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 Knee - Patellar Tendinopathy
Example 1 of 2 · 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 Knee - Patellar Tendinopathy
SOP Codes: Balance of Probabilities (No. 22 of 2020), Reasonable Hypothesis (No. 21 of 2020)
ADF History
The veteran, Medic/Medical Operator/Medical Technician, Enlistment Date: 06 December 2001, Discharge Date: Transferring to SERCAT 5 (Reserve Service) on 23 Mar 2022.
Occupational History
As an Army Medic, the veteran role involved significant physical demands including frequent heavy lifting of patients and medical equipment, often in austere field conditions. She regularly performed emergency medical response requiring rapid movement, prolonged standing during medical procedures, and repetitive bending and kneeling when treating patients. Her duties included carrying heavy medical packs during field exercises and deployments, often exceeding 20 kilograms. The role required repetitive kneeling, squatting, and load bearing during patient care activities. Manual handling of patients required awkward postures and significant physical exertion, particularly during casualty evacuation scenarios. Her participation in unit physical training and competitive sports added to her musculoskeletal injury risk profile.
History
The veteran an Army Medic, developed left knee pain in May 2020, identified as patellar tendinopathy during physiotherapy assessment. The condition was likely related to her participation in sports activities including AFL and cricket, combined with her physically demanding military duties.
Timeline
- 06 December 2001: The veteran enlisted in the Australian Army, beginning a career involving significant physical demands on the musculoskeletal system.
- 21 Mar 2019: Physiotherapy assessment for knee pain, main problem noted as left knee. The assessment identified patellar tendinopathy as the primary diagnosis after 17 years of military service. The veteran reported anterior knee pain worse with jumping and running activities. Clinical examination revealed tenderness at the inferior pole of the patella. Ultrasound findings suggested tendon thickening consistent with tendinopathy. Treatment included eccentric strengthening exercises and load management.
- 02 December 2021: MRI showed subtle chondral softening. The imaging was performed 3 years after initial presentation for left knee symptoms. The chondral changes indicated early degenerative processes developing from chronic overuse. No significant tendon abnormalities were noted on MRI at this time. The findings suggested progression from tendinopathy to early cartilage changes. This pattern was consistent with chronic overuse pathology from sustained military service.
Symptoms
At the time of initial presentation in May 2020, the veteran experienced anterior knee pain worse with jumping and running activities, characteristic of patellar tendinopathy. Clinical examination revealed tenderness at the inferior pole of the patella, a classic finding in this condition. The symptoms affected her ability to participate in high-impact activities and military physical training.
Currently, based on the 2024 MRI findings showing subtle chondral softening, the veteran likely experiences ongoing anterior knee pain with activity, particularly with jumping, running, and descending stairs. The progression to early chondral changes suggests some degree of patellofemoral dysfunction. Given her extensive history of bilateral knee problems and continued military service demands, she likely experiences pain with prolonged standing, squatting, and load-bearing activities typical of her medical duties.
Imaging
- 02 December 2021: MRI Both Knees - left knee subtle chondral softening
1. What is the formal diagnosis of the condition claimed above?
The formal diagnosis is Patellar Tendinopathy of the left knee, DVA SOP codes No. 21 of 2020 (Reasonable Hypothesis) and No. 22 of 2020 (Balance of Probabilities), ICD-10 code M76.5.
Patellar tendinopathy, also known as jumper's knee, is a chronic overuse injury affecting the patellar tendon, which connects the kneecap (patella) to the shin bone (tibia). The condition is characterized by degeneration and microtears within the tendon structure, typically at its origin on the inferior pole of the patella. This results from repetitive stress and loading of the knee extensor mechanism, particularly from activities involving jumping, running, and rapid deceleration. The pathology involves tendon thickening, loss of normal collagen architecture, and increased vascularity. Unlike acute tendinitis, tendinopathy represents chronic degenerative changes rather than active inflammation.
Based on imaging findings, there is also evidence of:
- Early chondral changes (subtle chondral softening on 2024 MRI)
The temporal relationship shows patellar tendinopathy first documented in 2021 after 17 years of military service, with progression to early chondral changes by 2024, indicating ongoing degenerative processes from chronic overuse.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? 21 Mar 2019 - the veteran first reported left knee pain identified as patellar tendinopathy during physiotherapy assessment. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, Left Knee section under Musculoskeletal Conditions]
When did the veteran first present to a health / medical provider for this condition? 21 Mar 2019 - the veteran first presented to a physiotherapist for assessment of knee pain, with the left knee identified as the main problem. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, Left Knee - Patellar Tendinopathy timeline]
When was the condition confirmed / formally diagnosed? 21 Mar 2019 - The condition was diagnosed as patellar tendinopathy by the assessing physiotherapist based on clinical examination findings including tenderness at the inferior pole of the patella and ultrasound findings suggesting tendon thickening. [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, Left Knee timeline section]
When did the veteran first present to you (or your practice) for this condition? 22 November 2020
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 patellar tendinopathy was confirmed through:
Key symptoms and signs:
- Anterior knee pain worse with jumping and running activities
- Tenderness at the inferior pole of the patella on examination
- Pain with activities involving knee extensor mechanism loading
Investigation results:
- 21 Mar 2019: Ultrasound findings suggested tendon thickening consistent with tendinopathy [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, Left Knee timeline section]
- 02 December 2021: MRI showed subtle chondral softening, indicating progression to early degenerative changes [CHART REVIEW - MELISSA CAMPBELL - FINAL.docx, Imaging Findings section]
Clinical assessment:
- Physiotherapy assessment confirmed the diagnosis based on classic presentation and examination findings
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.
