Hyperlipidaemia

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 — Hyperlipidaemia

Example 1 of 1 · fictitious patient (Veteran U)

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

Statement of Principles for Dyslipidaemia (Instrument No. 9 of 2016): Balance of Probabilities: Factors apply for non-warlike service Reasonable Hypothesis: Factors apply for warlike service or operational deployment

ADF History

The veteran, Aviation Technician (Avtech), enlisted Mar 1983, discharged 2014 (permanent service), with potential reserve service until September 2015.

Occupational History

Aviation Technicians in the RAAF are exposed to various occupational hazards including chemical exposures to solvents, cleaning agents, hydraulic fluids, and paints. Physical hazards include noise from aircraft engines, vibration from tools, ergonomic stresses from awkward postures and confined spaces, and inclement weather exposure. The role involves handling heavy equipment, working at heights, and exposure to electrical hazards, fire and explosion risks from flammable substances, and potential radiation exposure.

History

The veteran an RAAF Aviation Technician, developed hyperlipidaemia during his military service, first documented with elevated cholesterol levels in 2003 and formally diagnosed with mixed hyperlipidaemia in 2007 based on laboratory findings.

Timeline

07 October 1996 During a Comprehensive Preventive Health Examination, the veteran was found to have "elevated cholesterol". His BMI was recorded as 30.2 (obese) and he was advised on lifestyle modifications including weight loss and dietary changes. The examination noted he was at high risk for ischaemic heart disease and strongly recommended follow-through with medical attendants for ongoing management of his cardiovascular risk factors.
12 Jan 2001 A Health Promotion Profile blood test revealed significantly elevated lipid levels. His total cholesterol was "7.91 mmol/L", triglycerides were "2.15 mmol/L", and calculated LDL cholesterol was "5.67 mmol/L". These results were well above target ranges (total cholesterol target <4.0-5.5, triglycerides <2.0, LDL <2.5-3.5) and indicated significant dyslipidaemia requiring immediate medical attention.
18 Jan 2001 Following the abnormal lipid profile, the treating doctor documented "Mixed hyperlipidaemia-?familial" as one of the issues requiring management for the veteran ADF medical clearance. The query of familial hyperlipidaemia suggested a potential genetic component to his condition. Management planning was initiated including discussion of treatment options once other cardiovascular investigations were completed.
05 Mar 2003 During a Comprehensive Preventive Health Examination, the veteran was documented as taking "Lipitor 20mg daily" for management of his hyperlipidaemia. This prescription of a statin medication confirmed active medical management of his lipid disorder and represented successful therapeutic intervention to reduce his cardiovascular risk profile.
14 December 2014 Health records confirmed ongoing "hyperlipidaemia" as a current medical condition, indicating the chronic nature of this disorder requiring long-term management and monitoring throughout his post-service period.

Symptoms

At the time of initial diagnosis, the veteran was asymptomatic, as hyperlipidaemia typically does not cause symptoms and is usually detected through routine blood testing. Following diagnosis, he remained largely asymptomatic but was managed with statin therapy to reduce cardiovascular risk. Current documentation indicates the condition remains under ongoing medical management with no specific symptoms reported.

Imaging

No specific imaging was performed for the diagnosis or monitoring of hyperlipidaemia, as this condition is diagnosed and monitored through laboratory blood testing rather than imaging studies.

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

Hyperlipidaemia (ICD-10: E78.5) - Statement of Principles for Dyslipidaemia (Instrument No. 9 of 2016)

Dyslipidaemia is a medical condition characterized by abnormal levels of lipids (fats) in the blood, including cholesterol and triglycerides. Hyperlipidaemia specifically refers to elevated levels of these lipids above normal ranges. The condition encompasses various subtypes including hypercholesterolaemia (elevated cholesterol), hypertriglyceridaemia (elevated triglycerides), and mixed hyperlipidaemia (elevation of multiple lipid fractions). Dyslipidaemia is typically asymptomatic but significantly increases the risk of cardiovascular diseases including coronary artery disease, myocardial infarction, and stroke. The condition can be primary (genetic/familial) or secondary to other conditions such as diabetes, hypothyroidism, obesity, or lifestyle factors. Diagnosis is established through fasting lipid profile blood testing, and management typically involves lifestyle modifications and lipid-lowering medications such as statins.

The temporal relationship shows progression from initial elevated cholesterol detection in 2003 to formal diagnosis of mixed hyperlipidaemia in 2007, followed by appropriate therapeutic management with statin therapy and ongoing monitoring.

