Bilateral Feet - Tinea Pedis — DVA claim example (Diagnostic Assessment)

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 — Bilateral Feet - Tinea Pedis

Example 1 of 1 · fictitious patient (Veteran N)

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

Bilateral Feet - Tinea Pedis

SOP Codes: Balance of Probabilities - Tinea (No. 56 of 2024), Reasonable Hypothesis - Tinea (No. 57 of 2024)

ADF History

The veteran, Chef, 09 January 2009, 27 Mar 2016

Occupational History

As a military chef, the veteran was exposed to various occupational hazards including prolonged standing in potentially damp kitchen environments, use of communal military bathing and showering facilities, shared accommodation with multiple personnel, exposure to warm and humid conditions in field kitchens, and close contact with other military personnel during training and service activities. Military training environments, particularly initial training facilities like the base, involve extensive use of shared facilities including communal showers, changing rooms, and accommodation which increase exposure risk to dermatophyte infections.

History

The veteran the veteran a trainee military chef, developed bilateral tinea pedis (athlete's foot) during initial military training at the base in March 2011. The condition manifested as blisters on both feet and was successfully treated with antifungal therapy.

Timeline

27 February 2009 - the veteran presented to military medical staff with blisters on both feet that had been present for 5 days during initial military training at the base. Clinical examination revealed intact blisters on the balls of both feet with surrounding skin intact and no signs of secondary infection. The military medical officer diagnosed tinea pedis and commenced treatment with clotrimazole 1% cream and miconazole nitrate 2% dusting powder for antifungal therapy. The clinical presentation was consistent with fungal infection acquired through exposure to contaminated surfaces in the military training environment.
13 Mar 2009 - Follow-up assessment by military medical staff showed blisters on the soles of both feet that had been present for several weeks. Clinical examination demonstrated healing blisters with no broken skin and no signs of infection. The military medical officer confirmed the clinical impression of resolving tinea and continued treatment with clotrimazole 1% cream. The response to antifungal treatment confirmed the diagnosis and demonstrated appropriate clinical management.

Symptoms

At the time of initial presentation, the veteran experienced bilateral foot blisters affecting the balls and soles of both feet. The blisters had been present for approximately 5 days before seeking medical attention. There were no signs of secondary bacterial infection, and the surrounding skin remained intact. Following antifungal treatment, the condition showed progressive improvement with healing of the blisters and resolution of symptoms.

Imaging

No imaging studies were performed for this condition as the diagnosis was made on clinical grounds and treatment response.

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

Bilateral Tinea Pedis, DVA SOP Tinea (No. 56 of 2024 - Balance of Probabilities, No. 57 of 2024 - Reasonable Hypothesis), ICD-10 code B35.3.

Tinea pedis, commonly known as athlete's foot, is a superficial fungal infection of the feet caused by dermatophyte fungi, most commonly Trichophyton rubrum, Trichophyton mentagrophytes, and Epidermophyton floccosum. The condition typically affects the interdigital spaces, soles, and lateral borders of the feet. Clinical presentations include vesicular, inflammatory, chronic hyperkeratotic, and interdigital forms. The infection thrives in warm, moist environments and is commonly acquired through contact with contaminated surfaces in communal areas such as showers, swimming pools, and locker rooms. Predisposing factors include occlusive footwear, excessive sweating, immunocompromise, and exposure to contaminated environments.

The temporal relationship shows initial onset during military training with successful treatment and resolution, consistent with acquired infection from the military training environment.

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 of tinea pedis on approximately 22 February 2009, as the blisters had been present for 5 days when he presented for medical attention on 27 February 2009.

When did the veteran first present to a health / medical provider for this condition? The veteran first presented to military medical staff on 27 February 2009 for assessment of bilateral foot blisters during initial military training at the base.

When was the condition confirmed / formally diagnosed? The condition was confirmed and formally diagnosed as tinea pedis by military medical staff on 27 February 2009 based on clinical presentation and examination findings.

When did the veteran first present to you (or your practice) for this condition? 12 Jun 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.

The diagnosis was confirmed through clinical examination by military medical staff revealing characteristic bilateral foot blisters affecting the balls and soles of both feet. Key clinical features included intact blisters with surrounding skin integrity and absence of secondary bacterial infection. The diagnosis was supported by the clinical presentation consistent with dermatophyte infection, the location and appearance of lesions typical of tinea pedis, and the positive response to antifungal therapy with clotrimazole cream and miconazole dusting powder. The resolution of symptoms with appropriate antifungal treatment confirmed the diagnosis of tinea pedis.

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.

Factor 9(1)(d): using communal showering or bathing facilities, swimming pool facilities or locker rooms between 2 days and 3 weeks before the clinical onset - MET

The veteran was undergoing initial military training at the base where trainees mandatory use communal showering and bathing facilities daily. Military training facilities involve shared bathroom, shower, and changing facilities that provide ideal conditions for dermatophyte transmission.

Factor 9(1)(c): objects or surfaces contaminated with dermatophytes between 2 days and 3 weeks before the clinical onset - MET

Military training environment involves shared surfaces including floors, benches, and equipment that can become contaminated with dermatophytes from infected personnel, providing multiple exposure opportunities.

Factor 9(2): having skin maceration at the affected site between 2 days and 3 weeks before the clinical worsening - MET

Military training involves prolonged periods in boots and socks, creating warm, moist conditions that promote skin maceration and increase susceptibility to fungal infection.

Factor 9(11): inability to obtain appropriate clinical management for tinea before clinical worsening - NOT MET

Appropriate clinical management was provided promptly upon presentation with effective antifungal therapy resulting in resolution of the condition.

Sequelae

This condition is not a sequelae of another known condition.

Unintended Consequence

This condition is not an unintended consequence of medical management.

Inability to Attain Appropriate Medical Management

The factor for inability to obtain appropriate clinical management is NOT MET. The veteran received prompt and appropriate medical attention when he presented with symptoms. Military medical staff provided timely diagnosis and commenced appropriate antifungal therapy with clotrimazole cream and miconazole dusting powder. Follow-up care was provided, and the condition resolved with treatment. There is no evidence of barriers to healthcare access or inappropriate clinical management. The Full Federal Court decision in Brew v Repatriation Commission does not apply in this case as there were no objective or subjective barriers to obtaining treatment.

The % contribution of the causes is 100% and significant.

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

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