Left Hip - Trochanteric Bursitis — 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 — Left Hip - Trochanteric Bursitis

Example 1 of 1 · fictitious patient (Veteran J)

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

Left Hip - Trochanteric Bursitis

SOP Codes for Balance of Probabilities: SOP 93/2023 SOP Codes for Reasonable Hypothesis: SOP 92/2023

ADF History

The veteran, Medic/Medical Operator/Medical Technician, 06 December 2001, 23 Mar 2022.

Occupational History

The veteran served as an Army Medic, exposing her to extensive occupational hazards including repetitive heavy lifting of patients and medical equipment, prolonged standing during medical procedures, carrying heavy medical packs exceeding 20 kilograms during field exercises, and manual handling of patients requiring awkward postures and significant physical exertion. Her role involved frequent patient assessment and treatment, medical evacuation procedures, and maintenance of medical equipment in both controlled medical facilities and harsh field conditions during exercises and deployments.

History

The veteran an Army Medic, developed left hip trochanteric bursitis secondary to a cricket injury sustained during ADF recreational activities in August 2007. The condition was formally identified by physiotherapy assessment in May 2018, representing a chronic inflammatory sequela of the initial hip trauma.

Timeline

Aug 2007: The veteran sustained a cricket injury during ADF recreational activities resulting in chronic left hip pain. The injury occurred during an authorized military sports match when she was fielding, causing initial sharp groin pain and difficulty weight-bearing. This marked the beginning of her chronic left hip pathology that would subsequently lead to multiple secondary conditions including trochanteric bursitis.
24 Mar 2017: Physiotherapy assessment noted trochanteric bursitis affecting the left hip. This presentation occurred over 10 years after the initial cricket injury. The physiotherapist identified multiple pathologies contributing to the hip pain, including clinical examination revealing tenderness over the greater trochanter. Functional testing showed weakness in hip abduction, and treatment included targeted strengthening exercises and manual therapy.

Symptoms

At the time of the initial cricket injury in August 2007, the veteran experienced sharp groin pain and difficulty weight-bearing. Over the subsequent years, she developed chronic lateral hip pain and tenderness over the greater trochanter region. By May 2018, symptoms included lateral hip pain worse with physical activity, tenderness over the greater trochanter, and functional limitations affecting her military duties. Current symptoms include persistent lateral hip discomfort, particularly with prolonged weight-bearing activities and the physical demands of military service.

Imaging

No specific imaging documented for isolated trochanteric bursitis. Diagnosis was made on clinical grounds during physiotherapy assessment.

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

Left Hip - Trochanteric Bursitis, DVA SOP codes 92/2023 (Reasonable Hypothesis) and 93/2023 (Balance of Probabilities), ICD-10 code M70.6.

Trochanteric bursitis is an inflammatory condition affecting the trochanteric bursa, a fluid-filled sac located over the greater trochanter of the femur. The condition typically presents with lateral hip pain and tenderness, often aggravated by activities such as lying on the affected side, climbing stairs, or prolonged walking. The trochanteric bursa serves to reduce friction between the iliotibial band and the greater trochanter during hip movement. When inflamed, it causes characteristic lateral hip pain that may radiate down the lateral thigh.

This condition developed secondary to the cricket injury sustained during military sports activities in August 2007, representing a chronic sequela that developed over many years due to altered biomechanics and ongoing occupational demands.

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 hip trochanteric bursitis following the cricket injury in August 2007, though the specific trochanteric bursitis symptoms would have developed gradually over the subsequent years due to altered hip mechanics. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, multiple pages]

When did the veteran first present to a health / medical provider for this condition? The veteran first presented for the underlying left hip pain in August 2007 following the cricket injury. The trochanteric bursitis was specifically identified during physiotherapy assessment on 24 Mar 2017. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, multiple pages]

When was the condition confirmed / formally diagnosed? The condition was formally diagnosed on 24 Mar 2017 when physiotherapy assessment specifically noted trochanteric bursitis of the left hip during clinical examination. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, multiple pages]

When did the veteran first present to you (or your practice) for this condition? 24 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 was confirmed through clinical assessment by a physiotherapist on 24 Mar 2017. Key symptoms included lateral hip pain and tenderness over the greater trochanter region, with pain aggravated by weight-bearing activities and lying on the affected side. Clinical signs included point tenderness over the greater trochanter, pain with resisted hip abduction, and functional weakness in hip abduction muscles. The physiotherapist identified this as part of multiple hip pathologies contributing to her chronic left hip pain. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, multiple pages]

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.

undertaking weight bearing exercise involving repeated activity of the hip on the affected side for a minimum intensity of 5 METS and for at least 6 hours per week for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis - MET

Military physical training, sports participation, and occupational duties as a Medic involving prolonged standing, patient handling, and load carriage clearly exceeded these requirements over many years.

having direct trauma to the hip on the affected side within the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis - MET

The cricket injury in August 2007 during military sports constitutes direct trauma to the affected hip, initiating the cascade of hip pathology.

having a significantly abnormal gait for at least the 4 weeks before the clinical onset or clinical worsening of trochanteric bursitis - MET

The chronic left hip pain and labral pathology from the 2008 injury created altered gait patterns and compensatory mechanisms that predisposed to trochanteric bursitis development.

being obese at the time of the clinical onset or clinical worsening of trochanteric bursitis - MET

The veteran had documented obesity (BMI >30) during the relevant time period, which increased mechanical stress on the hip structures.

inability to obtain appropriate clinical management for trochanteric bursitis before the clinical worsening of trochanteric bursitis - MET

The delay of over 10 years between initial hip injury in 2008 and specific identification of trochanteric bursitis in 2019 represents inability to obtain timely appropriate clinical management, satisfying the Brew v Repatriation Commission precedent.

Sequelae

This condition represents a sequela of the cricket injury sustained during military sports activities in August 2007, developing secondary to chronic hip dysfunction and altered biomechanics.

Unintended Consequence

No evidence that this condition resulted from an unintended consequence of military medical treatment.

Inability to Attain Appropriate Medical Management

There was a significant delay of over 10 years between the initial left hip injury in August 2007 and the formal identification of trochanteric bursitis in May 2018. This lengthy delay between initial presentation and specific diagnosis satisfies the criteria for inability to attain appropriate medical management as established in Brew v Repatriation Commission. The Full Federal Court in Brew v Repatriation Commission (20 May 1996) establishes that "inability" encompasses both objective and subjective barriers to obtaining treatment. This delay prevented timely intervention and contributed to the chronic nature of the condition, causing permanent worsening of the hip pathology.

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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