other important areas of functioning. The stress-related disturbance does not meet criteria for another mental disorder and is not merely an exacerbation of a preexisting mental disorder. The symptoms do not represent normal bereavement. Once the stressor or its consequences have terminated, the symptoms do not persist for more than an additional six months.

The temporal relationship shows initial development of adjustment disorder during service (1995-1996) with documented stressors including physical injuries, parental separation, and denied compassionate leave. The condition subsequently evolved into discrete anxiety and depressive disorders post-discharge.

2. For each diagnosis identified, please also provide the following dates:

When did the veteran first experience symptoms attributable to this condition? First symptoms experienced in 1995 following confluence of physical injuries sustained during training and family stressors (parental separation) [CIA - MH - the veteran - WORD.docx, page 1; CHART REVIEW.docx, Timeline section]

When did the veteran first present to a health/medical provider for this condition? 1995-1996

When was the condition confirmed/formally diagnosed? 1996 (documented as adjustment disorder at time of service)

When did the veteran first present to you (or your practice) for this condition? 07 January 2018

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.

Diagnosis confirmed through comprehensive psychiatric assessment documenting DSM-5 criteria for Adjustment Disorder. Key symptoms included development of emotional symptoms within 3 months of identifiable stressors, marked distress disproportionate to stressor severity, significant impairment in occupational functioning. Clinical documentation shows psychological distress sufficient to seek chaplaincy support during service [CIA - MH - the veteran - WORD.docx, Military Service History section]. Service medical records document concurrent physical injuries creating cumulative stress burden [CHART REVIEW.docx, complete timeline]. Discharge documentation confirms adjustment disorder present at time of separation from service in 2000 [CHART REVIEW.docx, Discharge section].

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.

Causative Factors:

Factor 1 (BOP): experiencing a category 1A stressor within the three months before the clinical onset of adjustment disorder - NOT MET

No life-threatening events, serious physical attacks, or being threatened with weapon documented within timeframe

Factor 2 (BOP): experiencing a category 1B stressor within the three months before the clinical onset of adjustment disorder - NOT MET

No witnessing of deaths or critical injuries documented during service

Factor 3 (BOP): being exposed to repeated or extreme aversive details of severe traumatic events within the three months before the clinical onset - NOT MET

No documented exposure to repeated traumatic event details in occupational role

Factor 5 (BOP): experiencing a category 2 stressor within the three months before the clinical onset of adjustment disorder - MET

Multiple category 2 stressors present including problem with family relationships due to parental separation occurring 1995-1996, perceived lack of social support within military environment when compassionate leave denied, experiencing ongoing disharmony and perceived lack of control over situation

Factor 6 (BOP): experiencing the death of a significant other within the three months before the clinical onset - NOT MET

No deaths documented, though parental separation occurred

Factor 7 (BOP): having, or being diagnosed with, a medical illness or injury which is life-threatening or which results in serious physical or cognitive disability, within the three months before the clinical onset - MET

Multiple injuries sustained including lower back injury August 1992, ankle injury December 1992, and shoulder/neck/back injuries February 1994 resulting in serious physical disability affecting occupational functioning

Factor 8 (BOP): having persistent pain of at least three months duration at the time of the clinical onset of adjustment disorder - MET

Documented chronic lower back pain from August 1992 persisting throughout service, meeting criteria for persistent pain

Factor 9 (BOP): having a severe, chronic medical condition within the three months before the clinical onset - PARTIALLY MET

Multiple musculoskeletal conditions documented though not meeting full severity criteria for severe chronic medical condition

Factor 10 (BOP): having a miscarriage, foetal death in-utero or stillbirth, within the three months before the clinical onset - NOT MET

Not applicable to male veteran

Worsening Factors:

Factor 11 (BOP): inability to obtain appropriate clinical management for adjustment disorder - MET

Limited mental health resources available during military service period 1995-2000, reliance on chaplaincy support rather than psychiatric care, no structured psychological therapy documented, condition progressed to chronic anxiety and depression indicating inadequate initial management

The % contribution of the causes is 100% and significant

Sequelae

The adjustment disorder is not a sequela of another condition but rather arose primarily from service-related stressors. The subsequent development of Major Depressive Disorder and Generalized Anxiety Disorder represent sequelae of the initial adjustment disorder.

Unintended Consequence

The adjustment disorder does not represent an unintended consequence of medical management. While multiple physical injuries were treated during service, the psychiatric condition arose from the cumulative impact of injuries and psychosocial stressors rather than from treatment interventions.

Inability to Attain Appropriate Medical Management (for worsening)

There is clear evidence of inability to obtain appropriate clinical management - MET. Despite adjustment disorder symptoms documented from 1995-1996, the veteran received only chaplaincy support rather than structured psychiatric care. No evidence of psychological therapy, psychiatric consultation, or psychotropic medication during service period. The progression from adjustment disorder to chronic anxiety and depressive disorders demonstrates inadequate initial management. The reliance on informal support systems rather than evidence-based mental health treatment during critical early period represents systemic barrier to appropriate care. Military culture and stigma regarding mental health likely contributed to barriers accessing treatment.

5. Please provide a Health Summary and a medication/prescribing history. -see attached report

References

16 July 1990, Initial Injury Report, Base Medical Officer, Military Medicine
December 1992, Field Training Injury Report, K.M. Mahon, Military Medicine
1995-1996, Chaplaincy Support Documentation, Military Chaplain, Pastoral Care
17 January 1992, Sports Injury Report, Base Medical Officer, Sports Medicine
11 Apr 1992, CT Lumbar Spine, A. Pallewatte/Mackley, Radiology
07 May 1992, MRI Lumbar Spine, Hunter Valley Medical Imaging, Radiology
20 July 1992, Discharge Health Statement, V. Duffy, Military Medicine
27 July 1996, Discharge Documentation, RAAF Administration, Administrative
04 July 2019, Psychiatric Assessment, Treating Psychiatrist, Psychiatry
20 Jun 2019, MRI Multiple Regions, Gaurav Khera, Radiology

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