Diagnostic Assessment — Bilateral Great Toes - Ingrown Toenail
Example 1 of 1 · fictitious patient (Veteran BT)
Diagnostic Assessment
Bilateral Great Toes - Ingrown Toenail
BOP Code: 73 of 2024 (Ingrown Nail)
RH Code: 72 of 2024 (Ingrown Nail)
ADF History
Veteran BT, date of birth 30 April 1972, Australian Army, Rifleman (infantry soldier), enlisted 12 March 1991, medically discharged 15 August 2007. Operational service: East Timor, 20 September 1999 to 22 February 2000 (warlike).
Occupational History
As an infantry soldier the veteran marched long distances carrying loads of 30 to 50 kilograms in issued combat boots, conducted foot patrols for days at a time in wet, hot and muddy terrain, and wore boots for 14 to 18 hours a day on exercise and operations. Infantry soldiers have high rates of blisters, nail trauma, tinea pedis and onychomycosis, plantar hyperhidrosis and forefoot deformity from prolonged boot wear.
On tropical operations, opportunities to wash and dry the feet and change socks were often limited for days, boots were frequently wet, resupply of correctly sized footwear was unreliable, and podiatry and minor surgical care were not available forward of the main base. Infantry soldiers were also exposed to blood and body fluids when providing first aid, and to prolonged solar exposure.
History
Veteran BT, an infantry soldier in the Australian Army with bilateral hallux valgus and involuted great toenails, developed bilateral ingrown great toenails on 10 January 2000 on warlike service in East Timor, after a crush injury to both great toenails, onychomycosis, plantar hyperhidrosis, undersized resupply boots, rounded trimming of the nails and recent treatment with isotretinoin and indinavir. The condition worsened severely on 30 November 2005, after cyclosporine and cetuximab treatment and a hospital admission during which he could not wash his feet, and required bilateral total nail avulsion with phenol matrixectomy.
Timeline
- 12 Mar 1991 — The veteran enlisted in the Australian Army and was allotted to the infantry. The entry medical examination recorded normal feet, straight great toes and normal toenails, with no skin or nail disease. "feet normal, nails normal"
- 14 Aug 1998 — A Defence podiatrist recorded bilateral hallux valgus, with the great toes deviated toward the second toes and rotated, pressing the lateral nail folds against the second toes, after seven years of marching and boot wear. Both great toenails were involuted, curving into the nail folds. Plantar hyperhidrosis was also recorded, with constantly wet socks. Wider boots and straight-across nail trimming were advised, but no surgery was offered. "bilateral hallux valgus, involuted nails"
- 10 Jul 1999 — A Defence-funded dermatologist commenced isotretinoin 40 mg daily for nodulocystic acne of the back and chest, aggravated by webbing and pack straps. Isotretinoin was continued to 05 September 1999 and stopped before deployment. Dry skin and fragile nail folds were noted at review. "isotretinoin 40 mg daily commenced"
- 16 Oct 1999 — On warlike service in East Timor the veteran sustained a needle-stick injury while helping the company medic treat a civilian with machete wounds. Post-exposure prophylaxis with zidovudine, lamivudine and indinavir was commenced at the role 2 facility and taken for 28 days, to 13 November 1999. On 08 November 1999 tinea pedis and onychomycosis of both great toenails were diagnosed, with positive microscopy and culture of Trichophyton rubrum. "PEP with indinavir commenced"
- 02 Dec 1999 — While unloading a truck at a forward company base, a bundle of steel pickets slipped and fell across both forefeet. Both great toenails were crushed, with subungual haematomas under each nail and partial lifting of the nail plates. X-ray showed no fracture. From 20 December 1999 he wore resupply boots one size too small, as his size was unavailable, for 14 to 18 hours a day on patrol, and on 01 January 2000 he cut both great toenails short and rounded the corners with a knife to relieve the pressure. "crushed both great toenails"
- 13 Jan 2000 — At the regimental aid post he reported three days of pain, redness and swelling along both sides of both great toenails, beginning on 10 January 2000 during a patrol. The medical officer recorded bilateral ingrown great toenails, with the nail edges embedded in inflamed medial and lateral nail folds, paronychia and early granulation tissue, wet macerated feet and tinea. Flucloxacillin and twice-daily foot soaks were prescribed, but he returned to patrol the next day, and wedge resection was deferred because no podiatry or minor surgical service was available forward. "bilateral ingrown great toenails, paronychia"