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

When did the veteran first experience symptoms attributable to this condition? The veteran remained asymptomatic as hyperlipidaemia typically does not cause symptoms. The condition was detected through routine blood testing rather than symptomatic presentation. [Combined claims.pdf, page 2888; Combined1.pdf, page 1708]

When did the veteran first present to a health / medical provider for this condition? The veteran first presented to a medical officer during a Comprehensive Preventive Health Examination on 07 October 1996 when elevated cholesterol was initially detected during routine screening. [Combined claims.pdf, page 2888]

When was the condition confirmed / formally diagnosed? The condition was formally diagnosed on 12 Jan 2001 when the treating doctor documented "Mixed hyperlipidaemia-?familial" based on laboratory results showing total cholesterol 7.91 mmol/L, triglycerides 2.15 mmol/L, and LDL cholesterol 5.67 mmol/L. [Combined claims.pdf, page 3036; FILE REVIEW.docx, page 29]

When did the veteran first present to you (or your practice) for this condition? 21 November 2014

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 was confirmed through laboratory blood testing. Key investigation results included a Health Promotion Profile blood test on 12 Jan 2001 showing significantly elevated lipid levels: total cholesterol 7.91 mmol/L (target <4.0-5.5), triglycerides 2.15 mmol/L (target <2.0), and calculated LDL cholesterol 5.67 mmol/L (target <2.5-3.5). the treating doctor medical assessment documented "Mixed hyperlipidaemia-?familial" indicating both the diagnosis and potential genetic component. No specific symptoms were present as hyperlipidaemia is typically asymptomatic. Management was initiated with Lipitor 20mg daily by 2009, confirming the clinical significance of the diagnosis. [Combined claims.pdf, page 3036; Combined1.pdf, page 1268]

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.

There is no specific Statement of Principles for Hyperlipidaemia/Dyslipidaemia under current DVA legislation. However, the following factors contributed to the development of this condition:

Obesity - the veteran had documented obesity with BMI 30.2 in 2003, 31.05 in 2009, and 32.4 in 2021. Obesity is a well-established risk factor for dyslipidaemia through increased lipid synthesis in adipose tissue and metabolic dysfunction. MET

His documented obesity throughout the relevant period directly contributed to the development of hyperlipidaemia through increased lipid synthesis and metabolic dysfunction.

Smoking history - the veteran had a documented smoking history of 3-4 cigarettes per day for 19 years (approximately 1990-2009) and earlier reports of 10-15 cigarettes per day for 11 years. Smoking adversely affects lipid profiles by reducing HDL cholesterol and promoting atherogenic lipid patterns. MET

His significant smoking history materially contributed to the development of dyslipidaemia through adverse effects on lipid metabolism.

Alcohol consumption - the veteran had a documented alcohol history consuming 2-3 standard drinks, 2-3 times per week in 2009, with earlier reports of drinking for several years. Alcohol consumption can increase triglyceride production and impair lipid clearance. MET

His alcohol consumption pattern contributed to the development of hyperlipidaemia through effects on hepatic lipid metabolism.

Hypertension - the veteran had documented hypertension with multiple elevated blood pressure readings from 1998 onwards. Hypertension and hyperlipidaemia often coexist and share common pathophysiological mechanisms including endothelial dysfunction and metabolic syndrome. MET

His documented hypertension contributed to the overall cardiovascular risk profile and metabolic dysfunction associated with hyperlipidaemia.

Genetic predisposition - The documentation of "?familial" hyperlipidaemia in 2007 suggests a potential genetic component to his condition. PARTIALLY MET

While genetic predisposition is suggested by the clinical assessment, definitive genetic testing results are not documented.

Sequelae

This condition is not a sequelae of another service-related condition but rather represents a primary metabolic disorder influenced by multiple risk factors including service-related lifestyle factors.

Unintended Consequence

This condition is not an unintended consequence of medical management. No documented medical procedures or medications during service contributed to the development of hyperlipidaemia.

Inability to Attain Appropriate Medical Management

The Full Federal Court in Brew v Repatriation Commission (19 May 1990) established that "inability" encompasses both objective and subjective barriers to obtaining treatment, including psychological, emotional, or circumstantial factors that prevent seeking or receiving appropriate care.

The veteran hyperlipidaemia was appropriately diagnosed and managed following detection. The condition was identified through routine screening in 2003, formally diagnosed in 2007, and appropriately treated with statin therapy by 2009. There is no evidence of inability to attain appropriate medical management as the condition was properly identified, diagnosed, and treated within appropriate timeframes according to contemporary medical standards. NOT MET

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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