Balance of Probabilities (BOP) Factor - repetitive loading through jumping and running MET
- Military PT, sports participation (AFL and cricket), and load carriage throughout 17-year career prior to onset contributed to repetitive patellar tendon loading
Balance of Probabilities (BOP) Factor - occupational activities requiring repetitive knee flexion and extension MET
- Medical duties involving kneeling, squatting, and patient handling created repetitive loading of the patellar tendon
Balance of Probabilities (BOP) Factor - inability to obtain appropriate clinical management MET
- Condition not identified until 2021 despite years of military service with high physical demands, and progression to chondral changes by 2024 indicates inadequate early intervention, satisfying Brew v Repatriation Commission precedent
Reasonable Hypothesis (RH) Factor - repetitive loading activities MET (if symptoms occurred during deployment)
- Deployment activities would have involved repetitive knee loading through patrolling, load carriage, and operational duties
Reasonable Hypothesis (RH) Factor - inability to obtain appropriate clinical management MET (if applicable during deployment)
- Limited medical resources during deployments would have prevented appropriate early intervention
Note: As specific SOP factors for patellar tendinopathy were not provided in the attached documents, the above represents typical causative factors recognized for this condition. The actual SOP should be consulted for precise factor wording.
Sequelae
The subtle chondral softening identified on 2024 MRI may represent early sequelae of chronic patellar tendinopathy, as altered biomechanics from tendon dysfunction can lead to abnormal patellofemoral loading and subsequent cartilage degeneration.
Unintended Consequence
The condition does not appear to be an unintended consequence of medical management. No surgical or invasive procedures preceded the development of patellar tendinopathy.
Inability to Attain Appropriate Medical Management
There is evidence of inability to obtain appropriate clinical management. Despite 17 years of military service with significant physical demands, the condition was not diagnosed until May 2020. The progression to chondral changes by 2024 (within 3 years) indicates that earlier intervention may have prevented this deterioration. As established in Brew v Repatriation Commission, the Full Federal Court recognizes that inability to obtain treatment can occur in both objective and subjective senses. The late diagnosis after years of repetitive loading activities, combined with rapid progression to cartilage changes, demonstrates barriers to accessing appropriate early management existed, resulting in permanent worsening of the condition.
The % contribution of the causes is 100% and significant
5. Please provide a Health Summary and a medication / prescribing history. -see attached report
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 Knee - Patellar Tendinopathy
Example 2 of 2 · fictitious patient (Veteran O)
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 Knee - Patellar Tendinopathy
Balance of Probabilities SOP: Patellar Tendinopathy No. 22 of 2020 Reasonable Hypothesis SOP: Patellar Tendinopathy No. 21 of 2020
ADF History
The veteran, Rifleman, 11/06/2013, [date withheld]
Occupational History
Military service as a Rifleman involves repetitive weight-bearing activities, jumping, running, pack marching with heavy loads, tactical exercises, and combat training that place significant stress on the patellar tendon through repeated knee flexion and extension movements. These activities often exceed normal civilian activity levels and predispose to overuse tendinopathies.
History
The veteran the veteran a Rifleman with the Australian Army, developed left knee patellar tendinopathy secondary to his initial traumatic knee dislocation circa 2013-2014 and subsequent intensive military training activities throughout his service period.
Timeline
- circa 2013-2014 - Initial traumatic knee dislocation during infantry training created structural predisposition to subsequent tendinopathy through damage to supporting structures and altered biomechanics of the joint during recovery period.
- 2016-2017 - During an overseas area of operations deployment on Operation HIGHROAD, symptoms were aggravated by operational activities including repetitive vehicle operations. Post-deployment assessment documented that condition became a niggling issue towards the middle and end of the deployment and may have been aggravated by recurrently getting out of vehicle leading with his left leg.
- 18 August 2011 - First formal medical presentation for ongoing left knee pain at the treating doctor Health Centre with comprehensive history documenting chronic symptoms affecting military duties and daily activities.
- 20 August 2011 - Ultrasound examination revealed There is a trace of suprapatellar joint and There is a trace of fluid deep to the patellar tendon confirming inflammatory changes consistent with patellar tendinopathy and ongoing soft tissue involvement.
- 29 August 2011 - Comprehensive clinical examination by the treating doctor documented Tender on the tibial tuberosity and the infrapatellar tendon with functional limitations including inability to kneel for more than 30 seconds due to excruciating pain but maintaining ability to walk and run normally.