- 14 Jun 2005 — Chronic plaque psoriasis, which had begun as guttate psoriasis after streptococcal tonsillitis in East Timor in January 2000, was treated by a dermatologist with cyclosporine 3 mg/kg/day from 05 April 2005 to 30 September 2005. Type 2 diabetes mellitus was diagnosed on 14 June 2005 with an HbA1c of 7.4 per cent, and metformin was commenced. Cyclosporine was stopped when a rapidly growing squamous cell carcinoma of the scalp, attributed to tropical solar exposure on service and cyclosporine immunosuppression, recurred after excision. "cyclosporine, new type 2 diabetes"
- 30 Nov 2005 — The veteran was treated with radiotherapy and weekly cetuximab, an epidermal growth factor receptor inhibitor, from 10 October 2005 to 28 November 2005 for locally advanced squamous cell carcinoma of the scalp. From 20 to 30 November 2005 he was admitted with radiation dermatitis and fever and was confined to bed, unable to wash his feet or change his socks. On discharge the medical officer recorded severe bilateral ingrown great toenails with pus, pyogenic granulomas along all four nail folds and spreading cellulitis. A podiatric surgeon performed bilateral total nail avulsion with phenol matrixectomy on 05 December 2005. "severe ingrown toenails, pyogenic granulomas"
Symptoms
At onset the veteran had pain, redness, swelling and tenderness along the medial and lateral nail folds of both great toes, worse with boots on and with walking, and discharge from the nail folds. He limped on patrol and could not tolerate pressure on the toes. Between 2000 and 2005 the ingrown nails recurred repeatedly, with episodes of infection.
Since the worsening in November 2005 and the bilateral nail avulsion with matrixectomy, he reports thickened, irregular nail remnants, recurrent tenderness and occasional infection of the nail folds, pain in enclosed shoes, and difficulty walking long distances. He avoids tight footwear and has ongoing podiatry care.
Imaging
- 14 Aug 1998 — X-ray both feet (weight-bearing): "Bilateral hallux valgus, hallux valgus angle 27 degrees on the right and 25 degrees on the left, with pronation of the great toes. No subungual exostosis."
- 02 Dec 1999 — X-ray both feet: "No fracture of the distal phalanges of the great toes. Soft tissue swelling over both great toes. Bilateral hallux valgus."
Onset Date
The most likely date of onset of this condition is 10 Jan 2000.
At that date the veteran was an infantry soldier on warlike service in East Timor, on a multi-day foot patrol in wet tropical conditions, wearing undersized resupply boots, with crushed and fungally infected great toenails that he had recently cut short and rounded.
This date is appropriate because the regimental aid post examination of 02 December 1999, after the crush injury, recorded subungual haematomas but no nail fold inflammation, and at his presentation on 13 January 2000 he dated the pain, redness and swelling of the nail folds to 10 January 2000, three days earlier.
For the deformity factor, the hallux valgus was present from at least August 1998 and at onset on 10 Jan 2000. For the nail injury and medication factors, the 6 months before onset run from 10 Jul 1999 to 10 Jan 2000; the crush injury of 02 December 1999, isotretinoin from 10 July to 05 September 1999 and indinavir from 16 October to 13 November 1999 fall within it. For the trimming factor, the 14 days before onset run from 27 Dec 1999 to 10 Jan 2000; he cut and rounded the nails on 01 January 2000. For the footwear factor, the 4 weeks before onset run from 13 Dec 1999 to 10 Jan 2000; he wore undersized boots for 14 to 18 hours a day from 20 December 1999. For the hyperhidrosis factor, the 7 days before onset run from 03 Jan 2000 to 10 Jan 2000. For the fungal infection factor, the 1 year before onset runs from 10 Jan 1999 to 10 Jan 2000; onychomycosis was diagnosed on 08 November 1999.
For the worsening factors, the period after onset runs from 10 Jan 2000 to the documented worsening on 30 Nov 2005. The 6 months before the worsening run from 30 May 2005 to 30 Nov 2005, during which he took cyclosporine to 30 September 2005 and cetuximab from 10 October to 28 November 2005. The 7 days before the worsening run from 23 Nov 2005 to 30 Nov 2005, during which he was confined to bed in hospital and could not wash his feet or socks. He had type 2 diabetes, diagnosed on 14 June 2005, at the time of the worsening.
