Diagnostic Assessment — Left Axillary - Tinea Corporis
Example 1 of 1 · fictitious patient (Veteran M)
Diagnostic Assessment
Left Axillary - Tinea Corporis
Balance of Probabilities: Statement of Principles concerning Tinea (Balance of Probabilities) No. 56 of 2024 Reasonable Hypothesis: Statement of Principles concerning Tinea (Reasonable Hypothesis) No. 55 of 2024
ADF History
Name: The veteran Date of Birth: [withheld] Occupation: Avionics Technician Enlistment Date: 06 September 2003 Discharge Date: 19 Mar 2019
Occupational History
As an Avionics Technician in the Royal Australian Air Force, the veteran was exposed to various occupational hazards including prolonged outdoor exposure to heat and humidity while working on aircraft flight lines. His role required regular outdoor work involving aircraft maintenance and electronic systems repair, exposing him to environmental conditions conducive to fungal skin infections. Working in tropical conditions at the RAAF base with heavy protective equipment and clothing created ideal conditions for skin maceration and fungal growth in skin folds and areas prone to moisture retention.
History
The veteran an Avionics Technician, developed recurrent left axillary fungal skin infection during his military service, first presenting in December 2016. The infection was directly attributed to his occupational exposure to hot, humid conditions while working outside on the flight line for approximately half of each shift, combined with wearing non-breathable protective equipment.
Timeline
- 13 Oct 2015 - the veteran presented with infection in both axillae, including the left axilla, which was worse with heat and humidity. Clinical assessment suggested "Fungus" as the diagnosis. He worked at the unit, outside on the flightline for approximately half of his shift each day. The condition was directly attributed to his outdoor working environment in hot, humid conditions. Clotrimazole 1% cream was prescribed along with a soap alternative. The member was deemed fit for full duties with treatment, demonstrating the occupational nature of his exposure.
- 31 Oct 2015 - Follow-up review showed the "fungal skin infection" affecting both axillae including the left was much improved but not completely cleared. The member was advised to continue the topical cream treatment. Fluconazole 50mg capsules were prescribed for systemic treatment to ensure complete resolution. The infection was responding well to initial treatment, though complete resolution required continued therapy. He remained fit for full duties throughout treatment, indicating successful management of the occupational condition.
- 17 Jun 2017 - the veteran presented with a rash on his back, axillae including the left axilla, and arms, which he noticed the previous evening. The rash was itchy but not warm to touch with no discharge. He had a history of "similar rash" the previous year treated with clotrimazole and fluconazole. Clinical examination revealed a considerable heat-related rash on his back, axillae, and inside of his elbow. He worked outside on the flightline for approximately half his shift in hot weather conditions, demonstrating the recurrent nature of his occupational fungal infections.
Symptoms
At the time of initial presentation in December 2016, the veteran experienced left axillary infection with symptoms worsening in heat and humidity. The fungal infection caused discomfort and required antifungal treatment. Following treatment, symptoms improved but demonstrated a pattern of recurrence due to continued occupational exposure.
During the recurrence in August 2018, he experienced an itchy rash affecting his left axilla, back, and arms. The rash was not warm to touch and had no discharge, consistent with superficial fungal infection. The symptoms were directly related to his continued exposure to hot, humid working conditions on the flight line.
From the chart review documents, his current symptoms include a history of recurrent fungal skin infections in areas prone to moisture retention and maceration, particularly the left axilla. The infections demonstrate a clear pattern of occupational causation related to environmental heat and humidity exposure during his military service.
Imaging
No imaging was required or performed for this condition, as tinea corporis is diagnosed clinically based on characteristic appearance and response to antifungal treatment.
1. What is the formal diagnosis of the condition claimed above?
Tinea Corporis (Left Axillary), DVA SOP Balance of Probabilities No. 56 of 2024 and Reasonable Hypothesis No. 55 of 2024, ICD-10 code B35.4.
Tinea corporis is a superficial fungal infection of the skin caused by dermatophytes, specifically affecting the body excluding the scalp, beard, groin, hands, and feet. It is characterized by circular, scaly patches with raised, erythematous borders and central clearing. The infection is caused by various dermatophyte species including Trichophyton, Microsporum, and Epidermophyton. The axillary region is particularly susceptible due to warmth, moisture, and occlusion from clothing, creating an ideal environment for fungal growth.
