Alcohol Use Disorder, Severe

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 — Alcohol Use Disorder, Severe

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: 49 of 2017 RH Code: 48 of 2017

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 worked in environments with significant occupational stressors contributing to substance use vulnerability. The role involved high-pressure maintenance of critical aircraft systems where errors could result in catastrophic consequences. Work environments included exposure to industrial chemicals and solvents with psychoactive properties. The military culture during the late 1990s and early 2000s normalized alcohol consumption as stress management and social bonding mechanism. Shift work patterns and operational demands disrupted normal sleep-wake cycles, contributing to reliance on substances for sleep regulation. Post-deployment decompression periods often involved sanctioned alcohol consumption. The combination of chronic pain from occupational injuries, psychological stress from military service, and cultural normalization of alcohol use created multiple pathways to substance use disorders.

History

The veteran an Avionics Mechanic in the Royal Australian Air Force, developed severe Alcohol Use Disorder during military service as maladaptive coping for untreated adjustment disorder, chronic pain, and sleep disturbance. The condition progressed from initial use during service (1995-1996) to current severe disorder with consumption of 10 standard drinks nightly.

Timeline

19 Jul 1991 - Initial documentation of alcohol consumption in Periodic Health Assessment showing intake as "1-2 standard drinks" consumed 2-4 times per month. This represents baseline alcohol use pattern before development of disorder. Social drinking within normal limits at this early service period. No evidence of problematic use or dependence features documented. Regular health monitoring established pattern of moderate consumption initially. This assessment provides important baseline for tracking progression to pathological use.
1995-1996 - Alcohol use increased during period of significant psychosocial stress including parental separation and denied compassionate leave. Sleep disturbance documented with alcohol emerging as "sleep aid" for managing insomnia. Initial pattern of self-medication established during adjustment disorder development. Alcohol providing temporary relief from psychological distress and physical pain symptoms. Cultural acceptance within military environment normalized increasing consumption patterns. Transition from social to medicinal use marking early disorder development.
17 Feb 1992 - Clinical note documents smoking "20 cigarettes per day" indicating polysubstance use pattern emerging. Co-occurrence of nicotine dependence and increasing alcohol use suggesting addiction vulnerability. Both substances used for stress management and emotional regulation during service. Pattern of multiple substance dependencies developing concurrently. Combined tobacco and alcohol use amplifying health risks and dependency features. Substance use becoming primary coping mechanism for service-related stressors.
1996-2000 - Progressive escalation of alcohol consumption during remainder of military service period. Chronic pain from multiple injuries driving increased use for analgesic effects. Untreated adjustment disorder and emerging depression reinforcing "self-medication" patterns. Sleep disturbance becoming chronic with nightly alcohol use for sedation. Tolerance developing requiring increased amounts for desired effects. Pattern firmly established by discharge with features of physiological dependence.
2000-2019 - Post-discharge period marked by continued escalation to current consumption pattern of 10 standard drinks nightly. Chronic course without treatment attempts or periods of abstinence documented. Alcohol use disorder serving multiple functions including "anxiety management" and sleep induction. Social isolation reinforced by alcohol use creating vicious cycle. Occupational functioning maintained despite severe disorder suggesting high tolerance. Marriage providing some protective factor but unable to modify consumption pattern.
2019 - Severe psychiatric decompensation with suicidal ideation during legal stressors while maintaining heavy alcohol use. Crisis potentially precipitated or worsened by alcohol's depressant effects on mood. No reduction in consumption during "crisis period" indicating severe dependence. Alcohol use likely interfering with antidepressant medication effectiveness. Pattern of using alcohol to cope with acute stressors firmly entrenched. Crisis resolution without addressing underlying alcohol disorder.
04 Jul 2019 - Comprehensive assessment documenting severe Alcohol Use Disorder with consumption of "10 standard drinks nightly". Meeting multiple DSM-5 criteria including tolerance, unsuccessful attempts to reduce, continued use despite problems. Significant time spent obtaining and consuming alcohol evident in daily pattern. Physical hazard of driving while intoxicated probable given consumption levels. Alcohol use causing relationship strain though marriage maintained. Severe disorder requiring intensive intervention including supervised withdrawal and relapse prevention.

Symptoms

At initial development during service, the veteran exhibited increasing alcohol consumption for sleep and stress management, progression from social to daily use pattern, early tolerance requiring increased amounts, use despite military regulations and duties, concealment of consumption levels during health assessments, and interference with optimal physical recovery from injuries. These early symptoms indicated transition from use to disorder.

Current symptoms demonstrate severe Alcohol Use Disorder with alcohol taken in larger amounts than intended (10 drinks nightly), persistent desire with unsuccessful attempts to reduce consumption, significant time spent obtaining and consuming alcohol daily, strong cravings and urges to use alcohol, failure to fulfill major role obligations when intoxicated, continued use despite marital concerns and health problems, important social and recreational activities abandoned, recurrent use in physically hazardous situations likely, continued use despite knowledge of psychological problems, marked tolerance evident requiring 10 drinks for effect, and likely withdrawal symptoms masked by continuous consumption. Associated features include using alcohol as primary coping mechanism, complete social isolation except when drinking, exacerbation of depression and anxiety symptoms, chronic insomnia despite sedative use, and significant health risks from sustained heavy consumption.

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

The formal diagnosis is Alcohol Use Disorder, Severe (F10.20 per ICD-10). DVA SOP codes are BOP 49 of 2017 and RH 48 of 2017.

