Bruxism — DVA claim example

Diagnostic Assessment — Bruxism

Example 1 of 1 · fictitious patient (Veteran F)

Diagnostic Assessment

Bruxism

BOP Code: 8 of 2026 (Bruxism)
RH Code: 7 of 2026 (Bruxism)

ADF History

Veteran F, date of birth 21 October 1985, Australian Army, Infantry Soldier (Rifleman, later Section Commander), enlisted 08 March 2004, medically discharged 17 October 2019. Operational service: Afghanistan, 11 April 2008 to 02 November 2008 (warlike); Afghanistan, 07 February 2011 to 12 July 2011 (warlike, ended by aeromedical evacuation after a blast injury).

Occupational History

As an infantry soldier the veteran conducted foot patrols carrying 35 to 50 kilograms, manned observation posts and sentry positions through the night, and took part in cordon and search operations in a high-threat environment. Sleep on operations was broken into short blocks around picquet rosters, and caffeine was relied on to stay alert through night duties.

Infantry soldiers on route and foot patrols in southern Afghanistan carried a high risk of improvised explosive device blast, small arms contact and traumatic brain injury, and repeated exposure to casualties and threat to life is strongly associated with posttraumatic stress disorder, anxiety and depression. Post-deployment heavy drinking was common in the unit culture of the period.

History

Veteran F, an infantry soldier in the Australian Army, developed sleep and awake bruxism on 02 August 2011, 23 days after a moderate traumatic brain injury with an acute subdural haematoma from an improvised explosive device blast in Afghanistan, while already being treated for posttraumatic stress disorder, anxiety and depression with sertraline and quetiapine. The bruxism worsened markedly in September 2020, when his occlusal splint could not be replaced during COVID-19 dental restrictions and he was drinking heavily and taking several medications that aggravate bruxism.

Timeline

• 14 Nov 2009 — Twelve months after his first Afghanistan deployment the veteran was referred to a psychiatrist with nightmares, hypervigilance, low mood and constant worry. The psychiatrist diagnosed posttraumatic stress disorder related to a contact in which a section member was killed, together with major depressive disorder and generalised anxiety disorder. Sertraline was commenced and titrated to 150 mg daily. Quetiapine 50 mg at night was added on 03 June 2010 for persisting nightmares and both medications were continued without interruption. "PTSD, MDD, GAD; sertraline 150 mg"
• 20 Apr 2011 — On warlike service in Afghanistan the veteran presented to the role 1 medical post with heartburn, acid regurgitation and epigastric pain, worse at night after long picquet shifts. The medical officer recorded seven to eight cups of brewed and instant coffee a day since arrival in February and diagnosed gastro-oesophageal reflux disease. Esomeprazole 40 mg daily was commenced and continued. His sertraline and quetiapine were continued on deployment under psychiatric review. "GORD, 7-8 coffees daily"
• 10 Jul 2011 — During a foot patrol the veteran was thrown by the blast of an improvised explosive device. He lost consciousness for approximately 45 minutes, his Glasgow Coma Scale score on arrival at the role 3 hospital was 11, and post-traumatic amnesia lasted three days. CT of the brain showed a left acute subdural haematoma with 4 mm midline shift, which was evacuated through a craniotomy. He was aeromedically evacuated to Australia on 12 July 2011. "moderate TBI, acute SDH evacuated"
• 04 Aug 2011 — On the neurosurgical rehabilitation ward nursing staff had recorded loud tooth grinding during sleep from the night of 02 August 2011 and daytime jaw clenching. A dental officer reviewed him on 04 August and found fresh attrition facets on the canines and incisors, a fractured cusp on the lower left first molar, tender hypertrophied masseters and morning jaw pain. Methylphenidate 10 mg twice daily had been started on 26 July 2011 by the rehabilitation physician for post-traumatic inattention, and sertraline, quetiapine and esomeprazole were continuing. "nocturnal grinding, fresh attrition facets"
• 21 Sep 2011 — An oral medicine specialist confirmed sleep and awake bruxism. Audio-video polysomnography on 16 September 2011 had shown rhythmic masticatory muscle activity at 6.2 episodes per hour of sleep with audible grinding sounds. A hard acrylic maxillary occlusal splint was fitted and habit-reversal advice given. The specialist noted the temporal relationship to the brain injury and the contribution of the psychiatric disorders and medications. "sleep and awake bruxism confirmed"
• 22 Jul 2019 — At his separation medical examination the veteran's medications were recorded as desvenlafaxine 100 mg (substituted for sertraline in March 2016), quetiapine 50 mg at night, dexamphetamine 10 mg twice daily (substituted for methylphenidate in May 2017), levodopa with benserazide 100/25 mg at night for antidepressant-associated restless legs syndrome (from February 2018) and flunarizine 10 mg at night for post-traumatic vestibular migraine (from April 2019, under the Special Access Scheme). The splint remained in nightly use and the bruxism was described as controlled. "bruxism controlled on nightly splint"
• 14 Sep 2020 — The veteran presented to his general practitioner and dentist with constant jaw pain, temporal headaches on waking, a cracked upper right first molar and a fractured lower incisor. His splint had fractured in February 2020 and could not be replaced while non-urgent dental care was suspended and his transition-era dental entitlement was unresolved. Since March 2020 he had been drinking about six standard drinks a day and using cocaine at weekends, recorded by his psychologist. Masseter hypertrophy was marked and repeat polysomnography showed 11.8 episodes of rhythmic masticatory muscle activity per hour. "splint broken, bruxism markedly worse"

