Diagnostic Assessment — Generalised Anxiety Disorder
Example 1 of 1 · fictitious patient (Veteran V)
Diagnostic Assessment
Generalised Anxiety Disorder
BOP Code: 101 of 2023 RH Code: 100 of 2023
ADF History
The veteran, Avionics Mechanic, 12 July 1990, 27 July 1996
Occupational History
As an Avionics Mechanic in the Royal Australian Air Force, the veteran was exposed to significant occupational stressors inherent to military aviation maintenance. This role required maintaining complex electronic systems under operational pressures, working in high noise environments requiring hearing protection, and performing duties in physically demanding conditions including confined aircraft spaces and flight line operations. The occupation involved exposure to aviation fuels, hydraulic fluids, solvents, and other industrial chemicals. Physical demands included manual handling of heavy equipment, sustained awkward postures, and repetitive movements. The military environment imposed additional psychological stressors including strict adherence to safety protocols, responsibility for aircraft serviceability affecting aircrew safety, and the inherent pressures of military service including discipline, hierarchy, and operational readiness requirements.
History
The veteran an Avionics Mechanic in the Royal Australian Air Force, developed generalised anxiety disorder during his military service between 1994 and 2000. The condition arose following multiple physical injuries sustained during training and operational duties, concurrent family stressors including parental separation, and perceived institutional failures when his request for compassionate leave was denied.
Timeline
- 16 Jul 1990 - Initial physical injury sustained during field training at the RAAF base. Documentation indicates "lower back pain" following training incident. This represents the beginning of a cascade of physical and psychological stressors that would contribute to anxiety development. The injury occurred just days after enlistment, setting a pattern of physical vulnerability that would persist throughout service.
- Dec 1992 - Multiple physical injuries documented including ankle sprain and ongoing back pain. Medical records note recurring presentations for musculoskeletal complaints. Physical injuries creating functional limitations and uncertainty about career progression. Pattern of chronic pain beginning to establish, contributing to psychological distress.
- 1995-1996 - Period of significant psychosocial stress documented. Parents' marital separation occurred during this timeframe. Member requested compassionate posting and leave to provide family support. Request for compassionate leave denied by military administration. This denial experienced as "administrative violence" and moral injury.
- 17 Jan 1992 - Additional physical injuries sustained during authorized sports activities. Suffered concurrent injuries to neck, back, and shoulder during football game. Multiple body regions affected, indicating significant trauma. Cumulative effect of injuries contributing to overall distress and functional impairment.
- 1996 - Development of chronic pain syndrome with multiple musculoskeletal conditions. Undiagnosed pars interarticularis fracture causing ongoing symptoms. Experience of invalidation due to unrecognized pathology. Psychological impact of chronic pain and lack of appropriate medical validation contributing to anxiety symptoms.
- 1996-2000 - Progressive development of anxiety symptoms in context of chronic pain and psychosocial stressors. Sleep disturbance and alcohol use emerging as maladaptive coping strategies. Documentation of "adjustment disorder" at time of service. Anxiety symptoms interfering with military duties and personal functioning.
- 27 Jul 1996 - Discharged from RAAF on compassionate grounds. Medical discharge documentation notes ongoing physical and psychological conditions. Anxiety disorder established by time of separation from service. Condition has persisted and evolved post-service.
Symptoms
At the time of initial development during service, the veteran experienced excessive worry about his physical injuries, career progression, and family situation. He reported difficulty controlling worry, restlessness, sleep disturbance, irritability, muscle tension, and concentration difficulties. These symptoms caused significant distress and impairment in his military functioning.
Current symptoms demonstrate persistence and evolution of the anxiety disorder. He experiences persistent nervousness and feeling on edge occurring more than half the days, difficulty controlling worry about multiple life domains, excessive worry extending beyond specific triggers, psychomotor restlessness, muscle tension, irritability with decreased frustration tolerance, and chronic insomnia. Additionally, he exhibits marked social avoidance, complete withdrawal from social situations, significant difficulties with patience, crowd avoidance, and has developed comorbid alcohol use disorder with consumption of 10 standard drinks nightly as maladaptive coping. His symptoms cause clinically significant distress and functional impairment across social, occupational, and personal domains.
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Generalised Anxiety Disorder (F41.1 per ICD-10). DVA SOP codes are BOP 101 of 2023 and RH 100 of 2023.
Generalised Anxiety Disorder is characterized by excessive anxiety and worry occurring more days than not for at least 6 months about multiple events or activities. The worry is difficult to control and is associated with physical and cognitive symptoms including restlessness, fatigue, concentration difficulties, irritability, muscle tension, and sleep disturbance. The condition causes clinically significant distress or impairment in functioning.
Additional diagnoses identified include Major Depressive Disorder (F32.1) and Alcohol Use Disorder (F10.20), which developed secondary to or concurrent with the primary anxiety disorder.
The temporal relationship shows initial development of adjustment disorder during service (1995-1996), evolution to generalised anxiety disorder by discharge (2000), with subsequent development of comorbid depressive and alcohol use disorders.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition?
First anxiety symptoms experienced in 1995 following confluence of physical injuries and family stressors during military service [24. MENTAL HEALTH - the veteran.docx, page 1; CHART REVIEW.docx, Timeline section].
When did the veteran first present to a health/medical provider for this condition?
1995-1996
When was the condition confirmed/formally diagnosed?
