Chest - Anxiety - related Chest Pain — 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 — Chest - Anxiety - related Chest Pain

Example 1 of 1 · fictitious patient (Veteran B)

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

Chest - Anxiety-related Chest Pain

ADF History

The veteran served in the Australian Defence Force from 05 Mar 1989 to 21 August 2018. His service included both warlike and non-warlike deployments from 05 Mar 1989 to 30 May 2007, followed by additional periods of service from 01 June 2007 to 28 February 2013 and 29 February 2013 to 21 August 2018.

Occupational History

As a member of a signals unit and working in intelligence roles, the veteran occupational duties likely included periods of high stress and responsibility. Intelligence work in the military involves processing sensitive information, making critical decisions under pressure, and potentially dealing with traumatic or distressing content. These psychological stressors, combined with the general operational demands of military service, can create an environment conducive to the development of anxiety-related conditions.

History

The veteran has a history of chest pain that was initially experienced in 2000 and was later diagnosed as being related to anxiety in 2003. The chest pain was a physical manifestation of underlying anxiety rather than a primary cardiovascular condition.

Timeline

2000: Initial experience of chest pain. He had chest pain in 2000 [DIA5 CIA1-3 INTAKE.docx]
2003: Diagnosis of anxiety made, explaining the chest pain symptoms. diagnosed with anxiety in 2003, after which he has been able to mange iit [DIA5 CIA1-3 INTAKE.docx]
Oct 2001: Stability of chest pain condition noted. Stability. Oct 2001 [DIA5 CIA1-3 INTAKE.docx]

Symptoms

The veteran experienced chest pain as a physical manifestation of anxiety. The documentation indicates that there were no other associated symptoms with the chest pain. After being diagnosed with anxiety in 2003, he was able to manage the condition and presumably the chest pain symptoms improved with this management.

Imaging

No specific imaging for the chest pain is mentioned in the provided documents, which is consistent with the diagnosis of anxiety-related chest pain rather than a primary cardiac or pulmonary condition.

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

Chest - Anxiety-related Chest Pain

The anxiety component of this condition would align with the Generalised Anxiety Disorder SOP (E027), which covers anxiety disorders where anxiety is a significant clinical manifestation. The chest pain in this case represents a somatic manifestation of anxiety rather than a primary cardiovascular condition.

Anxiety-related chest pain is a recognized manifestation of anxiety disorders. It involves chest discomfort or pain that is caused by psychological factors rather than organic heart disease. The pain can be caused by muscle tension, hyperventilation, or heightened awareness of normal bodily sensations that occurs during anxiety states.

The veteran experienced chest pain in 2000 that was later attributed to anxiety when he received this diagnosis in 2003. The documentation indicates that after the anxiety diagnosis and presumably with appropriate management, he was able to control these symptoms.

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 attributable to this condition in 2000, as documented in the intake records [DIA5 CIA1-3 INTAKE.docx].

When did the veteran first present to a health / medical provider for this condition? While the exact date of first presentation is not explicitly stated, it appears that the veteran sought medical attention for chest pain sometime between 2000 (when symptoms began) and 2003 (when the diagnosis of anxiety was made) [DIA5 CIA1-3 INTAKE.docx].

When was the condition confirmed / formally diagnosed? The condition was formally diagnosed in 2003 when anxiety was identified as the underlying cause of the chest pain [DIA5 CIA1-3 INTAKE.docx].

When did the veteran first present to you (or your practice) for this condition? August 14, 2023

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 of anxiety-related chest pain was confirmed based on:

Clinical history documenting chest pain beginning in 2000 [DIA5 CIA1-3 INTAKE.docx]
Clinical evaluation leading to the diagnosis of anxiety in 2003, with recognition that the chest pain was "secondary to anxiety and was a physical manifestation of that and was directly related to that" [DIA5 CIA1-3 INTAKE.docx]
Notation that "there was no other symptoms" associated with the chest pain, supporting a non-cardiac etiology [DIA5 CIA1-3 INTAKE.docx]
Documentation that after the diagnosis of anxiety in 2003, the veteran "has been able to manage it," suggesting that addressing the anxiety resulted in improvement of the chest pain [DIA5 CIA1-3 INTAKE.docx]
Absence of findings suggestive of cardiac pathology on the cardiovascular risk factor assessment form [DIA1.pdf]

The diagnosis was likely made after exclusion of organic cardiac disease through appropriate cardiac evaluation, though specific details of this workup are not provided in the available documentation.

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.

For anxiety disorder, which is the underlying cause of the chest pain in this case, the relevant SOP factors include:

experiencing a category 2 stressor within the six months before the clinical onset of anxiety disorder LIKELY MET

The veteran military service, particularly in intelligence roles, likely involved category 2 stressors such as demanding work environments, high responsibility, and potentially exposure to distressing information.
The timeline of chest pain onset (2000) coincides with his period of warlike service (1991-2009), which would likely involve increased occupational stressors.

having a medical illness or injury which is life-threatening or which results in serious physical or cognitive disability, within the two years before the clinical onset of anxiety disorder POSSIBLY MET

While specific details are not provided, the veteran service records may contain information about injuries or illnesses that could have contributed to anxiety development.

experiencing the death of a significant other within the one year before the clinical onset of anxiety disorder POSSIBLY MET

The records mention that "His wife dies in 2002" [DIA5 CIA1-3 INTAKE.docx], which is after the initial chest pain symptoms in 2000 but could have exacerbated the anxiety condition.

Additional information from the records indicates:

The veteran had "longstanding anxiety identified but not communicated to the patient" [DIA5 CIA1-3 INTAKE.docx]
After his wife's death in 2002, he was "diagnosed with anxiety and depression in 2003" [DIA5 CIA1-3 INTAKE.docx]
He was experiencing "chest pains due to anxiety at that time and he was not diagnosed or treated" [DIA5 CIA1-3 INTAKE.docx]
He was "only just self-diagnosed as part of the DVA process" [DIA5 CIA1-3 INTAKE.docx]
When getting tinnitus evaluated, "the audiologist diagnosed him with anxiety causing tinnitus" [DIA5 CIA1-3 INTAKE.docx]

Based on this information, it appears that the veteran had underlying anxiety that manifested as chest pain in 2000, was exacerbated by the death of his wife in 2002, and was formally diagnosed in 2003, with recognition that the chest pain was a physical manifestation of the anxiety disorder.

Sequelae The chest pain in this case is a sequela of the underlying anxiety disorder rather than a primary condition.

Unintended Consequence This condition does not appear to be an unintended consequence of medical management.

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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