Symptoms

At onset the veteran had loud nightly tooth grinding witnessed by ward staff, daytime jaw clenching, morning jaw and temple pain, tender enlarged masseter muscles and fresh wear facets with a fractured molar cusp. Symptoms were constant from August 2011 and were controlled, though not abolished, by the nightly occlusal splint.

Since the worsening in 2020 he reports jaw pain most days, headaches on waking, jaw fatigue when chewing, sensitivity in the cracked teeth and partner-reported grinding most nights. Two teeth have required crowns and he wears a replacement splint every night.

Imaging

• 10 Jul 2011 — CT brain: "Left acute subdural haematoma, maximum thickness 11 mm, with 4 mm midline shift. Small left frontal contusion."
• 17 Jul 2011 — CT brain (post-operative): "Satisfactory evacuation of the left subdural haematoma with a small residual collection. No new haemorrhage."
• 04 Aug 2011 — Orthopantomogram: "Fracture of the distolingual cusp of the lower left first molar. Flattened incisal edges. Temporomandibular joints normal in appearance."
• 14 Sep 2020 — Orthopantomogram and periapical radiographs: "Vertical crack line in the upper right first molar and fracture of the lower right central incisor crown. Generalised attrition progressed since 2011. Bilateral masseteric prominence on the soft tissue shadow."

Onset Date

The most likely date of onset of this condition is 02 Aug 2011.

At that date the veteran was a serving infantry soldier, an inpatient on a neurosurgical rehabilitation ward in Australia after aeromedical evacuation from warlike service in Afghanistan. Nursing staff recorded loud tooth grinding during sleep from that night, followed by daytime clenching and jaw pain.

This date is appropriate because his pre-deployment dental examination on 18 January 2011 recorded no wear facets, no muscle tenderness and no history of grinding, and the first presentation to a dental officer with the features of bruxism was on 04 August 2011, two days after the first nursing record. The onset falls within continuous full-time service.

For the traumatic brain injury factor, the 30 days before onset run from 03 Jul 2011 to 02 Aug 2011; the moderate traumatic brain injury occurred on 10 Jul 2011, 23 days before onset, and the subdural haematoma was present at onset. For the coffee factor, the 6 months before onset run from 02 Feb 2011 to 02 Aug 2011; he drank seven to eight cups of coffee a day from his arrival in Afghanistan on 07 Feb 2011 and continued at the same level on the ward, and during pre-deployment training in January and early February 2011 he was already drinking six to seven cups a day, as recorded in the dietitian's intake history. Posttraumatic stress disorder, depressive disorder, anxiety disorder and gastro-oesophageal reflux disease were each diagnosed before 02 Aug 2011 and present on that date, and he was taking sertraline, quetiapine and methylphenidate on that date.

For the worsening factors, the period after onset runs from 02 Aug 2011 to the documented worsening on 14 Sep 2020. The 6 months before the worsening run from 14 Mar 2020 to 14 Sep 2020, during which he drank an average of about 60 grams of alcohol a day. At the worsening he was taking desvenlafaxine, dexamphetamine, levodopa and flunarizine and was using cocaine, and his occlusal splint had been unavailable since February 2020.