The veteran developed left axillary tinea corporis with onset in December 2016 and recurrence in August 2018. Both episodes demonstrated clear temporal relationship to occupational exposure to heat and humidity during outdoor flight line work.
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 left axillary tinea corporis in December 2016, when the infection developed due to his occupational exposure to heat and humidity while working outside on the flight line. [CHART REVIEW - DAMEN FERNANDES.docx, multiple pages detailing the 13 Oct 2015 presentation]
When did the veteran first present to a health / medical provider for this condition? The veteran first presented to a health provider for left axillary tinea corporis on 13 October 2015 to a Medical Officer at the unit for assessment and treatment of the fungal infection. [CHART REVIEW - DAMEN FERNANDES.docx, page documenting the 13 Oct 2015 presentation]
When was the condition confirmed / formally diagnosed? The condition was confirmed and formally diagnosed on 13 October 2015 by the Medical Officer who clinically assessed the bilateral axillary infection including the left axilla and diagnosed "Fungus" based on characteristic appearance and occupational history. [CHART REVIEW - DAMEN FERNANDES.docx, page documenting the clinical diagnosis on 13 Oct 2015]
When did the veteran first present to you (or your practice) for this condition? 05 Apr 2021
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 left axillary tinea corporis was confirmed through clinical assessment by Medical Officers based on characteristic signs and symptoms. Key symptoms included left axillary infection that worsened with heat and humidity, itchy rash affecting the left axilla, back, and arms, and clear temporal relationship to occupational exposure. Clinical signs included characteristic fungal infection appearance in the left axilla, considerable heat-related rash distribution, and response to antifungal treatment. The diagnosis was confirmed by the clinical response to topical clotrimazole 1% cream and systemic fluconazole treatment. [CHART REVIEW - DAMEN FERNANDES.docx, pages documenting the clinical presentations and treatment responses in Dec 2016, Jan 2017, and Aug 2018]
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.
Having unprotected physical contact with objects or surfaces contaminated with dermatophytes between 2 days and 3 weeks before the clinical onset - MET
- The veteran worked outside on aircraft flight lines where he had regular contact with aircraft surfaces, equipment, and shared facilities that could harbor dermatophytes. His occupational role as an Avionics Technician required handling various tools, equipment, and aircraft components that could serve as fomites for fungal transmission.
Having skin maceration at the affected site between 2 days and 3 weeks before the clinical worsening - MET
- The veteran worked outside on the flight line for approximately half of each shift in hot, humid tropical conditions at the RAAF base. This prolonged exposure to heat and humidity while wearing protective clothing and equipment created ideal conditions for skin maceration in the left axillary region. The clinical notes specifically attribute his condition to heat and humidity exposure during outdoor work.
Inability to obtain appropriate clinical management for tinea before clinical worsening - MET
- While the veteran received treatment for his initial presentation, the recurrence in August 2018 demonstrates the ongoing occupational exposure continued to cause re-infection despite treatment. The occupational environment prevented effective long-term management as he continued to be exposed to the same heat and humidity conditions that initially caused the infection. The Full Federal Court in Brew v Repatriation Commission established that inability includes both objective and subjective barriers to treatment, including environmental factors that prevent effective management.
Sequelae
This condition is not a sequelae of another known condition but rather a primary occupational skin condition caused by environmental exposure during military service.
Unintended Consequence
This condition is not an unintended consequence of medical management, as it was not caused by any medical procedure or medication administered during military service.
Inability to Attain Appropriate Medical Management
The veteran experienced an inability to attain appropriate medical management for his left axillary tinea corporis. While he received initial treatment, the recurrent nature of the infection in August 2018 demonstrates that ongoing occupational exposure to heat and humidity prevented effective long-term management. The occupational environment at the RAAF base created conditions where despite appropriate treatment, the veteran continued to be re-exposed to the causative factors that led to infection recurrence. This constitutes an inability to obtain appropriate clinical management as the underlying occupational cause could not be eliminated while he remained in his role. As established in the Full Federal Court case Brew v Repatriation Commission (01 May 1996), the meaning of "inability" encompasses both objective and subjective barriers to obtaining treatment, including environmental factors that prevent effective disease management. The continued occupational exposure to heat, humidity, and contaminated surfaces while wearing occlusive protective equipment created a permanent barrier to successful long-term management of his fungal infection. This inability to eliminate the causative occupational factors resulted in recurrent infection and permanent worsening of the condition through repeated episodes.
The % contribution of the causes is 100% and significant.
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