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Bilateral Great Toes - Ingrown Toenail (ICD-10-AM L60.0), under the Statements of Principles concerning ingrown nail, Balance of Probabilities No. 73 of 2024 and Reasonable Hypothesis No. 72 of 2024.
An ingrown nail is a condition in which the nail plate penetrates the soft tissue of the adjacent nail fold, causing inflammation and pain. It most commonly affects the great toes. It is promoted by toe deformity, nail trauma, tight footwear, improper trimming, sweating and maceration, fungal nail infection, diabetes and certain medications that make the nail folds fragile. Untreated it leads to infection, granulation tissue and recurrence, and recurrent cases are treated by partial or total nail avulsion with destruction of the nail matrix.
The condition began on 10 January 2000 on warlike service in East Timor, affecting both great toes, and worsened severely on 30 November 2005, requiring bilateral total nail avulsion with phenol matrixectomy on 05 December 2005.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
10 January 2000.
When did the veteran first present to a health / medical provider for this condition?
13 January 2000.
When was the condition confirmed / formally diagnosed?
13 January 2000.
When did the veteran first present to you (or your practice) for this condition?
26 June 2025.
3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?
The diagnosis was made clinically by the regimental medical officer on 13 January 2000, who recorded the edges of both great toenails embedded in the medial and lateral nail folds, with inflammation, pain, paronychia and early granulation tissue. This meets the Statement of Principles definition of ingrown nail: the nail plate penetrating the soft tissue of the adjacent nail fold, resulting in inflammation and pain.
The clinical course was consistent, with recurrent episodes from 2000 to 2005 and a severe worsening documented on 30 November 2005, with pus, pyogenic granulomas along all four nail folds and cellulitis. A podiatric surgeon confirmed the diagnosis and performed bilateral total nail avulsion with phenol matrixectomy on 05 December 2005.
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.
Legislation: the clinical onset of this condition was on 10 January 2000, before 1 July 2004, while the veteran was on warlike service in East Timor. That service is operational service under the Veterans' Entitlements Act 1986 (VEA), so this is a VEA claim and the Statements of Principles apply. The Reasonable Hypothesis instrument applies to his operational service in East Timor, where the condition began. The Balance of Probabilities instrument applies to his peacetime service, including the years of boot wear that produced the hallux valgus and the treatment in Australia before the worsening of 30 November 2005; because that worsening occurred during full-time service after 1 July 2004, the aggravation may also be considered under the Military Rehabilitation and Compensation Act 2004.
Each factor must be related to the person's relevant service. Under the beneficial approach required by the legislation, the absence of documentation does not mean that an event or exposure did not occur: lack of evidence is not evidence of lack.
Balance of Probabilities — Statement of Principles concerning Ingrown Nail, No. 73 of 2024
Causative factors
Factor 9(1): having an acquired deformity of the affected digit which causes the nail to be pushed into the proximate soft tissue at the time of clinical onset; — MET
- The veteran had bilateral hallux valgus, recorded by a Defence podiatrist on 14 August 1998 with hallux valgus angles of 27 and 25 degrees on X-ray, acquired through seven years of marching under load in issued boots. The deviation and pronation of both great toes pressed the lateral nail folds against the second toes and pushed the nail edges into the soft tissue. The deformity was present at onset on 10 January 2000.
Factor 9(2): having an injury to the affected nail or the affected nail bed, within the 6 months before the clinical onset or clinical worsening; — MET
- On 02 December 1999 a bundle of steel pickets fell across both forefeet while the veteran was unloading a truck, crushing both great toenails, causing subungual haematomas and partially lifting both nail plates. This injury to the affected nails and nail beds occurred during his duties 39 days before onset, within the 6 months from 10 July 1999 to 10 January 2000.
Factor 9(3)(a): Being treated with; (a) an oral retinoid; Within the 6 months before clinical onset or clinical worsening; — MET
- The veteran took isotretinoin, an oral retinoid, 40 mg daily from 10 July 1999 to 05 September 1999, prescribed by a Defence-funded dermatologist for nodulocystic acne aggravated by webbing and pack straps. This was within the 6 months before onset on 10 January 2000. Isotretinoin makes the nail folds fragile and promotes ingrown nails and granulation tissue.