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

The formal diagnosis is Bruxism (ICD-10-AM G47.63), comprising sleep bruxism and awake bruxism, under the Statements of Principles concerning bruxism, Balance of Probabilities No. 8 of 2026 and Reasonable Hypothesis No. 7 of 2026.

Bruxism is a disorder of jaw muscle activity characterised by repetitive, involuntary clenching or grinding of the teeth, or bracing or thrusting of the mandible, occurring during sleep, wakefulness or both. Sleep bruxism is associated with micro-arousals and is aggravated by brain injury, psychological distress, alcohol, caffeine, stimulants and serotonergic medication. Its consequences include tooth wear and fracture, failure of dental restorations, masticatory muscle pain and hypertrophy, temporomandibular disorder and headache.

The bruxism began on 02 August 2011, 23 days after a moderate traumatic brain injury on warlike service, was confirmed by an oral medicine specialist on polysomnography in September 2011 and worsened in September 2020.

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

When did the veteran first experience symptoms attributable to this condition?

02 August 2011.

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

04 August 2011.

When was the condition confirmed / formally diagnosed?

21 September 2011.

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

18 June 2025.

3. How was this diagnosis confirmed? i.e. what were the key symptoms and signs, investigation results, specialist opinions?

The diagnosis was confirmed by an oral medicine specialist on 21 September 2011 on the basis of witnessed grinding during sleep, awake clenching, fresh attrition facets on the canines and incisors, a fractured molar cusp, morning jaw pain and tender, hypertrophied masseter muscles. Audio-video polysomnography on 16 September 2011 recorded rhythmic masticatory muscle activity at 6.2 episodes per hour with grinding sounds, which meets the polysomnographic criteria for definite sleep bruxism. This meets the Statement of Principles definition of bruxism.

The worsening on 14 September 2020 was confirmed clinically and radiologically, with new cracked and fractured teeth, progression of attrition, marked masseter hypertrophy, and repeat polysomnography showing 11.8 episodes of rhythmic masticatory muscle activity per hour, almost double the 2011 figure.

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 02 August 2011, after 1 July 2004, during continuous full-time service. This is a Military Rehabilitation and Compensation Act 2004 (MRCA) claim and the Statements of Principles apply. The Balance of Probabilities instrument applies to peacetime service. The Reasonable Hypothesis instrument applies to the veteran's warlike service in Afghanistan in 2008 and 2011, where the posttraumatic stress disorder arose, the gastro-oesophageal reflux disease and heavy caffeine intake began, and the traumatic brain injury and subdural haematoma were sustained.

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 Bruxism, No. 8 of 2026

Causative factors (clinical onset or clinical worsening)

Factor 9(1): experiencing a moderate to severe traumatic brain injury within the 30 days before clinical onset or clinical worsening; — MET

- The veteran sustained a moderate traumatic brain injury in an improvised explosive device blast on 10 July 2011, with loss of consciousness of about 45 minutes, a Glasgow Coma Scale score of 11 and post-traumatic amnesia of three days. Bruxism began on 02 August 2011, 23 days later, within the 30-day window. The injury arose from his service as an infantry soldier.

Factor 9(2): having a clinically significant neurological condition as specified at the time of the clinical onset or clinical worsening; — MET

- CT of the brain on 10 July 2011 showed a left acute subdural haematoma with midline shift, evacuated by craniotomy, and the residual collection was still present on CT of 17 July 2011. Subdural haematoma is on the specified list, and it was present and under neurosurgical follow-up at the onset on 02 August 2011. It was caused by the blast during service.

Factor 9(3): having an anxiety disorder at the time of clinical onset or clinical worsening; — MET

- A psychiatrist diagnosed generalised anxiety disorder on 14 November 2009, arising from his service, and it required ongoing treatment with sertraline and later desvenlafaxine and psychology. It was clinically significant and present at the onset on 02 August 2011 and again at the worsening on 14 September 2020.

Factor 9(4)(a): taking any of the following at the time of the clinical onset or clinical worsening: amphetamines or amphetamine derivatives, including methamphetamine, 3,4-methylenedioxymethamphetamine (ecstasy or MDMA); — MET

- Dexamphetamine, an amphetamine, was prescribed at 10 mg twice daily from May 2017 for attention deficits after the service-related brain injury, and he was taking it at the worsening on 14 September 2020, as recorded at his separation medical and in the general practice record.