1996 (as adjustment disorder), evolving to generalised anxiety disorder by 2000
When did the veteran first present to you (or your practice) for this condition?
07 January 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.
Diagnosis confirmed through comprehensive psychiatric assessment documenting DSM-5-TR criteria for Generalised Anxiety Disorder. Key symptoms included persistent excessive worry for greater than 6 months, difficulty controlling worry, restlessness, irritability, muscle tension, sleep disturbance, and concentration difficulties. Psychological assessment tools administered showing K10 score of 23 (high distress), DASS21 showing moderate depression, severe anxiety, moderate stress, and GAD-7 score of 11 (moderate anxiety) [24. MENTAL HEALTH - the veteran.docx, Scoring section; DASS21.pdf; GAD7.pdf; K10.pdf]. Clinical interview revealed chronic course with onset during military service, persistence post-discharge, and significant functional impairment [24. MENTAL HEALTH - the veteran.docx, complete document].
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.
Causative Factors:
Factor 2 (BOP): experiencing a category 1B stressor within the 2 years before the clinical onset of generalised anxiety disorder - MET
- Multiple severe physical injuries during military training and duties constitute category 1B stressors including witnessing critical injuries and participating in management of casualties during training exercises.
Factor 3 (BOP): experiencing severe childhood abuse before the clinical onset of generalised anxiety disorder - NOT MET
- No evidence of childhood abuse documented in service or medical records.
Factor 5 (BOP): experiencing the death of a family member or close friend within the 2 years before the clinical onset of generalised anxiety disorder - NOT MET
- No deaths documented, though parental separation occurred during service.
Factor 7 (BOP): experiencing a category 2 stressor within the 6 months before the clinical onset of generalised anxiety disorder - MET
- Multiple category 2 stressors present including problem with family relationships due to parental separation, perceived lack of support within military environment, and experiencing serious physical injuries affecting career progression.
Factor 8 (BOP): having a clinically significant disorder of mental health within the 5 years before the clinical onset of generalised anxiety disorder - NOT MET
- No pre-existing mental health conditions documented prior to service.
Factor 9 (BOP): having a medical illness which is life-threatening or which results in serious physical or cognitive disability within the 3 years before the clinical onset of generalised anxiety disorder - MET
- Multiple musculoskeletal injuries resulting in serious physical disability including chronic back pain, undiagnosed pars fracture, and multiple joint injuries significantly impacting function.
Factor 12 (BOP): having persistent pain of at least 6 months duration at the time of the clinical onset of generalised anxiety disorder - MET
- Documented chronic lower back pain from August 1992 persisting throughout service, meeting criteria for persistent pain.
Factor 14 (BOP): inability to undertake physical activity greater than 3 METs for a continuous period of at least the 3 months before the clinical onset of generalised anxiety disorder - PARTIALLY MET
- Physical limitations from multiple injuries likely restricted activity levels though specific MET measurements not documented.
Worsening Factors:
Factor 48 (BOP): inability to obtain appropriate clinical management for anxiety disorder before the clinical worsening of anxiety disorder - MET
- Lack of structured mental health treatment documented. Previous antidepressant treatment 4 years ago without follow-up. No current psychiatric care despite chronic symptoms.
The % contribution of the causes is 100% and significant.
Sequelae
The generalised anxiety disorder is not a sequela of another condition but rather arose primarily from service-related stressors and injuries. The subsequent development of Major Depressive Disorder and Alcohol Use Disorder represent sequelae of the chronic anxiety disorder.
Unintended Consequence
The condition does not represent an unintended consequence of medical management. While multiple physical injuries were treated during service, the anxiety disorder arose from the cumulative impact of injuries and psychosocial stressors rather than from treatment interventions.
Inability to Attain Appropriate Medical Management (for worsening)
There is clear evidence of inability to obtain appropriate clinical management. Despite chronic anxiety symptoms spanning over 20 years, the veteran has received only intermittent and inadequate mental health treatment. He was prescribed antidepressants 4 years ago but has had no structured follow-up or optimization of treatment. Currently sees GP opportunistically rather than for scheduled mental health management. No engagement with specialist psychiatric services or structured psychological therapy. The prolonged period between initial presentation (1995-1996) and current lack of comprehensive treatment (2023) demonstrates systemic barriers to appropriate mental health care - MET.
5. Please provide a Health Summary and a medication/prescribing history.
-see attached report
References
- 16 July 1990, Initial Injury Report, Base Medical Officer, Military Medicine
- December 1992, Physiotherapy Assessment, D. Prettie, Physiotherapy
- 06 Mar 1991, Medical Consultation, the treating doctor, Military Medicine
- 10 May 1991, Clinical Notes, CPL Jones, Military Medicine
- 21 Jun 1991, Lumbar Spine X-ray, the treating doctor Niekerk, Radiology
- 17 January 1992, Injury Report, Base Medical Officer, Sports Medicine
- 07 Apr 1992, Neurosurgical Consultation, the treating doctor, Neurosurgery
- 07 Jun 1992, Orthopaedic Consultation, the treating doctor, Orthopaedics
- 20 July 1992, Discharge Medical Statement, the treating doctor, Military Medicine
- 27 July 1996, Discharge Documentation, RAAF Administration
- 20 Jun 2019, MRI Multiple Regions, the treating doctor, Radiology
- 04 July 2019, Psychiatric Assessment, Treating Psychiatrist, Psychiatry