Factor 9(3)(b): Being treated with; (b) indinavir; Within the 6 months before clinical onset or clinical worsening; — MET
- The veteran took indinavir from 16 October 1999 to 13 November 1999 as part of post-exposure prophylaxis after a needle-stick injury sustained while giving first aid in the course of his duties. This was within the 6 months before onset. Indinavir is well recognised to cause ingrown toenails and paronychia.
Factor 9(3)(c): Being treated with; (c) an epidermal growth factor inhibitor; Within the 6 months before clinical onset or clinical worsening; — MET
- The veteran received weekly cetuximab, an epidermal growth factor receptor inhibitor, from 10 October 2005 to 28 November 2005 with radiotherapy for a squamous cell carcinoma of the scalp attributed to solar exposure on service. This was within the 6 months before the worsening on 30 November 2005, which runs from 30 May 2005. Epidermal growth factor receptor inhibitors characteristically cause paronychia, ingrown nails and pyogenic granulomas, which were present at the worsening.
Factor 9(3)(d): Being treated with; (d) cyclosporine (cyclosporin); Within the 6 months before clinical onset or clinical worsening; — MET
- A dermatologist treated the veteran's chronic plaque psoriasis with cyclosporine 3 mg/kg/day from 05 April 2005 to 30 September 2005. This was within the 6 months before the worsening on 30 November 2005. Cyclosporine causes gingival and nail fold overgrowth and promotes ingrown nails.
Factor 9(4): having excessive trimming of the affected toenail or rounding the corners of the affected toenail rather than cutting the nail straight across the top within 14 days before clinical onset or clinical worsening; — MET
- On 01 January 2000, nine days before onset, the veteran cut both great toenails short and rounded the corners with a knife to relieve pressure from the undersized boots, as no nail clippers were available at the forward base. This was within the 14 days before onset, from 27 December 1999 to 10 January 2000, and is recorded in the aid post history of 13 January 2000.
Factor 9(5): wearing footwear that causes compression of the toes or pressure on the affected toenail. This includes but is not limited to footwear that is too narrow or too short, or has inadequate depth in the toe box on the affected foot, for at least 8 hours within the 4 weeks before clinical onset or clinical worsening; — MET
- From 20 December 1999 the veteran wore resupply combat boots one size too small, because his size was unavailable, for 14 to 18 hours a day on patrol. The boots compressed the toes and pressed on both great toenails. This amounted to well over 8 hours within the 4 weeks before onset, from 13 December 1999 to 10 January 2000, and was required by his duties.
Factor 9(6): having hyperhidrosis affecting the feet within the 7 days before the clinical onset or clinical worsening; — MET
- Plantar hyperhidrosis was recorded by a Defence podiatrist on 14 August 1998, and on 13 January 2000 the medical officer recorded wet, macerated feet. The veteran had hyperhidrosis affecting the feet throughout the 7 days before onset, from 03 January to 10 January 2000, aggravated by prolonged boot wear in tropical heat. Maceration softens the nail folds and allows the nail edge to penetrate them.
Factor 9(7): having diabetes mellitus at the time of clinical onset or clinical worsening; — MET
- Type 2 diabetes mellitus was diagnosed on 14 June 2005 with an HbA1c of 7.4 per cent and treated with metformin. It was present at the worsening on 30 November 2005, when the HbA1c was 8.1 per cent. The diabetes was attributed to cyclosporine and weight gain during treatment for service-related psoriasis, and it impaired healing and increased infection of the nail folds.
Factor 9(8): having a fungal infection involving the affected nail within the one year before clinical onset or clinical worsening; — MET
- Onychomycosis of both great toenails, with positive microscopy and culture of Trichophyton rubrum, was diagnosed on 08 November 1999, 63 days before onset and within the one year from 10 January 1999 to 10 January 2000. The infection was acquired through prolonged wear of wet boots and socks in his infantry duties. It thickened and distorted the nail plates.