Factor 9(4)(b): taking any of the following at the time of the clinical onset or clinical worsening: antipsychotics; — MET

- Quetiapine, an antipsychotic, was prescribed at 50 mg at night from 03 June 2010 for nightmares of service-related posttraumatic stress disorder and was being taken at the onset on 02 August 2011, as recorded on the ward medication chart.

Factor 9(4)(c): taking any of the following at the time of the clinical onset or clinical worsening: dexamphetamine; — MET

- Dexamphetamine 10 mg twice daily was prescribed from May 2017 for post-traumatic inattention following the service-related brain injury and was being taken at the worsening on 14 September 2020.

Factor 9(4)(d): taking any of the following at the time of the clinical onset or clinical worsening: methylphenidate; — MET

- Methylphenidate 10 mg twice daily was commenced on 26 July 2011 by the rehabilitation physician for post-traumatic inattention and was being taken at the onset on 02 August 2011, recorded on the ward medication chart.

Factor 9(4)(e): taking any of the following at the time of the clinical onset or clinical worsening: selective serotonin reuptake inhibitors; — MET

- Sertraline, a selective serotonin reuptake inhibitor, was prescribed from 14 November 2009 at 150 mg daily for service-related posttraumatic stress disorder, depression and anxiety, and was being taken at the onset on 02 August 2011.

Factor 9(4)(f): taking any of the following at the time of the clinical onset or clinical worsening: serotonin and noradrenaline (norepinephrine) reuptake inhibitors. — MET

- Desvenlafaxine, a serotonin and noradrenaline reuptake inhibitor, replaced sertraline in March 2016 at 100 mg daily for the same service-related psychiatric conditions and was being taken at the worsening on 14 September 2020.

Factor 9(5): having gastro-oesophageal reflux disease at the time of the clinical onset or clinical worsening; — MET

- Gastro-oesophageal reflux disease was diagnosed by a medical officer on 20 April 2011 and treated continuously with esomeprazole 40 mg daily. It was present at the onset on 02 August 2011, and it was again symptomatic at the worsening on 14 September 2020. It developed with the heavy caffeine intake, irregular meals and night duties of his service.

Worsening factors

Factor 9(6): inability to obtain appropriate clinical management for bruxism before clinical worsening. — MET

- The veteran's prescribed occlusal splint fractured in February 2020 and could not be replaced for seven months, from February to September 2020, because non-urgent dental services were suspended under the COVID-19 restrictions and his post-discharge dental entitlement was unresolved. During that period the bruxism was unmanaged and it worsened, documented on 14 September 2020 by new tooth fractures and an increase in rhythmic masticatory muscle activity from 6.2 to 11.8 episodes per hour. Under Brew v Repatriation Commission (1999) this is an inability to obtain appropriate clinical management.

Reasonable Hypothesis — Statement of Principles concerning Bruxism, No. 7 of 2026

Causative factors (clinical onset or clinical worsening)

Factor 9(1): experiencing a moderate to severe traumatic brain injury within the 30 days before clinical onset or clinical worsening; — MET

- The moderate traumatic brain injury occurred on warlike service in Afghanistan on 10 July 2011, when an improvised explosive device detonated on his foot patrol. Loss of consciousness lasted about 45 minutes, the Glasgow Coma Scale score was 11 and post-traumatic amnesia lasted three days. Bruxism began 23 days later, on 02 August 2011.

Factor 9(2): having a clinically significant neurological condition as specified at the time of the clinical onset or clinical worsening; — MET

- The acute subdural haematoma, shown on CT on 10 July 2011 and evacuated by craniotomy at the role 3 hospital, was caused by the blast on warlike service in Afghanistan. Subdural haematoma is on the specified list and it was present, with a residual collection, at the onset on 02 August 2011.

Factor 9(3)(a): having one of the following clinically significant disorders of mental health at the time of clinical onset or clinical worsening: anxiety disorder; — MET

- Generalised anxiety disorder was diagnosed on 14 November 2009 following his warlike service in Afghanistan in 2008, warranted ongoing treatment with sertraline and psychology, and was present at the onset on 02 August 2011 and at the worsening on 14 September 2020.

Factor 9(3)(b): having one of the following clinically significant disorders of mental health at the time of clinical onset or clinical worsening: depressive disorder; — MET

- Major depressive disorder was diagnosed by the psychiatrist on 14 November 2009 following warlike service in Afghanistan, was treated continuously with antidepressants, and was present at onset on 02 August 2011 and at the worsening, when the psychologist recorded a PHQ-9 score of 19.

