Diagnostic Assessment — Bilateral Foot - Pes Planus (Flat Feet)
Example 1 of 1 · fictitious patient (Veteran L)
Diagnostic Assessment
Bilateral Foot - Pes Planus (Flat Feet)
Balance of Probabilities SOP: Pes Planus SOP No. 68 of 2021 - Factors (26), (23) Reasonable Hypothesis SOP: Pes Planus SOP No. 67 of 2021 - Factors (26), (27)
ADF History
The veteran, Date of Birth: [withheld] Electronic Warfare Operator, enlistment date 09 Feb 1990, discharge date 17 February 2000.
Occupational History
As an Electronic Warfare Operator in the Australian Army, the veteran was required to carry heavy equipment including radios, antennas, and generators over extended periods during training and deployments. The role involved prolonged standing, marching with heavy loads, and operations in challenging terrain conditions. Military duties required extensive weight-bearing activities often with inadequate footwear support in operational environments. The physical demands included repetitive stress on the feet through prolonged standing, marching, and carrying heavy equipment loads that could contribute to the development or exacerbation of foot arch problems.
History
The veteran an Electronic Warfare Operator, developed pes planus (flat feet) noted during his discharge medical examination in 2003, likely due to the repetitive strain and heavy load-bearing demands of his military service including walking while carrying heavy equipment loads.
Timeline
20 August 1999: The veteran reported foot pain during his discharge medical examination, with the condition diagnosed as pes planus (flat feet). The condition caused significant discomfort during prolonged standing and walking activities, impacting his functional capacity. The pes planus was likely exacerbated by the extensive physical demands of his military role, including walking while carrying heavy equipment loads of at least 15 kilograms (radios, antennas, generators) over challenging terrain during deployments and training exercises for well over 10 kilometres per week. No imaging was conducted to confirm the diagnosis, which was made based on clinical observation of foot structure showing substantial collapse of the medial longitudinal arch and reported symptoms of medial foot pain. The condition was noted as a contributing factor to his physical limitations at the time of discharge from military service. Supportive measures were likely advised, though specific treatment recommendations were not detailed in the available records.
Symptoms
At the time of the 2003 discharge examination, the veteran experienced medial foot pain during prolonged standing and walking, consistent with pes planus causing mechanical stress and discomfort from the substantial collapse of the medial longitudinal arch. The condition affected his ability to perform weight-bearing activities comfortably. Current symptoms include ongoing medial foot discomfort during prolonged standing and walking, with confirmed pes planus causing mechanical stress on the foot structures, ongoing pain, and functional limitation that affects daily activities and quality of life, particularly during extended periods of standing or walking.
Imaging
20 August 1999: No imaging was conducted as the diagnosis of flat feet was made based on clinical observation of foot structure and reported symptoms during the discharge medical examination.
1. What is the formal diagnosis of the condition claimed above?
Bilateral Foot - Pes Planus (M21.40), DVA SOP Pes Planus SOP No. 68 of 2021 and No. 67 of 2021, ICD-10 code M21.40.
Pes planus (also known as flat feet or flatfoot deformity) is a substantial collapse of the medial longitudinal arch of the foot that results in either medical treatment or symptoms of medial foot pain. This condition can be congenital, developmental, or acquired, and when acquired, often results from repetitive stress, prolonged weight-bearing, or biomechanical factors that cause the supporting structures of the arch to weaken or fail. Pes planus can cause significant discomfort, particularly during prolonged standing or walking, and may lead to compensatory problems in the ankles, knees, hips, and lower back. The condition involves the entire sole of the foot making contact with the ground due to the collapse of the medial longitudinal arch.
The temporal relationship shows the condition being identified at discharge in 2003, though the exact onset during his military service is unclear, suggesting gradual development over his service period.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 13 September 1998 - gradual onset during military service (estimated based on discharge examination findings).
When did the veteran first present to a health/medical provider for this condition? 20 August 1999 - the veteran first presented to a Medical Officer during his discharge medical examination when foot pain and flat feet were identified.
When was the condition confirmed/formally diagnosed? 20 August 1999 - Pes planus was formally diagnosed by a Medical Officer during the discharge medical examination based on clinical observation and reported symptoms of medial foot pain.
When did the veteran first present to you (or your practice) for this condition? 25 November 2017
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?
The diagnosis of pes planus was confirmed by clinical assessment during the discharge medical examination on 20 August 1999. Key symptoms included medial foot pain during prolonged standing and walking activities, consistent with the SOP definition requiring either medical treatment or symptoms of medial foot pain. The diagnosis was based on clinical observation of foot structure showing substantial collapse of the medial longitudinal arch, with the entire sole of the foot making contact with the ground.
No imaging or specialist opinions were documented, as the diagnosis was clinical based on visual assessment of foot structure and reported symptoms of medial foot pain. The examining Medical Officer noted the condition as contributing to his physical limitations at discharge, linking it to the extensive physical demands of his military service including walking while carrying heavy equipment loads exceeding 15 kilograms for well over 10 kilometres per week during training and deployments.
4. What do you consider to be the cause(s) of the condition in this veteran?
Walking: (a) an average of at least 10 kilometres per week; and (b) while carrying loads of at least 15 kilograms; and (c) for at least the 4 weeks before the clinical worsening of pes planus - MET
- The veteran regularly walked well over 10 kilometres per week while carrying loads of at least 15 kilograms (radios, antennas, generators) during his military service as an Electronic Warfare Operator for extended periods exceeding 4 weeks, contributing to the worsening of his pes planus condition.
Inability to obtain appropriate clinical management for pes planus - MET
- There is evidence of inadequate clinical management as the pes planus was only identified at discharge in 2003 without prior recognition or management during his military service, representing failure to provide appropriate ongoing clinical management per Brew v Repatriation Commission that could have prevented progression of the condition.
Sequelae
This condition is not a sequela of another identified service-related condition, but rather a primary condition resulting from the mechanical stresses of military service.
Unintended Consequence
This condition is not an unintended consequence of medical management as no specific medical procedures or medications directly caused the condition.
Inability to Attain Appropriate Medical Management
There was clear inability to attain appropriate medical management for pes planus as evidenced by the condition only being identified at discharge in 2003 without prior recognition or intervention during his military service. The Full Federal Court in Brew v Repatriation Commission establishes that inability encompasses the lack of ability to get treatment in both objective and subjective senses. The failure to identify and manage the progressive development of pes planus during service, despite ongoing symptoms and functional limitations from walking with heavy loads, represents inadequate clinical management. Early identification and intervention with appropriate footwear, orthotics, or activity modification could have prevented the progression to symptomatic pes planus requiring medical treatment. This resulted in permanent worsening as the condition progressed to require ongoing management for medial foot pain and functional limitation.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication/prescribing history.
- See attached report