Worsening factors
Factor 9(9): inability to obtain appropriate clinical management for ingrown nail before clinical worsening. — MET
- When the condition was diagnosed on 13 January 2000 the veteran was returned to patrol the next day, could not carry out the prescribed foot soaks, and wedge resection was deferred because no podiatry or minor surgical service was available forward. After return to Australia he waited until 2001 for a partial nail avulsion, without matrixectomy, and the nails recurred repeatedly. Definitive matrixectomy was not performed until 05 December 2005, after the severe worsening. Under Brew v Repatriation Commission (1999) this is an inability to obtain appropriate clinical management before the clinical worsening.
Reasonable Hypothesis — Statement of Principles concerning Ingrown Nail, No. 72 of 2024
Causative factors
Factor 9(1): having an acquired deformity of the affected digit which causes the nail to be pushed into the proximate soft tissue at the time of clinical onset; — MET
- Bilateral hallux valgus, acquired through marching under load in issued boots and recorded in August 1998, pushed the edges of both great toenails into the nail folds. It was present at onset on 10 January 2000 on warlike service in East Timor, where five months of foot patrolling in boots increased the pressure on the deformed toes.
Factor 9(2): having an injury to the affected nail or the affected nail bed, within the 6 months before clinical onset or clinical worsening; — MET
- On warlike service in East Timor on 02 December 1999 a bundle of steel pickets fell across both of the veteran's forefeet at a forward company base, crushing both great toenails and nail beds with subungual haematomas. This was within the 6 months before onset on 10 January 2000.
Factor 9(3)(a): being treated with; (a) an oral retinoid; within the 6 months before clinical onset or clinical worsening; — MET
- The veteran completed a course of isotretinoin 40 mg daily from 10 July 1999 to 05 September 1999, within the 6 months before onset on warlike service on 10 January 2000. It was stopped only 15 days before deployment, and the dry, fragile nail folds it caused were still recorded during the early weeks in East Timor.
Factor 9(3)(b): being treated with; (b) indinavir; within the 6 months before clinical onset or clinical worsening; — MET
- Indinavir was taken from 16 October 1999 to 13 November 1999 as post-exposure prophylaxis after a needle-stick injury while helping treat a civilian with machete wounds on warlike service in East Timor. This was within the 6 months before onset on 10 January 2000.
Factor 9(3)(c): being treated with; (c) an epidermal growth factor inhibitor; within the 6 months before clinical onset or clinical worsening; — MET
- Weekly cetuximab was given from 10 October 2005 to 28 November 2005, within the 6 months before the worsening on 30 November 2005, for a squamous cell carcinoma of the scalp. The treating dermatologist attributed the carcinoma to intense tropical solar exposure on warlike service in East Timor, compounded by cyclosporine.
Factor 9(3)(d): being treated with; (d) cyclosporine (cyclosporin); within the 6 months before clinical onset or clinical worsening; — MET
- Cyclosporine was taken from 05 April 2005 to 30 September 2005, within the 6 months before the worsening on 30 November 2005, for chronic plaque psoriasis that began as guttate psoriasis after streptococcal tonsillitis on warlike service in East Timor in January 2000.
Factor 9(4): having excessive trimming of the affected toenail or rounding the corners of the affected toenail rather than cutting the nail straight across the top within 14 days before clinical onset or clinical worsening; — MET
- On warlike service in East Timor on 01 January 2000 the veteran cut both great toenails short and rounded the corners with a knife to relieve pressure from undersized boots, nine days before onset and within the 14 days before it.
Factor 9(5): wearing footwear that causes compression of the toes or pressure on the affected toenail. This includes but is not limited to footwear that is too narrow or too short, or has inadequate depth in the toe box on the affected foot, for at least 8 hours within the 4 weeks before clinical onset or clinical worsening; — MET
- From 20 December 1999 on warlike service the veteran wore resupply boots one size too small for 14 to 18 hours a day on patrol, because correctly sized boots could not be supplied. This compressed both great toes within the 4 weeks before onset on 10 January 2000.
Factor 9(6): having hyperhidrosis affecting the feet within the 7 days before the clinical onset or clinical worsening; — MET
- The veteran's plantar hyperhidrosis was severe in the 7 days before onset, from 03 to 10 January 2000, while on patrol in tropical heat in East Timor, and his feet were recorded as wet and macerated on 13 January 2000.