Factor 9(3)(c): having one of the following clinically significant disorders of mental health at the time of clinical onset or clinical worsening: posttraumatic stress disorder; — MET

- Posttraumatic stress disorder was diagnosed on 14 November 2009, related to a contact on warlike service in Afghanistan in 2008 in which a section member was killed. It was re-exacerbated by the 2011 blast and was present at the onset on 02 August 2011 and at the worsening on 14 September 2020, with a PCL-5 score of 58 in 2020.

Factor 9(4)(a): taking any of the following at the time of the clinical onset or clinical worsening: amphetamines or amphetamine derivatives, including methamphetamine, 3,4-methylenedioxymethamphetamine (ecstasy or MDMA); — MET

- Dexamphetamine, an amphetamine, was being taken at 10 mg twice daily at the worsening on 14 September 2020, prescribed from May 2017 for inattention resulting from the brain injury sustained on warlike service in Afghanistan.

Factor 9(4)(b): taking any of the following at the time of the clinical onset or clinical worsening: antipsychotics; — MET

- Quetiapine 50 mg at night, an antipsychotic, was being taken at the onset on 02 August 2011 and at the worsening, prescribed from 03 June 2010 for nightmares of posttraumatic stress disorder arising from warlike service in Afghanistan.

Factor 9(4)(c): taking any of the following at the time of the clinical onset or clinical worsening: cocaine; — MET

- At the time of the worsening on 14 September 2020 the veteran was using cocaine at weekends, recorded by his treating psychologist on 07 September 2020 and confirmed by a positive urine drug screen on 15 September 2020. The use began in March 2020 as self-medication of posttraumatic stress disorder arising from warlike service in Afghanistan, during a period of isolation and loss of routine after discharge.

Factor 9(4)(d): taking any of the following at the time of the clinical onset or clinical worsening: dexamphetamine; — MET

- Dexamphetamine 10 mg twice daily was being taken at the worsening on 14 September 2020, prescribed for post-traumatic inattention from the brain injury sustained on warlike service in Afghanistan.

Factor 9(4)(e): taking any of the following at the time of the clinical onset or clinical worsening: flunarizine; — MET

- Flunarizine 10 mg at night was prescribed by a neurologist under the Special Access Scheme from April 2019 for post-traumatic vestibular migraine, a consequence of the blast injury on warlike service in Afghanistan, and was being taken at the worsening on 14 September 2020.

Factor 9(4)(f): taking any of the following at the time of the clinical onset or clinical worsening: levodopa; — MET

- Levodopa with benserazide 100/25 mg at night was prescribed from February 2018 for restless legs syndrome induced by the antidepressants taken for posttraumatic stress disorder arising from warlike service, and was being taken at the worsening on 14 September 2020.

Factor 9(4)(g): taking any of the following at the time of the clinical onset or clinical worsening: methylphenidate; — MET

- Methylphenidate 10 mg twice daily was commenced on 26 July 2011 for inattention after the brain injury sustained on warlike service in Afghanistan and was being taken at the onset on 02 August 2011.

Factor 9(4)(h): taking any of the following at the time of the clinical onset or clinical worsening: selective serotonin reuptake inhibitors; — MET

- Sertraline 150 mg daily, a selective serotonin reuptake inhibitor, was being taken at the onset on 02 August 2011, prescribed from 14 November 2009 for posttraumatic stress disorder, depression and anxiety arising from warlike service in Afghanistan, and continued on deployment in 2011.

Factor 9(4)(i): taking any of the following at the time of the clinical onset or clinical worsening: serotonin and noradrenaline (norepinephrine) reuptake inhibitors; — MET

- Desvenlafaxine 100 mg daily, a serotonin and noradrenaline reuptake inhibitor, was being taken at the worsening on 14 September 2020, prescribed from March 2016 for the posttraumatic stress disorder and depression arising from warlike service in Afghanistan.

Factor 9(5): consuming an average of at least 30 grams of alcohol per day for a continuous period of 6 months before the clinical onset or clinical worsening; — MET

- In the 6 months before the worsening, from 14 March 2020 to 14 September 2020, the veteran drank about six standard drinks, or 60 grams of alcohol, every day, recorded by his general practitioner and psychologist with an AUDIT score of 24. The drinking was driven by posttraumatic stress disorder arising from warlike service in Afghanistan.