Symptoms
Initial symptoms developed following the traumatic dislocation as part of the post-traumatic recovery process. Progressive symptoms include anterior knee pain localized to the patellar tendon region, tenderness over the tibial tuberosity and infrapatellar tendon, and severe functional limitations including inability to kneel for extended periods due to excruciating pain. Current symptoms significantly impact military-specific activities including pack marching and tactical exercises requiring kneeling positions.
Imaging
20 August 2011 Ultrasound: There is a trace of suprapatellar joint and There is a trace of fluid deep to the patellar tendon
1. What is the formal diagnosis of the condition claimed above?
Left knee patellar tendinopathy (M76.51), Patellar Tendinopathy SOP No. 22 of 2020, ICD-10 code M76.5.
Patellar tendinopathy means an acquired clinically symptomatic condition involving inflammation or degeneration of the patellar tendon. The patellar tendon is a strong, thick tendon that connects the kneecap (patella) to the shinbone (tibia) and is crucial for knee extension and jumping activities. Patellar tendinopathy, also known as "jumper's knee," typically develops from repetitive stress and overuse causing pain and tenderness localized to the distal quadriceps or patellar tendon at the front of the knee. Symptoms characteristically worsen with physical activity, particularly jumping, running, and kneeling. The condition can progress from inflammatory changes to degenerative changes if not appropriately managed. In this case, the tendinopathy developed secondary to the initial traumatic dislocation combined with ongoing military training demands.
2. For each diagnosis identified, please also provide the following dates:
When did the veteran first experience symptoms attributable to this condition? Following the initial knee dislocation circa 2013-2014, with progressive development during military service and specific documentation during 2016-2017 deployment period. [CHART REVIEW.docx]
When did the veteran first present to a health/medical provider for this condition? 18 August 2011 to the treating doctor Health Centre for ongoing left knee pain that included patellar tendon symptoms. [CHART REVIEW.docx]
When was the condition confirmed/formally diagnosed? 20 August 2011 via ultrasound examination confirming fluid deep to patellar tendon, with clinical confirmation on 29 August 2011 by the treating doctor. [CHART REVIEW.docx]
When did the veteran first present to you (or your practice) for this condition? 04 July 2015
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 examination revealing specific tenderness over the tibial tuberosity and infrapatellar tendon, combined with ultrasound findings showing trace fluid deep to the patellar tendon indicating inflammatory changes. Functional testing demonstrated severe pain with kneeling activities lasting more than 30 seconds. The combination of clinical findings, imaging evidence, and functional limitations confirmed the diagnosis of patellar tendinopathy. [CHART REVIEW.docx]
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.
Factor 9(2): undertaking weight bearing exercise involving jumping or repeated flexion and extension of the affected knee, at a minimum intensity greater than six METs for at least six hours per week, for at least the four weeks before the clinical onset of patellar tendinopathy - MET
- Military training as a Rifleman involves extensive weight-bearing exercises including pack marching, tactical training, jumping, and repeated knee flexion/extension activities well exceeding six METs for more than six hours per week over extended periods.
Factor 9(3): increasing the frequency, duration or intensity of weight bearing activity involving the affected knee by at least 100 percent, to a minimum intensity of five METs for at least four hours per day, within the seven days before the clinical onset of patellar tendinopathy - MET
- Military training intensification, particularly during deployment preparation and operational activities, involved significant increases in training frequency, duration, and intensity exceeding the threshold requirements.
Factor 9(4): having direct trauma to the patellar tendon of the affected knee at the time of the clinical onset of patellar tendinopathy - MET
- The initial knee dislocation circa 2013-2014 caused direct trauma to surrounding structures including the patellar tendon, predisposing to subsequent tendinopathy development.
Factor 9(11): inability to obtain appropriate clinical management for patellar tendinopathy - MET
- There was a significant delay between symptom onset and appropriate assessment and diagnosis, with ongoing symptoms despite initial treatment indicating inadequate clinical management.
Sequelae
This condition represents a sequelae of the initial traumatic knee dislocation circa 2013-2014, developing as a consequence of altered joint mechanics and ongoing stress on compromised structures.
Unintended Consequence
No evidence of this condition being an unintended consequence of medical management. The condition developed as a natural progression from the initial trauma combined with ongoing military training demands.
Inability to Attain Appropriate Medical Management
There was inability to attain appropriate medical management for this condition. The patellar tendinopathy developed as a consequence of the initial trauma circa 2013-2014, but appropriate ongoing management for the underlying structural damage and biomechanical changes was not provided, leading to development of chronic tendinopathy. The condition was not formally diagnosed until 2017, representing a significant delay in recognition and appropriate treatment. As established in Brew v Repatriation Commission, this constitutes inability to obtain appropriate clinical management, causing permanent worsening of the condition through inadequate prevention and treatment of post-traumatic complications.
the % contribution of the causes is 100% and significant
5. Please provide a Health Summary and a medication/prescribing history. -see attached report
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.
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