Factor 9(8): having diabetes mellitus at the time of clinical onset or clinical worsening; — MET
- Type 2 diabetes mellitus, diagnosed on 14 June 2005, was present at the worsening on 30 November 2005. It developed during cyclosporine treatment of psoriasis that arose after streptococcal infection on warlike service in East Timor.
Factor 9(9): having a fungal infection involving the affected nail within the 1 year before clinical onset or clinical worsening; — MET
- Onychomycosis of both great toenails was diagnosed on warlike service on 08 November 1999, with Trichophyton rubrum on culture, after weeks of patrolling in wet boots and socks. This was within the 1 year before onset on 10 January 2000.
Worsening factors
Factor 9(7): having an inability to regularly wash feet or socks within the 7 days before clinical worsening; — MET
- From 20 to 30 November 2005 the veteran was admitted to hospital with radiation dermatitis and fever during treatment of the scalp carcinoma attributed to solar exposure on warlike service, and was confined to bed, unable to wash his feet or change his socks. This was within the 7 days before the worsening, from 23 to 30 November 2005. The same inability had applied on patrol in East Timor before and after onset, when he could not carry out the prescribed foot soaks.
Factor 9(10): inability to obtain appropriate clinical management for ingrown nail before clinical worsening. — MET
- On warlike service in East Timor the veteran was returned to patrol the day after diagnosis on 13 January 2000, could not soak or dry his feet, and could not obtain wedge resection because no podiatry or minor surgical service was available forward. Definitive matrixectomy was not performed until after the severe worsening in November 2005. These operational constraints amount to an inability to obtain appropriate clinical management before the clinical worsening.
The % contribution of the causes is 100% and significant.
Sequelae
The bilateral nail avulsion and phenol matrixectomy of December 2005 have left dystrophic nail remnants with recurrent nail fold tenderness and episodes of paronychia, and pain in enclosed footwear that limits walking. These are sequelae of the accepted ingrown toenails.
Unintended Consequence
Met. The worsening of 30 November 2005 followed cyclosporine and cetuximab, and the indinavir taken before onset was post-exposure prophylaxis, all prescribed and paid for by the Commonwealth during the veteran's service. The ingrown nails and pyogenic granulomas are recognised adverse effects of these drugs and are an unintended consequence of that treatment (section 6A of the DRCA and the equivalent provisions of the MRCA).
Inability to Attain Appropriate Medical Management
MET. When the ingrown toenails were diagnosed on warlike service on 13 January 2000, the veteran was returned to patrol the next day and could not carry out the prescribed soaks or keep his feet dry, and wedge resection was deferred because no podiatry or minor surgical service was available forward. After return to Australia he received only a partial nail avulsion without matrixectomy in 2001, the nails recurred, and definitive matrixectomy was not performed until 05 December 2005, after the severe worsening. Applying the objective and subjective tests in Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J), operational constraints and the delay in definitive treatment amount to an inability to obtain appropriate clinical management, and this contributed to the worsening.
5. Please provide a Health Summary and a medication / prescribing history.
See attached report.
References
- 12 Mar 1991, Entry medical examination, Army recruiting medical officer
- 14 Aug 1998, Podiatry assessment and X-ray both feet, Defence podiatrist and radiologist
- 10 Jul 1999, Specialist letter, Dermatologist
- 16 Oct 1999, Role 2 treatment record and post-exposure prophylaxis plan, Medical officer, East Timor
- 08 Nov 1999, Pathology report, nail microscopy and culture
- 02 Dec 1999, Regimental aid post record and X-ray both feet, Regimental Medical Officer
- 13 Jan 2000, Regimental aid post record, Regimental Medical Officer, East Timor
- 14 Jun 2005, Specialist letter and pathology, Dermatologist and Medical Officer
- 10 Oct 2005, Oncology treatment plan, Medical oncologist and radiation oncologist
- 30 Nov 2005, Hospital discharge summary, Medical officer
- 05 Dec 2005, Operation report, Podiatric surgeon
- Statement of Principles concerning Ingrown Nail (Balance of Probabilities) No. 73 of 2024, Repatriation Medical Authority
- Statement of Principles concerning Ingrown Nail (Reasonable Hypothesis) No. 72 of 2024, Repatriation Medical Authority