Factor 9(6): consuming an average of at least 6 cups of caffeinated coffee per day, daily during the 6 months before clinical onset or clinical worsening; — MET

- From his arrival in Afghanistan on 07 February 2011 the veteran drank seven to eight cups of coffee a day to stay alert through night picquets, recorded by the medical officer on 20 April 2011, and continued at six to seven cups a day on the rehabilitation ward. He had already been drinking six to seven cups a day during pre-deployment training in January 2011, and he drank at least 6 cups every day throughout the 6 months before onset, from 02 February 2011 to 02 August 2011, the habit arising from the night duties of warlike service.

Factor 9(7): having gastro-oesophageal reflux disease at the time of the clinical onset or clinical worsening; — MET

- Gastro-oesophageal reflux disease was diagnosed on warlike service in Afghanistan on 20 April 2011, after heavy caffeine intake and night duties, and was treated with esomeprazole. It was present at the onset on 02 August 2011 and at the worsening on 14 September 2020.

Worsening factors

Factor 9(8): inability to obtain appropriate clinical management for bruxism before clinical worsening. — MET

- From February to September 2020 the veteran could not obtain a replacement for his fractured occlusal splint because non-urgent dental care was suspended and his entitlement was unresolved. The bruxism, which had arisen from his warlike service, went unmanaged and worsened, with new tooth fractures and a near doubling of masticatory muscle activity on polysomnography by 14 September 2020.

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

Sequelae

The bruxism is a sequela of the veteran's accepted conditions: the moderate traumatic brain injury and subdural haematoma sustained on warlike service, the posttraumatic stress disorder, depressive disorder and generalised anxiety disorder, the gastro-oesophageal reflux disease, and the alcohol use disorder that developed as a complication of the posttraumatic stress disorder. The dental fractures, crowns and masticatory myalgia are in turn sequelae of the bruxism.

Unintended Consequence

Met. The bruxism is in part an unintended consequence of treatment provided and paid for by the Commonwealth for accepted conditions: sertraline, desvenlafaxine and quetiapine for posttraumatic stress disorder, methylphenidate and dexamphetamine for post-traumatic inattention, levodopa for antidepressant-associated restless legs syndrome and flunarizine for post-traumatic migraine (section 6A of the DRCA and the equivalent provisions of the MRCA).

Inability to Attain Appropriate Medical Management

MET. The veteran's occlusal splint fractured in February 2020 and he was unable to obtain a replacement for seven months because non-urgent dental care was suspended during the COVID-19 restrictions and his dental entitlement after discharge had not been resolved. Without the splint the bruxism went unmanaged, and by 14 September 2020 he had a cracked molar, a fractured incisor, marked masseter hypertrophy and a near doubling of rhythmic masticatory muscle activity on polysomnography. Applying the objective and subjective tests in Brew v Repatriation Commission (Full Federal Court, 10 September 1999, Merkel J), the unavailability of the prescribed treatment for reasons outside the veteran's control amounts to an inability to obtain appropriate clinical management, and it materially contributed to the worsening.

5. Please provide a Health Summary and a medication / prescribing history.

See attached report.

References

1. 14 Nov 2009, Psychiatric assessment, Consultant psychiatrist
2. 03 Jun 2010, Psychiatric review, Consultant psychiatrist
3. 18 Jan 2011, Pre-deployment dental examination, Dental Officer
4. 20 Apr 2011, Deployed health record, Medical Officer, Role 1 medical post, Afghanistan
5. 10 Jul 2011, Trauma admission, CT brain and operation report, Role 3 hospital, Afghanistan
6. 26 Jul 2011, Rehabilitation medicine consultation, Rehabilitation physician
7. 04 Aug 2011, Nursing notes and dental consultation, Dental Officer
8. 16 Sep 2011, Audio-video polysomnography report, Sleep physician
9. 21 Sep 2011, Specialist consultation, Oral medicine specialist
10. 22 Jul 2019, Separation medical examination, Medical Officer, Garrison health centre
11. 14 Sep 2020, General practice consultation, General practitioner
12. 14 Sep 2020, Dental consultation and radiographs, Dentist
13. 28 Sep 2020, Repeat polysomnography report, Sleep physician
14. Statement of Principles concerning Bruxism (Balance of Probabilities) No. 8 of 2026, Repatriation Medical Authority
15. Statement of Principles concerning Bruxism (Reasonable Hypothesis) No. 7 of 2026, Repatriation Medical Authority