Alcohol Use Disorder is characterized by a problematic pattern of alcohol use leading to clinically significant impairment or distress, manifested by at least four of the following within a 12-month period: alcohol taken in larger amounts or longer than intended, persistent desire or unsuccessful efforts to cut down, great deal of time spent in activities to obtain/use/recover from alcohol, craving, failure to fulfill major role obligations, continued use despite social problems, important activities given up, recurrent use in hazardous situations, continued use despite physical/psychological problems, tolerance, and withdrawal. Severity is determined by number of criteria met: mild (2-3), moderate (4-5), or severe (6 or more).

The temporal relationship shows initial moderate use documented 1995, escalation during service stressors 1995-1996, established pattern by discharge 2000, and progression to severe disorder with current consumption of 10 standard drinks nightly.

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

When did the veteran first experience symptoms attributable to this condition? First problematic alcohol use 1995-1996 during period of adjustment disorder and family stressors [CIA - MH - the veteran - WORD.docx, page 2; CHART REVIEW.docx, page 18]

When did the veteran first present to a health/medical provider for this condition? 19 July 1991 (documented alcohol consumption in health assessment)

When was the condition confirmed/formally diagnosed? 04 July 2019 (formal diagnosis of severe Alcohol Use Disorder)

When did the veteran first present to you (or your practice) for this condition? 16 Mar 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 psychiatric assessment documenting severe Alcohol Use Disorder meeting multiple DSM-5 criteria. Key findings included consumption of 10 standard drinks nightly indicating severe disorder [CIA - MH - the veteran - WORD.docx, page 2]. Clinical evidence of tolerance, continued use despite problems, significant time spent drinking [CIA - MH - the veteran - WORD.docx, Alcohol Use section]. Historical progression from 1-2 drinks documented 1995 to current 10 drinks nightly showing escalation [CHART REVIEW.docx, page 18]. Use as maladaptive coping for anxiety and insomnia documented [CIA - MH - the veteran - WORD.docx, page 3]. Physical examination and mental state consistent with chronic heavy alcohol use [CIA - MH - the veteran - WORD.docx, MSE 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): having a clinically significant disorder of mental health as specified at the time of the clinical onset of alcohol use disorder - MET

Adjustment disorder documented 1995-1996 concurrent with escalation of alcohol use from social to problematic pattern

Factor 2 (BOP): experiencing a category 1A stressor within the two years before the clinical onset - NOT MET

No life-threatening events documented within two years of onset

Factor 3 (BOP): experiencing a category 1B stressor within the two years before the clinical onset - NOT MET

No witnessing of deaths or critical injuries documented

Factor 4 (BOP): experiencing the death of a significant other within the ten years before the clinical onset - NOT MET

No deaths documented though parental separation occurred

Factor 5 (BOP): experiencing severe childhood abuse before the clinical onset - NOT MET

No childhood abuse documented in comprehensive history

Factor 6 (BOP): experiencing a category 2 stressor within the six months before the clinical onset - MET

Multiple category 2 stressors including parental separation, denied compassionate leave, ongoing physical injuries affecting career, perceived lack of support within military environment

Worsening Factors:

Factor 7 (BOP): having a clinically significant disorder of mental health as specified at the time of the clinical worsening - MET

Major depressive disorder and generalized anxiety disorder present throughout course contributing to escalation from moderate to severe

Factor 13 (BOP): inability to obtain appropriate clinical management for alcohol use disorder - MET

No documented treatment for alcohol use disorder despite 25+ years of problematic use, no referrals to addiction services, no supervised withdrawal attempts, no psychological intervention for substance use, progression from moderate to severe indicating treatment failure

The % contribution of the causes is 100% and significant

Sequelae

Alcohol Use Disorder developed as maladaptive coping mechanism for untreated Adjustment Disorder and chronic pain conditions arising during military service. The alcohol disorder subsequently contributed to worsening of depression and anxiety creating complex comorbidity pattern.

Unintended Consequence

The Alcohol Use Disorder does not represent unintended consequence of medical management. No medications prescribed during service known to precipitate alcohol use disorder. Condition arose from self-medication for untreated psychiatric and pain conditions.

Inability to Attain Appropriate Medical Management (for worsening)

Clear evidence of inability to obtain appropriate clinical management - MET. Despite severe Alcohol Use Disorder documented over 25+ years, no evidence of addiction treatment, supervised withdrawal, psychological intervention, or rehabilitation programs. Health assessments documented consumption but no interventions offered. Current consumption of 10 drinks nightly without treatment represents complete failure of healthcare system to address severe substance use disorder. Barriers likely include stigma, lack of integrated mental health and addiction services, and systemic under-recognition of alcohol disorders in veteran population.

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

References

19 July 1991, Periodic Health Assessment, Military Medicine, Preventive Health
17 February 1992, Clinical Note, Military Medicine, General Practice
20 July 1992, Discharge Health Statement, V. Duffy, Military Medicine
27 July 1996, Discharge Documentation, RAAF Administration, Administrative
2019, Crisis Intervention Record, General Practitioner, General Practice
04 July 2019, Psychiatric Assessment, Treating Psychiatrist, Psychiatry
04 July 2019, Substance Use Assessment, Treating Psychiatrist, Addiction Psychiatry
20 Jun 2019, MRI Brain, Gaurav Khera, Radiology

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